Accelerating healing for patients with dementia or delirium
Thursday, September 01, 2016
A new approach to geriatric inpatient care has improved outcomes and recognition scores at Long Island Jewish (LIJ) Medical Center.
While people age 65 and older account for 46 percent of LIJ's hospital days, the facility's patient floors weren't optimized for geriatric patients with dementia or delirium. This situation complicated delivery of care and helping patients to achieve functional dependence.
The medical center met the challenge with MindFULL CARE, which emphasizes connectedness, awareness, respect and empathy for senior patients with acute confusion or a memory disorder. LIJ clinical leaders in nursing, psychology, psychiatry, internal medicine and geriatric medicine collaborated to create it.
Giving patients a more open, welcoming environment helps them feel more comfortable — and ready to heal — so renovation was a priority. The unit revamp incorporated soft colors and fewer walls, plus a shared area for patients, families and staff that encourages communication and enhances a feeling of connectedness.
Adding patient engagement specialists (PESs) to the multidisciplinary team is another significant enhancement. Under direction from nursing and patient experience leaders, PESs use techniques like dynamic appraisal of situational aggression (DASA) to help stabilize patients while they are on the mend. They involve patients with daily living activities and diversions like leisurely walks; assist RNs with certain tasks; and observe patient events and interactions that may trigger agitation or aggression.
PESs have helped LIJ Medical Center improve outcomes and significantly reduce the high costs associated with one-on-one care. Whereas the facility previously required 20 to 30 "sitters" a day at a cost of more than $2 million annually, the MindFULL CARE model needs a daily maximum of five patient engagement specialists, with projected savings of $1.2 million per year.
At the same time, MindFULL CARE has increased patient satisfaction, earning an HCAHPS survey score of 100 percent this year — the average for the previous three years was 77 percent. Furthermore, the program has eliminated the need for patient restraints and reduced readmissions.
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