Nurse Practitioner enhances patient-centred care for seniors

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A new Nurse Practitioner role with a special focus on Geriatrics is helping the most frail and complex patients at St. Joseph’s Health Centre return home safely with the supports they need.

This new dedicated resource within the Health Centre’s Medicine and Seniors Care Program works closely with the interprofessional frontline teams and physicians to pull together the right internal and external community supports as soon as a senior patient is admitted to one of the medicine beds.

Stella Cruz is proud to take on this new role as Nurse Practitioner in an area of medicine she is very passionate about. Cruz will be working to support a collaborative and consultative model of care that starts on “day #1”, providing early assessment and intervention that follows geriatric medicine patients throughout their care journey at St. Joe’s.

“I can assess patients admitted to the unit with a focus on geriatric medicine, to try and identify all of the issues that have brought these patients into the hospital,” Cruz explains.

Providing health care services to meet the needs of the growing number of seniors is a priority. St. Joe’s serves a catchment area where 34 per cent of the population is over the age of 65. In the last two years, 13,700 patients over the age of 70 went to the emergency department (ED) for care, with 4,900 being admitted. On average, patient over 70 stayed more than 7.8 days in hospital, compared to 3.5 days for patients under 70 years of age.

For the last several years, St. Joe’s has been working to enhance a senior-friendly philosophy, notes Catherine Cotton, Administrative Program Director for the Medicine and Seniors Care Program. “We have been implementing several strategies in our program and in partnership with other areas in the hospital that enable our senior patients to maintain optimal health and function while in our care so that they can successfully and safely transition home to their families and their lives,” Cotton explains. “We are very pleased to welcome Stella to this role in our program.”

Adding a dedicated Nurse Practitioner in the Medicine and Seniors Care Program builds on the success of a project that was started in the ED last year called the First Three Days. The project’s aim was to prevent seniors from experiencing further decline in their function (making sure that patients don’t lose their mobility and can still do normal, every day activities on their own such as eating and getting dressed) while being treated in the hospital, with the goal of sending them home with as much of their independence intact as possible.

“This project was very successful and showed that very early assessment, intervention and follow through for geriatric patients helped decrease their length of stay, increase patient satisfaction and identify those patients who may lack much needed support at home – so by having a Nurse Practitioner in the Medicine Program, it will help us carry this approach through to patients right on the unit,” says Cruz.

Elderly patients tend to have multiple, complex medical issues, on top of other financial, social and environmental issues that impact their overall health and wellbeing. “All of these complex pieces have to be taken into consideration before our patients can go home,” says Cruz. “There are several staff and clinicians involved in caring for seniors; it’s a very interprofessional and collaborative approach.”

Cruz participates in “bullet rounds”, which are daily update meetings that bring the entire team together to discuss every aspect of their patients’ care. This close collaboration allows Cruz and her colleagues (physicians, nurses, physical therapists, occupational therapists, social workers, pharmacists) to work together in developing discharge plans for patients to get them home safely.

In her role, Cruz also meets with patients and their families directly every day from the time they are admitted to a hospital bed from the ED. Over the coming months, the Medicine and Seniors Care Program will continue to evaluate the impact this new strategy is having on geriatric patients’ quality of care and experience of care.