The Portal of Geriatrics Online Education

25 HOSP: Communicate a discharge plan

25. Communicate the key components of a safe discharge plan (e.g., accurate medication list, plan for follow-up), including comparing/contrasting potential sites for discharge.

Building Caregiver Partnerships Through Interprofessional Education

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

Family caregivers are on the frontlines managing complicated chronic illnesses, assisting with day-to-day functioning, and providing direct care to manage symptoms and improve the quality of life of their loved ones. Yet, health professions students, medical/surgical residents, and care providers receive little, if any, training on the vital role that caregivers play on the healthcare team and how, effective partnering optimizes patient care throughout the illness trajectory and at end-of life.

The goal of Building Caregiver Partnerships through Innovative Interprofessional Education is to create effective partnerships between healthcare providers and family caregivers to reduce the burdens, ease suffering, and enhance the meaning of the caregiving experience for the patient, family and health care providers.  The project centers on a 20-minute film, No Roadmap: Caregiver Journeys, which features the compelling stories of four caregiving families. The film and companion discussion guides as well as resources for case-based learning and structured clinical encounters are freely accessible on the website. http://www.neomed.edu/medicine/palliativecare/building-caregiver-partnerships/

The website is designed so that faculty can easily select the materials that best fit their learners’ needs and the time constraints within their programs. The curricula is appropriate for medical, pharmacy, nursing, and other health professions educational programs at both undergraduate and graduate levels. Additionally, tools have been developed for interdisciplinary team-based forums and health provider training.  For medical/surgical residency programs, relevant ACGME milestones are identified. 

Educational objectives: 

The objectives of the educational tools are to prepare learners to:
• Describe home-based eldercare as a shared experience and the importance of building a relationship with family caregivers and care recipients based on trust, compassion and open communication; 
• Describe the vital role of family caregivers as important, but under recognized, members of the health care team;
• Discuss the meaning and challenges of family caregiving;
• Engage caregivers in meaningful discussions to identify the needs, values and goals of their caregiving family;
• Identify resources to address caregiver concerns and provide ongoing support; and
• Provide holistic team-based care to family caregivers that improves the quality of life for the care recipient and the caregivers. 

 

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

~~Date/Location Meeting/Forum Presentation Title Presenter(s)
Jan 28-31, 2016, Phoenix, Arizona; Society of Teachers of Family Medicine; 45 min presentation;  Exploring Caregiver Journeys: A Curricular Tool for Family Medicine Clerks;  D. Sperling; J.T. Thomas

March 10-13, 2016; Chicago, Ill;  American Academy of Hospice and Palliative Medicine;  60-min workshop; Using Film to Foster Empathetic Partnerships between Care Providers and Family Caregivers;  J. Drost; E. Scott; M. Scott; D. Damore; S. Radwany

May 19-21, 2016; Long Beach, Ca; American Geriatrics Society; Poster; Building Caregiver Partnerships Through Innovative Health Professions Education; E. Scott, S. Radwany, D. Drost, K. Baughman, B. Palmisano, M. Sanders

May 19-21, 2016; Long Beach, Ca; American Geriatrics Society; Educational Product Session; Building Caregiver Partnership Through Innovative Health Professions Education; J. Drost; B. Palmisano

May 25, 2016; NEOMED Department of Family and Community Medicine Resident Scholarship Day; 15 min presentation; Exploring Caregiver Journeys: A Curricular Tool for Family Medicine Residents; D. Sperling; J.T. Thomas
 

Date posted: 
Mon, 12/12/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 09/23/2020
Contact Person/Corresponding Author:



Suggested Citation:
Building Caregiver Partnerships Through Interprofessional Education. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/173

Transitions of Care Workshop- Preparing 4th year Medical Students for Internship

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

Care Transitions are complicated and ineffective transitions result in poor patient outcomes and readmissions. The Association for American Medical Colleges (AAMC) has recently developed Entrustable Professional Activities (EPA) required for graduating medical students and two of the thirteen focus on transition of care issues. Residency programs are formalizing curricula around this topic as it is one of six focus areas within the Clinical Learning Environment Review (CLER) program, however graduating medical students have no formalized training in Care Transitions as of this time. This product provides a framework for practical training for graduating medical students and interns. A case based workshop on care transitions was created and utilized to instruct 4th yeard medical students and  Interns.  This included a small group didactic and a team based problem-solving session focused on a discharge case of a geriatric patient with multimorbidity. This curriculum was initially designed for medical students and interns on Internal Medicine, but can also be utilized to instruct learners in other fields and interprofessional learners.

