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Senior Friendly Hospitals & RGPsSenior Friendly Hospitals & RGPsof Ontario of Ontario
HNHB LHIN Board Meeting – June 22, 2011Report of SFH Survey Findings for HNHB LHINReport of SFH Survey Findings for HNHB LHIN
Acknowledgements:Ken Wong, Resource Consultant, RGP of Toronto
Dr. Barbara Liu, Executive Director, RGP of TorontoMs. Anne Pizzacella, CNS, HHS
Ms. Shirley Stewart, Advisor HNHB LHINDavid Jewell, RGP Central, Administrative Director
Thank you to the Ms. Donna Cripps, Ms. S SShirley Stewart, and the HNHB Board, and invited guests
HNHB LHIN/Geriatric Access and Integration Network Senior Friendly Hospital Task Force y pWorking Group◦ LHIN Student contributors: Elizabeth Erent and Jennifer
Gallant◦ RGP Project Assistants: Natasha Voogd and Anisha
Chouhand
2
1. Introductions & Background of Senior Friendly Hospital (SFH) Survey & Next Steps – 5 - 7mins
2. Senior Friendly Hospital Survey Report – Summary of findings – 30 mins
3. Self Assessment Aggregate Responses & Summary of Recommendations – 5-7 minsSummary of Recommendations 5 7 mins
4. Questions & Comments – 10 mins
3
Senior Friendly Hospital Care in the HNHB LHIN• Background document & self assessment template were distributed to HNHB LHIN hospital CEOs December 2010CEOs, December 2010
• Both documents, RGPs of Ontario endorsed Senior Friendly Hospital Framework
•5 Domains
• Submission of completed surveys March 2011
• “A Summary of Senior Friendly Care in HNHB LHIN Hospitals” in June 2011
Id tifi ti f i i ti i th HNHB • Identification of promising practices in the HNHB LHIN and opportunities for system-level improvement in Senior Friendly Care
• Current - “Roll out” and work plan 2011
Senior Friendly Hospital Care in the HNHB LHIN• Background document & self assessment template were distributed to HNHB LHIN hospital CEOs December 2010CEOs, December 2010
• Both documents, RGPs of Ontario endorsed Senior Friendly Hospital Framework
•5 Domains
• Submission of completed surveys March 2011
• “A Summary of Senior Friendly Care in TC LHIN Hospitals” in June 2011
Id tifi ti f i i ti i th HNHB • Identification of promising practices in the HNHB LHIN and opportunities for system-level improvement in Senior Friendly Care
• Current - “Roll out” and work plan 2011
Five DomainsOrganizational SupportO ga at o a Suppo t
• leadership structures/committees with influence to guideorganizational direction and to champion SFH initiativesorganizational direction and to champion SFH initiatives
• support for organization-wide education on the needs of olderpatients to create a culture that empowers senior friendly care
- 3 tier NICHE-based program that includes clinical, non-clinical, and volunteer staff
• HR practices which encourage development in frailty focusedknowledge and skills
• consulting with stakeholders including older patients and• consulting with stakeholders, including older patients andcommunity partners, when developing programs
Five DomainsProcesses of Care
Clinical protocols:
use of protocols/metrics for:
falls, pressure ulcers, restraints, pain, incontinence, behavioural problems,
delirium, dementia, functional decline, elder abuse, sleep, hydration/ nutrition
prevention of deconditioning and rehabilitation programs for cognitively impaired patients
teamwork and inter-professional practice in hospitalsteamwork and inter-professional practice in hospitals
inter-organizational collaboration for partnership with the community-
Five DomainsEmotional and Behavioural Environment
• Quality programs structured to improve care or service in a waythat considers the needs of seniors
Emotional and Behavioural Environment
- for example, senior-specific elements in patientsatisfaction surveys
F l h i t b tt ti t /f ili i • Formal mechanisms to better engage patients/families in care- admission screening tool to determine preferences in careparticipation
ti t/f il t d l i d i i- patient/family engagement rounds early in admission- programs offering education to the public
Ethics in Clinical Care and Research• services of an ethicist, and having the capacity and resources torespond to unique ethical situations as they arise
Ethics in Clinical Care and Research
p q y
Five Domains
Physical Environment
• Senior friendly resources id d di
Physical Environment
or evidence used to auditphysical spaces
• having staff with expertise on senior friendly design• having staff with expertise on senior friendly designprinciples who contribute to physical planning committees
- geriatrics representation on accessibility committee
• knowledge transfer of senior friendly physical design to guide ongoing environmental changes, development, maintenance
and equipment and furniture procurementand equipment and furniture procurement
What’s Next?What s Next?• HNHB LHIN Senior Friendly Hospital survey reports –June 14, 2011•Senior Friendly Hospital survey reports across theprovince of Ontario to be sent to TC RGP
• RGPs of Ontario working with 13 LHINs to produce• RGPs of Ontario working with 13 LHINs to produceregional SFH summary reports • Coordination by TC LHIN
and RGP of Toronto• 14 LHIN reports will beanalyzed and provincialsummary report of SFHsummary report of SFHcare will be written
•July 2011
What’s Next?What s Next?
