COMMUNITY GERIATRICS - Department of Family & Community Medicine

Inpatient Acute Care for the Elderly (ACE) Unit

 

image_Christus Santa RosaWelcome to the Christus Santa Rosa Medical Center Hospital ACE rotations!

 

The ACE training experience includes two (2) family medicine resident experiences: 1) a four-week second year rotation and 2) a two-week third year rotation.

 

Policies are outlined below and should be reviewed prior to the rotation, as you will be responsible for following these policies during your rotation.

 

OBJECTIVES
At the end of the rotation the resident physician will be able to:

  • Diagnose and manage common inpatient medical problems to the elder population, including critically-ill patients requiring critical care unit management.
  • Provide medical care for the older surgical patient, including pre-operative evaluation and post-operative management.
  • Complete a comprehensive assessment of functional status and appropriate levels of care, e.g., "can this patient go home rather than to a nursing home, or to some other less restrictive environment?"
  • Participate in discharge planning to optimize use of community and outpatient services available for the elderly, including follow-up with Senior Health Care Center, if desired.
  • Provide care for older adults using an ACE model.
  • Works collaborate as part of an interdisciplinary team.
  • Provide successful transitions of care for older adults

We hope you enjoy the time that you spend with us. We love and respect our patients and take pride in being able to improve the quality of life for each of them. We have gathered information, instructions and tips we hope will help you succeed in this challenging rotation. Please familiarize yourself with the contents before your rotation begins. We are constantly attempting to improve it, so if you have any questions, concerns, or suggestions, please contact Dr. Yanping Ye (yey@uthscsa.edu) or Ruby Mathew (mathewr3@uthscsa.edu)

 


Before You Start:

  1. Make sure that you have completed training and have a current username/password for 1) the Christus Meditec EMR Meditech /CPOM) and 2) the UT medicine EPIC care EMR. Contact Janie Trevino (trevinoj@uthscsa.edu) PRIOR to starting the rotation for assistance.
  1. Review presentation over ACE Unit. We use an Acute Care of the Elderly approach on this service.
  2. Review the Curriculum for the Aging Hospitalized Medical Patient (CHAMPS).
  3. Review the geriatric assessment tools on this web site. You will use them daily.
  4. Mandatory Resources:
    1. Palm Pilot or equivalent with ePocrates or equivalent medical database.
    2. Copy of Reuben's Geriatrics at Your Fingertips, available from attending.
    3. Review Merck Manual of Geriatrics (http://www.merck.com/mkgr/mmg/home.jsp).

     

    Read articles available in the Assessment Tools & Readings section of this web site. You will use this information daily.

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More about the: ACUTE CARE OF THE ELDERLY (ACE) UNIT

 

The ACE inpatient unit and consult service will offer you the opportunity to learn patient care skills unique to older, frail patients, to practice systems based care, and to experience working as part of an interdisciplinary team (IDT).

 

The Vision:
We utilize an Acute Care of the Elderly (ACE) model of care, an evidence based approach shown to improve outcomes for elders. The ACE approach strives to maintain function, independence, and quality of life for elders and to prevent iatrogenic illness (illness caused by medical care). CLICK HERE to view ACE presentation.

 

The goal of the ACE approach is to avoid the cycle of complications and extended hospital stays common to older patients illustrated below.

Risks of Hospitalization of Elders
 
image_diagram Hosptialization Risks for Elders

 

The ACE Unit is located at 2827 Babcock, Christus Santa Rosa Medical Center Hospital.

 

The patients admitted to the ACE unit are ambulatory or long term care patients of the UT Medicine Family Medicine Community Geriatrics Group, UT Medicine Internal Medicine Geriatrics Group, other UT faculty group patients, and patients from community physicians.

 

A key learning activity is the residents' participation in the daily 30-minute geriatrics interdisciplinary team meeting, held at 1130 am each week day. The team consists of the geriatricians, Nurse practitioner, and ACE unit nursing coordinator, primary nurses, rehabilitation staff, a dietician, a discharge planner, Pharm D, and other health care providers. These meetings provide unique opportunities for communication which has been demonstrated to improve patient care quality. The IDT team also reviews individual patient progress and discharge planning.

 

 Info for Family Medicine Residents on ACE Unit

 

1. Cap on patient numbers:
There will be a cap of 5 patients/resident. The PGY3s can cover patients in the ICU, but PGY2s should not be assigned ICU patients. On afternoons when a resident goes to clinic, the remaining resident is expected to cover both residents' patients, to a max of 10 totals. Any new admissions beyond the cap of 10 total will be managed by the faculty, fellow or NP.

 

2. Work hours:
Residents are expected to be at the ACE Unit by 7 am latest every day to prepare for rounds; they are required to get their earlier if they think they need more time, and particularly on days they might have to go to clinic, conference, or nursing home.

 

3. Nursing home attendance:
Residents are not to be expected to attend nursing home while on the Geri IPS rotation.

 

4. Daily rounds:
Faculty rounds will occur at 9 am both during the week and on weekends when a resident is rounding.
7 AM to 9 AM House staff pre-rounds work
9 AM to 10 AM Morning report
10 AM to 10:15 AM Radiology rounds
10:15 AM to 11:30 AM Bedside teaching rounds
11:30 AM to 12:00 PM Interdisciplinary Team Meeting
1:00 PM to 5:00 PM Resident and Fellow patient care

 

5. Nursing home/Geri ACE unit home call:
Faculty takes first call for ACE from 5 pm to 7 am. The residents are not allowed to take any night call for the ACE.
There is no call requirement for residents from geriatric service

 

6. ACE Unit resident schedule:

 

  Mon Tues Wed Thurs Fri Sat Sun
AM PGY2 & PGY3 PGY2 & PGY3 PGY2 & PGY3 PGY2 & PGY3 PGY2 & PGY3 PGY3* PGY2*
PM PGY3
(PGY2 goes to FHC)
PGY2+
(PGY3 goes to FHC)
PGY3
(PGY2 goes to conference)
PGY2
(PGY3 goes to FHC)
PGY3+
(PGY2 goes to FHC)
   

 

7. Weekend cap on patient numbers:
The resident is expected to cover the entire service to a max of 10 totals. Any new admissions or existing patients beyond the cap of 10 totals will be managed by the faculty or NP/fellow (if they are on weekend).

 

8. ACE checkout process:  All ACE unit calls will be covered by attending on the service or NP. Resident is expected to send email checkout handout to attending and NP every afternoon. Faculty will send back updated patients’ information (including new admissions overnight) to residents prior to 7am the next day.

 

9. IDT Meetings: The meeting starts at 1130 are on time M-F. The residents are required to be present at the IDT meeting.

 

10. Others
No consults on our ACE patients without discussing with faculty first.
Do not admit a patient or agree to admit a patient without discussing with attending faculty first.
Do not discharge a patient without discussing with faculty first.
Any patient with the diagnosis of CHF on the chart must have an ejection fraction documented on the charts.

 

Key Phone Numbers:
Clerk 705-6195
Admitting 704-2457
Direct Admit/Patient intake 704-3292
Hospital main line 705-6300
ACE UNIT: 210 705-6195
ACE FAX NO:  210-705-6523
ER 705-6810
ER fax 705-6519
Radiology 705-6303
CSR UT Senior Health Clinic 450-9890
CSR UT Senior Health Clinic fax 450-6088
UT medicine (MARC) - 450-9000
Telemetry – 705-6485.
Surgical – 705-6285
Transplant – 705-6375. 
MICU – 705-6358

 

 

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