Educational objectives: 
Define a care transition
Identify those at high risk for a complicated care transition
Apply specific risk assessment tools including the 8P’s, to estimate risk
Appraise the consequences resulting from ineffective transitions of care
Formulate a  safe care transition and discharge plan
Identify the important components of  successful transitional care
Additional information/Special implementation requirements or guidelines: 
Transitions of Care curriculum for 4th year medical students and Medical Interns
Interactive case based workshop to provide practical training on Transitions of Care
Small group classroom session with power point presentation and with a team based problem-solving component focusing on a discharge case of a geriatric patient with multimorbidit
Faculty Guide designed to guide active learning while students worked through the case in their teams
Publications from, presentations from, and/or citations to this product: 

Kranz, Kimberly, Strano-Paul, Lisa.  Preparing Graduating 4th year Medical Students for Internship- Implementing a Transitions of Care Workshop. Model Geriatric Programs: Geriatric Education Materials and Methods Swap. Presented at American Geriatric Society Annual Meeting Long Beach CA May 2016   

Kranz, K, Strano-Paul L, Go, R. Preparing graduating 4th year medical students for internship: Implementing a Transitions of Care Workshop. American Geriatric Society Annual Meeting, Long Beach CA, May 2016.

Kranz, K, Strano-Paul L, Go, R. Preparing graduating 4th year medical students for internship: Implementing a Transitions of Care Workshop. Women in Medicine Research Day. Stony Brook School of Medicine, Stony Brook, NY March 2016.

Kranz, K, Strano-Paul L, Go, R. Preparing graduating 4th year medical students for internship: Implementing a Transitions of Care Workshop. Clerkship Directors of Internal Medicine, Academic Internal Medicine Week, Atlanta, GA. October 2015.

                               

Date posted: 
Mon, 06/20/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Mon, 06/20/2016
Contact Person/Corresponding Author:



Suggested Citation:
Transitions of Care Workshop- Preparing 4th year Medical Students for Internship. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/173

Gait Velocity Assessment Toolkit

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

Gait Velocity is a marker of functional and cognitive status in older adults.  Slow gait speed has been associated with poor clinical outcomes such as cognitive decline, falls and hospitalization. This toolkit provides  instructions on how to perform a gait speed or gait velocity assessment.  It includes START and STOP labels, labels for the Timed Zone, and instructions on how to interprete and apply the results.  The examiner will need to measure and mark a walkway, and supply a stopwatch or watch with a second hand. By following these simple steps, gait velocity assessment can become a routine practice for clinicians who care for older adults.

Educational objectives: 

1. Describe how to perform and interpret gait velocity assessment in older adults.

2. Discuss the clinical implications of slow gait speed

Date posted: 
Fri, 10/09/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Fri, 04/13/2018
Contact Person/Corresponding Author:



Suggested Citation:
Gait Velocity Assessment Toolkit. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/173

"TMI"... (Too Many Interpretations): Mr. Moore's Medication Misadventures!

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

This two hour interprofessional curriculum brings together fourth year medical students and third year pharmacy students in a hands-on, interactive small group session. Learners are given a guide briefly describing the case and delineating five health care members and their roles and expertise in Mr. Moore's healthcare team (Mr. Moore's partner, the outpatient pharmacist, the inpatient intern, etc). A pair of interprofessional facilitators guide learners through the case, utilizing different healthcare team members' roles and expertise to explore methods of medication organization and systemic barriers to accurate and safe discharge medication reconciliation. Learners discover and discuss discrepancies in high-risk medications, gain an appreciation of systems hurdles for patients and healthcare providers during transitions of care, complete an exercise in writing discharge medication instructions, and brainstorm action items to personally employ to overcome systemic hurdles for safer discharge medication reconciliation.

