If ACE Units Are So Great, Why Aren't They Everywhere?

Cheryl Clark, April 25, 2013

"We get older people to return to their homes safely," she says. ACE teams with geriatric specialists aggressively urge patients to move about, assess them for delirium and confusion, and guard against adverse reactions to polypharmacy. Team members use restraints judiciously, talk at length with family members and loved ones, and contact community resources to supply services patients need after discharge

It's not sexy stuff. In fact it's really quite routine care, involving communication and discharge planning that should be the norm for all hospitals trying to do what's right for their patients.

But it's much tougher for this population.

Many care processes don't work for frail seniors in the same way they do with younger patients because the same rules don't apply. How medications affect them, how they understand instructions, their need for additional safety precautions in the hospital and at home, and their relative intolerance for invasive procedures may all get overlooked outside of these dedicated units, ACE unit researchers and advocates say.

That's why these teams employ geriatric-trained therapists, dieticians, social workers, physicians, and nurses, who intensely communicate daily as a team.

They also make sure that patients don't get care that won't benefit them or that they wouldn't want, such as feeding tubes or imaging studies.

Asked why more hospitals haven't established these services, Edgar Pierluissi, MD, medical director of the six-year-old, 22-bed ACE unit at San Francisco General Hospital, says they're starting to. There are 10 on the West Coast, including Oregon's Legacy Health, he says. And Aurora Health Care in Wisconsin has nine.

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