UT Southwestern Medical Center has received exemplar status by the Nurses Improving Care for Healthsystem Elders (NICHE) – an international designation that indicates a hospital’s commitment to achieving the highest level of geriatric care excellence.
“Taking excellent care of older adults requires coordination and teamwork across disciplines and professions, and this recognition is a testament to the leadership role our nurses have taken in this mission as well as to our team’s ongoing commitment to deliver quality care to every older adult who enters our Medical Center,” said Thomas Dalton, M.D., Associate Professor of Internal Medicine at UTSW’s Mildred Wyatt & Ivor P. Wold Center for Geriatric Care, which provides both primary geriatric medical care and specialty consultation to patients age 80 and older. “This team works day in and day out to not only implement evidence-based and person-centered practices but also to innovate and spread those practices across the UT Southwestern Health System.”
UT Southwestern is ranked as the nation’s 26th top program in geriatrics by U.S. News & World Report and has been recognized as a participant in Age-Friendly Health Systems, a movement to deliver safe, reliable, high-quality health care in every setting based on what matters most to older adults as individuals. UT Southwestern has multiple programs aimed specifically at providing patient-centric care and education for older patients and developing coordinated, multidisciplinary care plans that focus on the complete individual, including social and psychological issues as well as medical conditions.
Criteria for the NICHE designation include expanded patient-centric geriatric care services to meet the needs of older patients and their families, supporting people with disabilities, improving orthopedic surgery outcomes, identifying and managing delirium, and strengthening community engagement.
Specialty care at UT Southwestern for older adults includes:
- UT Southwestern’s Acute Care for Elders (ACE) specialty unit at William P. Clements Jr. University Hospital, an interdisciplinary team that brings together the expertise of specialists in all aspects of geriatric care to help older adults preserve and reclaim their function and independence after hospitalization. UT Southwestern has the only ACE unit in the Dallas-Fort Worth area. Research shows that patients who are cared for in an ACE unit have improved outcomes, including:
- Better functional and cognitive results
- Fewer hospital-acquired complications
- Reduced health care costs
- Shorter hospital stays
Less likelihood to move to a nursing home following hospitalization ACE units have been developed to specifically address issues such as cognitive decline, delirium, functional decline, and pressure ulcers; and include interventions such as medication reviews, nutritional counseling, physical therapy, sleep hygiene, and planning for care after discharge.
- The UT Southwestern Perioperative Optimization of Senior Health (POSH) Program, offered by the Division of Geriatric Medicine and the Departments of Surgery and Anesthesiology and Pain Management, provides comprehensive evaluation of older adults who are planning to undergo surgery. Specialists evaluate older adults before surgery to anticipate any risk of adverse postoperative events and to provide an optimization plan to avoid complications and improve outcomes. After the procedure, UTSW POSH care team members continue to provide consultative management of multiple conditions, make recommendations for delirium prevention, and assist with a safe transition out of the hospital.
- UT Southwestern’s Care of the Vulnerable Elderly (COVE) home-based primary care program provides an interdisciplinary approach to the care of vulnerable older adults with multiple chronic conditions. COVE is staffed by advanced practice NPs and doctors who are specially trained in geriatrics as well as a clinical social worker, a clinical coordinator, and a registered nurse with geriatric expertise. In the home, the team can provide nearly any type of care performed by a clinic. This includes physical exams, vaccinations, phlebotomy, EKGs, cortisone joint injections, and mental health screenings. Advances in mobile equipment such as ultrasound have made it possible to do both evaluation and management in the home setting. COVE serves patients who are over 65, who require assistance in at least one aspect of personal care, who have a chronic condition and require assistance traveling to medical appointments.
- The Southwestern Aging and Geriatrics Education Program (UT SAGE) is a comprehensive initiative designed to increase geriatrics education through an innovative curriculum that emphasizes patient safety and patient-centered care for vulnerable older adults. UT SAGE was created through a generous grant from the Donald W. Reynolds Foundation with strong institutional support from across UT Southwestern.
“UT Southwestern has made significant investments in the infrastructure of supportive care needed that can not only ease travel and access burdens for seniors and elderly patients and their families, but importantly improve surgical and orthopedic outcomes, help manage comorbidities including heart, lung, and gastrointestinal issues, and address the full spectrum of neuropsychiatric care for dementia and other issues,” said Craig Rubin, M.D., Distinguished Teaching Professor and Chief of the Division of Geriatric Medicine, who holds the Seymour Eisenberg Distinguished Professorship in Geriatric Medicine, Margaret and Trammell Crow Distinguished Chair in Alzheimer’s and Geriatric Research, Walsdorf Professorship in Geriatrics Research, and the Sinor/Pritchard (Katy Sinor and Kay Pritchard) Professorship in Medical Education Honoring Donald W. Seldin, M.D. “That infrastructure has the added advantage of reducing hospitalizations and readmissions, which further helps reduce the total cost of care.”
