The Portal of Geriatrics Online Education

Patient Safety

Care Transitions Curriculum for Medicine Residents.

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
2
Abstract: 

The Joint Commission, American Geriatric Society, ACGME and LCME have all identified care transitions as a core element of patient care and a critical component of health professional education. Only 16% of Internal Medicine residency programs have formal discharge curricula. We describe a comprehensive Care Transitions Curriculum (CTC) developed for Internal Medicine Primary Care and Categorical residents. 

The curriculum is delivered in the setting of an interactive case based 90 minute workshop using a multimodal approach that combines didactics with small group discussions and an interactive board game exercise. The curriculum focuses on addressing the core aspects of discharge care including (1) Appropriate Predischarge Assessment, (2)Medication Reconciliation, (3) Provider – Provider Communication, (4) Patient Education, (5) Care Coordination,  (6)Post discharge settings of care.

Evaluations received so far have shown that the curriculum is well received by the residents. 

 

Educational objectives: 
  1. Define transitions in care and the roles patients, providers and the system play in safe transitions.
  2. Describe the care transitions process and identify potential multilevel factors that are contributory to failure in transitions of care.
  3. Describe the effects of unsafe transitions and recognize the key elements of safe transitions.
  4. Identify appropriate discharge locations for patients.
  5. Identify processes of efficient and effective care coordination that will ensure seamless transition of patients to other care settings.
  6. Communicate effectively with accountable care providers at the point of discharge – Interdisciplinary team members, PCP, Home Health team, providers at other health care facilities.
  7. Complete an effective pre-discharge patient education on diagnosis, medications and warning symptoms.
Date posted: 
Fri, 03/07/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 03/07/2014
Contact Person/Corresponding Author:



Suggested Citation:
and . Care Transitions Curriculum for Medicine Residents. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1089

Elder Care: A Resource for Interprofessional Providers: Canes

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

Canes is one of a continuing series of practical, evidence based, Provider Fact Sheets which summarize key geriatric topics and provide clinically useful assessments and interventions. Initially developed for remote, rural clinical sites, they are useful for students and health care professionals from many fields and across a very broad range of health care settings.

Educational objectives: 

After reading this issue of Elder Care, you should be able to…

  1. List the three main types of canes
  2. State which type of cane us best for patients who need the cane to support weight
  3. State the elbow flexion and length for a properly fitted cane
Additional information/Special implementation requirements or guidelines: 

Subscribers to POGOe are free to reprint Elder Care on their own stationery or in other publications without obtaining specific permission, so long as

  1. content is not changed,
  2. no one is charged a fee to use or read the publication,
  3. authors and their affiliated institutions are noted without change, and
  4. the reprint includes the following statement: “Reprinted courtesy of the Arizona Reynolds Program of Applied Geriatrics and the Arizona Geriatric Education Center."

For more information on this series, go to http://www.reynolds.med.arizona.edu/html/ElderCare.html.

Publications from, presentations from, and/or citations to this product: 

The Elder Care provider sheets are occasionally published in the Arizona Geriatrics Society Journal, which is published twice yearly.

Date posted: 
Thu, 03/01/2018
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 03/06/2018
Contact Person/Corresponding Author:



Suggested Citation:
and . Elder Care: A Resource for Interprofessional Providers: Canes. POGOe - Portal of Geriatrics Online Education; 2018 Available from: https://pogoe.org/taxonomy/term/1089

Office-Based Inter-Professional Care Transitions Curriculum for Third Year Medical Students

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
999
Abstract: 

This product consists of a series of activities conducted as a month-long module among third-year medical students during their ambulatory rotation aimed at educating them about provider-related factors in care transitions and best practices that assure patient safety during transitions. This product is also aimed at educating the students on the critical role of the receiving outpatient physician in care coordination and inter-professional collaboration during the transitions period. The activities are delivered in the context of an interactive case-based learning workshop followed by month-long web-based activities. 

