Implementing a Senior Friendly Hospital Strategy

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Implementing a Senior Friendly Hospital Strategy
Introduction Rationale Indicators of Quality
Care What does a SFH Look Like Benefits of Being
Senior Friendly Examples of Success with Similar
Initiatives Strategies Used by the Ottawa
Regional Geriatric Program Conceptual
Framework Evaluation Where to Go From
Here Conclusion
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• Genesis of the SFH Initiative
• Ottawa RGAP has multiple innovative
  patient-centred intiatives arising from Vision
  for Care Strategic Plan.
• Effective efficient treatment of the
• elderly in the hospital
• Market Segmentation
• Review evolving patient groups-Seniors or Frail
  Elderly
• Needs vs. current practices and design
• Environmental Scan
• Internal Strengths and Weaknesses
• Geriatric specialists available to support
  project
• Geriatric principles not pervasive through
  facilities
• External Opportunities and Threats
• Graying of the beds
• Constrained resources

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Rationale In twenty years, seniors will be 1/4
of population Seniors represent 63 of patient
pop those gt 70 years represent 44 of total
patient population Seniors consume 43 of
health-care costs Frailest elderly 3 of
population are the major client group, use 30 of
health-care resources Seniors use 1/3 of all
hospital admissions 2/3 of inpatient
days Readmission rates 42 in patients gt75
years Seniors have higher rates of return visits
to emergency Disconnect between patient needs and
hospital practices hostile environment Frail
elderly experience further functional decline not
related to acute episode but to hospital
practices Adverse effects are higher in frail
elderly even when adjusted for age/co
morbidity Challenge of reduced number of beds and
shortened length of stay
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Indicators of Quality Hospital Patient
Satisfaction Survey NRC Canadian
Average Respect for Patients Preferences 54.2
Had enough to say about their treatment 80.1
Treated with respect/dignity Emotional Support
62.5 All Dimensions combined 47 Nurse
discussed anxieties/fears 57.9 Ease of finding
someone to talk to Information Education 64.8
All Dimensions combined Continuity
Transition 58.2 When to resume normal
activities Involvement with Family 60.9 Amount
of information given to family 62.3 Family had
enough recovery information
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Other indicators Skin Integrity is a key quality
indicator Related elements are level of
activity, mobility and nutrition These elements
can be controlled with good clinical
practice Pressure Survey - 2002 83 of
patients are at risk Of these, 65 have a
deficit in nutrition 18 prevalence rate in
ulcers 37 of ulcers develop within first 7 days
after admission Seniors represent 77 of ulcer
population Costs LOS, average 31 days Vs 21 days
in intact skin population
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Other indicators
Falls 2003/04 Of the 2200 falls, those gt 71
yrs. experienced 41 of all falls Those gt71 yrs.
had 64 of pop with moderate degree of injury
Those gt71 yrs. had 74 of serious degree of
injury Use of Restraints Those gt70 yrs.
represent 39.4 of pop using restraints Those
gt70 yrs. 26.4 with both Physical Chemical
restraints
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What Does a SFH Look Like?

•   patients functional abilities are maintained
  and/or improved,
• safe and comfortable in the physical and
  emotional environments,
• care and services are provided in a respectful
  and responsive way,
• staff ask questions and listen for responses
  without making assumptions, and
• patients and families have input into decisions
  and are supported in their decisions.

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Benefits of Being Senior Friendly
Patients and families receive targeted
approaches and best practice care Care providers
note increased job satisfaction and
morale Hospitals realize reduced costs and
inappropriate use of resources Reduced LOS
benefits care receiver and provider Enhanced
Accreditation Process Increased patient
satisfaction results in Loyal, supportive
community of patients/families
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Similar Initiatives
Edmonton-Senior Friendly Toolkit Sponsored
by the Alberta Council on Aging Targeted the
community(retail sector) to direct changes in
facilities services Guide book,
Workshops/seminars, Presenters Kit, Tee shirts,
Stickers Senior Friendly Checkup with manual,
checklist scale
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Other Similar Initiatives Vancouver Island
Health Authority- Elder Friendly Hospital
Adopted the gerontology perspective for all
programs/services System-wide approach-involved
all levels and types of staff High-risk screen
at admission on all patients Objectives Predict
and prevent adverse consequences of
hospitalization Preserve functional
ability Early discharge planning and return to
the community Built strategies to enhance
nursing education re geriatric principles -
created awareness for need for change Volunteers
to follow isolated patient for 6 weeks at home
post discharge
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Implementing a Senior Friendly Hospital Strategy

• Steering Committee mandated by the RGAC to
  develop a Senior Friendly Hospital Strategy to
• Improve patient outcomes
• Reduce high rate of inappropriate use of
  resources
• Contribute to improved patient and family
  satisfaction
• K Graham, VP at the QC hospital agreed to chair
  the committee and a consultant was hired to
  develop a conceptual framework
• Partnered with the Council on Aging to collect
  information on the broader aspects from consumers
  providers on senior accessible health care with
  focus groups and a conference

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• Proposed Strategies
• Research develop Senior Friendly Guidelines
  for Physical Environment ( Acute care)
• Liaison with CCHSA re developing new
  Accreditation Standards for SFH
• Enhance Best Practice( reinforce the practice
  of approved protocols)
• Link with other facilities
• Leverage the Accessibility Act
• Liaison with St. Josephs buying group
• Theme at OHA Convention for RGPs of Ontario

