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Royal College 2023 > Models of Care > Flashcards

Models of Care Flashcards

1
Q

What are 5 outcomes associated with an orthogeriatric model of care?

A

Reduced:
1. Length of stay
2. Cost of stay
3. Delirium
4. Inpatient mortality
5. Long term mortality (1 year)
6. Post op complications
?
1. Discharge to LTC
No difference
1. Time to surgery
2. 30 day readmission rate

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2
Q

What are examples of orthogeriatric models of care?

A
  1. Usual care/reactive: care on ortho ward, geriatric consult upon request only
  2. Routine geri consult: care on ortho ward, routine consult for older adults
  3. Orthogeri ward: dedicated acute geri trauma ward with geri MRP, ortho consultant
  4. Co-management: ortho ward, ortho MRP, geri ongoing management
  5. Post op geri rehab unit: peri op on ortho ward, early discharge to rehab unit
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3
Q

Describe an ACE unit, what patient benefits, who is part of the team and what are outcomes?

A

ACE unit: prepared environment, patient centred care, discharge planning, medical care review, early rehab

Patient: >70, general medicine patients, community dwellers

Team: RN, PT/OT, SW, geriatrician

Outcomes: LOS, cost, discharge home, falls, delirium, functional decline

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4
Q

List 8 evidence based models of care for older adults in the acute care setting

A
  1. ACE unit
  2. Mobile ACE unit
  3. HELP program
  4. GEM nurses
  5. Orthogeriatrics
  6. Geri-oncology
  7. Geri-trauma
  8. Geri-TAVI
  9. Geriatric consult service
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5
Q

What are 4 patient populations where ACE principles have been applied?

A

ACE dementia unit
ACE stroke unit
ACE geriatric bone surgery unit
ACE cancer unit

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6
Q

What are 10 reasons to refer to geriatrics?

A
  1. Dementia
  2. Delirium
  3. Falls
  4. Osteoporosis/fracture
  5. Frailty
  6. Polypharmacy
  7. Capacity
  8. Mental health (anxiety, depression)
  9. Parkinsonism
  10. Urinary incontinence
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7
Q

What is the evidence for CGA in hospital?

A

Positive
1. More likely to be in own homes at 3-12 mos
2. Less likely to be in nursing home at 3-12 mos
No change
1. Overall mortality
2. Dependence
3. Cognitive function
4. LOS
5. Cost of stay
6. QALY

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8
Q

What is evidence for CGA in hospital for surgical patients?

A

Positive
1. Reduced discharge to inc level of care
2. Reduced mortality
3. Reduced LOS
4. Reduced cost
No change
1. Re admission rate
2. Major complications
3. Delirium

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9
Q

What is prehabilitation?

A

Intervention to enhance functional capacity in anticipation of a forthcoming physiological stressor

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10
Q

What are 3 activities associated with prehab?

A
  1. Moderate exercise program
  2. Nutritional intervention - counselling, protein
  3. Anxiety reduction - psychotherapy
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11
Q

What is one positive surgical outcome with prehab?

A
  1. Better post op walking capacity
  2. Higher levels of physical activity pre and post op
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12
Q

What are 5 features of an ACE unit?

A
  1. Discharge planning
  2. Prepared environment
  3. Medical review
  4. Early rehab
  5. Patient entered care
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13
Q

What are 5 outcomes to measure effectiveness of ACE unit?

A

CANDI
1. Cognition
2. Alive at home
3. Nursing home discharge
4. Death/deterioration
5. Independent function

LIMED
1. LOS
2. Inc level of support
3. Mortality
4. Expense
5. Delirium

RFP
1. Readmission
2. Falls
3. Pressure ulcers

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14
Q

What are positive outcomes of ACE unit?

A

CDDFFLL
1. Dec cost
2. Dec delirium
3. Inc discharge to home
4. Dec falls
5. Dec functional decline
6. Dec LOS
7. Dec LTC

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15
Q

What are benefits of neuropsychiatric evaluation?

A
  1. Distinguish between types of dementia
  2. Assess capacity
  3. Distinguish CI vs. mood
  4. Assess cognition in patient with apathy
  5. Predict course/progression
  6. Help determine strengths and weakness - help with driving, supports
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16
Q

What are components of person centred care in LTC?

A
  1. Resident centered system to get to know residents
  2. Creative staffing approaches
  3. Maximize independence
  4. Move in experience
  5. Understanding community normals
  6. Focus on possibilities
  7. Support for grief and loss
  8. Spirituality supports
  9. Culinary engagement
  10. Environment for living
  11. Community connections
  12. Transitions of care systems
17
Q

What is the PC PEARLS approach to person centred care in LTC?

