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Brought to you by: TRANSITION OF CARE SUMMIT JULY 10, 2014

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-Admitted to a Senior Living Community January 3, 2014 -87 Years Old -Atrial Fibrillation, Hypertension, Congestive Heart Failure, Dementia Mr. Graham Jones Insert Picture Here

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Holiday Time 2014 Mr. Jones is diagnosed with Lung Cancer Mr. Jones designated his daughter as his MPOA Mr. Jones discussed his desires at the end of life and completed a MOST form and OOH DNR Mr. Jones decided it was time to stop living at home due to debilitation from chemotherapy.

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Mr. Jones Favorite Activities Enjoyed Mens Luncheon Wii Golf Visiting the community store Waking up early to read the newspaper At HomeAt Community Enjoyed: Cooking & Grilling Waking up early to read the newspaper Golf Spending time with his Granddaughter

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At the Community March 12-Mr. Jones had a ground level fall after breakfast Assessment reveals Mr. Jones has a minor abrasion to scalp Doctor orders transport to ED for CT scan

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At the Community MedStar Contacted Staff Prepares MARS & Removes Last Given Doses Coumadin 2.5 mg once daily Digoxin 0.125 mg once daily Coreg 2.5 mg once daily Aricept 5 mg once daily EMS arrives on Scene

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MedStar Non-Emergent Transport Arrives Report provided and appropriate transport paperwork including the most recent Medication Administration Record and History & Physical by Physician Patient found sitting upright in bed without obvious sign of distress or discomfort

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Patient complains of only minor injury without tenderness to Cervical Spine or back. Patient placed on stretcher and transport completed without change in status or mentation V/S: B/P:142/80 P: 70 RR:16nl SPO2:99ra MedStar Non-Emergent Transport Arrives

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At Hospital CT exams performed negative INR results 3.5 with a desired INR of 2.0 Negative Exam Discharge Order Written with Coumadin decrease to 2.0 with INR rechecks daily Transport Called Report is not called ED Care Summary Sent to Community

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Return to Community Mr. Jones arrives via NETI later on March 12 at 8:00 pm Community greets Mr. Jones and prepares him dinner, while planning to call hospital for missed report At shift change, evening staff does not realize Mr. Jones went to hospital

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Return to Community March 13 th, the evening nurse brings him his daily newspaper and coffee at 5:00 am and Mr. Jones will not wake up Nurse calls 911 Nurse prepares documents for transfer to hospital

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MedStar Arrival Patient found lying supine in bed GCS: 4 B/P:250/140 P:40 RR:4 SPO2:50%ra Paramedic determines need for rapid Advanced Life Support

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MedStar Treatment BLS Airway Placed and patient transferred to ambulance ALS interventions in ambulance Intubation IV, EKG Emergent Transport to Trauma center Report Called to alert trauma staff

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MedStar Arrival At Hospital Patient moved to Trauma 1 and Stat Team given report During transition it was noted that Paperwork was soaked in emesis due to complications during intubation Paperwork destroyed

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At Hospital Mr. Jones has CT head reveals ICH with a midline shift Neurosurgery is consulted in ED Staff is unable to contact family Neurosurgery takes patient to Operating Room for emergency surgery

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OR to ICU Mr. Jones arrives to ICU on ventilator support and with ventricular drain Staff attempts to contact family with continued no response ICU Staff realizes patient is from Community ICU staff requests records from Community

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ICU Family returns call to ICU ICU staff speaks with family via phone ICU staff call Community again regarding paperwork

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Family Arrives

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ICU Paper work received from Community Out of Hospital DNR/Advance Directives received Family agrees to withdraw care Patient begins Palliative Treatment

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Cost Analysis ED Costs $4000 Operating Room Costs $15,000 ICU Room Costs $3,500 Total Cost $22,500

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Improvements & Discussions