We hope you have a wonderful rotation. Prior to beginning the rotation, you are required to complete the assigned reading material listed on this page. Your clinical time will be divided between Parklane West Skilled Nursing Facility, the Nix geriatrics office and the Family Health Center. *Absences: You must arrange for beeper coverage if you are anticipating an excused absences.
We hope you enjoy the time that you spend with us. We are constantly attempting to improve the experience. If you have any further questions or comments, please let the faculty know.
Skilled Nursing Facility Objectives:
- Demonstrate appropriate interdisciplinary coordination of the actions of multiple health professionals including physicians, nurses, social workers, dieticians, and rehabilitation experts, in the assessment and implementation of treatment.
- Demonstrate greater awareness of and familiarity with skilled nurse care, physical medicine and rehabilitation.
- Demonstrate an understanding of psychosocial aspects of aging, including interpersonal and family relationships, living situations, adjustment disorders, depression, bereavement and anxiety.
Ambulatory Geriatric Objectives (Nix Senior Healthcare Center):
- Diagnose and treat the ambulatory, frail elderly with a goal of evaluating one (1) new geriatric patient and four (4) follow up geriatric patients each week.
- Complete one geriatric assessment, including medical, affective, cognitive, functional status, social support, economic and environmental aspects related to health; activities of daily living (ADL)' and the instrumental activities of daily living (IADL).
- Understanding the unique aspects of geriatric preventative medicine, including nutrition, oral health, exercise, screening, immunization, chemoprophylaxis against disease, and advance directives.
- Understanding the cultural aspects of aging, including knowledge about demographics, health care status of older persons of diverse ethnicities, access to health care, cross-cultural assessment, and use of an interpreter in clinical care.
Nursing Home Objectives:
- Diagnose and treat the acutely ill, frail elderly in the less technologically sophisticated nursing home environment.
- Have an increased awareness of and familiarity with skilled nursing facility physical medicine and rehabilitation care.
- Understanding the ethical and legal issues pertinent to geriatric medicine, including limitation of treatment, competency, guardianship, right to refuse treatment, advance directives, wills and durable power of attorney for medical affairs.
- Understanding the management of patients in long-term settings, including palliative care, knowledge of the administration, regulation and financing of long-term institutions, and the continuum from short to long term care.
Evaluation will be base don attendance and participation. Interactions (or lack thereof) with the fellows will also be evaluated. Prompt feedback is the hallmark of the geriatrics rotations and will continue. Occasionally, due to vacations or rotation changes, the feedback may not be available until after the first two weeks. Please check with the attending to see how you are doing. A syllabus will be distributed at the beginning of the rotation for you to read. A written exam will be given to you the last week of the rotation and will be graded on a Pass/Fail basis.
Parklane is located on the third floor of the Parklane Health Care Center, see directions on this page. It is anticipated that the Skilled Nursing Service will have a census of 8-15 patients. Patients will be primarily over 65, but the unit can handle patients from 20-105 years of age. Patients will be a traditional private practice population and run the range of medical problems with common problems, including hip fracture rehabilitation, de-conditioning rehabilitation, chronic wound problems, stroke rehabilitation and general debility problems. The primary criteria to use for admission is that of a multi-problem, hemodynamically stable patient that does not need to be seen every day. Patients are pre-screened for admission, but information may be limited due to the vagaries of the long term care system. Check daily with the Parklane admissions coordinator for any potential admissions.
The Parklane resident will be responsible for admission management and discharge of patients, under the direction of the attending. All information on potential admissions will be faxed to the GERI clinic (568-5684). Resident physicians will write off-service notes on patients prior to leaving the service. Documentation should conform with Medicare guidelines.
