tri orientation geriatric rehabilitation dr. shabbir alibhai | dr. arielle berger | dr. vicky chau...
TRANSCRIPT
TRI OrientationGeriatric Rehabilitation
Dr. Shabbir Alibhai | Dr. Arielle Berger | Dr. Vicky ChauDr. Barry Goldlist | Dr. Dan Liberman | Dr. Karen Ng | Dr. Samir Sinha
Toronto Rehabilitation Institute, University Centre Site550 University Avenue
Toronto, Ontario, M5G 2A2(416) 586-4800 x 6641
Outline
• Introduction
• Geriatric consultations
• Clinics & Programs
• Rounds & Education
INTRODUCTION
Introduction
Acute medical illness & hospitalization often precipitate functional decline. Many factors
additionally contribute to further disability that often impacts rehabilitation.
Disability &
Functional Decline
Multiple medical
Comorbidities
Frailty
Acute Medical Illness &
Hospitalization
Conceptualizing Disability
WHO & ICF et al., 2002.
Impairment Activity Limitation Participation Restriction
Comprehensive Geriatric Assessment
Geriatric Rehabilitation
“ … a branch of geriatric medicine concerned with limiting the extent of disability, preventing functional
and social decline, and delaying or preventing loss of independence and institutionalization …”
AGS Education Committee. The Training of Geriatric Fellows in Rehabilitation: AGS Education Guidelines. 2002 .
A Specialized Focus
• Frail & medical complex older adults
• Holistic vs. Illness (e.g. stroke rehab) approach – All factors that impair function
• Multidisciplinary team
• Multifactorial & individualized interventions to improve function
Outcomes of Geriatric Rehabilitation
Outcomes At discharge At Follow Up
Function OR 1.75 (95% CI 1.31 to 2.35)
OR 1.36 (95% CI 1.07 to 1.71)
Nursing Home Admission
RR 0.64 (0.51 to 0.81) RR 0.84 (0.72 to 0.99)
Mortality RR 0.72 (0.55 to 0.95) 0.87 (0.77 to 0.97)
Bachmann et al., BMC 2010.
GERIATRIC CONSULTATIONS
Geriatric Consultation Team
• You!
• Geriatrician
• Florence Paat, Nurse Practitioner
Geriatric Referrals
• Automatic– Geriatric Rehabilitation Unit (6 South)– Geriatric Psychiatry Unit (5 South)– MSK Unit (7 & 8 South)
• Other– Other TRI floors
Geriatric Rehabilitation Unit (6 South)
• 25 bed inpatient unit built on a co-management model– Hospitalist (Dr. Robert Lam)– Geriatrician– Geriatric Nephrologist (Dr. Vanita Jassal)
• Geriatric patients & patients with dialysis needs are admitted into Team A, B, or C
• Consultations– Karlee Lin sends e-mail notifications of new admissions to geriatricians daily– Requests located in geriatrician mailbox on 6S nursing unit
Co-Management Focus
Geriatrics Hospitalist (MRP) Geriatric Nephrology
• Geriatric related issues (e.g. cognition, function, medications, pain, sleep, disposition)
• Management of complex medical diseases, if needed
• Management of complex medical diseases
• Urgent and/or medical emergencies
• Dialysis & Dialysis related issues*
* For dialysis patients, we complete a CGA and provide follow up as needed
Geriatric Psychiatry Unit (5 South)
• Locked unit of patients admitted with dementia related behaviours built upon a co-management model– Hospitalist (Dr. Tazkarji)– Geriatric Psychiatrist (Drs. Iaboni & Keren)
• Consultations– Requests obtained via May Seeto
MSK (7 & 8 South)
• Inpatient rehabilitation unit for patients with MSK conditions and/or those recovering after surgery built upon co-management model between hospitalist & physiatrist
• Consultation– All fractured hip patients transferred from MSH/TWH– Geriatricians receive e-mail notifications of newly
transferred patients
Limited Consultation & Follow Up
• Provides continuity of care and focused management of geriatric related issues– Cognition (e.g. delirium, depression)– Bone Health– Disposition
• Obtain MSH/TWH geriatric consultation, follow up, and sign out notes to assist with your management plan
Consult Recommendations
• GRU (6S)– Order blood work directly into EPR– Complete respective paper requisition for other investigations (e.g. ECG,
CXR, CT Head)– Write medication orders directly on order sheet
• MSK (7S & 8S)– Write suggestions in MRP’s black book
• Geriatric Psychiatry (5S)– Write suggestions in Dr. Tazkarji’s black book; or– E-mail Dr. Tazkarji (MRP) for recommendations
Consultation Notes
• All consultation notes are dictated– Include date, start/end times of consultation– Place written yellow consultation notes (if used) &
signed transcribed dictation notes in the chart
* Please ensure you obtain your UHN dictation code at the beginning of your rotation *
• Follow up notes written in multidisciplinary progress notes section
Sign-out Lists
*** ALWAYS UPDATE THE SIGN-OUT LIST ***
AMBULATORY CLINICS & PROGRAMS
Ambulatory Clinics
Geriatric Day Hospital Clinic at TRI (2nd Floor South Wing )Dr. Arielle Berger
Michelle Cordeiro (416) 597-3422 ext. 3065
Geriatric Medicine Clinic at Bickle Centre Complex Continuing Care
Specialty Clinics, Main Floor, Rm S-217Dr. Arielle Berger
Geriatric Nephrology Clinics at TGH (12NU Renal Clinics)Dr. Vanita Jassal
Samantha Ramsammy [email protected]
Programs
Falls Prevention Program (2nd Floor, South Wing)Ramona Gheorghe, RN & Marlee Beallor, PT
416-597-3422 X 3777 or 3783
Geriatric Day Hospital Program (2nd Floor, South Wing)Michelle Cordeiro (416) 597-3422 ext. 3065
Inpatient Dialysis Program (Ground floor, East Entrance)Pre-arrange with Dr. Vanita Jassal
ROUNDS & EDUCATION
Weekly Rounds
Education
• Interprofessional learning with care coordinator (Karlee Lee), NP, wound care NP, OT, PT, Nutritionist, Pharmacist, SW, Recreational therapist
• Additional Quality and Risk Safety Rounds (q2nd Thursday of the month)
• Weekly article review
Resident Office
• 4th Floor, Room 131
• Obtain ID badge for access from: – Tracia Young, Medical Education Coordinator– 10th Floor, Room 119– 416-597-3422 x 3834
Thank You!
• Questions?