Educational objectives: 

On completion, the learner will be able to:

  1. Structure the post discharge visit and perform post discharge outpatient best practices including medication reconciliation, review of a discharge summary with implementation of critical elements of the discharge care plan.
  2. Identify patient discharge care needs including factors that present a risk for re-hospitalization; develop a multidisciplinary care plan to address identified needs.
  3. Identify available community resources for the post discharge patient.
  4. Identify appropriate care settings for the post discharge patient.
  5. Apply skills for inter-professional team collaboration and care coordination in the management of a discharged patient.
Additional information/Special implementation requirements or guidelines: 

Blackboard Software for the web-based activities.

 

 

The transfer of patient care from the hospital team to providers in the community is a high-risk process characterized by fragmented, non-standardized, haphazard care. The contributory role of provider-related factors to failure in transitions of care is becoming more prevalent as a result of the lack of continuity of care with the emerging role of hospitalists in the care of patients, increasing the need for understanding of the roles of sending and receiving providers in the care transitions process.

 

 

The initial workshop consists of an interactive case-based presentation on the issues that occur at the point of transition, followed by recommended care transitions best practices. The workshop also incorporates hands on activities that simulate a patient’s post-discharge office visit with the participants role playing as the patient’s primary care physician. During this activity, the learners are trained on: structuring of the post discharge visit; identification of patient care needs, along with factors that present a risk for re-hospitalization; and, development of a multidisciplinary care plan to address the needs of the patient. This session is followed by a month-long web-based module that consists of participants’ review of web based study materials, completion of assignments along with online peer-peer and facilitator interaction. During the month, the participants continue to role play as the patient’s primary care physician while collaborating with other members of the healthcare team in caring for the patient. This aspect of the curriculum focuses on educating learners about the role of members of the healthcare team, inter-professional team collaboration and care coordination in the management of the discharged patient. It also highlights the role of the patient and family in the care transitions process, identification of available community resources to meet patient care needs, and appropriate discharge care settings.

The rotation is concluded with a wrap up session at the end of the month where interactive discussions are held to reinforce lessons learnt along with a discussion on appropriate discharge care settings, eligibility criteria and funding sources. The students then get to vote on a choice of an appropriate discharge care setting for their patient.

Date posted: 
Wed, 04/24/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 04/24/2013
Contact Person/Corresponding Author:



Suggested Citation:
and . Office-Based Inter-Professional Care Transitions Curriculum for Third Year Medical Students. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/1089

Transitions of Care: Online Curriculum

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

This module presents a series of case studies with patient information, interactions with medical staff, analysis, diagnosis and care recommendations. It is designed to build knowledge and skill in transitions of care and to test your knoweldge proficiency levels.

Educational objectives: 

At the end of the training, you will be able to:

  • Interpret a case where multiple transitions of care in the hospital and within the community are involved
  • Review important principles involved in transitions of care
  • Recognize adverse outcomes of poor transitions of care
  • Decide which procedures and what techniques are necessary to ensure a proper transition in care
Date posted: 
Thu, 08/07/2014
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 08/07/2014
Contact Person/Corresponding Author:



Suggested Citation:
Transitions of Care: Online Curriculum. POGOe - Portal of Geriatrics Online Education; 2014 Available from: https://pogoe.org/taxonomy/term/1089

Improving Patient Safety: Root Cause Analysis Training for Fourth Year Geriatric Sub-Interns

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
999
Abstract: 

This curriculum was developed to teach students one of the primary tools used for quality improvement in healthcare, root-cause analysis.

Educational objectives: 

By the end of the program, the student will be able to:

  1. The student will be able to complete a root cause analysis of an adverse event.
  2. The student will be able to identify actionable recommendations to decrease the likelihood of recurrence of an event based on a case study.
  3. The student will be able to effectively communicate to colleagues the importance and utility of root cause analyses in patient safety.
  4. The student will be able to relate clinical scenarios to the required AAMC Geriatric Competencies.
  5. The student will choose to use root cause analysis when encountering adverse events amenable to this type of analysis.
Date posted: 
Mon, 02/11/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 02/11/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , and . Improving Patient Safety: Root Cause Analysis Training for Fourth Year Geriatric Sub-Interns. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/1089

CampER Teaching Trigger Card: Iatrogenesis

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

This teaching trigger card is one in a series of eight cards developed to cue emergency medicine faculty on teaching appropriate assessment and care of the geriatric patient at bedside to emergency medicine residents. Each card touches upon identified geriatric competencies and includes references.

