Curriculum for the Hospitalized Aging Medical Patient

Curriculum for the Hospitalized Aging Medical Patient CHAMP Inpatient themes and topics:

Theme #1 ID/screen the frail or vulnerable elder  What is frailty? Why is it important to ID in the hospital setting?  Screening for cognitive impairment using the mini-cog  Screening for functional impairment  Recognizing dementia  Dementia and assessing decision making capacity  Dementia and treatment of non-dementia illnesses  Assessing and treating agitated delirium

Theme #2 Avoiding Hazards of Hospitalization  Adverse Drug Reactions  Polypharmacy/ polytherapy  Medication review  Delirium recognition—using the Confusion Assessment Method (CAM)  Delirium—workup and treatment in the aging patient  Delirium—risk factors/precipitating factors and prevention in the aging patient  Falls—screening/prevention  Pressure ulcers—staging/treatment/prevention  Deconditioning  Foley catheters  Restraint use

Theme #3 Palliate and address end-of-life issues  Assessing pain  Assessing pain in the demented patient  Pain treatment and opiate conversion  DNR and advance directives  Changing goals of care and prognostication  Hospice—the idea and the Medicare benefit  Having the feeding tube discussion

Theme #4 Improving transitions of care  The ideal hospital discharge—including PCP communication and medication reconciliation  Destinations of discharge—home, skilled nursing, rehab, long-term-care  Dementia and transitioning care Teaching on Today’s Wards—Addressing aspects of Systems Based Practice & Practice Based Learning and Improvement  What is a system?  Mapping a systems problem using the process mapping tool  Using a case audit as a tool for improvement  Using a census audit as a tool for improvement Expectations of members of the Inpatient Medicine Team

Attending  Regular teaching, facilitate learning  Available for consultation  Available to fight the political battles  Attending documentation/billing obligations  Feedback on performance

Resident  Organization of rounds and work rounds  The team manager  Supports the team  Oversees the clinical care—big picture and details  Reviews primary data where possible  Supports intern and promotes autonomy to next level as possible  Reviews case and exam of students  Teaches during rounds and on-call  Ask for help

Interns  Day to day patient care  Learning by doing  Give clinical care snippets to students as you can  Primary review of data when possible  Let students know when their patients are having procedures, etc.  Ask for help

Students  Admit 2 patients per call cycle  Hand in write-ups for review  Do your own separate H&P  Review cases with intern and resident  Participate on rounds as key provider of info and data on your patients  Read about your patients  Ask questions; Ask for help  Be available to help any member of the team