A
  1. Person and family engagement
  2. Care planning (pain assessment, focus on abilities, avoid restraints)
  3. Processes (operational)
  4. Environment (physical and social)
  5. Activity and recreation
  6. Leadership
  7. Staffing (training and support)
18
Q

What are barriers to the use of minimum data sets in LTC?

A
  1. Very long and tedious tool
  2. Requires money and time
  3. Minimal time to dedicate to quality improvement
  4. Change is hard to engage all stakeholders
19
Q

What are indications for home visits?

A
  1. Mobility disability
  2. High falls risks
  3. Behavioural issues
  4. End stage illness
  5. No access to transportation
20
Q

What are 10 things on a geriatric ward you can design to decrease falls?

A
  1. High colour and contrast
  2. Reduce barriers
  3. Continuous circuit route
  4. Visual cues for direction and way finding
  5. Hand railings
  6. Elevated toilet seats/commodes
  7. Shower seat
  8. Bed rails/super poles
  9. Rest area in hallways
  10. Wide hallways
21
Q

What are 4 psycho social reasons to transfer patient from nursing home to acute care?

A
  1. Behavioural issues
  2. Severe depression/anxiety/SI
  3. Palliation
  4. Neglect/harm
22
Q

What are outcomes of stroke units?

A

Decreased mortality
Decreased death or institutional care
Decreased death or dependency
Decreased poor outcome

23
Q

What are 10 required elements to develop a cross-specialty collaborative care model?

A
  1. Shared vision
  2. Partnership
  3. Symmetrical representation
  4. Engagement
  5. Consistency
  6. Trust
  7. Setting
  8. Communication
  9. Policy outlining the model (setting, population, roles of members)
  10. Evaluation strategy
24
Q

What are 2 strategies that can be utilized to sustain a cross-specialty collaborative care model?

A
  1. Policy Revision
  2. Workflow Assessment
  3. Evaluation
  4. Knowledge dissemination and academic cross pollination
25
List 6 quality indicators for seniors with dementia living in long-term care.
1. Taken antipsychotics without diagnosis of psychosis 2. Daily physical restraints 3. Has fallen 4. Worse cognition 5. Worse behavioural symptoms 6. Worse/remained dependent in ADLs 7. 1+ infection 8. Worsened/new stage 2-4 pressure ulcer 9. Worsened mood symptoms of depression
26
The Alzheimer Society developed a guideline for Person-Centred care of people with dementia living in care homes. What are the four core concepts of a person-centred philosophy?
1. Dignity and respect 2. Information sharing 3. Participation 4. Collaboration
27
How is interprofessional collaboration in healthcare defined
● A partnership between a team of health providers and a client/patient ● Process which includes shared communication and decision-making, enabling a synergistic influence of shared knowledge and skills ● Designed to work on common goals to improve patient outcomes ● Interactions reflect a blending of professional cultures as opposed to “multidisciplinary”: when team members work in parallel but maintain more strict disciplinary boundaries
28
10 recommendations for elder friendly hospital
ORGANIZATIONAL SUPPORT 1) Establish board and/or strategic plan commitments for a Senior Friendly Hospital 2) Designate a senior executive/medical leader in the hospital to lead and be responsible for senior friendly initiatives across the organization 3) Train and empower a clinical geriatrics champion(s) to act as a peer resource and to support practice and policy change across the organization 4) Commit to the training and development of human resources via seniors-focused skill development PROCESSES OF CARE 5) Implement inter-professional protocols across hospital departments to optimize the physical, cognitive, and psychosocial function of older patients – these processes should include high risk screening, prevention measures, management strategies, and monitoring/evaluation processes 6) Support transitions in care by implementing practices and developing partnerships that promote inter-organizational collaboration with community and post-acute services EMOTIONAL AND BEHAVIOURAL ENVIRONMENT 7) Provide all staff, clinical and non-clinical, with seniors sensitivity training to promote a senior friendly culture throughout the hospital’s operations 8) Apply a senior friendly lens to patient-centred care and diversity practices, so that the hospital promotes maximal involvement of older patients and families/caregivers in their care consistent with their personal values (e.g. cultural, linguistic, spiritual) ETHICS IN CLINICAL CARE AND RESEARCH 9) Provide access to a clinical ethicist or ethics consultation service to support staff, patients, and families in challenging ethical situations 10) Develop formal practices and policies to ensure that the autonomy and capacity of older patients are observed PHYSICAL ENVIRONMENT 11) Utilize senior friendly design resources, in addition to accessibility guidelines, to inform physical environment planning, supply chain and procurement activities, and ongoing maintenance 12) Conduct regular audits of the physical environment and implement improvements informed by senior friendly design principles and by personnel trained on the clinical needs of frail populations

Royal College 2023 (79 decks)

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