PHASE 1 PHASE 2 PHASE 3 - ONGOING
Objective• Identify current
Objective• Monitor and sustain hospital and systemy
state
Plan• Hospital self-
hospital and system improvements
Future StateP f i l d li
Objective • Close the gap
Plan• Hospital self-assessments
• LHIN-level roll-up
P i i l ll
• Prevent functional decline• Improve patient experience• Enable hospital staff
Plan• Implement hospital
improvement plans• Develop key
bl• Provincial roll-up • Improve equityenablers
The Senior Friendly Hospitals Toolkit• online at www.seniorfriendlyhospitals.ca, the toolkit providesclinical resources under the five framework domains, and providesan avenue for knowledge sharing to assist hospitals in their work
The Senior Friendly Hospitals Toolkit
an avenue for knowledge sharing to assist hospitals in their workof becoming Senior Friendly
Senior Friendly Hospitals & RGPs Senior Friendly Hospitals & RGPs of Ontarioof Ontario
Report of SFH Survey Findings for l ld dHamilton Niagara Haldimand Brant
LHIN
Presented by : Ms. Anne ll ClPizzacella, Clinician Nurse
Specialist
13
HNHB LHIN: 19.4 % of population > 65 (provincial average 17 %), 2008/20091
HNHB LHIN has the highest number of individuals > 65 in Ontario (200 000 plus)1individuals > 65 in Ontario (200,000 plus)1
Significant growth over the next 10 years :Significant growth over the next 10 years : age 65-74 growing by 43.8%, age 75 and over by 34.1% 2
1Bronskill, SE et al, Aging in Ontario: An ICES Chartbook of Health Service Use by Older Adults. Toronto: Institute for Clinical Evaluative Sciences; 2010.
2 Population Projections, LHIN, Ontario Ministry of Health and Long Term care, IntelliHEALTH2 Population Projections, LHIN, Ontario Ministry of Health and Long Term care, IntelliHEALTH Ontario,
14
Definition: Frailty denotes a multidimensional syndrome of loss of reserves (energy, physical ability, cognition, health)( gy, p y y, g , )that gives rise to vulnerability or increased risk of adverse health outcome (Rockwood,2005)
National Population Health Study, Rockwood 20113p y
Frailty rate 22.4 % over 65, increasing to 43.7% over 85
Frail people used health care resources more often
Institute of Clinical Evaluative Sciences 2008/09 1
Ontario Frailty rate, 8% over age 65
20% over age 85
3.Rockwood, K et al. 2011. Changes in Relative Fitness and Frailty Across the Adult Lifespan: Evidence from the Canadian National Population Health Survey. CMAJ
15
Seniors in HNHB LHIN represent
20% of hospital ER visits,
63% f t h it l d63% of acute hospital days
83% of hospital ALC days83% of hospital ALC days
16
40%
30%
35%
20%
25%
65-74
75-84
85+
10%
15% 85+
0%
5%
ED visits Hospital Days ALC days
17
10 h i l i i 2210 hospital corporations representing 22 hospitals
Size varies: 600 bed academic hospital to less than 50 bed rural hospital
12 acute, 5 Rehab/CC, 5 other (4 ambulatory and 1 tertiary care mental health)
70 % pop is urban (Hamilton/Burlington)
18
Survey design is not intended to be comprehensive or comparative between hospitals
Potential under reporting/over reporting i e successes and challengesi.e. successes and challenges
Analysis of reported data limited byAnalysis of reported data limited by heterogeneous measures (i.e. falls, ulcers and ED readmission)
19
O l SOrganizational Support
Processes of CareProcesses of Care
Emotional and Behavioural Environment
Ethics in Clinical Care and Research
Physical Environment
20
50% of hospital corporations have a board commitment to Senior Friendly model of carecommitment to Senior Friendly model of care
30% have a seniors focused committee structure (three hospitals)
80% have a senior executive designated as80% have a senior executive designated as lead for senior care initiatives
80% have identified at least one seniors’ champion (term not defined)
21
86% of hospitals have staff dedicated to care of older adults (FTE varies from 0 04 to 10)of older adults (FTE varies from 0.04 to 10)
Strong interest in recruiting/developing staff with specialized competencies in geriatricswith specialized competencies in geriatrics
Challenges:Fi di i d i li d ffFinding experienced specialized staffDedicating already limited staff to seniors issues (small systems)Resources and strategies to educate all staffNo HR strategy for future needs
22
S l l lStrategies; in-services, clinical protocols and interdisciplinary rounds
Seniors specific orientation to new staff-four acute sites and one CC-one hour to
