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Developing a Stroke Unit Using the Acute Care for Elders Intervention and Model of Care

Authors

  • Kyle R. Allen DO,

    1. From the *Division of Geriatric Medicine, Department of Medicine, Summa Health System, Akron, Ohio; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Section of Geriatric Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and §Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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  • Susan E. Hazelett MS, RN,

    1. From the *Division of Geriatric Medicine, Department of Medicine, Summa Health System, Akron, Ohio; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Section of Geriatric Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and §Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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  • Robert R. Palmer MD, MPH,

    1. From the *Division of Geriatric Medicine, Department of Medicine, Summa Health System, Akron, Ohio; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Section of Geriatric Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and §Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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  • David G. Jarjoura PhD,

    1. From the *Division of Geriatric Medicine, Department of Medicine, Summa Health System, Akron, Ohio; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Section of Geriatric Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and §Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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  • Glenda C. Wickstrom MD,

    1. From the *Division of Geriatric Medicine, Department of Medicine, Summa Health System, Akron, Ohio; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Section of Geriatric Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and §Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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  • Jan A. Weinhardt MSN, RN, CS,

    1. From the *Division of Geriatric Medicine, Department of Medicine, Summa Health System, Akron, Ohio; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Section of Geriatric Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and §Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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  • Robert Lada MD,

    1. From the *Division of Geriatric Medicine, Department of Medicine, Summa Health System, Akron, Ohio; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Section of Geriatric Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and §Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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  • Carolyn M. Holder MSN, RN, CS,

    1. From the *Division of Geriatric Medicine, Department of Medicine, Summa Health System, Akron, Ohio; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Section of Geriatric Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and §Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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  • Steven R. Counsell MD

    1. From the *Division of Geriatric Medicine, Department of Medicine, Summa Health System, Akron, Ohio; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Section of Geriatric Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio; and §Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana.
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  • This work was supported in part by the Summa Health System Foundation and Summa Health System Health Services Research and Education Institute. This work was presented in part at the 1998 and 2000 Annual Meetings of the American Geriatrics Society.

Address correspondence to Kyle R. Allen, DO, 75 Arch Street, Suite 301, Akron, OH 44304. E-mail: allenk@summa-health.org

Abstract

The Acute Care for Elders (ACE) model of care is a multicomponent intervention that improves outcomes for older patients hospitalized for acute medical illnesses. Likewise, stroke units improve outcomes for patients with acute stroke, yet the descriptions of their structure and approach to stroke management are heterogeneous. The purpose of this article is to describe how implementing the ACE model of care, using a continuous quality-improvement process, can serve as a foundation for a successful stroke unit aimed at improving stroke care. The ACE intervention (a prepared environment, interdisciplinary team management, patient-centered nursing care plans, early discharge planning, and review of medical care) was amplified in a community teaching hospital for stroke-specific care by creating a stroke interdisciplinary team, evidence-based stroke orders and protocols, and a redesigned environment. Administrative data show that the ACE model can be successfully adapted to create a disease-specific program for stroke patients, having the potential to improve the process of care and clinical stroke outcomes.

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