Older adults account for more than one-third of acute-care hospitalizations and 58% of hospital days
in Ontario, Canada. Leaders and staff at Mount Sinai Hospital in Toronto, Ontario, recognized that the current hospital system was designed to meet the needs of a younger population, not frail older adults. To better address the needs of frail older adults, the hospital sought to develop programs and tools that would help caregivers deliver the right care in the right place at the right time.
Acute Care for Elders strategy
Mount Sinai was able to seamlessly implement and enhance its Acute Care for Elders (ACE) strategy with its frontline clinicians and informatics department, in part because Cerner Millennium® was already established as the hospital’s electronic health record (EHR) platform. The informatics department staff met frequently with frontline caregivers to understand their needs and the care they sought to provide.
Key components of the ACE strategy include six evidence-based admission order sets (the general ACE unit order set and sets for older patients with chronic obstructive pulmonary disease, heart failure, cellulitis, pneumonia, and hip fractures). The ACE superset contains several admission order sets and ensures ACE-specific protocols are used in the care of every older patient. They also ensure patients receive optimal medications and care protocols as quickly as possible so that consultations with specialists and allied health providers can begin much earlier.
ACE also integrates documentation of key geriatric clinical pro¬cess and outcomes indicators into Mount Sinai’s existing clinical documentation tools. These indicators populate the vital signs section of the health record to better support the care of frail elderly patients and help monitor the overall quality of care being delivered.
Also, a more seamless integrated service delivery model has been implemented at several points in the hospitalization process and within several teams. This model promotes initiation of appropriate care in the emergency department (ED) and helps coordinate patient care in real time. Development of a real-time ACE report providing the location of ACE-designated patients across the hospital helps staff identify these patients more easily, aids transfer prioritization to the ACE unit, and allows staff to initiate best-practice care protocols wherever they may be.
Linked communication system
In addition to these hospital-based strategies, point-of-care interventions across the continuum of care have been enhanced by the creation of an email-notification and communication system regarding frail community-dwelling patients in the Mount Sinai/Community Care Access Centre (CCAC) Integrated Client Care Project (ICCP) and the House Calls program. If one of these patients requires an unscheduled trip to the ED, the patient’s arrival in the ED triggers email notification, promoting communication about the patient’s care.
The goal of this linked communication process using secure email is to enable important information exchange among clinical team members who know the patient at different points along the care continuum. Ideally, this information exchange is solution focused, aimed at avoiding hospitalization whenever possible and helping the patient return to the community as soon as possible.
Barb Duffey-Rosenstein is the director of nursing informatics at Mount Sinai Hospital in Toronto, Ontario Canada. Samir K. Sinha is the director of geriatrics at Mount Sinai and the University Health Network hospitals.