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The geriatric one-day hospital of the university centrum in Li

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The geriatric one-day hospital of the university centrum in Li ge, Belgium Dr Sophie Gillain, MD in charge of clinical activities in the geriatric daily clinic – PowerPoint PPT presentation

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Title: The geriatric one-day hospital of the university centrum in Li


1
The geriatric one-day hospital of the university
centrum in Liège, Belgium
  • Dr Sophie Gillain, MD in charge of clinical
    activities in the geriatric daily clinic
  • Christel Menozzi, Senior Head Nurse

2
Working plan
  • Legislative aspects of geriatric care (GC) in
    Belgium
  • Financial aspects of the geriatric one-day
    hospital
  • Every day organisation
  • Our activity
  • Guided visit and questions

3
Working plan
  • Legislative aspects of geriatric care (GC) in
    Belgium
  • Financial aspects of the geriatric one-day
    hospital
  • Every day organisation
  • Our activity
  • Guided visit and questions

4
Legislative aspects of geriatric care in Belgium
  • Since january 2007, Geriatric plan of care (GPC)
  • Each general hospital must have a GPC
  • Or be associated with an other hospital including
    these plan

5
Legislative aspects of geriatric care in Belgium
  • People gt 75 years old
  • At risk of frailty
  • At risk of polymedication
  • At risk of non typical clinical presentation of
    the disease
  • At risk of modification of drugs metabolism
  • At risk of functional declin
  • At risk of malnutrition
  • At risk to present psycho-social disorders

6
Legislative aspects of geriatric care in Belgium
  • Each people 75 years old, hospitalized have to
    be assess to these risk
  • ? role of the geriatric mobile team
  • Older assessed as at risk have to benefit of the
    GPC

7
Legislative aspects of geriatric care in Belgium
  • Main goals of GPC
  • Adapted care
  • Best way to prevent functional decline
  • Best way to carry out rehabilitation as higher is
    possible
  • Best plan of care after leaving geriatric
    department
  • Follow up
  • Discussion and plan with other caregivers
  • GP, Family members, Nursing homes,

8
Legislative aspects of geriatric care in Belgium
  • Main tools to do that
  • Acute geriatric ward
  • Geriatric consultation
  • Mobile geriatric team in the hospital
  • Mobile geriatric team beyong the hospital
  • Relation with GP, Nursing homes, Neuropsychiatric
    center
  • Geriatric one-day hospital
  • 6. Multidisciplinary approach by organise by
    caregivers

9
Specificity in university centrum
10
Legislative aspects of geriatric care in Belgium
  • Caregivers of the multidisciplinary approach
  • Geriatrician (6 years more than general medicine)
  • Geriatric nurse
  • Physiotherapist
  • Psychologist
  • Ergotherapist
  • Nutritionist
  • Speech therapist
  • Social worker

11
Legislative aspects of geriatric care in Belgium
  • Obligation concerning organisation
  • Assume all different functions
  • Acute geriatric care unit, one day hospital,
    mobile team
  • Information transmission
  • To other specialists, GP, patients and families
  • Multidisciplinary meeting / week / function
  • Find a adpated consensus for each patient

12
Legislative aspects of geriatric care in Belgium
  • Obligation concerning specialized
  • caregivers in the different functions of the GPC

13
Acute geriatric care unit (/ 24 beds)
  • 1 Geriatrician
  • Recommandations by SBGG and EUMS
  • 14.13 Full-Time Equivalent (FTE) divided into
  • 1 FTE Head nurse with a geriatric specialization
  • Minimum 4 FTE nurse with a geriatric
    specialization
  • Minimum 5 FTE nurse
  • 1,33 FTE paramedical staff
  • Neuropsychologist, Occupational therapist, Speech
    therapist

14
Mobile geriatric team
  • Concerning patients 75 years hospitalized
    outside geritric care unit and assess as at risk
  • Since 2007, funded as a pilot project 4 FTE
  • 1.7 FTE nurse and 2.3 FTE paramedical caregivers
  • Since 2014, structural financing 5.75 FTE
  • Free distribution into different caregivers

15
Geriatric One-day hospital
  • Pilot project
  • Funded 3 FTE
  • 2 FTE Nurse
  • 1 FTE Paramedical caregiver
  • Obligations to have occupational therapist,
    physiotherapist, neuropsychologist

16
Legislative aspects of geriatric care in Belgium
  • Obligation concerning continued training
  • Geriatrician
  • Ethical, Economical and Medical aspects
  • 20 points / year
  • 2 obligatory meetings / year
  • Nurses with a geriatric specialization 60 h/ 4
    years

17
Working plan
  • Legislative aspects of geriatric care (GC) in
    Belgium
  • Financial aspects of the geriatric one-day
    hospital
  • Every day organisation
  • Our activity
  • Guided visit and questions

18
Financial aspects of the one-day hospital
  • Since 2007, financial grants allowed by the
    government
  • Architectural obligations
  • Medical and multidisciplinary care obligations
  • Diagnosis and care
  • Rehabilitation
  • Only during the day
  • Obligation to have geriatrician, nurse,
    neuropsychologist, occupational therapist and
    physiotherapist
  • Possibility to consult nutritionist, social
    worker, speech therapist
  • Annual report of activities

19
Financial aspects of the one-day hsopital
  • Our classical financial support is related to
  • Only two multisciplinary assessment per year
  • For two differents reasons
  • All visit as a medical consultation
  • Some administrative tasks
  • Ask the reimbursement of specific drugs
  • Our special financial support is calculated on
    the number of multidisciplinary assessment done

20
Working plan
  • Legislative aspects of geriatric care (GC) in
    Belgium
  • Financial aspects of the geriatric one-day
    hospital
  • Every day organisation
  • Our activity
  • Guided visit and questions

