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Acute Care of the Elderly Unit and Palliative Care Unit

 Acute Care of the Elderly (ACE) Unit:

Background of the ACE unit:

  • Physical location: 8 Cardinal Carter
  • Maximum number of patients: 8 (regardless if some are bedspaced)
  • Criteria:
    • Age >70
    • From HOME (not a crisis/LTC issue)
    • Geriatric giant
    • Acute medical illness

Admissions Directly to the ACE unit:

  • Will ONLY happen Monday-Fridya, 8am-5pm
  • Monday-Friday, 8am-5pm: ED consult will be received by the PGY3 ED resident-->If consult deemed to be appropriate for ACE unit--> ACE blackberry paged-->ACE NP/Resident/Fellow does the entire consult and admits directly to ACE (reviews with Geriatrics staff)
  • Every day, the CMR will send an email to the ED residents, indicating how many beds are available on the ACE unit.
  • If someone is admitted overnight or on weekends who is deemed appropriate for ACE:
    • The patient will be admitted to GIM (direct admissions to ACE will NOT happen on evenings or weekends)
    • The Senior resident on call can tell the ED clerk that this patient is a "potential transfer to ACE" and this patient will be physically moved to 8CC (if possible) but they will still be admitted under GIM

    • The patient can then be potentially transferred to ACE the next day (see below)

Transfers to the ACE unit from GIM:

 

  • Will ONLY happen Monday-Fridya, 8am-5pm
  • GIM wil page the ACE blackberry for potential transfer
  • Geriatrics NP/Resident/Fellow will subsequently do the consult and assess the patient for transfer to ACE
  • Transfers during evenings and weekends are not permitted. Transfers will only happen from Monday-Friday during working hours.

 

Coverage of ACE inpatients:

  • Monday-Friday 8am-5pm: Geriatrics NP/Resident/Fellow
  • Evenings and weekends: CTU junior resident [on call schedule, will be denoted as (G)]

Palliative Care Unit (PCU)

To refer patients, call 5226. Occasionally, on-call CTU residents may be called to pronounce death for patients in the PCU. (For Palliative Care consults please fill and fax Palliative Care Referral Form)

PCU Admission Criteria:

  • The patient and the family agree to stop further active treatment for their illness and understand and agree to the philosophy of Palliative Care.
    • A “Do Not Resuscitate” status has been agreed to by the patient and family
    • Estimated survival is 3 months or less (for St. Michael’s Hospital PCU)
    • Estimated survival is 6 months or less (for Bridgepoint, Baycreast, and Toronto Grace PCUs)

PCU Exclusion Criteria:

  • Feedings via nasogastric tubes (previously established G-tubes are acceptable)
  • IV for hydration
  • Life expectancy of less than 24 hours (though the PCU will provide consultation on the medical ward)