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Geriatrics in the Emergency Department : OR OR ED, Geriatrics have very different Priorities Diagnostic Processes Thinking Personnel.

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Presentation on theme: "Geriatrics in the Emergency Department : OR OR ED, Geriatrics have very different Priorities Diagnostic Processes Thinking Personnel."— Presentation transcript:

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2 Geriatrics in the Emergency Department : OR OR

3 ED, Geriatrics have very different Priorities Diagnostic Processes Thinking Personnel

4 Blind Men Feeling an Elephant...

5 ED zWhat is your chief diagnosis here today ? z Is it life-threatening ? z How efficiently, quickly can we move you through the ED, and on out to wherever you are going ?

6 Geriatrics zWhat is your current level of functioning, and how can we maintain it, prevent your losing function ? zWhat are all your co-morbidities ? zHow do your various treatments interact ? zWho/what are your support systems ? zWhat else do you require for support?

7 BUT

8 But... You are the same patient/family, with the same problems

9 ED, GERIATRICS SPEAK DIFFERENT LANGUAGES Translation is required...

10 Enter... GEM

11  12 Toronto hospitals z Hamilton, Ottawa, Kingston RGP z British Columbia, Quebec z Cleveland, Ohio z etc., etc.

12 GEM in GTA zSunnybrook zScarborough Grace, General zNorth York General zToronto East General zSt. Joseph’s Health Centre zUHN [TWH and TGH] zYork Central, Markham Stouffville zSt. Michael’s zHRRH [Church St.]

13 GEM Service Models Diverse models Particular to each hospital’s needs, resources

14 Diverse GEM service models zResource RN zAdvanced Practice Nurse zNurse-Clinician zCNS zScreening tools zCross-appointed staff

15 Sunnybrook pioneered GEM zHospital committed to LTC [veterans] busy ED - 14,500 > 65 yrs zPilot project, 6 months referred [vs. 13 / previous one year] zGEM permanent, 5 days/week June days/week since 2002 zGEM nurses funded by RGP and Sunnybrook

16 Role Models Montreal site visits zJewish General zRoyal Victoria zMontreal General

17 Fear Sunnybrook ED biggest fear, introducing GEM: zIncreased LOS in ED

18 Reasons for referral zHistory of falls zCognitive changes zPossible abuse / neglect zSubstance abuse zCaregiver stress zCaregiver hospitalized … /2

19 Reasons for referral (2) zFunctional decline zAnxiety zAcute / Chronic Pain zRepeated ED visits / hospitalizations zPlacement

20 Referral Sources zEmergency MDs, RNs zVolunteers zCasefinding [computer EDIS] zCommunity zConsultants zAfter-Hours Referral Box zVoic

21 Geriatric Nurse- Clinician Role zAssessments zHelp decide to admit or not zCo-ordinate followup zGeriatric Research zEducation

22 GEM stats zPatients seen, zAverage per month 56.8 [Range 48 – 73] zFacilitated Discharges 70 %

23 GEM Bedside Assessment zObservation zCognitive Assessment zChart Review zTelephone Inquiries, zProfessional Followup zHome Support

24 GEM Assessment Tools zFolstein Mini-Mental State zGeriatric Depression Scale [short form] zConfusion Assessment Method zRGP Assessment Form [same for day hospital, clinic, consult team] zSocial Work screening tool

25 GEM Links to Community Resources zCCACs zGPs, Consultants zSGS services zDay Care zLifeline zVolunteer Drivers zPlacement

26 GEM Education zStaff Inservices zOrientation of new staff zInformal Education [for staff, caregivers, patients] zMarketing of services, media

27 GEM on Hospital Committees z‘Crisis Visits to the ED’ group zCommunity Partnership zGeneral Medicine Pain Collaborative Project zQuarterly Meeting: all GEM nurse- clinicians and all ED social workers zAccreditation, Quality Improvement zED Renovation

28 Challenges: Clinical zPain Management zIsolated Seniors / Limited Finances zCrisis Placement zAbsence of Convalescent Care

29 Challenges: Triage zBias Reporting : ‘Failure to Cope’ ‘Social Admission’ ‘Placement’

30 Challenges: Admin. zMarketing zVacation Relief zEvening Coverage zRotation with Consult Team

31 Keys to Success zVisibility zOffice Location zPrevious Clinical Experience zHands-On Care zTimely Followup z“Practical Tips for Seniors Visiting ED” … /2

32 Keys to Success (2) zFlexibility zMarketing / Orientation zCollaboration with Key Players zLinking to Community Resources zPartnerships zFeedback / ED Evaluation Forms … /3

33 Keys to Success (3) zClothing zTransportation zLoaner Equipment zLifeline Vouchers zPamphlets / Handouts

34 RGP Toronto Network z24 participating GTA hospitals zProvincial funding zother Ontario RGPs

35 Toronto RGP activities zLeadership zAdvocacy zService zEducation zResearch

36 Toronto RGP - Core Services provided by members zOutreach teams zAmbulatory care clinics zInternal consultation teams zGeriatric Rehabilitation Units zAcute Geriatric Units zDay Hospitals zGeriatric Emergency Management

37 RGP GEM Task Force zTo spread the word, share knowledge zProject Manager hired February, 2002 zMembers: 12 hospitals, ED & Geriatrics zQuarterly meetings zSubcommittees ad hoc re screening tools, elder-friendly environment, etc.

38 GEM Task Force Five Initial Priorities zHigh risk screening tool zNeeds Assessment zGeriatrics Education for Professionals zElder-friendly ED zPolicy Paper

39 Consultations to Hospitals zFor hospitals seeking to improve geriatric emergency management zWhat is possible even if you cannot hire a specialized geriatric nurse for the ED

40 “Toolkit” zWorkshop outline zObservation Guide, for elder-friendly ED zHigh-risk screening tool zNeeds assessment, data analysis support zElectronic listserves

41 Ideas for Future GEM z‘geri area’ in ED zStrategic partnerships between LTC, acute care hospitals [examples] zResearch : EMS workers gather information

42 Other suggestions ?

43 RGP Website

44 Contact Lisa Newman, MSW MHSc Project Manager RGP GEM Task Force (416) #7334

45 Contact Catherine Bald, RN BScN Nurse-Clinician RGP GICT / GEM (416) #3194, pager #1213


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