Demystifying the Different Meanings of ACE
In the nursing and healthcare community, the acronym ACE can refer to several distinct models and concepts. The two most common and relevant are the Acute Care for Elders (ACE) Unit model and the ACE Star Model of Evidence-Based Practice (EBP). It is crucial for nurses, students, and other healthcare professionals to understand the differences and applications of each to provide optimal, evidence-informed care.
The Acute Care for Elders (ACE) Unit Model
Developed in the 1990s, the Acute Care for Elders (ACE) unit is a specialized care delivery model designed to mitigate the functional decline that older adults often experience during hospitalization. Unlike traditional models that focus narrowly on a specific disease, ACE units take a holistic, patient-centered approach to prevent hospital-associated disability.
Core Components of the ACE Unit Model
The ACE unit intervention is built around four key elements:
- A Prepared, Elder-Friendly Environment: The physical environment is modified to promote patient independence, safety, and orientation. Features include uncluttered spaces, handrails, large clocks and calendars, and reduced ambient noise to minimize confusion and anxiety.
- Patient-Centered Interdisciplinary Team Care: Instead of siloed care, an interdisciplinary team—including nurses, geriatricians, physical therapists, social workers, and dietitians—collaborates on a patient's care plan. This team meets daily to address the patient's full range of needs and goals.
- Nursing-Initiated Protocols: Nurses are empowered with protocols to prevent common complications associated with hospitalization, such as falls, pressure injuries, delirium, and functional decline. The nursing role is pivotal in assessing and addressing mobility, cognition, and other key areas.
- Early, Comprehensive Discharge Planning: The planning for a patient's transition from the hospital begins on day one of admission. The goal is to ensure a safe and durable discharge, ideally returning the patient home with their independence intact, or arranging appropriate post-acute care.
The Proven Benefits of the ACE Unit
Clinical trials have demonstrated significant benefits associated with the ACE unit model, including:
- Reduced functional decline during hospitalization.
- Shorter hospital lengths of stay.
- Lower hospital costs.
- Fewer discharges to nursing homes.
- Lower readmission rates.
- Increased patient and family satisfaction with care.
The ACE Star Model of Knowledge Transformation
The ACE Star Model of Knowledge Transformation©, developed by Dr. Kathleen Stevens, is a framework for systematically integrating evidence into practice. It provides a structured process for healthcare providers to transform new knowledge from research into improved clinical care and patient outcomes.
The Five Stages of the ACE Star Model
The model's stages describe the journey of new knowledge, from its initial discovery to its final integration and evaluation:
- Discovery: This is the generation of new knowledge through primary research, such as clinical trials and observational studies.
- Evidence Summary: Researchers and clinicians critically appraise and synthesize individual studies into comprehensive evidence reviews, such as systematic reviews and meta-analyses.
- Translation: The summarized evidence is translated into practical clinical practice guidelines or protocols that are clear and actionable for practitioners.
- Integration: The guidelines are integrated into routine clinical workflows. This requires organizational support, policy changes, and staff education.
- Evaluation: The implemented evidence-based interventions are evaluated to monitor their effects on patient outcomes and care processes, ensuring continuous quality improvement.
Comparing the Acute Care and EBP ACE Models
While both models are integral to high-quality nursing, they serve very different functions. A clear understanding of their distinction is critical for professional practice.
| Feature | Acute Care for Elders (ACE) Unit | ACE Star Model (Evidence-Based Practice) |
|---|---|---|
| Purpose | To deliver specialized, holistic care to acutely ill older adults and prevent functional decline during hospitalization. | To provide a systematic framework for translating research knowledge into clinical practice. |
| Focus | Improving acute patient care for a specific population (elders) by modifying processes and the environment. | Changing the basis of practice from tradition to evidence by following a five-stage knowledge transformation process. |
| Key Outcome | Reduced functional decline, shorter hospital stays, fewer readmissions, and lower costs for older patients. | Improved clinical decision-making, enhanced quality of care, and better patient outcomes by using the latest evidence. |
| Team | Interdisciplinary bedside team (nurses, geriatricians, therapists, etc.). | Often involves a wider range of practitioners, researchers, and administrators across different departments. |
| Environment | The physical hospital unit is specifically adapted to be elder-friendly and support independence. | The focus is on the organizational process of knowledge transfer, not the physical environment. |
The Nurse's Pivotal Role in Both ACE Models
Nurses are essential to the success of both the Acute Care for Elders model and the ACE Star Model. In an ACE unit, the nurse is the 24/7 advocate and bedside expert, implementing protocols to prevent decline and mobilizing the patient. As advocates for older adults, nurses are crucial to incorporating patient values and preferences into the care plan.
For the ACE Star Model, nurses can be involved at every stage. They can identify clinical questions at the bedside (Discovery), search for evidence (Summary), help develop and implement practice guidelines (Translation and Integration), and evaluate the effectiveness of new protocols (Evaluation). This dual involvement underscores the nurse's central role in both direct care and the continuous improvement of healthcare delivery.
Challenges and Implementation in Practice
While both models offer significant benefits, their full implementation can be challenging. For the ACE unit model, barriers can include staffing limitations, the initial costs of training and environmental modifications, and resistance to changing established hospital culture. The ACE Star Model can be hampered by a lack of time for busy clinicians to engage in the EBP process, limited access to research, or institutional resistance to change.
However, innovative approaches, such as mobile ACE services that bring geriatric expertise to patients across the hospital, are helping to overcome these limitations and spread the benefits of ACE beyond dedicated units. As healthcare systems increasingly move toward value-based care, the evidence-based, cost-saving benefits of ACE models are becoming more compelling for hospital leadership.
For additional information on the Acute Care for Elders unit model, readers can consult the detailed commentary found on the National Institutes of Health (NIH) website: The Acute Care for Elders Unit Model of Care.
Conclusion
Understanding the nuanced differences between the various ACE models is key for modern nursing practice. The Acute Care for Elders model focuses on improving outcomes for hospitalized seniors through specialized unit design and interdisciplinary care, while the ACE Star Model provides a roadmap for integrating evidence-based knowledge into all facets of nursing. By applying these robust frameworks, nurses can drive significant improvements in patient care quality and lead the charge toward a more age-friendly healthcare system.