Educational objectives: 

By the end of the two-hour session, learners will work collaboratively to:

  1. Describe the roles and expertise of three health professions that can collaborate to reconcile medications and enhance safety of medication orders at the time of hospital discharge. 
  2. List three potential communication barriers between health professionals involved in discharge planning that contribute to medication errors in vulnerable older adults.
  3. Identify key components of discharge medication lists and instructions to communicate information safely to patients, caregivers, primary care providers and others on the healthcare team.
Date posted: 
Tue, 08/30/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 08/30/2016
Contact Person/Corresponding Author:



Suggested Citation:
"TMI"... (Too Many Interpretations): Mr. Moore's Medication Misadventures!. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/173

Interprofessional Collaborator Mini-Course

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

Physicians (and other health professionals) are often expected to participate with teams of health professionals; however, postgraduate training infrequently includes interprofessional (IP) or team training.  Thus, this curriculum was developed to teach and demonstrate the knowledge, skills and attitudes which lead to successful IP collaboration.  While created for an audience of in-training physicians, it may be used with other health professional audiences.

During a four-week geriatrics rotation, medicine interns complete a fifty-minute, in-person, multimedia lecture to introduce the IP collaborator concept and the Canadian and American IP competency frameworks. The IP pocket card is demonstrated and interns complete a guided, team-meeting video observation exercise. Using a SurveyMonkey, narrative reporting tool, interns analyze team competencies that they observe or initiate during geriatrics team meetings during the rotation. They report on two interactions. They complete a closing SurveyMonkey questionnaire and have an in-person debriefing.

Educational objectives: 

Given opportunity to work with interprofessional teams for patient care on the Geriatrics Block Rotation:

  • Learner will recognize interprofessional competencies.
  • Learner will understand the role of interprofessional collaborator.
  • Learner will observe and demonstrate the knowledge, skills and attitudes necessary to be an interprofessional collaborator according to CIHC and IPEC competencies
Publications from, presentations from, and/or citations to this product: 
Poster Presentation: Interprofessional Collaborator Curriculum
InterProfessional Care for the 21st Century
Redefining Education & Practice
Jefferson University, Philadelphia, PA
October 2014
Date posted: 
Tue, 06/14/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 04/03/2019
Contact Person/Corresponding Author:



Suggested Citation:
Interprofessional Collaborator Mini-Course. POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/173

It Takes a Village: Interprofessional Geriatrics Case Conference

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

Residency programs are grappling with the best ways to improve their curriculua to meet the requirements of the Next Accreditation System and ACGME Milestones.  Our review identified NAS requirements that align with established geriatrics care principles (e.g., transitions of care, interprofessional teamwork, managing complex patients, patient / caregiver communication).  Our internal medicine residency program transformed an existing monthly, hour long educational case conference into an an interdisciplinary team-based educational forum emphasizing key geriatrics care and interprofessional principles.  This educational product includes all tools and information necessary for this session to be successfully implemented and evaluated in other institutions.  

Materials and information includes:

  1. Outline / identification of interdisciplinary participants
  2. Forum structure and format 
  3. Content area examples
  4. Learner and curriculum evaluation tool. 

This session provides tools for learners to reach these training goals and requirements while integrating core geriatrics principles through use of team teaching with interprofessional colleagues.  Learners consistently reported an increase in knowledge gained in all targeted milestones with the most dramatic increases in milestones specific to systems-based practice and professionalism.

Educational objectives: 
  1. Integrate interprofessional colleagues into internal medicine residency education in a meaningful forum.
  2. Demonstrate how interprofessional collaboration and communication leads to higyh quality patient care through the use of practical patient cases with evidence to support key points drawn from the literature.
  3. Emphasize core geriatric syndromes and principles that are often overlooked or missed.

 

Additional information/Special implementation requirements or guidelines: 

Please see the attached Instructor's Guide for full implementation details and guidelines for the session.

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

Abstract/Poster Presentation: Kuester J, Carnahan J, Duthie E, Rehm J, Denson S, Duthie E Jr, Integration of ACGME Milestones into Internal Medicine Residency Curriculum Through Teaching Care Geriatric Principles, American Geriatrics Society Annual Meeting, Orlando, FL, 05/2014.

