Tuesday, March 22, 2011

Making Him Better Ruined His Life

Dan was 83 when he was admitted to the hospital with a lung condition, and the medical staff did a stellar job of treating it. In a matter of days, the condition had cleared up and Dan was discharged. But back home, he felt weak and anxious, and was occasionally disoriented. He no longer participated in the activities that had so enriched his life before he went into the hospital. His family worried that the independence Dan prized was about to end.

It didn't have to be that way. Typically, health care providers zero in on a patient's single, dominant ailment. But for Dan and the rapidly expanding cohort of elderly patients like him, other issues—physical and emotional—often complicate the picture, and the chances of robust recovery.

Far too few people working in hospitals today understand the unique needs of their elderly patients, a fact that must change as increasingly millions of Americans live far into their 80s and beyond and consume a larger share of the health care you provide. It's startling to realize that while almost every physician and nurse receives at least some education in pediatrics, only a tiny fraction get any training whatsoever for patients at the other end of the age scale.

Hospital executives are beginning to recognize the problem. "A lot of CEOs see improving geriatric care as good business," says Marie Boltz, R.N., associate director for practice at the Hartford Institute for Geriatric Nursing and an assistant professor at NYU School of Nursing. It can avoid costs due to complications, reduce readmissions, and increase patient and staff satisfaction.

Moreover, she says, "it resonates with them on a personal level because they have loved ones who are elderly."

One program that's tackling the geriatrics gap is called NICHE—Nurses Improving Care for Healthsystem Elders. Administered by Boltz's Hartford Institute, NICHE offers a series of modules that hospitals can implement to ramp up their clinicians' skills when it comes to such things as preventing falls, ensuring proper use of medications, reducing urinary tract infections, involving patients and their family members in decision-making, and preventing, diagnosing and treating delirium.

NICHE's six-week, Web-based Leadership Training Program gives a hospital the tools to conduct an internal evaluation of its strengths in geriatrics, the level of its staff's expertise and, importantly, how it might need to change policies, the environment and even its mission statement to foster improvement. "You can have a nurse with all the knowledge in the world in these areas, but if the culture doesn't support her, she can't put that knowledge to good use," Boltz says.

The results of the internal evaluation are benchmarked against other hospitals, and NICHE staff help prioritize educational and clinical initiatives. A team of at least three hospital staff members is trained to lead the effort internally and make sure improvements spread from unit to unit.

Nearly 300 hospitals have signed onto NICHE so far, representing all types and sizes. Collaboration among those participants is vital, Boltz says, with hospitals from across the continent sharing their experiences and advice with colleagues. The program is compiling data to identify best practices. And NICHE staff members mentor participants throughout the process and beyond. You can learn more at NICHE's web site.

Last Tuesday I asked readers if there was any tension among employees of different generations in their hospitals. The responses so far have been eye-opening and I'll share some of them next week. You still have time to respond by clicking on "I Can't Work With Anybody That Age." And as always, I welcome feedback and ideas about how the aging of America and other generational issues are affecting our health care system, from a patient's, clinician's and hospital executive's perspective. E-mail me at bsantamour@healthforum.com.


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