done day
Monthly geriatric roundsMonthly geriatric rounds
Seniors month education
23
P i d F ili Cli i lPatients and Families – Clinical encounters and Patient Relations
Three hospitals have internally developed senior specific surveys/interviews
All have generic patient satisfaction tools (PICKER)
Community partners-focus groups, forums
24
h h l l h hMany high level partnerships to smooth transitions, identify system gaps e.g. CCAC, LHINCCAC, LHIN
Regional programs: ALC, Regional Stroke, Hi fHip fracture
Many partnerships with communityMany partnerships with community service providers including outreach to LTC, “Y”
25
Increased CCAC resourcesIncreased CCAC resources
‘Hospital in the home’ alternatives
Enhanced primary care chronic disease management
Enhanced medical and NP resources in LTC
Enhanced End of Life planning and care throughout the system
More support for family and LTC to prevent and manage challenging behaviour
26
Board Commitment to a SFH model of care with executive structure in place to design andexecutive structure in place to design and implement initiatives
Two sites have adopted the RGP SFH frameworkTwo sites have adopted the RGP SFH framework
High interest in developing staff geriatric competenciescompetencies
Master Aging Plan
Sharing specialized staff between academic and rural hospitals
Gentle Persuasive Approaches in two Rehab and three acute sites 27
Protocols and Monitoring for Areas of Risk
Successful Geriatric Initiatives
Discharge Planning Practices
Needs of Seniors in the ED
l dSpecialized Geriatric Services
28
95% 95%100%
120%g
in P
lace
Hospital - Protocol in Place
Hospital Active
55%
91% 91%
64%
91%
77%86%
68%
86%
60%
80%
Activ
e M
onito
ring Hospital - Active
Monitoring of Metric
32%
50%55%
41%45%
27%
36%
18%
36%
18%23%
20%
40%
60%
with
Pro
toco
l/A
0%
9%
0%
9% 9%
0%
20%
cent
of H
ospi
tals
Perc
Confirmed Risk Area
29
Protocols : 80-95% of hospitals have l i l f f ll lprotocols in place for falls, pressure ulcers,
adverse drug reactions, pain management and restraintsand restraints
Monitoring: < 50% of hospitals have monitoring in place for protocols except falls, pressure sores, and adverse drug reactions
No protocol or metric for sleep management
30
10
12
4
6
8
10
Hos
pita
ls
0
2
4
# of
H
31
Cross Appointments: i.e.; Director across an acute hospital and a primary care organizationacute hospital and a primary care organization, manger between acute care and CCAC
Community partnerships: Long Term Care Sector,Community partnerships: Long Term Care Sector, Homeless Shelter, the “Y”
Complex Case Resolution committeep
Day therapy program for deconditioned seniors transitioning home
Graduated Discharge – rehab
32
HELP in ED – focus on preventing delirium, preserving cognition and functionpreserving cognition and function
GAITE – NP led multidisciplinary assessment p yof at risk seniors in ED
GIMRAC clinic internal med sees patientGIMRAC clinic-internal med sees patient within 24hours of ED visit
Hi-Lo Stretchers with pressure reduction surfaces
33
Staff orientation and education Programs
Age-sensitive patient satisfaction measure
Process to help older patients feel informed and involved
Supporting cultural diversity
Supporting attitudes and behaviours of health professional students
34
Yes 75%,
Varies in length – one hour to one day
Universal education for restraints and falls
GPA mandatory for all new staff in two Rehab/CCC sitesRehab/CCC sites
35
50% yes but50% yes but…
Picker survey, clinical encounters, patient l ti ( t iti )relations, (not age sensitive),
Introduction of senior specific satisfaction i 2011 h i lsurvey in 2011 at one hospital
Patient experience mappingp pp g
Senior specific surveying - HELP patients and GAITE clinic out patients p
36
All hospitals support cultural diversity through translators, texts in multiple language
Cultural support from chaplaincy
Aboriginal advocacy programs in 2 hospitalshospitals
None are senior specific p
37
Access to ethicist? 70% Yes
Advance Care Directives in place? 45 % yes, one in progress
Most common Ethical issues: Competency, SDM, End of Life Treatment, Living at risk, Interprofessional conflictInterprofessional conflict
Addressing Ethical issues: Capacity Board & Public Guardian, Capacity
Assessors, Psychiatry, policy on consent, interdisciplinary team, CCAC,
38
All hospitals reported physical environment as a challenge to SFHchallenge to SFH