Date posted: 
Thu, 10/01/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Thu, 10/01/2015
Contact Person/Corresponding Author:



Suggested Citation:
It Takes a Village: Interprofessional Geriatrics Case Conference. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/173

The Geriatric Transitions Objective Structured Video Examination (GT-OSVE)

:  
Date Posted: 
12/31/1969
Date Reviewed/Updated for Clinical Accuracy: 
12/31/1969
Product Information
Estimated time to complete: 
3
Abstract: 

OSVEs (Objective Structured Video Examinations) may be used to teach principles of effective interdisciplinary team-based transitional care.  First introduced at the Medical College of Wisconsin in the mid-1990s, the OSVEs were used as brief “trigger videos” demonstrating ACGME competencies to which trainees would respond by completing multiple-choice or fill-in-the blank questions.  The Geriatric Transitions OSVE (GT-OSVE) replaces the individual, paper-based exercise with an experiential, team-based exercise focused on transitions of care.  The GT-OSVE also addresses interprofessional (IPE) competencies, including the importance of understanding the roles of other health care professionals.  A series of three GT-OSVE cases was developed with HRSA Geriatric Academic Career Award support (#K01HP20487) to meet an unmet need in care transitions education.  Most existing care transitions educational materials focus on the time of hospital discharge.  The three GT-OSVE cases focus instead on post-hospital transitional care in various settings, including the outpatient primary care clinic, skilled nursing facility and assisted living facility.  The GT-OSVE case presented here (“Hospital to Outpatient Care Transition”) is the first case in this series and addresses the first post-hospital primary care outpatient visit.  The GT-OSVE “Hospital to Outpatient Care Transition” case is a required component of the Patient-Centered Medical Home (PCMH) rotation for third-year family medicine residents at the University of Utah.  These residents work with clinical pharmacy residents and physician assistant students to complete the GT-OSVE exercise.  The GT-OSVE was designed to be applicable to health professions trainees ranging from novice (e.g. preclinical medical student) to advanced (e.g. senior medical resident), and to be equally relevant to both interdisciplinary teams and teams whose members are all of the same discipline.

Educational objectives: 

Upon completion of this material you will be able to: 

1. Understand best practices in post-hospital transitional care.
2. Acquire practical experience in formulating a high-quality, team-based transitions plan.
3. Discuss the contributions of other health professions trainees in formulating effective transitions.

Additional information/Special implementation requirements or guidelines: 

Order of Resource Files


First, trainees should complete the pretest and self-efficacy survey.


Second, faculty facilitator(s) should consider emailing trainees the links to the online transitions and team functioning modules found in the optional advance preparation assignment document.  This content may be reviewed on each trainee’s own time prior to the didactic session.  The “Geriatric Interdisciplinary Team Training (GITT)” module is freely available; permission has been granted from the author of the “Transitions of Care:  Leaving the Hospital” module to use this module as an advance preparation assignment for the GT-OSVE.


Third, faculty should deliver the care transitions didactic presentation to trainees prior to the GT-OSVE exercise.  This didactic reinforces and expands upon the care transitions and team leadership content of the optional advance preparation assignment.


Fourth, on the day of the GT-OSVE exercise, faculty should ask each team member to discuss his or her role (e.g. resident, physician assistant, pharmacist, nurse, social worker).  A team leader (not necessarily the medical student or resident) should be identified.   Faculty should review the faculty and team leader instructions and discuss them with the team (see also “Facilitation Schema” below).  Trainees should then be provided with the hypothetical patient chart corresponding with Mr. John Coleman so that they have access to the same information as the resident physician depicted in the video.  Trainees should also be provided with the after-visit summary template that prompts them to consider Coleman’s “four pillars” of transitional care as well as barriers to transitional care.


Fifth, the video file, “Hospital to outpatient care transition,” should be shown.  The team leader should facilitate team discussion and should elicit the contributions of each team member.  After the team discussion, the team leader should present to faculty the transitions plan agreed upon by the team.  The faculty checklist of care transitions and team leadership domains should be used by faculty to help track the extent to which the team leader addresses key care transitions domains and identifies barriers to the transitions plan during his or her presentation of the transitions plan, and also the extent to which the team leader facilitates the transitions plan among the team. Finally, each trainee should complete the post-test and self-efficacy survey.


