The Portal of Geriatrics Online Education

Perelman School of Medicine at the University of Pennsylvania

Is this a Reynold's grantee: 
Yes

How to discuss Code Status and make a recommendation

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
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Other Learning Resource Type: 
Handout
Product Information
Estimated time to complete: 
1
Abstract: 

Code status discussions are often rushed events done during a hospital admission by a doctor that the patient has never met.  The content, and therefore the quality, of these discussions varies widely and often contains very incomplete information that fails to meet a person at their individual health literacy level.  Additionally, once a physician decides to make a recommendation for a DNR status, the methods used may be crude and border on coercive.  

The goal of this lecture is to provide the listener with a complete understanding of CPR outcomes that can be presented flexibly at the level of the health literacy of the patient and family.  Second, the lecture provides a framework for making a recommendation of CPR by not viewing it soley as a health literacy problem but as a fit between a patient's stated values and the likely outcomes of CPR.  In this way, there are many reasons why a person may choose to be DNR.  

First, an evidence review of outcomes are discussed by site of care (inpatient, outpatient and nursing home) including immediate failure, prolonged death in a hospital, survival with impaired neurological status and survival with intact neurological status.  Both absolute and relative rates are presented.  An evidence review of the risks are summarized including the trauma of CPR, what happens when a person fails to survive to hospital discharge and surviving with impaired neurological status.  Success rates in studies are analyzed by diagnosis, age, and functional baseline.  Finally, how to translate the outcomes into goals and values is discussed including when being DNR is appropriate for a patient.  Ideally, the learner will have more tools for helping a patient understand why DNR may be appropriate than before this educational session.  

Educational objectives: 

The purpose of this lecture is to allow the listener to have a much more complete understanding of the pros and cons of CPR and its outcomes and have a framework for making recommendations.  The goal is to move beyond simply thinking about the trauma and success rates of a procedure-oriented CPR discussion and move towards a value-based, patient-centered discussion.

Additional information/Special implementation requirements or guidelines: 

The power point lecture is accompanied by a handout that serves as a literature review.  There is also a bibliography.  In a small group setting, the handout could be the starting point of an interactive discussion.  I usually start by asking the housestaff and students when they have felt a patient who was full code should be DNR, why they felt that way, and how they went about trying to change the code status.  I ask what they communicate and how they communicate it. Having learners provide their own vignettes gets them more engaged in the discussion and at the end they can think about what they might have done differently.  

Date posted: 
Mon, 10/07/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/07/2013
Contact Person/Corresponding Author:



Suggested Citation:
How to discuss Code Status and make a recommendation. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/1186

Interdisciplinary Teaching Safe Transitions Case-Based Session

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
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Product Information
Abstract: 

This is an initial introduction for medical interns to the goals of safe discharge from the hospital and the role of the interdisciplinary team in facilitating transitions of care. This session includes: Case 1 - Overview of discharge planning; during this session, each team member will introduce her/himself, Case 2 - Discharge to home of elderly patient with multiple needs, and Case 3 - Uninsured patient - new diabetic (if have time to go over). The overall format should be one of a mock-interdisciplinary team meeting with interns reviewing the cases, asking questions, and interdisciplinary team members adding information and expertise. Each case will be discussed for approximately 10 minutes and will have attending internal medicine physician moderating to assist in ensuring the key points are discussed.

 

Educational objectives: 

At the end of the session, participants will be able to:

  1. Identify the importance of a safe discharge from the hospital.
  2. Identify the complexities of creating a safe transition of care out of hospital to home or facility.
  3. Identify high risk discharge issues.
  4. Discuss entry criteria and scope of care provided by the potential sites of care for hospital discharge.
  5. Identify the health professionals involved in facilitating a safe discharge and their respective roles in the process.
  6. Describe the interdisciplinary discharge process and value its role in facilitating a safe discharge.
  7. Describe the importance of communication with patient and family members in care transitions.
Additional information/Special implementation requirements or guidelines: 

Requires interdisciplinary discharge team member involvement - ie: RN, SW, Pharmacist. Can also add PT/OT.

