Des Peres Hospital’s Acute Care For The Elderly Unit Combines Clinical and High-Touch Techniques Combine to Reduce Risk of Complications 

A lengthy hospital stay has typically been a high-risk proposition for many older seniors – urinary tract infections, adverse drug reactions, development of pressure sores, and a loss of ability to handle tasks for daily living are just some of the complications that can arise. But it doesn’t have to be this way. 

While not all risk can be eliminated from a hospital stay, particularly for those already in fragile health, hospitals can take steps to reduce the complications of a hospital stay.  Des Peres Hospital’s Acute Care for the Elderly (ACE) Unit implements new techniques in geriatric patient care designed specifically to reduce the complications of a hospital stay.  It operates under the guidance of Saint Louis University geriatricians Dr. John Morley and Dr. Joseph Flaherty, with input and support from community internists and geriatricians.

“We are seeing some exciting results,” said Michele Meyer, CEO of Des Peres Hospital.  “Our performance in three critical areas: adverse drug reaction, hospital-acquired urinary tract infections and hospital-acquired wounds, is better than national rates.”

Outcome                                                  2004      YTD 03/2005    National Rate
Adverse Drug Reaction (1)                    2.93              2.15                      6.7
Hospital Acquired Wounds (2)             2.42              2.19                      5.00
Hospital Acquired Infections (UTI) (3) 2.14              2.19                      3.80

(1) Adverse drug reactions expressed as percent of admissions.   National rate according to the FDA’s Center for Drug Evaluation and Research, “Preventable Adverse Drug Reactions: A Focus on Drug Interactions.”
(2) Hospital acquired wounds are presented as incidents per 1,000 patient days. National rate per Dr. David Thomas, Saint Louis University School of Medicine and Geriatric Research.
(3) Hospital acquired urinary tract infections are presented as incidents per 1,000 patient days. National rate from NNIS.

When one considers that adverse drug reactions, hospital-acquired wounds and hospital-acquired urinary tract infections can be life threatening, these statistics become important.

So how do they do it? In the Des Peres Hospital ACE Unit, older patients are under the care of a specialized, multi-disciplinary team, devoted to minimizing the adverse consequences of procedures, tests and medications, and to maintaining the patient’s function levels in order to reduce the length of stay in the hospital.  The ACE team consists of nurses, physicians, physical therapists, occupational therapists, pharmacists, case managers, dietitians and pastoral care staff, as appropriate.  Together, they conduct daily medical, behavioral and emotional reviews of each patient to help ensure that the patient, the family and everyone on the ACE team is coordinating their efforts to avoid complications and assist the patient in regaining and maintaining good function.

Clinical protocols help ensure that the team treats the patient in ways that minimize the opportunity for infection, pressure wounds or adverse drug reactions.  For example, in order to avoid urinary tract infections, foley catheters are not used as a matter of course.  In addition, wound and skin integrity guidelines ensure that patients are on a regular turning and hygiene schedule.  Finally, in order to minimize adverse drug reactions and interactions, the pharmacists make sure that patients receive the minimal number of medications with maximum effectiveness.
 
But just as important as clinical techniques, the team promotes high-touch activities to ensure that patients maintain their level of functionality and independence.  So, patients in the ACE Unit may:

• Spend less time in bed and more time walking or socializing, which helps the patient’s circulation and digestion;
• Take their meals and enjoy social and group physical therapy activities in a common area; and
• Be encouraged to maintain as many activities of daily living as possible.

“With older patients, the key is to prevent functional decline,” explained Dr. Morley.  “Getting them up and moving quickly is vital to their recovery.  It’s important to enable them to resume their normal routines.”

According to the national Centers for Disease Control, the ability to perform basic activities of daily living, such as bathing, dressing and using the toilet, is an indicator of the health and well being of the older population.  Being limited in activities of daily living compromises the quality of life of older persons and often results in the need for informal or formal caregiving services.

To be placed on the ACE Unit at Des Peres Hospital, patients have to be 65 or older and have an acute illness.