Practical implementation advice
The GT-OSVE case, “Hospital to Outpatient Care Transition,” was designed to ease the scheduling demands often inherent in interdisciplinary education.   Since this GT-OSVE case presents a videotaped encounter with a standardized patient, programs do not need to compensate or schedule standardized patients.  Required materials include a computer with Internet access, PowerPoint slides, and hard copies of ancillary materials including pretest and posttest surveys, faculty and team leader instructions, hypothetical patient chart materials, after-visit summary template and faculty checklist.  Optional materials include the advance preparation assignment and a projector and screen, although the video case can be displayed on a laptop with small groups.  Trainees will require 40 minutes to review the online modules prior to GT-OSVE administration.  Faculty should allow approximately 60 minutes on the day of the GT-OSVE exercise to include the following activities: explanation of the GT-OSVE exercise (10 minutes), viewing of the “Hospital to Outpatient Care Transition” video case (10 to 15 minutes), team formulation of the transitions plan (10 minutes), presentation of the transitions plan by the team leader to faculty (5 minutes), faculty debrief and team discussion (10 minutes) and completion of the posttest survey (5 minutes).  At least one faculty member must be present to set up the video and hard copy materials, introduce the case and debrief trainees at the end of the session.  Whenever possible, faculty from additional disciplines should participate to enrich the feedback provided to trainees during the debriefing component.  Estimated faculty preparation time includes reviewing the online modules (40 minutes), PowerPoint slides and GT-OSVE case (60 minutes), and hard copy materials (30 minutes).

Strategies to avoid potential pitfalls
We have noticed several potential pitfalls when administering the GT-OSVE “Hospital to Outpatient Care Transition” case.  First, depending on the personality of the trainees involved, one trainee sometimes dominates the team discussion.  In order to ensure that each trainee contributes to the transitions plan equitably, we created the after-visit summary template containing the “four pillars” of effective care transitions as well as a fifth component (barriers to an effective transition).  We ask each trainee to jot down notes on this after-visit summary template as they watch the GT-OSVE with the expectation that the team leader will elicit and integrate the contributions of each trainee.  This approach has reduced the tendency of one team member to dominate the discussion.  Second, we noticed that the 4 minute and 36 second pre-visit planning section section (from 0:00 to 4:36) and the 3 minute and 14 second post-visit planning section of the GT-OSVE “Hospital to Outpatient Care Transition” video (from 12:01-15:15), which depicts a resident physician modeling pre and post-visit planning with a medical assistant and a care manager, can prompt trainees with numerous items to include in the transitions plan.  As a result, we generally reserve the pre and post-visit planning sections of this GT-OSVE case for more novice teams of trainees, such as preclinical medical students, who are less likely than more advanced trainees to be familiar with the medical home setting.  This reduces the length of the video to 9 minutes and 10 seconds (4:37 – 12:00 and 15:16-17:03). Third, we noticed that stopping the video at 12:00 (just after the conversation with Mr. Coleman and his daughter-in-law) works well since, when trainees viewed the end of the clinical encounter (15:16 – 17:03) before discussing the case as a team, they provided feedback that the office visit was over and that parts of the transitions plan had already been presented in the video before they had an opportunity to formulate their own transitions plan.  We now play the last part of the clinical encounter (15:16-17:03) after the trainees present their transition plan.  This approach has worked well since the final segment demonstrates that even a carefully crafted transitions plan might not succeed if the patient is not fully engaged in the plan.  Finally, there may be instances in which more than one trainee from a single discipline is present (e.g. two physician assistant students).  When this occurs, we encourage the “duplicate” trainee to consider attending to aspects of the case they might not often address (e.g. nutritional, psychosocial, or functional issues).  We feel this approach helps increase trainees’ appreciation for the roles of other disciplines, even when trainees from other disciplines are not present, and also demonstrates that team members’ roles can often overlap.


