scholarly journals Transitional Care: Looking for the Right Shoes to Fit Older Adult Patients

2013 ◽  
Vol 14 (2) ◽  
pp. 78-83 ◽  
Author(s):  
Adam G. Golden ◽  
Judith Ortiz ◽  
Thomas T.H. Wan
Keyword(s):  
Older Adult ◽  
Financial Incentives ◽  
Best Practice ◽  
Transitional Care ◽  
Adult Patients ◽  
Care Organization ◽  
Avoidable Hospitalizations ◽  
Reform Legislation ◽  
Increased Risk ◽  
New Models

Potentially avoidable hospitalizations are associated with high costs and an increased risk for iatrogenic conditions in older adult patients. Although care managers may be aware of the common potential pitfalls that may arise in the transfer of patients to and from the hospital, defining best practice models has been difficult. Many current models of geriatric care have had little or no impact on lowering the rates of hospitalizations and rehospitalizations when formally studied. Health care reform legislation mandates initiatives involving new models of coordinated or guided care such as the medical home model and the accountable care organization. These new models too will face significant challenges in their attempt to provide the financial incentives and systematic changes needed to successfully address transitional care in older adults.

scholarly journals How to manage bleeding disorders in aging patients needing surgery

Hematology ◽  
2021 ◽  
Vol 2021 (1) ◽  
pp. 529-535
Author(s):  
Mouhamed Yazan Abou-Ismail ◽  
Nathan T. Connell
Keyword(s):  
Older Adult ◽  
Volume Overload ◽  
Von Willebrand Disease ◽  
Adult Patients ◽  
Bleeding Disorders ◽  
Age Related ◽  
Increased Risk ◽  
Individualized Approach ◽  
Underlying Disorder ◽  
Guidelines And Recommendations

Abstract With improvements in medical care, the life expectancy of patients with bleeding disorders is approaching that of the general population. A growing population of older adult patients with bleeding disorders is at risk of age-related comorbidities and in need of various elective and emergent age-related procedures. The increased risk of thrombosis and volume overload in older adults complicates perioperative hemostatic management. Furthermore, antithrombotic treatment such as antiplatelet or anticoagulant therapy, which is frequently required for various cardiovascular interventions, requires a meticulous individualized approach. Evidence-based guidelines for the management of aging patients with bleeding disorders are lacking, largely due to the underrepresentation of older adult patients in clinical trials as well as the rarity of many such bleeding disorders. We discuss the current guidelines and recommendations in the perioperative hemostatic management of older adult patients with hemophilia and von Willebrand disease as well as other rare bleeding disorders. The optimal management of these patients is often complex and requires a thorough multidisciplinary and individualized approach involving hematologists, surgeons, anesthesiologists, and the specialists treating the underlying disorder.

scholarly journals Development of salient medication reminders to facilitate information transfer during transition from inpatient to primary care: the Delphi process

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e041336
Author(s):  
Eliza Lai-Yi Wong ◽  
Kam-Shing Tang ◽  
Annie Wai-Ling Cheung ◽  
Ringo Kin-Cheung Sze ◽  
Jack Chi-Him Lau ◽  
...  
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Older Adult ◽  
Transitional Care ◽  
Expert Panel ◽  
Geriatric Medicine ◽  
Panel Discussion ◽  
Delphi Process ◽  
Public Hospitals ◽  
Adult Patients

ObjectiveTransitional care is important to successful hospital discharge. Providing patients with a clear and concise summary of medication-related information can help improve outcomes, in particular, among older adults. The present study aimed to propose a framework for the development of salient medication reminders (SMR), which include drug-related risks and precautions, using the Delphi process.DesignIdentification of potential SMR statements for 80% of medication types used by older adult patients discharged from geriatric medicine departments, followed by a Delphi survey and expert panel discussion.SettingsMedical and geriatric departments of public hospitals in Hong Kong.ParticipantsA panel of 13 geriatric medical experts.Outcome measureA Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) points, scoring item relevance, importance and clarity. The minimum of 70% consensus was required for each statement to be included.ResultsThe expert panel achieved consensus through the Delphi process on 80 statements for 44 medication entities. Subsequently, the SMR steering group endorsed the inclusion of these statements in the SMR to be disseminated among older adults at the time of discharge from geriatric medicine departments.ConclusionsThe Delphi process contributed to the development of SMR for older adult patients discharged from public hospitals in Hong Kong. Patient experience with and staff response to the SMR were assessed at four hospitals before implementation at all public hospitals.

scholarly journals Non-conveyance of older adult patients and association with subsequent clinical and adverse events after initial assessment by ambulance clinicians: a cohort analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jakob Lederman ◽  
Veronica Lindström ◽  
Carina Elmqvist ◽  
Caroline Löfvenmark ◽  
Gunnar Ljunggren ◽  
...  
Keyword(s):  
Older Adults ◽  
Patient Safety ◽  
Adverse Events ◽  
Older Adult ◽  
Emergency Department Visits ◽  
Adult Patients ◽  
Ambulance Service ◽  
Oxygen Saturation Level ◽  
Presenting Symptoms ◽  
Increased Risk

Abstract Background Older adults (age ≥ 65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively. Methods This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18–64 and ≥ 65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses. Results Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level < 95% or systolic blood pressure > 160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients. Conclusions Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex and variating presentation of symptoms and vital signs proved difficult for dispatch operators and ambulance clinicians to identify and assess, the identified risks raise questions on the patient safety of older adult non-conveyed patients. The results indicate a system failure that need to be managed within the ambulance service organisation to achieve higher levels of patient safety for older non-conveyed patients.

scholarly journals Non-conveyance of older adult patients and association with subsequent clinical and adverse events after initial assessment by ambulance clinicians: A cohort analysis

2020 ◽  
Author(s):  
Jakob Lederman ◽  
Veronica Lindström ◽  
Carina Elmqvist ◽  
Caroline Löfvenmark ◽  
Gunnar Ljunggren ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Events ◽  
Older Adult ◽  
Cohort Analysis ◽  
Significant Proportion ◽  
Emergency Department Visits ◽  
Adult Patients ◽  
Oxygen Saturation Level ◽  
Presenting Symptoms ◽  
Increased Risk

Abstract Background: Older adults (age ≥65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively.Methods: This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18–64 and ≥65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses.Results: Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level <95% or systolic blood pressure >160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients.Conclusions: Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex symptom presentation which proves difficult for dispatch operators and ambulance clinicians to identify, this risk raises questions on the patient safety of older adult non-conveyed patients.

Business: The Electronic Health Record: Front Line Experience

2011 ◽  
Vol 21 (1) ◽  
pp. 18-22
Author(s):  
Rosemary Griffin
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Electronic Health Record ◽  
Financial Incentives ◽  
Best Practice ◽  
Health Care Systems ◽  
The United States ◽  
Health Record ◽  
Health Trends ◽  
Electronic Health

National legislation is in place to facilitate reform of the United States health care industry. The Health Care Information Technology and Clinical Health Act (HITECH) offers financial incentives to hospitals, physicians, and individual providers to establish an electronic health record that ultimately will link with the health information technology of other health care systems and providers. The information collected will facilitate patient safety, promote best practice, and track health trends such as smoking and childhood obesity.

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