Educational objectives: 

By utilizing this teaching trigger card, which addresses Geriatric Emergency Medicine competencies related to iatrogenesis, the Emergency Medicine faculty member will prepare the resident to:

  1. Describe key information regarding iatrogenesis, including the dangers of common interventions performed in the emergency room, in the older adult.
  2. Use the key information to avoid iatrogenesis in elderly patients presenting to the emergency room.
Date posted: 
Fri, 01/11/2013
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 01/11/2013
Contact Person/Corresponding Author:



Suggested Citation:
, , , and . CampER Teaching Trigger Card: Iatrogenesis. POGOe - Portal of Geriatrics Online Education; 2013 Available from: https://pogoe.org/taxonomy/term/1089

Alliance for Geriatric Education in Specialties Curriculum

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Intended Learner Audiences: 
Product Information
Estimated time to complete: 
999
Abstract: 

The Alliance for Geriatrics Education in Specialties (AGES) consists of 8 interactive core curriculum modules: iatrogenic injury, delirium, dementia, polypharmacy, transitions of care, basics of geriatrics assessment and levels of care, physiology of aging, palliative care communication and medications. These 8 modules have been designed to teach specialty faculty, at all levels of their career, how to increase effectiveness and quality of care for their older adult patients. In 2009, the University of North Carolina School of Medicine at Chapel Hill conducted a needs assessment to evaluate the potential for improvement of UNC Healthcare System specialty/subspecialty faculty regarding geriatrics care through training. Based on the assessment results, the AGES curriculum was developed, implemented, evaluated, and now available for use through POGOe. The AGES curriculum can be taught as an entire course or each module can be taught as a separate training session. The UNC Healthcare System is currently using all 8 modules for training its non-geriatrician specialty faculty. Each of the 8 module PowerPoint presentations will take approximately 60 minutes per training session. *This curriculum may also be applicable to internists and family medicine practitioners.

Educational objectives: 

Objectives by Module

Module 1:    The Physiology of Aging

•          Learners will be able to describe the normal changes that occur with aging

•          Learners will be able to identify the common age-related changes that occur in the following systems: cardiovascular, respiratory, renal, hematology/immune, gastrointestinal, endocrine, neurologic, musculoskeletal, and reproductive

 

Module 2:    Dementia

•          Learners will be able to define dementia

•          Learners will be able to name risk factors/causes for dementia

•          Learners will be able to discuss why delirium and depression are predictors/red flags for dementia

•          Learners will be able to discuss assessment tools/strategies for identifying dementia

•          Learners will be able to name at least 5 types of dementia

•          Learners will be able to discuss the treatment options for dementia

 

Module 3:    Delirium

•          Learners will be able to define delirium and describe its cardinal features and underlying pathophysiology

•          Learners will be able to recognize that delirium is common, under-diagnosed, and associated with significant morbidity and mortality

•          Learners will be able to, regarding delirium, identify ways to: 

»      prevent

»      diagnose

»      evaluate

»      manage

•          Learners will be able to teach key concepts in < 1 minute

•          Learners will be able to define delirium and describe its cardinal features and underlying pathophysiology

 

Module 4:    Transitions of Care

•          Learners will be able to define transitional care

•          Learners will be able to identify barriers to providing improved transitional care to patients

 

Module 5:    Basics of Geriatric Assessment & Levels of Care

•          Learners will be able to illustrate the importance of physical, cognitive, and psychosocial assessments for older adults

•          Learners will be able to describe Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)

•          Learners will be able to demonstrate gait assessment and falls risk assessment with an older adult

•          Learners will be able to demonstrate cognitive and depression screening with an older adult

 

Module 6:    Iatrogenic Injury

•          Learners will be able to list the most common types of iatrogenic injuries

•          Learners will be able to identify the most common cause of nosocomial fever in the hospital

•          Learners will be able to identify the reasons for use of restraints and how to avoid using them