Limitations of the resource and opportunities for improvement
The most important limitation of the GT-OSVE involves its videotaped format.  Although the videotaped standardized patient encounter ensures lack of variability in the case from session to session, we are unable to reproduce the spontaneity of live interactions between trainees and the standardized patient.  However, faculty can rewind the video to replay particularly noteworthy video clips and use this technique as a basis for discussion with their trainees.  The GT-OSVE could also serve as a training video to create a live OSCE session dedicated to care transitions.  We also recognize that the length of time (25 to 30 minutes) allotted for the team members to watch the video, formulate a transitions plan and present to a faculty preceptor may be longer than the time allotted during a real-world post-hospital primary care outpatient visit.  We mention in our faculty debrief to trainees that they may have less time to conduct real-world transitional care visits, and we emphasize that best practices in care transitions taught by the GT-OSVE case can be an organizing principle to help them structure what can otherwise be chaotic office visits following hospital discharge.  We also discuss in our faculty debrief to trainees the importance of other team members’ roles and working as a team to best meet the complex needs of vulnerable older adult patients in a timely fashion.

Permissions for Advance Preparation Assignment Materials

The GITT (Geriatrics Interdisciplinary Team Training) modules are freely available online from the Hartford Institute for Geriatric Nursing.

The online module entitled "Transitions of Care:  Leaving the Hospital" is used with permission from Kathyrn Eubank, MD.

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

Publications
Farrell T, Brunker C (2015). GT-OSVE: A Method to Teach Effective Interdisciplinary Team-Based Post-Hospital Transitional Care [Web]. MedEdPORTAL Publications.  Available from: https://www.mededportal.org/publication/10129 http://dx.doi.org/10.15766/mep_2374-8265.10129 - See more at: https://www.mededportal.org/publication/10129#sthash.R35yConZ.dpuf.


Farrell TW, Brunker C, Wong B, Luptak M, Supiano KP (2015). Health professions trainees' satisfaction with the Geriatric Transitions Objective Structured Video Examination (GT-OSVE) and self-efficacy in care transitions domains [Abstract]. Journal of the American Geriatrics Society, 63(S1), S56.


Farrell TW, Brunker CB (2014). Tools you can use: geriatric structured video examination [Web]. John A. Hartford Foundation. Available from: http://www.jhartfound.org/blog/tools-you-can-use-geriatric-transitions-objective-structured-video-examination/


Presentations
Farrell TW. Health professions trainees' satisfaction with the Geriatric Transitions Objective Structured Video Examination (GT-OSVE) and self-efficacy in care transitions domains. American Geriatrics Society 2015 Annual Scientific Meeting, National Harbor, MD.


Farrell TW, Brunker CP, Supiano KP (2015). The Geriatric Transitions Objective Structured Video Examination (GT-OSVE): an interdisciplinary approach to teaching and assessing best practices in transitional care. University of Utah Division of Geriatics: Research in Progress series.


Farrell TW and Brunker CB (2014). The Geriatric Transitions Objective Structured Video Examination (GT-OSVE): an interdisciplinary approach to teaching and assessing best practices in transitional care. Society for Social Work Leadership in Health Care (SSWLHC) 49th Annual Conference, Salt Lake City, UT.


Farrell TW (2014). Geriatric Transitions Objective Structured Video Examination (GT-OSVE). Department of Veterans Affairs National GEC Leads Virtual Conference.


Farrell TW and Brunker CB (2014). Geriatrics Transitions Objective Structured Video Examination (GT-OSVE). HRSA Geriatric Academic Career Award: Quarterly Technical Assistance Call.


Farrell TW (2014).  Geriatrics Transitions Objective Structured Video Examination (GT-OSVE).  John A. Hartford Center of Geriatric Nursing Excellence annual site visit.


Luther B, Farrell TW, Wilson R (2014). Innovative methods of developing interprofessional education. University of Utah College of Nursing Care Management Workshop: Developing Skills of Change. Salt Lake City, UT.


Farrell TW. Objective structured video examinations (OSVEs) focused on transitions of care. Presented at Education Product Showcase, American Geriatrics Society 2013 Annual Scientific Meeting. Grapevine, TX.


Farrell TW, Brunker CB (2013). Geriatric transitions objective structured video examination (OSVE). Marketplace II session, Donald W. Reynolds Foundation 11th Annual Grantee Meeting. Coronado, CA.


Farrell TW, Brunker CB (2012). Geriatric transitions objective structured video examination (OSVE). Presented at Marketplace I session, Donald W. Reynolds Foundation 10th Annual Meeting. St. Louis, MO.


Farrell TW (2012). Geriatric Transitions Objective Structured Video Examination (OSVE).  John A. Hartford Center of Geriatric Nursing Excellence annual site visit. Salt Lake City, UT.