Accessibility for Ontarians with Disability Act th t d d t i ifiwas the common standard – not senior specific
2 corporations (7sites) have conducted senior friendly environmental audits using Code Plus
19 of 22 hospitals are making/planning changes 9 o osp ta s a e a g/p a g c a gesto the environment over the next 3 years
39
Resources – financial (N=10), human (N=6)
Aging physical environment (N=9)
Culture: competing demands, specialization focus, ageism (N=6), g ( )
Indicators/measurement (N=2)
Specialized knowledge (N=2)
40
LHIN wide model of SFH care
LHIN wide standards and metrics with d imandatory reporting
Best Evidence Based Practices for SeniorsBest Evidence Based Practices for Seniors added to accreditation standards
LHIN wide senior specific patient satisfaction tools
41
Enhanced community supports
Help with recruitment of specialized i lseniors roles
Dissemination of successesDissemination of successes
Physical environment; standards andPhysical environment; standards and strategies
42
Falls Pressure ulcers Hospital utilization (ED, LOS, Diverted d i i ALC d di i i )admission, ALC days, disposition)
Restraint usePressure ulcersPressure ulcersContinenceEducationEducationPhysical Environment
43
Senior Friendly Hospitals & RGPs Senior Friendly Hospitals & RGPs of Ontarioof Ontario
Report of SFH Survey –dRecommendations
d b hPresented by : Dr. Sharon Marr
44
Self Assessment Question Aggregate All Hospitals ResponseResponse
A1.0 SFH priority or goal 41 % yes
C1.1 Board of Directors and is there an explicit commitment
45 % yesthere an explicit commitmentC1.2 Senior Executive for SFH 64 % yes
C1.4 Designated committee for 41 % yescare of the elderlyC2.1 Protocols & Monitoring 48 % in place
C3.2 Age-sensitive patient 50 % yesC3.2 Age sensitive patient satisfaction
50 % yes
C3.5 Programs/processes to support attitudes and
82 % yes
45
behaviours of HCP learners
Self Assessment Question Aggregate All Hospitals Response
C3.4 Support for cultural 95 % yes *ppdiversity among seniors and their families
y
C4.1 Access to ethicist 82 % yes
C4.2 Specific policy on Advance Care Directives
45 % yes
C5 2 SFH di f i h i l 32 %C5.2 SFH audit of its physical environment
32 % yes
46
Organizational Support
There is a need for the following:Explicit commitment from all hospital p c t co t e t o a osp taboards with the designation of senior executive role(s)
Development of a committee structure to develop, adopt, and implement the goals p, p , p gand strategies for a Senior Friendly Hospital
47
Processes of CareHNHB LHIN should request hospitals to
“clearly state” their QI plans, including EBM practice guidelines, protocols, and measurement tools for a Senior Friendly H it lHospitalStandardization of performance indicators measurement tools andindicators, measurement tools, and monitoring methods are needed
48
Processes of CareHNHB LHIN should request the Geriatric
Access & Integration Network (GAIN) in ll b i i h h RGP C l HNHBcollaboration with the RGP Central, HNHB
Hospitals, community organization, and LHIN reps to:LHIN reps to:
Identify and establish EBM best practicesy pFoster the implementation of these Collaboration and partnerships
49
Emotional & BehaviouralEnvironmentHNHB LHIN hospitals should have a
h i HR l f h fcomprehensive HR plan for the future needs of our seniors
AHSC including its universities and colleges need to collaborate with HNHB hospitals to educate our future health care providers and leaders
50
Emotional & BehaviouralEnvironment – continued
Need for cultural diversity to be senior-specific & explicitly defined
51
Ethics in Clinical Care and ResearchAll HNHB LHIN hospital staff should
have timely access to ethical expertise and processes (i.e. Advanced Directives) when managing ethical dilemmas
Capacity building strongly d drecommended
52
Physical EnvironmentHealth Capital Investment Branch of the
MOH LTC should incorporate Code Plus design guidelines into their capital planning guidelines and facility
tassessment processAll HNHB LHIN hospitals should conduct regularly scheduled senior friendlyregularly scheduled senior friendly environmental audits
53
Physical Environmenty
Need for education andNeed for education and dissemination of Senior Friendly Hospital design guidelines toHospital design guidelines to appropriate staff
54
Questions and CommentsComments
55
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