During this rotation, learners are expected to:
Complete an appropriate chart review, history, and physical examination (that is appropriate for Geriatric Medicine) for new consultations assigned to their care. (See "Responsibilities of the Learner", below, for more detail.)
Complete a relevant Dovetale chart review, and targeted history and examination, on follow-up patients assigned to their care.
After review with the Geriatric Medicine Attending, communicate findings and recommendations promptly to the referring service (via an updated consultation note on Dovetale, and possibly an in-person discussion).
Complete this updated (and spell-checked) consultation note within 24 hours of reviewing a patient with the Geriatric Medicine Attending.
Work collaboratively and respectfully with the Case Managers.
Continue to follow to assigned patients at least twice weekly, until discharged from the consult service ()or discharged home). Leave clearly written notes in a patient's chart each time a follow-up is completed.
Provide cross-coverage for patients of other residents on the service when they are absent
Possibly send a brief follow-up note to a patient's Family Physician (and other involved MDs) regarding updates or outstanding issues arising from the Geriatrics consultation. (E.g. results of cognitive testing, new cognitive diagnoses, orthostatic vitals once ambulatory, results of kitchen/driving assessment, etc.) These items may not be included in the MRP discharge summary but should be conveyed to a patient's Family Physician.
This can be can be accomplished by routing a progress note. Ask your Attending for more instructions and details re same.
Provide handover (using the Geriatrics "Handover/To Do" section on Dovetale for active patients at the end of the month.
Interprofessional Collaboration
There is a heavy emphasis on interprofessional collaboration, and residents work closely with the geriatrics case managers. Residents are expected to be responsive to the requests of case managers when they feel that physician involvement is required, and decisions to discharge a patient from the service must be mutually agreed upon. Though there is naturally some overlap of roles and expertise to allow the service to work most effectively as a team, in general we follow these principles:
Responsibilities of the Case Manager:
Receive, triage and assign referrals.
Clarify with the referring team when the reason for referral is unclear.
Obtain collateral history from a patient's family member, next of kin, or close contact, regarding prior cognitive, mood and/or functional problems
Identify and obtain relevant records from prior Geriatric Medicine or Geriatric Psychiatry assessments
Perform initial cognitive screening, when indicated.
Generate an initial Case Manager’s assessment/problem list (via a Progress note in Dovetale), identifying areas that need further assessment and clarification by the physician.
Liaise with Residents after the initial consult has been reviewed to establish the follow-up plan.
Take primary responsibility for patient/family education, support, and counseling about dementia, delirium and other geriatric syndromes.
Attend Family Meetings regarding discharge planning and community services.
Advise and help implement effective non-pharmacologic strategies to prevent and manage geriatric syndromes.
Responsibilities of the Learner (Resident/Clerk):
Review the patient's past and current medical problems to understand how these are contributing to his/her/their current status.
Review the patient's course in hospital to understand the trajectory of their current issues.
Perform a detailed medication review (including use of PRN medications).
Read the Case Manager’s collateral history (in their progress note on Dovetale) and most recent iinterprofessional care team notes, to understand the patient's past and current functional and cognitive status.
Include information gathered by the Case Managers in the Consultation note on Dovetale.
Perform a thorough physical exam and review all relevant medical tests.
Using all of the above sources, generate a final assessment and problem list, with recommendations, and present this to the Geriatric Medicine Attending.
Within 24 hours of reviewing a patient with the Attending, complete an updated consultation note in Dovetale, which includes the outcome of that review (Imp/Plan and relevant issues), any recommendations (and rationale for same), and who will be responsible for implementing each of them (ie MRP or Geriatrics team).
Liaise with case managers after the initial consult has been reviewed to establish the follow-up plan.
Take primary responsibility for follow-up of medical issues identified, tests ordered, and any medication changes made to prevent and manage geriatric syndromes.
Review and collaborate with case managers on follow-up issues that arise
Review follow-up issues with the attending geriatricians on Mon/Thurs or Tues/Fri (or similar).