Overview
Clinical Responsibilities
Background Information
Clinical Rotation Objectives
Weekly Schedule
Consultation Guidelines

Overview

e are an interdisciplinary group of health care providers with a special interest in older adults.


Our Resources Include:

Clinical Pharmacist
Dietitian
Nurses
Occupational Therapists
Physical Therapists
Physicians from Geriatrics and Internal Medicine, and Geropsychiatry
Psychologist
Recreational Therapists
Social Workers


What Services Do We Provide?

Consultation

Consultation on older patients (age > 65) concerning any aspects of acute or long-term care. Our special interest is in those patients with multiple interacting problems that threaten independent function. The scope of the consultation service includes:

	Diagnosis and management of medical problems of older adults
	Medical care of the older surgical patient, including pre-operative evaluation and post-operative management
	Comprehensive assessment of functional status and appropriate levels of care, e.g., "can this patient go home rather than to a nursing home, or to some other less restrictive environment?"
.	Discharge planning to optimize use of community and outpatient services available for the elderly, including follow-up with SeniorCare Clinic if desired.

Medicine G (SeniorCare) Inpatient Unit (4 East Hospital) 4EH

Patients are admitted or transferred to the inpatient unit if the patient has potential for rehabilitation or stabilization at an improved level of function through intensive and coordinated evaluation and therapy. (Contact the consultation resident).

SeniorCare Outpatient Clinic (4 West Clinic) 4WC

Comprehensive outpatient care is provided at the SeniorCare Clinic by a multidisciplinary team of physicians, nurses, social workers, and a physical therapist. Post-hospitalization appointments can be scheduled through the SeniorCare Clinic (731-4191).


Who Do You Contact For Consultation?

Page the Medicine G resident or send consultation sheet to 4EH Medicine G (Box 359815) stating the purpose of the consultation, and specific questions to be addressed.



Clinical Responsibilities

Inpatient Service - The interns are primarily responsible for caring for inpatients under the direct supervision of the resident. The Attending supervises the intern when the resident is not available (e.g., during clinic).

Consultation Service - The geriatrics service provides geriatric medicine consultations for all orthopedic and urology patients 65 years of age and older within 24 hours of admission (see memoranda attached), and for patients on other services by request. The resident has primary responsibility for consultations.

SeniorCare Clinic - Interns attend weekly SeniorCare Clinic on Tuesdays, 8:30 am to 12 noon or Thursdays, 12:30 to 5:00 pm (4WC).

Rounds - On weekdays, interns and residents jointly conduct work rounds on inpatients and active consultations. On weekends and holidays when the intern is on-call, he/she is accompanied on work rounds by the Attending; the resident rounds independently (or with the subintern if one is on service). Attending rounds, Chief of Service rounds, geriatrics multidisciplinary team rounds, geropsychiatry rounds and geriatrics/neurology/ rehabilitation medicine rounds are required for interns and residents (please see schedule for times and locations). Interns and residents are responsible for presenting inpatients and consultations, respectively, to the geriatrics team at multidisciplinary team rounds.

Conferences - Attendance at the following conferences is required:

Department of Medicine Grand Rounds, every Thursday 8:00 - 9:00 AM, UW Health Sciences Center

Division of Gerontology and Geriatric Medicine Weekly Conferences (Grand Rounds, Journal Club, Research Conference) Friday, 8:00 - 9:00 AM, HMC 10EH18.

During their rotation, each intern and resident is required to formally present a geriatrics topic of their choice to the geriatric medicine team.

Admissions-See attached for eligibility criteria. The resident in conjunction with the Attending is primarily responsible for decisions regarding admission or transfer of patients to geriatrics inpatient unit.

Progress Notes-House officers are expected to write daily progress notes and dictate discharge summaries for all inpatients, as required by the JCAHO.


Background Information

he SeniorCare Program was initially conceived in 1976 by the Long Term Comprehensive Care Committee at the University of Washington. 1979 was the beginning of the outpatient clinic portion and in 1980 we began the inpatient program with six beds.

We have built up the program to include:

	A full-time medical fellow.
	A geriatrics oriented nursing staff.
	A full-time social worker, part-time social worker assistant.
	A recreational therapist.
	An occupational therapist.
	A physical therapist.
	A pharmacist.
	Medical resident rotations.
	An elective subinternship rotation for medical students.
	Nutrition support services.
	Nursing home follow-up service .

