An Acute Care for Elders (ACE) unit in the emergency department

Background: Evidence for Comprehensive Geriatric Assessment (CGA) in discrete units is now well accepted but in the emergency department setting is not as clear and may offer significant benefits. Methods: We evaluated the implementation of a four-bedded Acute Care for Elders (ACE) unit in the emergency department. Three cohorts of patients were recruited in a prospective before and after evaluation. Results: Patients in the ACE unit were more likely to be discharged immediately (17.1% vs. 1.4% "before" and 7.7% "after", P < 0.0005). Access to specialty beds on the day of admission was significantly different (71% "before", 69% ACE unit, 60% "after", P = 0.019). Length of stay in a non-specialty bed was not reduced compared to the "before" group (1.0 days vs. 1.2 days, P = 0.09) but was compared to the "after" group (1.0 days vs. 1.6 days, P = 0.0001). Length of stay was not significantly different (12.2 days "before" vs. 12.7 days ACE unit, P = 0.78 or vs. 11.7 days "after", P = 0.54). Seven and 30-day readmission, 12-month mortality, admission to residential care or living at home were not significantly different. Conclusion: ACE units in the emergency department can reduce admissions and offer immediate CGA without adverse outcomes for patients. (C) 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.