panel: preventing readmissions in those with memory impairment kim butrum ms, rn, gnp: moderator jim...
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![Page 1: Panel: Preventing Readmissions in those with Memory Impairment Kim Butrum MS, RN, GNP: Moderator Jim McAleer MPA Leslie Zun MD Nicholas Jauregui MD October](https://reader030.vdocuments.mx/reader030/viewer/2022033106/56649ccc5503460f9499528e/html5/thumbnails/1.jpg)
Panel: Preventing Readmissions in those with
Memory Impairment
Kim Butrum MS, RN, GNP: ModeratorJim McAleer MPALeslie Zun MD
Nicholas Jauregui MD
October 16, 2014
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The Evidence
• Memory impairing diseases are a significant area of concern in reducing readmission rates.
NRPC So Cal Readmissions UpdateOctober 16, 2014
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Utilizing Clinical Outcomes to Prevent Readmission in those
with Dementia
Kim Butrum MS, RN, GNPVice President- Health Service
Silverado
October 16, 2014
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Use of Clinical Outcomes:The Silverado Experience
• Through the collection of clinical outcomes over the past 18 years, Silverado has reduced both their 30 day readmission rate and transfer to the acute rate to industry leading levels.
:NRPC So Cal Readmissions UpdateOctober 16, 2014
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How do we do it?
• Our culture • Education and training • Early identification and management of a
behavioral or functional change• Alignment with strong partners for both
extra support and palliative care/hospice care at different points of the disease
NRPC So Cal Readmissions UpdateOctober 16, 2014
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Don’t Prevent Readmission – Promote Community
Retention…
Presented by Jim McAleer., MPAPresident/CEO
Alzheimer’s Association
October 16, 2014
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Objectives • Know what community programs and
services can make a difference
• The Caregiver matters
• Preventing readmission begins long before the patient leaves the hospital
• Alzheimer’s Association Case Study
NRPC So Cal Readmissions UpdateOctober 16, 2014
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Dealing with Patients who have Memory Impairment in the Emergency Department
Leslie S Zun, MD, MBA, FAAEMChairman and Professor
Department of Emergency MedicineRFUMS/Chicago Medical School
Mount Sinai HospitalChicago, Illinois
October 16, 2014
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Objectives
• Understand the role of the emergency department in evaluating memory impaired patients
• To determine if the patient has a medical, psychiatric, substance use or behavioral problem
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Case #1
• 64 year old female is brought to the hospital for manic behavior. Patient has multiple medical problems but no prior psychiatric history.
• What further information is needed?
• What to look for in the physical exam?
• What testing is indicated?
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Medical ClearancePurpose
• Primary Purpose - To determine whether a medical illness is causing or exacerbating the psychiatric condition.
• Secondary Purpose - To identify medical or surgical conditions incidental to the psychiatric problem that may need treatment.
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Primary Purpose Etiology
• Drug and alcohol intoxication or withdrawal
• Medical • Hypoglycemia• Hyperthyroidism• Delirium• Dementia• Head Trauma• Temporal Lobe
Epilepsy
• Psychiatric
Psychiatric
Medical
DeliriumDementia
Hyperthyroidism Head Trauma
Temporal Lobe Epilepsy
SchizophreniaBipolsr IllnessDepression
Drug intoxication/withdrawal
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Delirium vs. dementiaDelirium Dementia
Onset Acute Slow
Awareness Reduced Clear
Alertness Fluctuates Normal
Orientation Impaired Impaired
Memory Impaired Impaired
Perception Hallucinations Intact
Thinking Disorganized Vague
Language Slow Word finding difficulty
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Primary Purpose - Differentiate Medical from
Psychiatric Etiology• Age >45 years old
• Prior psychiatric/medical history
• Abnormal vital signs
• Physical examination findings
• Cognitive deficits
• Focal neurologic findings
• New or different psychiatric complaints
• Laboratories?
• Advanced testing?
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Case #1 64 year old female is brought to the hospital for manic behavior. Patient has multiple medical problems but no prior psychiatric history.
• What information is needed?• Prior psychiatric history - none• History of medical problems – DM, HTN, CVAs• Use of drugs and alcohol - Denies
• What to look for in the physical exam?• Vital signs – tachycardia & hypertensive• Focal deficits – right sided weakness• Signs of intoxication – Heightened consciousness
• What testing is indicated?• CBC, electrolytes, UDS, alcohol level• EKG, CT scan head, CXR
• Diagnosis – Delirium from Hyperthyroidism
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Take Home Points
• Memory Impaired may present to the Emergency Department for social, behavioral, medical, substance use or psychiatric reasons.
• It is important to identify which problem or problems is/are involved
• Does the patient need to be admitted/readmitted?
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Contact Information
Leslie Zun, MD
Mount Sinai Hospital
1501 S California
Chicago, IL 60608
773-257-6957
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Preventing Readmissions in those with Dementia Across the Post Acute Continuum
Nicholas Jauregui MD
Supportive Care Medical Group
October 16, 2014
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Care Across the post- acute continuum
• Dr. Jauregui is board certified in Hospice and Palliative Care Medicine
• Medical Director: Supportive Care Medical Group, an active SNF and housecall medical group in Southern CA
NRPC So Cal Readmissions UpdateOctober 16, 2014