Date of Graduation

Winter 12-17-2021

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Executive Leader DNP

First Advisor

Mary Lynne Knighten

Second Advisor

Catherine Coleman

Abstract

Background: “Baby boomers” (born between 1946 and 1964) represent 15% of the total population of the United States (Population Reference Bureau, 2019), but 50% of its total healthcare expenses (Mattison, 2021). Growth of this population will have a corresponding rise in demand on healthcare resources. Replication of a geriatric inpatient care model (Palmer et al., 1994) was introduced in a large geographically and ethnically diverse integrated care delivery system.

Problem: The demographic for this small community hospital located in Northern California has a larger percentage of patients over the age of 65 compared to other facilities within this delivery system. On the 24-bed intervention unit, an overall fall rate of 2.17 per 1000 patient days was present compared to a national fall rate of 3-5 falls per 1000 patient days (AHRQ, 2019). Baseline 30-day readmission rate for this unit of four patients per month and length of stay (LOS) of 3.9 days. Patients on this unit had a discharge diagnosis of delirium of 18% compared to a national range of 3-16% (Inouye et al., 2007).

Methods: Review of literature revealed a geriatric model of care improved outcomes (Counsell et al., 2015; Fox et al., 2013: Palmer et al.,1994).A cost avoidance analysis was conducted as well as the development and definition of inclusion/exclusion criteria and a microsystem assessment.

Interventions: An ACE pilot unit was implemented in this community hospital with key interventions formation of an ACE Steering Committee, physical modifications to the unit and daily multi-disciplinary rounds that incorporated a patient-centered approach to optimize patient and organizational outcomes.

Results: Outcome data were collected on 51 patients admitted to the ACE unit between April 26, 2021, and August 31, 2021. One fall without injury was recorded for the unit and no 30-day readmissions to the ACE unit. Length of stay was reduced by two days and no significant changes in the number of patients discharged with a delirium diagnosis occurred.

Conclusions: The ACE unit in one community hospital improved outcomes with reduced falls, lengths of stay, and readmissions. Hospital administrators and nursing leaders need to consider expanding the inclusion criteria and introduce ACE unit implementation with concurrent evaluation.

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