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At left, John Gotelli, NSN, GNP, Nurse Practitioner at the ACE unit, gives a lecture to the UNC Division of Geriatric Medicine Fellows (from left to right, Drs. LaMantia, Halpern, and Khandelwal) on wound management in frail elder hospital patients. February 2008
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Maintain a patient-centered program that specializes in care for frail elders to include:
- Environmental modifications (non-slip floors, accessible bathrooms, rails, etc.), along with specialized equipment (beds that can go lower to the floor and are equipped with safety alarms, recliner chairs, etc.)
- Interdisciplinary team approach to care, delivery and coordination of services
- Medical director and dedicated nursing staff and ancillary servces to include nutrition, pharmacy, social services, pastoral care, physical occupational and recreational therapy.
Minimize functional decline in elders by:
- Keeping the use of physical/chemical restraints to the absolute minimum
- Identifying early onset or worsening delirium that could adversely affect patient outcomes and health care costs
- Reducing falls and the negative impact of injuries from falls that could have an effect on the length of stay (LOS)
- Reducing the number of nosocomial infections
Increase coordination of care through interdisciplinary team rounds by:
- Identification of patients in need of a change in living situation within 48 hours of arrival to the unit to prevent discharge delays
- Reducing unavoidable discharge delays to an average of less that one per stay
- Timely referrals to appropriate disciplines within three hours of arrival on the unit and initial evaluation performed within one workday
Demonstrate fiscal prudence as measured by:
- Reducing unplanned re-admissions within 31 days of discharge (an unplanned re-admission is defined as inpatient admission to a medicine service for a problem related to the prior discharge)
- Control ratio to cost increases between the unit population and the remainder of the hospital inpatient population to less than or equal to 8.2%
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