UF Health launches acute care for the elderly team to improve patient outcomes

A new University of Florida Health geriatric team today is launching a health care program at UF Health Shands Hospital that is expected to reduce hospital stays and readmissions and lower health care costs while improving health outcomes for elderly patients.

The “acute care for the elderly” program, or ACE, is being led by the UF College of Medicine’s division of geriatric medicine and will initially be in one unit of the hospital, with the goal of eventually expanding it to other areas.

The team, composed of a geriatrician, a geriatrics nurse educator, a clinical nurse, a clinical pharmacist, a rehabilitation therapist for physical and occupational therapies, and a case manager, will make its rounds on a seventh-floor unit of the hospital. While that floor houses adult patients of all ages, the team’s work will be focused exclusively on those at least 70 years old.

The ACE team will communicate with hospital staffers on the floor and make recommendations on their patients’ care, said Laurence M. Solberg, M.D., chief of the geriatric medicine division and a member of the UF Institute on Aging.

“The medical care of hospital elders is very complicated,” said Solberg. “They usually have multiple comorbidities and sometimes not everything gets addressed in the hospital because the medical focus is on the immediate reason for which they are hospitalized.

“If they have pneumonia, their primary hospitalist team will focus on that,’’ he said. “Are we treating it? Yes. We’re doing a great job. But maybe the patient hasn’t been out of bed in three days and now they’re weaker and can’t get home. That’s what we want to avoid.”

Solberg said the ACE team will have the capacity to handle up to 18 patients at a time and could reduce medical costs by $500,000 to $1 million annually. The director of the ACE program is Jacobo Hincapie Echeverri, M.D., a clinical assistant professor in the division of geriatric medicine.

“This is a big step for our operation, for geriatric health care in Gainesville and for our community,” said Marco Pahor, M.D., director of the UF Institute on Aging. “What typically happens in a hospital is that patients are taken care of by the medical specialty of their main disease. The problem that older people often face is that they don’t have one main disease. They can have an array of main diseases that together interact to influence their health outcome.”

ACE units have been started at more than 200 hospitals around the nation after the concept’s birth two decades ago. Research at other medical centers has shown that ACE units can lead to dramatic cost reductions while improving patient’s functional abilities; reducing reliance on drugs, particularly antipsychotic medications; shortening the length of hospitalization; reducing adverse events; and unnecessary medical tests.

Solberg said UF Health Shands Hospital personnel have been very supportive of the concept and have been involved in the planning. “The model is to work in parallel with their hospitalists and with good cross-communication,” he said.

The idea for the ACE team came after David S. Guzick, M.D., Ph.D., senior vice president for health affairs at UF and president of UF Health, asked Pahor and Solberg in March to find a new way to enhance the care of elderly patients using existing resources.

Many hospitals operate a fixed ACE unit, where elderly patients are routed upon admission. But that model can be challenging, especially at hospitals that, like UF Health Shands, often operate near capacity. Beds set aside for the elderly can be allocated to younger patients.

“If there’s not an older person in the ER, then that younger person is going to get the bed,” said Solberg. “And rightly so. We want people out of the ER and up to a room.”

So, UF adopted a hybrid ACE team that can float on a floor, providing the same level of care as a team in a fixed physical space, Solberg said.

The team is composed of existing personnel, he said, but all are trained in the medical needs of the elderly.

“Along with our recent expansion of services in outpatient clinical care, skilled nursing facility care and now the ACE service, this really completes the entire continuum of care for elderly patients that we are working to provide,” said Pahor.