•          Learners will be able to list the appropriate use of urinary catheters

 

Module 7:    Palliative Care Communications

•          Learners will be able to address Palliative Care misconceptions: What, Why, Where, Who

•          Learners will be able to review outcomes of Palliative Care

•          Learners will be able to present general communication strategies

•          Learners will be able to discuss pain assessment and management principles for older adults

 

Module 8:    Polypharmacy

•          Learners will be able to identify risk factors for Adverse Drug Events (ADEs) in older adults

•          Learners will be able to identify the physiologic changes associated with normal aging that influence pharmacokinetics and pharmacodynamics

•          Learners will be able to recognize ADEs when an older adult presents with a new clinical condition or complaint

•          Learners will be able to avoid potentially harmful medications for older adults

•          Learners will be able to utilize strategies for shortening medication lists and carefully introducing new medications

 

Date posted: 
Wed, 08/29/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 08/29/2012
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , , , and . Alliance for Geriatric Education in Specialties Curriculum. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/1089

MUSC Aging Q3 Mobile App

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Other Learning Resource Type: 
Product Information
Abstract: 

Almost 2/3 of all people 25-34 years old have smartphones. A smartphone is a mobile phone with computer-like features that can include e-mail, an internet browser, a personal organizer, a touch screen or a keyboard. With the Aging Q3 APP, you can access "on the go" teaching tools and materials on geriatric medicine from your mobile device. Educators and trainees can find links to topic-related evidence-based literature and clinical teaching tools helpful during educational and patient care encounters. The content is comprised of curriculum-developed and evidence-based facts collected in the MUSC Aging Q3 Program, supported by the D.W. Reynolds Foundation. The Aging Q3 Mobile App is designed for use on all mobile devices including iPads, Tablets, iPhones, and Android phones, and provides easier organization of aging-related materials with quick and easy access.

Educational objectives: 
  1. Facilitate "on the go" access to Aging Q3 curriculum (16 geriatric topics) and teaching tools for educational and  patient care encounters from any mobile device.
  2. Facilitate "on the go" access to links of topic related evidence-based literature from any mobile device.
  3. Facilitate "on the go" access to clinical tools including calculators and assessment tools on aging related topics such as depression and osteopororsis risk from any mobile device.
  4. Faciliate access to POGOe (Portal of Geriatric Online Education) from any mobile device.
Additional information/Special implementation requirements or guidelines: 

To download the Aging Q3 APP to your mobile device:

  1. Using your mobile device's web browser, access agingq3.myapp.name
  2. Depending on your device:
    1. Android: From “bookmarks”, click and hold down the Aging Q3 bookmark until an options screen pops up.
    2. Iphone: Add Aging Q3 site to your home screen when prompted.
  3. From the options screen choose “add shortcut” to home screen.
  4. Aging Q3 icon will now appear on your home screen.
Date posted: 
Thu, 08/23/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 08/23/2012
Contact Person/Corresponding Author:



Suggested Citation:
, and . MUSC Aging Q3 Mobile App. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/1089

Handover and Care Transitions Training for Internal Medicine Residents

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

The presentations and exercises in this resource are intended to serve as introductory training tools for interns and residents for them to better perform care transitions. In this context, care transitions are defined as “the movement patients make between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness” (Care Transitions Program, http://caretransitions.org). For our training exercises, we have focused on two types of transitions: handovers of patients between hospital providers, as well as hospital discharges.

In this resource, we have two different training experiences offered to internal medicine interns and residents at the Emory University School of Medicine: a two-hour workshop on care transitions issues offered to interns during their initial orientation, as well as an interactive presentation given to all residents a month into the academic year.

Educational objectives: 

After completing the course, learners should be able to:

  1. Identify what patient information should be included at handover.
  2. Communicate the essential elements of a nightly handover.
  3. Recognize patients at risk during transitions of care.
  4. Communicate clearly with patients and families, and members of the health care team during hospital discharge.
  5. Manage discharge medications to ensure safety and patient adherence.
Additional information/Special implementation requirements or guidelines: 

Effectiveness and Significance
The enclosed learning materials are part of a comprehensive curriculum for internal medicine interns and residents addressing care transitions in the hospital. It specifically covers handovers of patients in the hospital, as well as issues regarding patient care at discharge.