Farrell TW (2012).  Geriatrics Transitions Objective Structured Video Examination (GT-OSVE).  John A. Hartford Center of Geriatric Nursing Excellence annual site visit.  Salt Lake City, UT.


Farrell TW and Nagoshi M (2012).  Interprofessional education products developed by the University of Utah and the University of Hawaii. 'Geri-West' consortium conference call.


Citations
US Department of Health and Human Services.  Multiple chronic conditions resource summary:  Geriatric Transitions Objective Structured Video Examination (GT-OSVE).  Available at:  http://www.hhs.gov/ash/initiatives/mcc/educational...

 

 

 

 

Date posted: 
Thu, 10/06/2016
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Sun, 06/30/2019
Product Viewing Instructions: 
Each user is asked to indicate his or her name, degree, academic title, name of institution or organization, contact information, purpose for using OSVE videos, and disciplines of those using the videos.
Contact Person/Corresponding Author:



Suggested Citation:
The Geriatric Transitions Objective Structured Video Examination (GT-OSVE). POGOe - Portal of Geriatrics Online Education; 2016 Available from: https://pogoe.org/taxonomy/term/173

PRIMED and READY: A Transitions of Care Pocket Card

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

     Transitions of care are important in improving patient safety and decreasing health care costs. Despite the necessity of education about this subject, there is often insufficient time to adequately teach internal medicine residents about performing care transitions. In many institutions, documentation of hospital discharge summaries, communication between transition sites, and patient education at the time of discharge need to be improved. Presented here is a pocket card consisting of two mnemonics which may be useful reminders for improving discharge summary documentation and transitions of care practices.
     One side of the card uses the mnemonic PRIMED to illustrate vital aspects of a discharge summary and stands for: Primary diagnosis, Return to, Inpatient course, Medication reconciliation, Exams and Expertise, and Destination and DNR status. The other side of the card uses the mnemonic READY as a reminder of steps needed to improve transitions of care and stands for: Referring and Receiving Providers, Educate, Anticipate needs, Discharge summary and Drugs, and Your contact information.

Educational objectives: 

To improve discharge summary documentation and transitions of care practices.

Date posted: 
Mon, 08/17/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Wed, 03/24/2021
Contact Person/Corresponding Author:



Suggested Citation:
PRIMED and READY: A Transitions of Care Pocket Card. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/173

2015 Quick Reference App: Internal Medicine and Family Medicine Resident Geriatric Competencies

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

In 2010, the essential geriatric competencies for Internal Medicine (IM) and Family Medicine (FM) residents were published. To reinforce and disseminate these critical skills, we created a quick reference mobile application for IM and FM residents that addresses competencies in each of the seven key competency domains: Medication Management; Cognitive, Affective and Behavioral Health; Complex or Chronic Illness; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care.

This application can be used as a comprehensive reference by learners of multiple levels and disciplines while caring for patients in a variety of settings, including inpatient wards, outpatient clinic, nursing homes and home visits. Various screening tools, criteria, mnemonics and guidelines supporting each competency are included in this concise guide to caring for aging adults.

To access the free app:

  1. Go to Geriatrics Quick Reference App on AgileMD
  2. Create a free AgileMD account  
  3. Download the free AgileMD application using your smartphone app store 
  4. Open the AgileMD app and login with the username and password you created
Educational objectives: 
After using this quick reference tool, learners will be able to:
1.) Select and apply evidence-based tools to screen for or assess geriatric syndromes.
2.) Asses for and manage issues affecting older adult health across seven key competency domains: Medication Management; Cognitive, Affective and Behavioral Health; Complex or Chronic Illness; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care.
Publications from, presentations from, and/or citations to this product: 

AGS 2015 Educational Showcase Product Swap

Date posted: 
Mon, 09/28/2015
Date Submitted or Reviewed/Updated for Clinical Accuracy: 
Tue, 04/03/2018
Contact Person/Corresponding Author:



Suggested Citation:
2015 Quick Reference App: Internal Medicine and Family Medicine Resident Geriatric Competencies. POGOe - Portal of Geriatrics Online Education; 2015 Available from: https://pogoe.org/taxonomy/term/173

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