43 year-old female - University of Chicago



Picking up the Missed Opportunities:

Topics to teach for geriatrics and the ACGME core competencies

1. 43 year-old female. Acute pancreatitis with a fever.

Geriatric Topics

Pain management

Systems Based Practice

Transition Trigger

Surgical service to medicine service

Topic Trigger

Pancreatitis

Failure Trigger

CT scan cancelled

Practice Based Learning

Review of appropriate use of medical imaging

2. 80 year old male with mental status changes and falls for nursing home placement.

Geriatric Topics

Delirium

Unmasked dementia

Decision Making Capacity

Polypharmacy

Deconditioning

Falls

Systems Based Practice

Transition Trigger

Home to NH

Topic Trigger

Delirium—risk stratification and prevention

Failure Trigger

Admission for NHP—unrecognized dementia as an outpatient

Professionalism & Communication

Family crisis intervention—discussing the dementia diagnosis and need for 24

hour supervision

Practice Based Learning

Geriatric discharge case audit

3. 62 year-old male. Transfer from the MICU after 8 day ARDS/sepsis stay

Geriatric Topics

Transitions of care

Functional Assessment and Decline

Systems Based Practice

Transition Trigger

Topic Trigger

ARDS

SEPSIS

Failure Trigger

Doc to Doc Communication

Practice Based Learning

Stress ulcer prophylaxis census audit

Foley catheter census audit

DVT prophylaxis census audit

4. 28 year-old male. Pneumonia in what may be a newly diagnosed HIV patient

Geriatric Topics

Chronic disease model

Systems Based Practice

Transition Trigger

Move from health to chronic disease state

Initiation into health care system

Topic Trigger

HIV and societal costs

Failure Trigger

Inability to get AFB smears

Practice Based Learning

Immunizations in the inpatient setting

Review of education provided

Professionalism and Communication:

HIV test counseling

Educating and counseling a newly diagnosed HIV patient about the disease

5. 67 year-old female. ESRD with fevers, possible line infection.

Geriatric Topics

Sepsis

Delirium

Drugs and the aging kidney

Dialysis utilization and advancing age

Systems Based Practice

Transition Trigger

Transition back to outpatient dialysis

Topic Trigger

Dialysis utilization and cost

Failure Trigger

Nosocomial infections

6. 90 year-old female. Elderly patient from NH with urosepsis, stable.

Geriatric Topics

Nosocomial infections

Foley catheter indications

Skin exam and pressure ulcers

Apathetic delirium

Delirium prevention, risk stratification

Systems Based Practice

Transition Trigger

Transition back to the NH—trouble shooting the weekend transfer

Topic Trigger

NH—the structure, cost and oversight of NH care in the U.S.

Failure Trigger

NH patients and the need for acute hospitalization

--balancing NH oversight, patient wishes, resources and systems issues in U. S.

medicare/medicaid NHs. ________________________________________________________________________

7. 31 year-old male. Acute asthma exacerbation, looks ok

Geriatric Topics

Acute on chronic model

Systems Based Practice

Transition Trigger

Facilitation to county health system

Topic Trigger

Asthma outcome in the Chicago Metro area

Practice Based Learning

Review of adherence to guidelines/pathways

Timeliness of nebulizer treatment and monitoring

________________________________________________________________________

8. 84 year-old female. Transfer from neurosurgery service with a subdural hematoma, fever, mental status changes.

Geriatric Topics

Delirium

Falls

Prognostication

End-of-life issues/care

Systems Based Practice

Transition trigger

Transferring a patient from the surgical service to the medical service

Shifting care to the palliative mode

Topic trigger

Catastrophic injury at advanced age

Cost of hospital care at end-of-life in the U.S.

Patient wishes and end-of-life care in the U.S.

Failure trigger

Determining patient wishes and health care proxy for end-of-life decisions

Practice Based Learning

Review how to give bad news, discuss end-of-life issues

Professionalism & Communication

When surgery requests a medicine consult

Addressing end-of-life issues with family

____________________________________________________________________

9. 76 year-old female. Admitted with pneumonia, chest x-ray with cavitary lesions.

Geriatric Topics

Pneumonia and the aging patient

TB and the aging patient

Functional assessment

Delirium prevention for the patient in isolation

Systems Based Practice

Transition Trigger

Assuring appropriate follow-up for high-risk infection like TB

Topic trigger

Demographics of TB in the U.S. aging population

State of the Public Health System in the US

Failure trigger

Making the diagnosis of TB in the community

Professionalism & Communication

Infectious disease consult

______________________________________________________________________

10. 41 year-old female. Sickle crisis and chest pain

Geriatric Topics

Acute on chronic disease model

Pain management

Systems Based Practice

Transition Trigger

Lack of sickle cell center

Topic Trigger

Effect of small percentage of high volume in-hospital users on the sickle cell population at large

Failure Trigger

Difficulty with initiation and monitoring of pain management

Practice Based Learning

Pain management review

Professionalism and Communication:

Team approach to pain management

Approaches to developing a pain management plan with joint decision making

Recognizing personal and system biases towards the treatment of certain disease populations

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