Replicating the Hospital Elder Life Program in a Community Hospital and Demonstrating Effectiveness Using Quality Improvement Methodology

Rubin, Fred H.; Williams, Joseph B; Lescisin, Dianne A; Mook, William; Hassan, Shuja; Inouye, Sharon K.

doi:10.1111/j.1532-5415.2006.00744.x

Cited by 105 publications

(110 citation statements)

References 13 publications

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“…Another key strength of the study is that all study patients received non-pharmacologic interventions to reduce the risk of delirium, including frequent reorientation, cognitive stimulation, early mobilization, sleep hygiene, and use of hearing or vision aids. Thus, while their baseline rate of delirium in the placebo group (23%) may seem low when compared to other trials of delirium interventions, this rate is consistent with other studies that utilized non-pharmacologic interventions (15). The study was limited by enrollment of patients after surgery, many of whom required consent via proxy due to medication administration and/or altered mentation.…”

Section: Commentarymentioning

confidence: 62%

“…The impact that delirium has on healthcare costs and patient outcomes has led to a number of interventions to prevent it or reduce its duration, but unfortunately the high prevalence of delirium persists despite these attempts. Many studies of therapies to prevent postoperative or ICU delirium have focused on nonpharmacologic interventions, including multicomponent care pathways, geriatrics consultation, optimization of the patient's environment, enforcing appropriate sleep hygiene, and utilization of sensory aids (14)(15)(16)(17)(18)(19). Even with multiple non-pharmacologic measures, however, delirium persists in the studied populations.…”

mentioning

confidence: 99%

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Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery

Karren¹,

King²,

Hughes³

2016

J. Thorac. Dis.

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Section: Commentarymentioning

confidence: 62%

mentioning

confidence: 99%

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery

Karren¹,

King²,

Hughes³

2016

J. Thorac. Dis.

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“…Protocols, trained staff, and physical modifications targeted at the geriatric patient in inpatient settings have already been shown to successfully reduce the risk of delirium, iatrogenic complications, cost, hospital length of stay, and transfer to long-term care facilities, while increasing patient and provider satisfaction and preserving patient function. [14][15][16][17] It has recently been shown that these programs are replicable in community hospitals, demonstrating the widespread applicability and effectiveness of geriatricfocused interventions for inpatient geriatric care. The proposed GEDIs would initially be targeted toward patients aged 65 and older and could potentially be implemented (incrementally, depending on fiscal, physical, and demographic constraints of hospital systems) in all types of EDs.…”

Section: Geriatric Emergency Department Interventionsmentioning

confidence: 99%

The Geriatric Emergency Department

Hwang

Morrison

2007

J American Geriatrics Society

291

197

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With the aging of the population and the demographic shift of older adults in the healthcare system, the emergency department (ED) will be increasingly challenged with complexities of providing care to geriatric patients. The special care needs of older adults unfortunately may not be aligned with the priorities for how ED physical design and care is rendered. Rapid triage and diagnosis may be impossible in the older patient with multiple comorbidities, polypharmacy, and functional and cognitive impairments who often presents with subtle clinical signs and symptoms of acute illness. The use of Geriatric Emergency Department Interventions, structural and process of care modifications addressing the special care needs of older patients, may help to address these challenges. J Am Geriatr Soc 55:1873-1876, 2007. Key words: emergency medicine; geriatric health services F or most of the 20th century, the growth of the population aged 65 and older has far outpaced other age groups, and this trend will continue well into the 21st century. As a result of this demographic shift and an increase in longevity resulting from changes in lifestyles, health, and medical advances, one in five Americans will be aged 65 and older in 2030. By 2050, nearly 25% of Medicare beneficiaries will be aged 85 and older. 1 As the U.S. population continues to age, the healthcare system will need to face and embrace the challenges of caring for older adults. Care for elderly people is increasingly being sought in emergency departments (EDs), where older patients typically present with complex medical conditions, stay longer for more-extensive diagnostic testing and treatment regimens, and require special needs during their visit. The use of Geriatric Emergency Department Interventions may help to address these challenges and thereby improve the quality of care of elderly people in the ED. OLDER ADULTS AND THE EDAlthough the aging population will affect all areas of health care, the ED is likely to be disproportionately affected. In 2002, approximately 58% of 75-year-olds had at least one visit to an ED, as compared to 39% of those of all ages, and ED use increased with increasing age.3 Once in the ED, older patients are more likely to have an emergent or urgent condition, be hospitalized, and be admitted to a critical care unit. 4 In addition, older patients are also more likely to receive a greater number of diagnostic tests, spend longer times in the ED, and have higher charges for their ED services than younger patients. 5The Disconnect Between Emergency and Elder Care The ED is a unique environment where highly specialized care is delivered to the acutely ill and injured and safety net care is provided to disenfranchised and vulnerable populations. Although studies have begun to demonstrate disparities in care for older adults, most have focused on specific diseases or conditions 6 and have not looked specifically at how ED care and environmental factors may be associated with patient outcomes. Nonetheless, there are indications that the cu...

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“…21 The initiation of regularly scheduled psychoactive medications while hospitalized should be discouraged. 4 Finally, nonpharmacologic interventions have demonstrated efficacy in preventing delirium in the elderly individuals while hospitalized (Table 3), 11,23 and the neurologist evaluating a patient preoperatively should comment on these when appropriate. In a group of elderly patients treated with these and other interventions when appropriate, only 10% developed delirium compared to 15% in a nonintervention control group 11 ; while in a community hospital setting similar interventions led to a 35% relative reduction in delirium.…”

Section: Disturbances Of Consciousness: Delirium and Dementiamentioning

confidence: 99%

The Preoperative Neurological Evaluation

Probasco

Sahin

Tran

et al. 2013

The Neurohospitalist

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Neurological diseases are prevalent in the general population, and the neurohospitalist has an important role to play in the preoperative planning for patients with and at risk for developing neurological disease. The neurohospitalist can provide patients and their families as well as anesthesiologists, surgeons, hospitalists, and other providers guidance in particular to the patient's neurological disease and those he or she is at risk for. Here we present considerations and guidance for the neurohospitalist providing preoperative consultation for the neurological patient with or at risk of disturbances of consciousness, cerebrovascular and carotid disease, epilepsy, neuromuscular disease, and Parkinson disease.

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Replicating the Hospital Elder Life Program in a Community Hospital and Demonstrating Effectiveness Using Quality Improvement Methodology

Abstract: HELP can be successfully replicated in a community hospital, yielding clinical and financial benefits.

Cited by 105 publications

References 13 publications

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery

The Geriatric Emergency Department

The Preoperative Neurological Evaluation

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