On the first implementation of this curriculum during the 2010-2011 academic year, the interns receiving the initial orientation gave the course a 4.1/5 in terms of perceived effectiveness. Interns’ confidence in their ability to perform care transitions tasks improved from 19.8 to 25.7 on a 30-point scale (p<0.0001), and knowledge scores improved from 4.5 to 5.7 out of 8 (p<0.0001), from pre- to post-course. After the course, 79% (34 of 43) answered “agree” or “strongly agree” when asked whether the course played a key role in their ability to hand over patients. 67% (29 of 43) answered “agree” or “strongly agree” when asked the same question about their ability to discharge patients.

This was the first dedicated curriculum on handovers or care transitions for medical residents at the Emory University School of Medicine. The lectures and exercises included in this resource are the core of a longitudinal care transitions curriculum that is now part of Emory's internal medicine training program.

Special Implementation Guidelines or Requirements
The materials contained in this package are meant to help with training of internal medicine (or family medicine) interns and residents on issues surrounding care transitions. The files attached were utilized for two distinct sessions: a two-hour session during the weeklong intern orientation, as well as an hourlong core lecture given a month later for the entire class of PGY 1-3 in Medicine.

Implementation of Intern Orientation
Detailed instructions on how to implement the exercises involved in intern orientation are in the attached documents. About two hours would be required for the exercise. Forty-five minutes would be used for the initial slide presentation, and about one hour would be used for the small group exercises. The handover and discharge summary exercises should be carried out dividing the larger class into groups of no more ten interns. The number of faculty required for this exercise will depend on the size of the intern class.

Core Lecture
The lecture can be given by one faculty member in a conference room. There is no predetermined limit on class size, as the interactive parts can be performed by asking residents to work in pairs and then having a discussion with the larger group.

The first document we recommend reading is facilitator_guide.doc, which contains instructions for both sessions.

Lessons Learned
We have received encouraging feedback for our training sessions on care transitions. The most important challenge we've worked with has been the integration of the lessons learned in the course into daily clinical practice. Our on care transitions transitions is very skills-oriented, so we needed to work with the faculty and administration at our different clinical sites to make sure that the skills our residents were learning were able to be integrated into clinical practice.

Publications from, presentations from, and/or citations to this product: 

Eskildsen M, Bonsall J, Miller A, Ohuabunwa U, Payne C, Rimler E, et al. Handover and Care Transitions Training for Internal Medicine Residents. MedEdPORTAL; 2012. Available from: www.mededportal.org/publication/9101

Date posted: 
Thu, 03/22/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 03/22/2012
Contact Person/Corresponding Author:



Suggested Citation:
, , , , , and . Handover and Care Transitions Training for Internal Medicine Residents. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/1089

Transitions of Care: Leaving the Hospital

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

This is a web-based, online, interactive module on "Transitions of Care: Leaving the Hospital" that is appropriate for learners from all disciplines who are involved in helping patients transition from hospital to home. It uses multiple learning modalities including patient scenarios, videos, interactive multiple-choice questions, and a narrator with visual aids and illustration. It also includes printable aids with links to check lists, samples of discharge summaries, and outside resources. This module was developed with collaboration betweenThe University of Texas Southwestern Medical School and The University of Arizona Health Science Center.  

Access at:  www.transitionsofcaremodule.com  or  http://tinyurl.com/transitionsmodule 

 

Educational objectives: 

Upon completion of this module the learner will be able to:

  1. Define transitional care and recognize why it is important
  2. Describe how transitions affect quality of care and patient safety
  3. Prepare a patient for a safe transition
  4. Write targeted and high quality discharge summaries
Date posted: 
Fri, 06/15/2012
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 06/15/2012
Contact Person/Corresponding Author:



Suggested Citation:
Transitions of Care: Leaving the Hospital. POGOe - Portal of Geriatrics Online Education; 2012 Available from: https://pogoe.org/taxonomy/term/1089

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