The ACE Unit at Penn Presbyterian Medical Center

The Acute Care for Elders Unit (ACE Unit), located at Penn Presbyterian Medical Center, is a hospital inpatient unit specifically designed for adults over the age of 70. The ACE Unit offers patient-centered care for older adults through a strong inter-professional collaborative care model. Most patients admitted to the ACE Unit are cared for by geriatric specialists, led by an attending physician from the Penn Division of Geriatric Medicine.

During a patient’s time in the ACE Unit, their experienced, interdisciplinary care team can include the following members:

1. Geriatrician: A board-certified specialist from Penn Geriatrics
2. Geriatric-trained registered nurses
3. Geriatric-certified physical therapist
4. Social worker
5. Case manager

ACE Unit Models of Care

While there are fewer than 50 ACE Units in the country, the ACE Unit at Penn Presbyterian Medical Center is the first such unit in the Philadelphia area and a leader in providing specialized, comprehensive care for older adults.

ACE Units involve a system of care designed to help acutely ill older patients prevent functional decline and hospital-related complications like falls, pressure ulcers, and delirium. ACE Units allow patients to recover functional losses caused by illness, resume their former lives, and when appropriate, aim for discharge back home rather than to a rehab facility.

The ACE Unit has a proactive, prehabilitative approach, comprising five components:

1. Prepared environment: Physical environment that promotes mobility and orientation (e.g. carpeting, raised toilet seats, low beds, clocks, calendars, pictures)
2. Interprofessional, team-based patient-centered care with registered nurse-initiated protocols for independent self-care, nutrition, sleep hygiene, skin care, mood and cognition
3. Early rehabilitation from physical therapists or occupational therapists, who provide therapy services and are integrated into the care team
4. Early planning for discharge with goal of returning home, accompanied by social work intervention to mobilize a patient’s family and other resources
5. Medical review to promote optimal prescribing and protocols to minimize adverse effects (e.g. medication reconciliation and avoidance of urinary catheterization)

Age-Specific Care

The ACE Unit team is continuously innovating to improve care delivery in the unit and to serve as a model of care for older patients throughout the hospital. Care-improvement initiatives include focusing on the following areas:

1. Improved sleep: Since proper sleep is important to recovery, registered nurses and certified nursing assistants make every effort to promote uninterrupted sleep between the hours of 10pm – 6am. This includes turning down lights, closing blinds, creating a quiet environment, and avoiding vital signs monitoring and medication administration while patients should be sleeping. Conversely, we aim to keep patients awake and stimulated during the day, by raising the curtains in the morning, encouraging meals be eaten out of bed, and assisting patients to eat when necessary. Our registered nurses, certified nursing assistants, and physical therapists also encourage patients to be active, awake, and ambulating whenever possible during the day to prevent functional decline and improve sleep at night.
2. Patient comfort: Unit registered nurses, certified nursing assistants and clerks strive to make patients and their visitors feel comfortable during their time in the hospital. The team is available to assist with personal care, which includes 1:1 assistance with meals, when necessary, proactively assisting patients to the rest room, and providing easy access to a fresh pitcher of water. Quick and in-person responses to call bell requests and patient satisfaction and comfort are of the utmost importance.
3. Early discharges: When preparing for discharge, it’s often best to arrange discharge earlier in the day to allow plenty of time for transportation and time for the patient to adjust to being home or at the next site of care. The care team participates in a discharge huddle every afternoon to prepare for discharges the following day, making sure all paperwork and arrangements are completed for a seamless discharge.
4. Research: The unit participates in a bi-annual Clinical Effectiveness and Quality Improvement meeting to focus on patient safety and quality improvement informed by research related to the types of care the unit provides. For example, a registered nurse scientist from the Penn School of Nursing is currently exploring the use of PARO robotic seals in the management of delirium and behavioral symptoms of dementia.