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Getting Started Organizational Commitment to
facilitate change Letters to the Boards and CEOs
Introduced the Senior Friendly Hospital
concept Extended invitation to be involved and
have a representative on the Steering
Committee Invited participation of the newly
formed Accessibility Working Groups in each
hospital to participate Strong endorsement
received from local and Ottawa Valley
hospitals The intent was to have a Check List
that would inform a Report Card to direct quality
improvement activities
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Senior Friendly HospitalMajor Elements
Process of Care

• Assessment and diagnosis with special emphasis
  on age related changes
• Planning emphasis on avoiding hazards of
  hospitalization
• Implementation-use of aids to compensate for
  sensory losses
• Evaluation - consider response to
  hospitalization, impact of treatment

• Emotional and Behavioural
• Environment
• Courtesy of staff
• Respect
• Information sharing and listening
• Individualized approach to each patient
• Culturally and gender sensitive

• Ethics in Clinical Care and Research
• Confirm patients understanding of informed
  consent
• Use of Advanced Directives
• Thoughtful discussion of treatment options and
  palliative care options

• Organizational Support
• Relevant policies and procedures
• Inclusion into program development
• Staff recruitment, orientation, ongoing
  education
• Membership and TOR for committees dealing with
  patient outcomes

• Physical Environment
• Visual aspects
• Physical space including external
  surfaces/crosswalks,speed bumps, sidewalks /
  grounds
• Sensory Comfort
• Furniture

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Senior Friendly HospitalDimensions of Quality
Process of Care

• Access
• Continuity and Transition
• Coordination of Care

• Physical Comfort
• Overall Impressions
• Additional Items

• Emotional and Behavioural Environment
• Emotional support
• Information and education
• Respect for Patient Preferences
• Involvement of Family
• Overall Impressions

Ethics in Clinical Care and Research Item not
included in NRC(Picker/Smaller World ) Patient
Survey

• Organizational Support
• Additional questions

• Physical Environment
• Amenities

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Senior Friendly HospitalOther Measurements
Process of Care

• Develop and implement Senior Sensitive
  Protocols Falls, Restraints, Delirium, etc
• Adverse Events ( Encon)
• Patient / Family Comment Cards
• Utilization readmission, discharge disposition
  etc.

• Ethics in Clinical Care and Research
• Audits for informed consents
• Proportion of seniors enrolled in Research
  projects

• Emotional and Behavioural Environment
• Comment Cards
• Focus Groups

• Organizational Support
• Audits of Policies and Procedures to ensure
  sensitivity to seniors needs

• Physical Environment
• Adherence to Senior Friendly Guidelines
• Accessibility Working groups
• Focus Groups
• Audits

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Physical Environment

• Seniors are a primary patient population in
  hospitals and have distinct needs,
• WHO is recommending senior friendly health-care
  centres,
• Guidelines to support decision making for
  capital projects , purchasing and accessibility
  planning.

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Physical Environment Guidelines

• Impacts on patient safety and functional level
• Current environment creates a potential risk of
  harm and functional loss
• Causing increased LOS and cost- in human and
  financial terms
• Guidelines developed to enhance the minimum
  standards for barrier-free accessibility
• Guidelines will create a universally friendly
  hospital for all ages, education and disability
  levels and cultures

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Physical Environment Criteria

• Overall Environment
• Lighting
• Noise / Sound
• Décor
• Orientation / Wayfinding

• Specific Functional Areas
• Bedrooms
• Telephone
• Light Switches
• Hallways, Waiting Rooms, Washrooms

• Safe Mobility
• Flooring
• Doors

• Other Factors
• Large print on written materials
• Hearing amplifiers for all staff
• Consider nutrition needs

• Furniture
• Tables
• Beds, and bedside tables
• Chairs

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Emotional Behavioural Environment
Patients and their families report a need to
improve the way we communicate and demonstrate
respect Respect/dignity is a an illusive element
to measure Developed a checklist with indicators
to monitor performance in this quality domain
Clustered around questions in the NRC Hospital
Patient Satisfaction Survey Patient Satisfaction
Survey Reports will inform quality improvement
Is there a correlation between the hospitals
patient satisfaction score and the checklist
score
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Comparison of Hospital Patient Satisfaction
Survey with SFH Guidelines
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Comparison of Hospital Patient Satisfaction
Survey with SFH Guidelines
Senior Friendly Guidelines
Are staffs communications senior friendly?
Information Sharing/Listening
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Evaluation Strategies Build on Existing Tools
1. OHA Patient Satisfaction Survey Process for
Comparative Analysis Match with NRC questions
Cluster the items that are most senior
sensitive Get data releases signed by
participants Develop Proposal for Ethics
Review Identify resources needed Analysis Dr S.
Amos-RGP and Dr. A. Brown, University of
Toronto Expected Outcomes Senior Specific
Hospital Report Card Comparison of SFH
achievement across the region and provincial
hospitals 2. Use other data collection tools and
stratify by age Prevalence reports Falls,
Restraints, Adverse Incidents, etc. Patient/Family
Comment Cards, etc.
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Where to Go From Here?

• Continue to develop Conceptual Framework Elements
• Physical Environment-Completed
• Emotional/Behavioural Environment-November 03
• Care Process-June 2004
• Organizational Support- tbd
• Ethics in Clinical Care and Research-tbd
• Continue with the Communication and Education
• OHA- Toronto Nov 03
• Publication of Guidelines

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Conclusion
Acute care is not adequately oriented to the
needs of seniors , and as a result may contribute
to further loss of function Senior Friendly
Hospital Strategies promote a systematic approach
to re-orient hospitals to the needs of older
patients Ensure an environment where choices are
guided by education, research and wishes of
seniors This Senior Friendly Hospital initiative
builds on the many strengths of its community,
leaders and care receivers and providers We are
just beginning, but have made a wonderful start