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Dr. Parker visits with a paitent at the ACE Unit

ACE-ing elderly care

September 2012

by Sheila Hotchkin

Hospitals save lives – no doubt about it. But for the elderly, they are full of hazards.

Fluorescent lights and round-the-clock activity make it difficult to sleep, which can cause delirium in elders. Shiny hospital floors contribute to falls, while staying in bed can lead to pressure ulcers. The elderly are susceptible to infections and often take many medications, opening the door to interactions.

UT Medicine San Antonio has teamed up with CHRISTUS Santa Rosa Health System to create a specialized hospital unit for elderly patients at high risk for complications during inpatient stays. The Acute Care of the Elderly (ACE) Unit is the first of its kind in San Antonio.

"It’s designed to reduce all the complications that elders may suffer in hospitals," said UT Medicine geriatrician Robert Parker, M.D. "There are lots of processes we can use to improve delivery of care."

ACE Unit room
Every room in the ACE Unit is specially designed to prevent complications that elders may experience in hospitals.
The difference starts with physical design. Non-reflective, non-slip floors help elderly patients stay surefooted. Every bed has an alarm, and patients at high risk for falls are identified with bracelets and a star outside their rooms. Thanks to steps like these, falls are a rarity in the ACE Unit, and injuries from falls are nonexistent.

Mattresses are designed to prevent pressure ulcers – important for elderly patients, whose skin is fragile and slower to heal. The ACE Unit uses soft lighting and decibel meters, which flash when the noise level gets high. A common room gives patients a place to share meals, encouraging them to move around and socialize.

The 2-year-old unit moved this summer from CHRISTUS’s downtown campus to CHRISTUS Santa Rosa Hospital – Medical Center. The new unit is being adapted to include the same amenities in an inviting, patient-centered atmosphere.

Beyond design flourishes, the medical staff has adopted many practices to improve patient care.

ACE Unit team
UT Medicine physicians on the ACE Unit team include (L-R) Ted Suh, M.D., Ph.D.; David Espino, M.D.; Yanping Ye, M.D.; Neela Patel, M.D., M.P.H.; Liliana Oakes, M.D.; and Ughanmwan Efeovbokhan, GNP, Ph.D. Not pictured are Robert Parker, M.D., and Rosina Finley, M.D.
They have limited use of Foley catheters, which are often overused with elderly patients and can cause urinary-tract infections. They do not use physical restraints, which can heighten delirium. They also are alert to drug interactions and avoid certain commonly used medications that, in elderly patients, are known to have effects like confusion, sedation and convulsions.

"You can do harm to an elderly patient without realizing it," said Imelda Sanchez, R.N., B.S.N., director of the ACE Unit.

The ACE team attempts to give patients six or seven hours of uninterrupted sleep, which substantially reduces delirium. All patients receive daily visits from a restorative aide, who keeps them physically and mentally engaged.

New patients are screened for personal risk factors, which are closely monitored during their stay. Nurses may take preventive steps without waiting for a physician’s order. Also, the ACE team devotes a lot of time to families, educating them on their elders’ conditions and explaining how to care for them.

An interdisciplinary team that can include doctors, nurses, dietitians, social workers, pharmacists, chaplains and more meets daily to discuss every currently admitted patient, ensuring that all members of the ACE team are on the same page about treatment.

The ACE Unit’s success is reflected in the numbers: It has never had an injury fall or pressure ulcer, and its 30-day readmission rate for the same diagnosis is just over 3 percent, compared with the national rate of 14 percent.

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