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STAFF INFORMATION SHEET
ACUTE CARE OF THE ELDERLY (ACE)
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NAME Hospital provides service to an ageing population with number % of bed days
occupied by people over the age of 70 years. Recognising this increasing need it is essential to
provide accessible and appropriate acute care for older Australians and to optimise the use of
acute care beds.
THE ACUTE CARE OF THE ELDERLY (ACE) MODEL OF CARE
ACE is a shared care model designed to foster the independent functioning of patients. It is
shared care between the physicians and geriatricians (and their teams). ACE integrates
geriatric assessment into the optimal medical and nursing care of patients, in an
interdisciplinary environment.
The ACE process begins in the Emergency Department with the Risk Assessment And
Discharge Planning Tool being used and nursing and medical staff identifying patients who
will benefit from early geriatric input.
The aim of ACE is to maintain patients’ level of functioning, muscle strength and
independence while in hospital and return patients to their previous accommodation i.e back
to their hostel or home.
WHAT IS THE ACE PATIENT CRITERIA

Age generally over 65 years of age
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Younger patients may be accepted due to pre existing medical co-morbidities
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Aboriginal /Torres Strait Islanders over 55 years
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Acutely ill needing general medical or specialist medical management
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Pre existing co morbidities
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At risk of functional decline whilst in hospital
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Experienced functional decline in the two weeks prior to presentation at the Emergency
Department
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Nursing and medical staff can identify ACE patients.
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WHERE IS ACE LOCATED
ACE is currently only available in Ward NAME.
WHAT IS SHARED CARE

Generally, medical patients who are acutely ill are admitted under the appropriate
physician and teams. The ACE Team, which includes a geriatrician, works in
collaboration with the medical team.
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Prior to the ACE rounds, which are held on Monday, Wednesday and Friday, the ACE
Registrar or Senior Registrar Medical Officer makes a detailed functional/social
assessment of the patient.

The ACE Team focuses on early identification of barriers to discharge and the early
intervention of allied health staff, to maintain patient function and reduce de-conditioning.
The ACE Team makes an assessment as to whether the patient would benefit from
rehabilitation to reduce the risk of their re-admission within 28 days.

A Pharmacological Round is held every Thursday with the Geriatrician and the Chief
Pharmacist focusing on aged care drug interactions.
HOW TO IDENTIFY ACE PATIENTS
The ACE patients can be identified on the Acute Medical Ward patient board by the pink dot
against their name.
FLOW OF ACE PATIENTS

The ACE model of care begins on admission to the Emergency Department. If available,
patients are requested to bring their health assessment or care plan that their General
Practitioner has completed. This helps to give Emergency Department staff an idea of how
the patient normally functions at home.

The Risk Assessment and Discharge Planning Tool is begun to help staff to recognise
that the patient may benefit from the combined care of both a physician and geriatrician.

The physician treats the patients’ presenting problem that may, for example, be a chest or
heart problem. In collaboration with the physicians and their teams, the ACE team
reviews the patients’ mobility, medications, how they are managing at home, document
the help they receive and identify services that maybe needed in the future.

The ACE Team assesses the patient within the first 24-48 hours of admission to the ACE
Ward.
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FOCUS ON FUNCTION
The ACE model of care is designed to foster the independent functioning of patients and
reduce deconditioning while in hospital. This means the ACE Team wants to keep patients
exercising as much as possible. As soon as the ACE patients are medically stable, they are
encourage to do as much as possible for themselves.
The nurses encourage patients to move frequently between the chair and bed, walk to the
toilet rather than having a pan. The Mobility Enhancement Team are utilised as soon as
possible to walk patients. Patients are encouraged to go to the Dining Room to eat and to
socialise with other patients.
PATIENT SAFETY AND ACE

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Literature reviews show evidence that ACE model of care is not more dangerous than
current model of care. On the ACE Ward, there has been a reduction in adverse events
such as medication errors, falls and pressure areas for the ACE the target group.
There has been a reduced total length of stay in hospital for ACE patients.
EXPECTED OUTCOMES AND EVALUATION
1. Improved Length of Stay (LOS) for the total episode of care that will the include
Emergency Department, ACE Unit and Rehabilitation if appropriate.
2. Increased patient and staff satisfaction measured through surveys.
3. Reduction in iatrogenic complications such as falls and pressure areas. The Quality
Improvement Department collects data on adverse events.
4. Improved discharge planning and reduced re-admissions within 28 days.
5. Patients will use the activity room for meals and to socialise.
6. Improved attraction, satisfaction and retention of nursing staff measured by staff retention
and surveys.
7. Reduction in time from the identification of nursing home need to nursing home
placement.
8. More patients will be able return to their previous accommodation.