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- Title
ACE IMPACT: EVALUATION OF AN INTEGRATED GERIATRIC SERVICE.
- Authors
Bell, C.; Hashemi, N.; Wieland, F.; Lowrey, C.; Kaur, V.
- Abstract
Background: Unplanned admissions for older people can result in lengthy hospital stays. It has been recognised that many of these admissions are avoidable, often associated with adverse patient outcomes and potential resource misappropriation.There is a drive to seek novel processes to better assess and manage frail elderly people presenting to Emergency Departments (ED).Innovation: Within a busy London District General Hospital, an Acute Care of the Elderly (ACE) service was designed. Based in the ED Observation Ward this service provides an in-reach service to the ED, and liaison to the Acute Medical Unit.This is a consultant-led service, with support from a trust grade junior doctor and Band 6 nurse. At present this is a weekday in-hours resource. Comprehensive geriatric assessment is delivered to patients over the age of 80, with complex problems or frailty, but who do not require inpatient care. Therapies and social care support is provided through existing teams operating in the ED.Evaluation: Between January and October 2013, 662 patients have been assessed by the ACE team, in whom 459 inappropriate admissions were avoided. To receive a comprehensive geriatric assessment and appropriate treatment to facilitate discharge of these patients only needed to stay an extra 4.76 hours on average in hospital.Since the introduction of the ACE service the rate of admission in older people from ED Observation Ward has reduced 61.2% in 2012 to 35.1% this year, despite similar levels of activity. Comparing similarly aged patients and episode diagnosis coding, in excess of 4,200 bed days could be saved per year.Conclusions: The ACE service has provided clear benefits to patients and the trust by avoiding un-necessary hospital admission, while providing focused consultant-delivered care in a timely manner. Expansion to a seven-day service is imminent, with expected further benefits.
- Publication
Age & Ageing, 2014, Vol 43, Issue suppl_2, pii7
- ISSN
0002-0729
- Publication type
Academic Journal