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Acing Acute Care for Elders

Cheryl Clark, for HealthLeaders Media, September 9, 2013

As Malone walked down the hallway 14 years ago frustrated about his patient's oversedation and resulting decompensation, he was thinking about the ACE concept when he saw a medical resident exiting a mothballed med-surge unit that was being used as an on-call sleeping area.

This would be the perfect place to dedicate specialty care for frail elders, Malone thought. The administration "agreed that we have to do a better job, and we started on this journey we've been on for the past 14 years."

Not only did Aurora establish two ACE units at two facilities—a 16-bed unit in 2000 at the 145-staffed-bed Aurora Sinai Medical Center in Milwaukee and a 28-bed unit in 2005 at its 197-staffed-bed Aurora West Allis Medical Center—its teams also created the ACE Tracker, a telemedicine, electronic health record system that enables the interdisciplinary ACE care team to deliver ACE care to patients in any Aurora hospital across a 150-mile swath of eastern Wisconsin from Kenosha to Green Bay.

"This has helped us move from an ACE unit to a system that deploys the ACE model of care to all our hospitals," Malone says.

One goal is to reduce the use of urinary catheters, which impair seniors' mobility and can lead to falls and infections. The ACE unit's dedicated efforts in this area has dropped utilization of urinary catheters from about 30% throughout the system to 20%, and within the Sinai ACE unit, it's now 10%. Likewise, the hospital system has seen a drop in central line bloodstream infections between 2010 and 2013.

Early physical therapy assessment for each older patient is up to 72%, "when it used to be closer to 40% when we started," Malone says.

Aurora Health's Bruce Van Cleave, MD, chief clinical officer, says the C-suite is delighted with the ACE units and ACE Tracker because they've helped reduce readmissions, hospital-acquired conditions, and catheter-associated urinary tract infections.

Asked whether ACE units provide positive return on investment, Van Cleave says Aurora just doesn't think about the unit in those terms. "There's a part of this that speaks to the idea that the care we are delivering today is the care we will be receiving eventually. We want to have a healthcare system we are proud to send our friends and family to."

Van Cleave says Aurora is trying to expand the program still. "It's a challenge to constantly make sure that the lessons we know are consistently applied. But we're still learning."

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