21
Every day organisation
  • Our location
  • Brull, outpatients medical center of CHU of Liège
  • All medical competences available
  • Close to the memory clinic and neurologist
  • Laboratory on the highest floor
  • Imagery center on the first floor
  • Main limitations
  • Not close to the acute hospital
  • Caregivers physicaly separated from the rest of
    the team
  • Restricted access and parking
  • Misunderstanding for patients

22
Every day organisation
  • Caregivers
  • 2 Geriatricians
  • Pr Petermans, head of geriatric department
  • Dr Gillain, MD
  • Team of nurses
  • 2 one-day specific nurses
  • 4 additional nurses from the acute care unit
  • 2 nurses in training
  • Able to assume all functions of the GPC
  • One-day hospital, acute geriatric ward, geriatric
    mobile team
  • Allowing training and replacement

23
Every day organisation
  • Caregivers
  • Neuropsychologist
  • Alternating every 3 months
  • Occupational therapist
  • Alternating every 3 months
  • Physiotherapist
  • Team of two

24
Reason to come to
  • From the GPs
  • Cognitive disorders
  • Falls
  • Functional decline
  • Loss of appetit and weight
  • From the hospital
  • Frailty detect during hospitalisation by the
    mobile geriatric team
  • Emergencies department, medical or surgerical
    wards
  • Follow up asked by the geriatrician after
    hospitalisation in the geraitric ward because of
    need to be evaluated without acute illness
  • Delirium during infectious disease

25
Typical assessment
  • First consultation with the geriatrician
  • Carry out the multisciplinary approach
  • Second visit to benefit to the complete
    assessment
  • Complete multidisciplinary assessment
  • Design care and/or rehabilitation
  • First follow up after 3 months
  • Follow up / 6 month or / year
  • In the same line with the GPs
  • We are the second line

26
Every day organisation
  • Role of geriatrician First consultation
  • Anamnesis and physical exam
  • Heteroanamnesis with family or neighbours
  • Sometimes tools to detect frailty
  • MMSE, Clock drawing test, Gait test (dual task)
  • Design the multidisciplinary evaluation
  • Organic tests imagery, blood analysis
  • Need of neuropsychological evaluation
  • Need of occupational evaluation
  • Need of physiotherapist
  • Need to evaluate ability to drive
  • Write a report to the GP

27
Every day organisation
  • Role of geriatrician Second consultation
  • After the complete multidisciplinary evaluation
    designed
  • Summary evaluations and physical testing
  • Inform to the diagnosis
  • Suggest specific treatment and care
  • Specific drugs
  • Specific rehabilitation programme
  • General advices concerning nutrition, physical
    activities, social activites
  • Review of drugs and prevent polypharmacy and side
    effects
  • Suggest adapting helper (Social workers)
  • Answer the questions of patient and family
  • Write a report to the GP
  • Including the complete multidiciplinary
    assessment and suggestions

28
Every day organisation
  • Role of nurses
  • Plan the muldisciplinary assessment
  • Parameters
  • blood pression, cardiac frequency, weight
  • Geriatric scale
  • MNA, ADL, IADL, NPI, Water Test by Di Pipo,
  • If needed,
  • blood samples, ECG
  • If needed,
  • Heteroanamnesis with family but without the
    patient
  • Inform the geriatrician of new data unknown
  • Write a specific report for the geriatrician

29
Every day organisation
  • Role of Occupational therapist
  • Evaluate the daily-life environment
  • Test vision and hear capacities
  • Give some advice concerning
  • Needs of help in IADL or ADL
  • Needs of help concerning houseworks
  • Needs of specific device to maintain autonomy
  • Pill-box explain interest and check correct use
  • Stringer socks
  • Personal alarm
  • Needs to adapt environment
  • Carpets, furniture,

30
Every day organisation
  • Role of neuropsychologist
  • Essentialy neuropsychological test asked by the
    geriatrician
  • MMSE, MOCA, Mattis
  • Clock drawing test, Trail Making test, Stroop
  • Grober 16 or 64 items, CVLT
  • Fluency tests
  • Attentionnal tests
  • Specific tests to assess neuropsychological
    ability to drive
  • Less often moral support
  • To the patient and/or to the close relation
  • Write a report for the geriatrician

31
Every day organisation
  • Role of physiotherapist
  • Gait and balance test
  • Grip strength and Gait speed
  • Tinetti
  • Timed up and go prescription
    rehabilitation
  • Time chair stand test
  • Assess fear and risk of falling and postural
    reaction
  • Assess abilty to fall without danger and abillity
    to get up
  • Check shoes and use of the walking stick
  • Give specific advices
  • Write a report for the geriatrician
  • Specific rehabilitation (2/ week)
  • Fallers / Parkinsonian / Demented person

32
Typical day
  • Geriatrician
  • 4-5 new patients in the morning
  • First consultation
  • 6 patients in the afternoon
  • First multidisciplinary assessment
  • Follow-up
  • Other caregivers
  • Specific assessment asked by geriatrician and
    planed by the nurse
  • In mean 6-8 assessments/day
  • Physiotherapists (2)
  • 8-10 mobility assessments (new patients or follow
    up)
  • 10-16 patients in rehabilitation

33
Working plan
  • Legislative aspects of geriatric care (GC) in
    Belgium
  • Financial aspects of the geriatric one-day
    hospital
  • Every day organisation
  • Our activity
  • Guided visit and questions

34
Our activity
  • For patients and families
  • Only two days
  • Limitations to the staff
  • Because general lack of caregivers in Belgium
  • Different places in charge of geriatric care in
    CHU
  • For administrative works
  • One day more
  • Planning assessment
  • Papers concerning reimbursement of drugs
  • 500 patients / an

35
  • Thanks for coming and
  • Please feel free to ask your questions !
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