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- No conflict of interest
The Icelandic ACE Experience: Successes and Obstacles Anna Bjrg - - PowerPoint PPT Presentation
The Icelandic ACE Experience: Successes and Obstacles Anna Bjrg - - PowerPoint PPT Presentation
The Icelandic ACE Experience: Successes and Obstacles Anna Bjrg Jnsdttir, Consultant Geriatrician, Department of Geriatric Medicine, the National University Hospital of Iceland No conflict of interest What do you know about Iceland?
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What do you know about Iceland?
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Patients seeking health care service at Landspitali come from all health districts in the country
Reykjavík
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Our nation
- Icelandic population 338.349 (1. January 2017)
- About 219.900 live in the capital area
- 67 years and older: 40.832 (12,1%)
- One university hospital
- Several small hospitals, primary care,
nursing homes
- Primary health care centres
- Private practices
Statistics Iceland; www.hagstofa.is
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Type of organization
- Fully equipped emergency, medical and surgical hospital
- 103.500 emergency visits
- 323.000 outpatient visits
- 26.000 admissions
- 700 hospital beds
- 7,8 day average length of stay
- 15.700 surgical procedures
- 2.900 births
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What is the ACE collaborative?
- Working with:
– Canadian Foundation for Healthcare Improvement (http://www.cfhi- fcass.ca/Home.aspx) – Canadian Frailty Network (http://www.cfn- nce.ca/)
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ACE strategy - Toronto
- Continuity in service for the elderly
– Community – Emergency Department – Inpatient – Ambulatory
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ACE strategy - Reykjavík
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Objectives
- To improve the acute care of elderly patients at
LSH
- Increase ED staff education on the needs of
geriatric patients.
- Reduce revisits of pt. 75 and older to the ED
- Reduce hospital admissions for the elderly
- Shorten the length of stay of patients 75 yrs and
- lder.
- Decreased readmission rates within 30 days
- Standardise evaluation of patient needs and care
pathways for those 75 years and old
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Standardized screening
- Inter-RAI ED
screener
- Translated in
2015
- Tested in spring
2016
- Implemented in
autumn 2016
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28% 30% 32% 29% 31% 62% 32% 30% 29% 30% 0,1 0,2 0,3 0,4 0,5 0,6 0,7 Tímabil
- des. 2016
- jan. 2017
- feb. 2017
mars 2017 Apríl 2017 Maí 2017 Júni 2017 Júli 2017 Ágúst 2017
- Sept. 2017
HLUTFALL
Proportion of 75 years and
- lder screened
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GEM nurses
- GEM nurses training in september 2016
- Implementation of the Inter-RAI ED screener and
Contact assessment in the ED
- Started in October 2016
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GEM nurses
- 6 days a week from 10:00 to 18:00
- See minimum 3 persons a day
- The majority discharges home or about 80%
- A lot of phone calls as follow ups
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Building a bridge!
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Assessment clinic for the elderly
- 3P-workshop
October 2015
- Trial spring
2016
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27,0% 28,0% 29,0% 30,0% 31,0% 32,0% 33,0% 34,0% 35,0% 2016 2017
Family report feeling overwhelmed by persons illness
N=65
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0,0% 5,0% 10,0% 15,0% 20,0% 25,0% 30,0% 35,0% 40,0% 45,0% 50,0% Excellent Good Fair Poor Could not respond
Self-reported health
Premorbid Admission N=65
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7 18 32 21
5 10 15 20 25 30 35
0.0 - 0.3 0.3 - 0.6 0.6-0.8 0.9 - 1.25 Number Walking speed m/s
N=78
10 m walking speed
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N=76; Period Feb 2016 til May 2017.
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Assessment clinic for the elderly
- Expanding the service to 2-3 times a week
- We are initiating a conversation with home-care
and GP’s
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Challenges
- Small group
– Few people to do everything
- Workplan in Iceland – summer holidays
- IT takes time
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The good things
- A small group
- Key members within their specialites
- Communication is easy
- Support from our leaders
- The environment is ready for changes
- Engagement from everybody
- Focus has been undisputed and clear
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