We have Interdisciplinary Rounds on Tuesdays, 1:45 - 2:45 pm and on Thursdays, 11:30 am - 12:00 noon.



Clinical Rotation Objectives

hese objectives have been designed to provide you with the opportunity for a better understanding of the geriatric program.


Nursing Objectives

	To understand the structure of the current consultation team and to support it.
	Review of format for Tuesday Interdisciplinary Rounds.
	Familiarity with established nursing protocols for 4EH (i.e., wound management, bowel programs, etc.).
	Discussion of on-call system and expectations for weekend coverage.
	Explanation of structure of Nursing Service, objectives with primary nursing and nursing plan of care.
	Overview of discharge planning, necessity for information sharing and expectations from nursing that assists with process.

Social Work Objectives

	To participate in a family conference that includes the interdisciplinary team.
	To do a complete psychosocial assessment of a SeniorCare patient.
	To understand options available for legal interventions for patients who are incapacitated or abused/neglected.
	To review "continuum of care" options from least restrictive living environments to the most restrictive living environment.
	Review teaching articles used for educating families about the dementia process.
	Overview of discharge planning from social work perspective.

Occupational Therapy Objectives

	Recognize the importance of functional evaluations for geriatric patients to increase safety and decrease change of readmission.
	To recognize how important home visits are in disposition planning for evaluation of safety, w/c accessibility, and more thorough assessment of cognitive function within patient's own environment.
	To recognize which cognitive skills are necessary for a patient to function at home.
	Given a geriatric patient, determine if the patient has sufficient skills to function in a CCF, at home with assistance, or home alone.
	To make appropriate referrals to Occupational Therapy.

Physical Therapy

	To observe how a physical therapy evaluation is done and a treatment plan developed.
	Advantages and disadvantages of different hydrotherapy treatments and pain treatments.
	Review services provided (gait training, mobility training, therapeutic exercise, advanced ambulation skills, standard PT modalities, etc.)
	To understand how a PT program for a geriatric patient is developed to address the multiple deficits of aging, the physical, mental, and social changes, the effects of prolonged bed rest and of medication side-effects on mobility.

Recreational Therapy

	To review the working philosophy and goals of the RT services in working with the geriatric patient.
	To review on-unit/in-house programs offered by RT (exercise session, group lunch, leisure assessment, cooking, performing arts program).
	To review the RT role in the discharge planning process (Community Integration Program, disposition visits, community referrals).

Nutrition Services

	To be able to identify patients at nutritional risk who require an in-depth nutritional assessment.
	To be familiar with methods used to calculate patient's calorie/protein needs and conditions in which the patient is hypermetobolic.
	Evaluate patient's ability to meet energy/protein needs with p.o. intake alone vs. supplemental support.
	To review oral supplements and tube feeding products available at HMC.
	Assess the appropriateness of a restricted diet for home use, considering factors such as economic feasibility, patient's knowledge and motivation, home support, intake PTA, cultural food preferences, etc.

Weekly Schedule

Weekly Schedule (July 2004-June 2005) 
Harborview Medical Center

Consultation Guidelines

ur purpose is twofold:

To improve pre-operative and post-operative care of elderly patients on the Orthopedic and Urology Services.

To enhance educational experience of medicine housestaff in the pre-operative and post-operative care of surgical patients with emphasis on the problems of the elderly.

	All patients, 65 years and older, admitted to the Orthopaedic or Urology Services will be referred to the Geriatric Medicine team by the Orthopaedic or Urology Resident and as soon after admission as possible.
	The consultation should be made by phone directly to the Geriatric Resident on-call. A call schedule is available on the SeniorCare, Orthopedics and Urology Services.
	The Geriatric Medicine team will see patients on a daily basis.
	The Geriatric Attending will see patients within 24 hours of admission.
	Decisions to transfer patients to Medicine G (4 East Hospital) will be made in conjunction with the Orthopaedic or the Urology Resident.
	The Geriatric Resident will be able to order non-invasive diagnostic tests directly and will write "OK'd by Ortho or Urology" under his/her signature.
	Further plans for management of medical problems will be outlined in the consultation note from the Geriatric Resident.

Any questions regarding these guidelines, please contact the Geriatrics Resident.

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Last updated March 16, 2005