Improving Geriatric Care Processes on Two Medical- Surgical Acute Care Units: A Pilot Study Katrina A. Booth · Emily E. Simmons · Andres F. Viles · Whitney A. Gray · Kelsey R. Kennedy · Shari H. Biswal · Jason A. Lowe · Anisa Xhaja · Richard E. Kennedy · Cynthia J. Brown · Kellie L. Flood ABSTRACT 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 5 .04) and the prevalence of an abnormal delirium screening score was lower (13.6% vs. 4.8%, p 5 .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. Keywords: models of care, acute care of vulnerable elders, geriatric assessment, geriatric care processes Introduction Up to 40% of hospitalized older adults experience delirium or functional decline, which are associated with longer lengths of stay (LOS) and higher readmission rates. 1-3 In order to improve the care of hospitalized older adults, geriatric quality indica- tors, including care processes such as evaluation of cognitive status at admission, have been integrated into clinical practice guidelines. 4-7 One model of care incorporating these care processes that exists in approximately 200 hospitals in the United States is the Acute Care for Elders (ACE) Unit. 8 Core components of an ACE Unit include geriatric assess- ments by interprofessional staff, nurse-driven care protocols, daily medical review by a geriatrician, and early transition planning, all discussed during daily interdisciplinary meetings. Acute Care for Elders Units have been shown to reduce hospital-acquired cognitive and functional deficits, restraint use, rates of posthospital institutionalization, LOS, cost, and 30- day readmissions. 9-13 However, ACE Units reach a small proportion of older adults. In order to improve the quality of care for all older adults, the John A. Hartford Foundation and the Institute for Healthcare Improvement announced the “Creating Age-Friendly Health Systems” initiative that aims to spread geriatric best-practices to 20% of US hospitals by 2020. 14 Prior studies report barriers to develop- ment of “age-friendly” hospitals including lack of provider geriatric expertise and training for inter- professional staff, 15,16 and inconsistent processes of care. 17-19 To overcome these barriers and dissemi- nate ACE Unit principles to non-ACE Units, we developed the “Virtual ACE Intervention.” This paper describes the development, implementation, and pilot outcomes of the Virtual ACE Intervention on two medical-surgical units at an academic medical center. Methods The site is a 1,152-bed tertiary care academic hospital with 52 acute care units, including one ACE Unit. The target units were two medical-surgical units, Journal for Healthcare Quality, Vol. nnn, No. nnn, pp. 1–9 © 2018 National Association for Healthcare Quality The authors declare no conflict of interest. For more information on this article, contact Katrina A. Booth at kjulian@ uabmc.edu. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and in the HTML and PDF versions of the article at www.jhqonline.com. DOI: 10.1097/JHQ.0000000000000140 Journal for Healthcare Quality Month 2018 · Volume 0 · Number 0 1 Original Article Copyright Ó 2018 by the National Association for Healthcare Quality. Unauthorized reproduction of this article is prohibited.