Date posted: 
Mon, 10/24/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/24/2011
Contact Person/Corresponding Author:



Suggested Citation:
, , and . Interdisciplinary Teaching Safe Transitions Case-Based Session. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/1186

Older Surgical Patient Case

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Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
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Abstract: 

During the surgery clerkship, medical students are exposed to many elderly patients and cover age-related issues on a case-by-base basis.  The purpose of this educational initiative is to reach all of the medical students during their surgery clerkship to ensure a baseline of knowledge, skill, and attitude for caring for the older surgical patient. Through a problem-based learning case and working in teams, students will address the following topics: co-morbidity and frailty assessment, discussion of peri-operative assessment and decision-making with regard to surgery, and transitional care planning of the older surgery patient.

Educational objectives: 

 

  • Students will appreciate the unique problems of the increasing number of older adult patients undergoing abdominal surgery
  • Students will characterize the medical and surgical causes of acute abdominal pain in the older adult patient
  • Students will discuss the approach to an older adult patient with an acute abdomen
  • Students will appreciate the complex decision-making and rationale for the management options for an older adult surgical patient (i.e. emergent surgery, serial abdominal exams, and non-operative management)
  • Students will recognize the peri-operative complications common in the older adult surgical patient
  • Students will recognize different sites of care for older adults to recover after surgery
Date posted: 
Fri, 09/30/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 09/30/2011
Contact Person/Corresponding Author:



Suggested Citation:
and . Older Surgical Patient Case. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/1186

Hospice Experience: part of the aging theme

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
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Other Learning Resource Type: 
hospice visit(s)
Other Intended Learner Audiences: 
inter-professional learners of the graduate level
Product Information
Estimated time to complete: 
999
Abstract: 

As part of the Reynolds Aging Theme Curriculum at the University of Pennsylvania, all medical students participate in a hospice visit during the Family Medicine Clerkship. Hospice and palliative care is an important part of caring for older adults. A growing number of hospice enrollees are older adults and those with non-cancer diagnosis (i.e. dementia, COPD, CHF). During the Hospice Experience, students spend approximately 3 hours with a volunteer member of the hospice interprofessional team which allows for 1-2 hospice patient/family visits. 

Educational objectives: 
  • To appreciate the reasons a patient/family select hospice as an active treatment option
  • To review the different roles of the hospice interdisciplinary team members and to identify how the hospice team approach benefits a patient/family
     
Additional information/Special implementation requirements or guidelines: 

Students at the University of Pennsylvania attend an older adult home visit during their first semester of medical school, followed by plenary lectures on healthy older adults for comparison and contrast. In addition, students attend plenary lectures on hospice and palliative care as well as participate in small group discussions prior to the Hospice Experience. 

Date posted: 
Mon, 12/05/2011
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 12/05/2011
Contact Person/Corresponding Author:



Suggested Citation:
Hospice Experience: part of the aging theme. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/1186

Advance Care Planning with Surrogate of Older Adult with Dementia

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
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Other Intended Learner Audiences: 
physicians-in-training
Product Information
Abstract: 

Medical students are given the opportunity in small groups to practice communication skills with a standardized patient.  Students assume the role of attending physician, who is in charge of this patient’s care while attending on the Acute Care for the Elderly (ACE) Unit, and speak to the patient’s adult child. The objective is to have the student discuss the patient’s clinical condition and what the goals of care should be during this hospitalization, i.e., whether the patient should be transferred to the ICU if she worsens and, if so, whether she should be intubated and resuscitated.

Educational objectives: 
  1. To discuss clinical condition of older adult with surrogate.
  2. To discuss goals of care for a hospitalized older adult with surrogate; specific to CPR, ventilation, and ICU level of care.
Date posted: 
Mon, 10/04/2010
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 10/04/2010
Contact Person/Corresponding Author:



Suggested Citation:
and . Advance Care Planning with Surrogate of Older Adult with Dementia. POGOe - Portal of Geriatrics Online Education; 2010 Available from: https://pogoe.org/taxonomy/term/1186
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