Recognizing the growing numbers of seniors presenting at the Chatham-Kent Health Alliance’s (CKHA) Emergency Department (ED), it was obvious the unique needs of this group needed to be addressed. Last July, in alignment with Ontario’s Action Plan for Seniors, CKHA proposed a new Care of the Elderly Strategy incorporating a system-level integrated approach for improved care.
With support from the Erie St. Clair Local Health Integrated Network (ESC LHIN) and IDEAS, a province-wide learning initiative to advance Ontario’s health system priorities, an IDEAS project, Improving Access to Geriatric Rehabilitative Care for Seniors Presenting to the Emergency Department was developed at CKHA to address the challenges of senior patients who present at the Emergency Department. A new screening tool to identify patients at highest risk was the first project priority.
“Sometimes there is a perception that an older person would not be able to manage at home and because of this, there is a potentially premature movement towards institutionalization,” said Nancy Snobelen, Director, Partnerships, System Integration and Rural Health. “Using this screening tool helps us send patients home in a more optimal state and offer an effective care path to better their mobility.”
The project’s goal is to properly identify seniors who require comprehensive geriatric assessment and service planning when they present at the ED. This involves identifying seniors at high-risk for functional impairment, hospital admission and complex discharge planning; improving transitions to the community; designing and delivering the most efficient use of specialized geriatric resources and rehabilitative care; and, facilitating knowledge transfer and process change across the ESC LHIN region.
“Frail seniors with complex medical needs are a priority population in our strategic plan. This project helps us identify these patients and provide the care they need,” said Helen Johnson, Lead – Erie St. Clair Rehabilitation Network. “We also need specialized knowledge and training to address the challenges of a growing proportion of older people with complex issues, which is work the hospital is taking on.”
The project introduced a new screening tool, the Assessment Urgency Algorithm (AUA) to identify older adults who are at highest risk and require assessment by the GEM Nurse. A secondary goal is to identify older patients who might be able to proceed directly into rehabilitative care, avoiding an acute care admission. This tool has been endorsed as a provincial standard to identify frail seniors at high risk of acute care or long-term care admission, and has the potential to develop standardized care paths in the ED.
Now, when an elderly patient (75+) presents to the ED during the day shift, the patient receives the essential care they require. The GEM nurse consults with the patient using the AUA screening tool, a comprehensive plan is developed, and connects the patient with a Care Coordinator from the Community Care Access Centre (CCAC) in the community.
When a patient presents off-hours, the primary care nurses and physicians provide care to the best of their ability, however, they may not always be able to meet the needs unique to the elderly. Work is being done to create a plan for follow-up for patients who present in the evening, and are identified as requiring assessment by a GEM nurse or CCAC Care Coordinator.
To support the project and advance its own, “Care of the Elderly” strategy, CKHA is planning three layers of education around the IDEAS project – from introductory to advanced levels of knowledge.
Gentle Persuasion Approaches, facilitated by the Alzheimer Society of Chatham-Kent, offer staff a basic understanding of dementia and associated responsive behaviours. Staff will learn communication strategies to help diffuse some common challenging situations and learn that all responsive behaviours have meaning and often represent the unmet needs of clients.
A staff focus group determined that case studies and role-playing were preferred ways to learn. Since patient advisors are the voice of the patient, patient advisors acting as patients will support the second level of education. Staff will learn about physical changes common with aging, and how to adapt their approaches to provide specialized care to seniors. Through this role playing, staff learns what they do right, how they can change and improve to make care better.
The final level of education is Champion Training. This involves training clinical experts in the organization (other than GEM nurses) in more advanced levels of geriatric assessment and management. In this way, the tracking tool helps identify those patients at higher risk and training helps build a well-equipped staff to help the patient along their journey.
The AUA tool will be spread to other hospitals in the ESC LHIN. As well, the entire IDEAS project is part of a larger provincial initiative of implementing an “Assess and Restore” philosophy of care. In understanding how this new tool and process works, Chatham-Kent Health Alliance and other hospitals will be more prepared for the wave of seniors presenting to Emergency Departments across the province.