Booth Katrina A, Simmons Emily E, Viles Andres F, Gray Whitney A, Kennedy Kelsey R, Biswal Shari H, Lowe Jason A, Xhaja Anisa, Kennedy Richard E, Brown Cynthia J, Flood Kellie L
J Healthc Qual. 2019 Jan/Feb;41(1):23-31. doi: 10.1097/JHQ.0000000000000140.
The Acute Care for Elders (ACE) Unit model improves cognitive and functional outcomes for hospitalized elders but reaches a small proportion of patients. To disseminate ACE Unit principles, we piloted the "Virtual ACE Intervention" that standardizes care processes for cognition and function without daily geriatrician oversight on two non-ACE units. The Virtual ACE Intervention includes staff training on geriatric assessments for cognition and function and on nurse-driven care algorithms. Completion of the geriatric assessments by nursing staff in patients aged 65 years and older and measures of patient mobility and prevalence of an abnormal delirium screening score were compared preintervention and postintervention. Postintervention, the completion of the assessments for current functional status and delirium improved (62.5% vs. 88.5%, p < .001) and (4.2% vs. 96.5%, p < .001). In a subsample analysis, in the postintervention period, more patients were up to the chair in the past day (36.4% vs. 63.5%, p = .04) and the prevalence of an abnormal delirium screening score was lower (13.6% vs. 4.8%, p = .16). The Virtual ACE Intervention is a feasible model for disseminating ACE Unit principles to non-ACE Units and may lead to increased adherence to care processes and improved clinical outcomes.
老年急性护理（ACE）单元模式可改善住院老年人的认知和功能结局，但受益患者比例较小。为推广ACE单元原则，我们试点了“虚拟ACE干预”，即在两个非ACE单元对认知和功能的护理流程进行标准化，且无需老年病医生每日监督。虚拟ACE干预包括对工作人员进行认知和功能老年评估以及护士主导护理算法的培训。比较了干预前后65岁及以上患者中护理人员完成老年评估的情况，以及患者活动能力的指标和谵妄筛查异常评分的患病率。干预后，当前功能状态和谵妄评估的完成情况有所改善（分别为62.5%对88.5%，p <.001）和（4.2%对96.5%，p <.001）。在亚组分析中，干预后期，过去一天内更多患者能够坐到椅子上（36.4%对63.5%，p =.04），谵妄筛查异常评分的患病率较低（13.6%对4.8%，p =.16）。虚拟ACE干预是一种将ACE单元原则推广到非ACE单元的可行模式，可能会提高对护理流程的依从性并改善临床结局。
