About the Project
How does a small, multidisciplinary team keep up with an increasing volume of patients without sacrificing quality of care? The Geriatric Evaluation and Management (GEM) team at VGH and RJH faced this challenge. The GEM team provides specialized geriatric assessment and treatment recommendations in a consultation liaison model as part of the Geriatric Specialty Services (GSS). Dr. Jennifer Oates, Geriatric Psychiatrist for the GEM team explained, “60% of those in the hospital are elderly. Not all are frail, but many are.”
Noting a decline in the quality of care provided to senior patients as a result of higher acuity, bed shortages, and staffing shortage, the GEM team wanted to explore how they could better support and build the capacity of acute care teams under these increasingly difficult conditions. As part of this review, the team felt it was crucial to seek the suggestions, concerns, and experiences of the hospitalists, who are the source of the majority of GEM referrals, and of others who increasingly share in the care of frail, elderly patients.
The GEM Team sought funding from the South Island MSA to meet with the hospitalists at VGH and RJH. Though the groups had connected informally before, this was a novel opportunity for everyone to share their common struggles around ensuring quality care and to devise steps to address these limitations.
Dr. Oates spoke about the value of bringing people together: “We had talked informally with them but this really cemented the connection. ‘You have my cell phone, I have yours’, that kind of thing. It generated some good common ideas about how to tackle these challenges.”
Feedback from the hospitalists and others with interest in seniors care was used to directly inform the next steps. Hospitalists spoke about the value of the GEM service, and of the need for it to be bigger to cope with increasing demand. In the short term, they discussed strategies to meet the needs of the growing patient population without a commensurate increase in resources. “The focus was on how we support people providing the care, so that we can identify problems early, and stop any negative outcomes,” says Dr. Oates. “If we have regular reminders about good delirium care, good procedures to follow when someone is disoriented, we can avoid unnecessary restraints and sedation whenever possible.”
This project culminated in a retreat that brought together the GEM geriatric medicine and psychiatry physician team, as well as their interdisciplinary colleagues, to review the feedback from hospitalists and devise working plans for the next two years. Two projects have launched as a result of these conversations: one to improve the mobilization of elderly patients in acute care, spearheaded by Dr. Ally Nakanishi, and another to identify the most vulnerable elderly for rapid, enhanced care )including targeted care in the ER), led by Dr. Alyson Osborne.
We commend the entire GEM team and the hospitalist service at RJH and VGH for their commitment to improving the care of frail and elderly patients!