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About the Innovation

Why Providing Elder-friendly Care Matters

Healthcare in Canada faces challenges meeting the needs of an aging population, straining our traditional hospital models that were developed to treat patients with acute issues. While individuals 65 and older account for 16% of the population, they represent 42% of all acute care hospitalizations and 58% of all hospital days across Canada. Often, older adults present to hospital with a number of inter-related chronic and acute health and social issues. The inability to understand and address these issues in a proactive manner contributes to increased lengths of stay, cognitive and functional decline, tendency to relapse into a previous condition, and poorer patient and staff satisfaction. Sadly, 30% of seniors are discharged at a significantly reduced level of functional ability and most will never recover to their previous level of independence. Many of these adverse outcomes are preventable.

The Innovation

Over the last six years, Mount Sinai Hospital has become Canada’s most widely recognized elder-friendly hospital. Located in Toronto, Ontario, Mount Sinai has implemented evidence-informed models and point-of-care interventions to demonstrate better patient, provider and system outcomes. ACE is a seamless model of care for older adults that spans the continuum of the emergency department, inpatient, outpatient and community care. Interprofessional teams of specialist physicians – particularly geriatricians and geriatric psychiatrists – advanced practice nurses, social workers, therapists, pharmacists, dieticians and volunteers work together to provide better, more coordinated care for patients.

Under the banner of the ACE Strategy, the hospital has demonstrated significant improvements in overall quality of care outcomes, as well as reduced lengths of stay, admissions, readmissions and inappropriate resource utilization. Mount Sinai’s continuous quality improvement is supported through a rigorous balanced scorecard benchmarking and performance measurement tool to evaluate the effectiveness of its strategy on improving care for its elderly patients.

Mount Sinai ACE Strategy Results

Comparing its baseline performance year of 2009/10 to 2013/14, four years after the launch of the ACE Strategy, Mount Sinai achieved significant results for its 65 and over medical inpatients, including:

  • reduced total lengths of stay (12 days → 8 days)
  • reduced alternate level of care days (20 percent reduction)
  • reduced readmissions within 30 days (15 percent → 13 percent)
  • reduced urinary catheter use (56 percent → 15 percent)
  • reduced pressure ulcer incidence (93 percent reduction)
  • improved rate of returning patients home as opposed to other institutional settings (71 percent → 79 percent)
  • increasing rates of patient satisfaction (95 percent → 97 percent)

These overall improvements were achieved despite the hospital seeing its rates of admitted medical patients over the age of 65 climb by 37 percent, despite sustaining the region’s lowest ED/admit ratio over the same period in a region with a fast growing population. Nevertheless, with improved efficiencies gained principally through length of stay reductions, the hospital was able to close eight medical beds. Overall, the cost-savings realized through these initiatives achieved an estimated $6.7 million in net acute care savings to the healthcare system in 2014.