Presentation on theme: "Panel: Preventing Readmissions in those with Memory Impairment"— Presentation transcript:
1Panel: Preventing Readmissions in those with Memory Impairment October 16, 2014Kim Butrum MS, RN, GNP: ModeratorJim McAleer MPALeslie Zun MDNicholas Jauregui MD
2The EvidenceMemory impairing diseases are a significant area of concern in reducing readmission rates.NRPC So Cal Readmissions UpdateOctober 16, 2014
3Kim Butrum MS, RN, GNP Vice President- Health Service Silverado Utilizing Clinical Outcomes to Prevent Readmission in those with DementiaOctober 16, 2014Kim Butrum MS, RN, GNPVice President- Health ServiceSilverado
4Use of Clinical Outcomes: The Silverado Experience Through the collection of clinical outcomes over the past 18 years, Silverado has reduced both their 30 day readmission rate and transfer to the acute rate to industry leading levels.:NRPC So Cal Readmissions UpdateOctober 16, 2014
5How do we do it? Our culture Education and training Early identification and management of a behavioral or functional changeAlignment with strong partners for both extra support and palliative care/hospice care at different points of the diseaseNRPC So Cal Readmissions UpdateOctober 16, 2014
6Don’t Prevent Readmission – Promote Community Retention… October 16, 2014Presented by Jim McAleer., MPAPresident/CEOAlzheimer’s Association
7ObjectivesKnow what community programs and services can make a differenceThe Caregiver mattersPreventing readmission begins long before the patient leaves the hospitalAlzheimer’s Association Case StudyNRPC So Cal Readmissions UpdateOctober 16, 2014
8Dealing with Patients who have Memory Impairment in the Emergency Department October 16, 2014Leslie S Zun, MD, MBA, FAAEMChairman and ProfessorDepartment of Emergency MedicineRFUMS/Chicago Medical SchoolMount Sinai HospitalChicago, Illinois
9ObjectivesUnderstand the role of the emergency department in evaluating memory impaired patientsTo determine if the patient has a medical, psychiatric, substance use or behavioral problem
10Case #164 year old female is brought to the hospital for manic behavior. Patient has multiple medical problems but no prior psychiatric history.What further information is needed?What to look for in the physical exam?What testing is indicated?
11Medical Clearance Purpose Primary Purpose - To determine whether a medical illness is causing or exacerbating the psychiatric condition.Secondary Purpose - To identify medical or surgical conditions incidental to the psychiatric problem that may need treatment.
12Primary Purpose Etiology Drug and alcohol intoxication or withdrawalMedicalHypoglycemiaHyperthyroidismDeliriumDementiaHead TraumaTemporal Lobe EpilepsyPsychiatric
14Primary Purpose - Differentiate Medical from Psychiatric Etiology Age >45 years oldPrior psychiatric/medical historyAbnormal vital signsPhysical examination findingsCognitive deficitsFocal neurologic findingsNew or different psychiatric complaintsLaboratories?Advanced testing?
15What information is needed? Case #1 64 year old female is brought to the hospital for manic behavior. Patient has multiple medical problems but no prior psychiatric history.What information is needed?Prior psychiatric history - noneHistory of medical problems – DM, HTN, CVAsUse of drugs and alcohol - DeniesWhat to look for in the physical exam?Vital signs – tachycardia & hypertensiveFocal deficits – right sided weaknessSigns of intoxication – Heightened consciousnessWhat testing is indicated?CBC, electrolytes, UDS, alcohol levelEKG, CT scan head, CXRDiagnosis – Delirium from Hyperthyroidism
16Take Home PointsMemory Impaired may present to the Emergency Department for social, behavioral, medical, substance use or psychiatric reasons.It is important to identify which problem or problems is/are involvedDoes the patient need to be admitted/readmitted?
17Contact InformationLeslie Zun, MDMount Sinai Hospital1501 S CaliforniaChicago, IL 60608
18Nicholas Jauregui MD Supportive Care Medical Group Preventing Readmissions in those with Dementia Across the Post Acute ContinuumOctober 16, 2014Nicholas Jauregui MDSupportive Care Medical Group
19Care Across the post- acute continuum Dr. Jauregui is board certified in Hospice and Palliative Care MedicineMedical Director: Supportive Care Medical Group, an active SNF and housecall medical group in Southern CANRPC So Cal Readmissions UpdateOctober 16, 2014