for Clinical Accuracy:
This tool is a double-sided pocket card intended to familiarize various learners with the many different functional impairments with which hospitalized elderly patients are vulnerable. Specifically, the tool includes a set of twelve critically important areas which should receive thoughtful consideration when performing an inpatient geriatrics consultation, as well as a subset of questions for each area of functional impairment which should be sequentially addressed. This tool was developed in conjunction with the interdisciplinary team members on a well established Acute Care for Elders Consult Service in an urban, academic safety-net setting (Wishard Memorial Hospital, Indianapolis, IN), with the secondary goal of assisting learners in identifying the roles of each member of the ACE interdisciplinary team and using these team members to help answer the questions on the pocket card when the team meets to discuss the patient. While this pocket card intends to provide the foundational elements of care recommended in most patients who receive ACE consultation, there clearly may be other appropriate recommendations to apply as every patient is a unique individual, and this card is furthermore applicable to any inpatient setting where care is delivered to the elderly, with or without the presence of an ACE team.
By using this pocket card during daily interdisciplinary teaching rounds on a one-week Acute Care for Elders Consult Service rotation, the learner will demonstrate proficiency in the following two objectives:
To recognize 12 of the most common geriatric syndromes and complex care needs of the typical patient seen in Acute Care for Elders (ACE) Consultation, including goals of care & advance care planning.
To be able to independently derive an appropriate list of recommendations for each of the identified syndromes and complex care needs recognized in each patient seen, incorporating the unique contributions of the members of the team.
"Proficiency" is demonstrated by the learner being able to use this pocket card as a guide to formulate appropriate assessments and plans for each patient seen in ACE consultation, taking into account the recommendations of the interdisciplinary team members which include social work, case management, nursing, physical & occupational therapy, and pharmacy. It is further intended that learners will keep this pocket card for use when developing care plans for elderly patients in other non-geriatric venues. Learners that will benefit from using this pocket card include medical students, family medicine and internal medicine interns and residents, medicine-pediatrics residents, geriatric fellows, and nurse practitioner / pharmacy / therapy students.
Additional information/Special implementation requirements or guidelines:
This interdisciplinary team teaching tool was developed by 3 current GACA recipients (Bowman, Nazir and James) in collaboration with one of their mentors (Westmoreland). It was a joint process closely developed with the suggestions of nursing, therapy, pharmacy, and social work members of our team, in addition to the recommendations and guidance of the 4 authoring physicians.
The tool has been printed double-sided in color on 9 1/2 X 13 inch size paper, has been laminated for permanence and distributed to various areas of our hospital, in particular to the places where teaching rounds are conducted and where housestaff enter their notes daily into the EMR. It has also been made available to other IUSM teaching hospitals with ACE consult services who host medical trainees of varying disciplines. A non-laminated form has also been widely disseminated in the orientation materials distributed at the start of the rotation for all resident and fellow learners. The intention is that once folded it can serve as a pocket-sized tool for future reference even after the learner has rotated off the ACE service.
Learners are strongly encouraged to carry this pocket card with them especially when seeing new hospital consults on ACE interdisciplinary teaching rounds. When encountering a learner who has difficulty synthesizing an assessment and plan based upon the patient's functional syndromes, he/she is openly encouraged to look at the card and use it as a guide for developing the plan of care. Through the use of this tool we have strived to assist new learners in "thinking like a geriatrician." A downstream effect of this tool is that we have been able to streamline the sometimes lengthy and repetitious discussions that take place during interdisciplinary teaching rounds, without compromising overall teaching time and quality (such as not having to remind learners daily to assess for tethers or prn medications given overnight). Through this process, we have found that our learners are more proactive, teaching rounds are not only more productive and conducive to learning, but most importantly there is more time for bedside teaching with the other team members leading the way because we don't spend as much time sitting at a table prompting learners to think about these issues - they have already proactively started thinking about them before rounds even begin.
This tool has been reviewed locally by IUSM senior faculty who are also mentors of authors Bowman, Nazir and James. Also closely reivewed in collaboration with all the non-physician members of our interdisciplinary team, without whom this product would not have been possible.
Date Submitted or Reviewed/Updated for Clinical Accuracy:
, , and . Interdisciplinary Team Training for Learners on an Acute Care for Elders (ACE) Consultation Service. POGOe - Portal of Geriatrics Online Education; 2011 Available from: https://pogoe.org/taxonomy/term/209