You will be rounding on Tuesday and Thursday mornings at 8:30am and Monday afternoon at 1:45pm. It is a good idea to get there ASAP, so you can get your evaluations started before the attending gets there. Look up an studies ordered and talk to the nurses about any that occurred since the last visit. If you need any studies faxed over, talk to the desk clerk. She'll call and get them for you. Start your notes. Once the attending arrives, you will get together in the conference room at the front and discuss the patients -- bring all charts with you, then you can write your orders and handle all other clinical care tasks more efficiently. Write your note on duplex paper like the one used at Morningside Manor. You will find plenty at medical records and you will also find the folders for the copies of the patients notes used of billing purposes.
On Thursday morning, you'll meet with the rest of the team caring for the patients. This includes PT, OT, Speech Therapy, Nursing, Social Work, Case Managers, and other members of the team. They will call you when they are ready to discuss the University team patients. During this meeting you learn the patients complete status including, PT, OT Wound Care, RT, Social issues concerning your patients and a clearer idea of patient plans. Get al l the charts, lug them into the conference room or dining area, and get ready to write orders. It doesn't last very long, but depends on the number of patients and the number of active issues. We usually select two patients on Tuesday to review on Thursday.
Check with the admissions coordinator on the first floor at Parklane. The admissions coordinator give you and your attending a "heads up" of a possible candidate for our service. At that point, we will have selected progress notes and studies from the transferring hospital (mostly Brook Army Medical Center and Northeast Baptist). It is good to have an idea of what medicines the patients are on so that when the patient actually reaches Parklane you can confirm the orders over the phone.
You have 90 hours to see new patients and enter their admission H&P into the Sevocity electronic medical record. Most of the patients discharge summaries from the discharge hospital are not available until the middle of the following week.
If a patient becomes unstable and requires transfer to the Emergency Room immediately, direct the nurses and they will take care of this for you. If you need to transfer a patient, our preferred hospital is the Nix, unless the patient has a continuity physician with admission privileges. The patient's hospital of choice is written on the update Parklane spreadsheet.
All labs are sent out. Please direct them when to call you with the results and your parameters for panic values. Otherwise, you will be getting normal lab values called to you at night. All labs are placed in the SNF book.
We have a psychologists that assists with psychotherapy. All other consultants are on the outside, with the patients' personal specialist or the Nix group.
Parklane Nursing Home Patients
Patients in the nursing home (2nd floor) will continue to be followed by Dr. Espino, with after hours team support from you.
You are scheduled to be at Morningside on Friday afternoons and to cover the facility for any semi acute patient concerns. After Hours Call & GERI Pager - 756-5580. See Call Schedule.
Nursing Home Rounds
Call on the units (phone #'s are on the patient list) and ask them if they have any patients from the University of Texas group (Drs. Espino, Parker, or Finley) that need to be seen that day. Start seeing the patients by yourself and preparing the notes. The attending will be at the nursing home by 2pm to begin rounds. Dr. Finley will be rounding on Mondays and Fridays, but you will only round on Fridays.
If there are residents scheduled to present patients, the group meets in the private dining room conference area of the assisted living area (St. Cloud Conference Room). As the residents present patients, update the list, verify that the medicines are current. Keep the copy of the note and put it in the folder to turn in at the Nix or give it to the Nurse Practitioner, make sure the copy has the patient's name, the attending and location, so that we can bill for it. After the residents present, you will round on the people that need to be seen with the attending (some like all the residents to come, some send the residents home early). REMEMBER to turn in a copy of all notes to the Nix staff or the Nurse Practitioner. Don't forget to see your own nursing home patients, preferably a day when only a few residents are presenting.
The UT Resident Folder
Get the folder that says FP resident from the medical records area (next to the St. Cloud conference room) and sign all the verbal orders and other forms that will be in there. Some of the forms in that folder need to be signed by an attending, like the DNR. ***You reserve the right to have an attending sign anything you feel uncomfortable signing.
If you and the fellow agree that a patient needs to be admitted, contact the family and let them know that our preference is Nix Hospital, as our team can take care of them there. Call the GERI-s Resident on call. The nursing home nurses will arrange for transportation. IF the patient is transferred to the Methodist ER, please call the ER and inform them that our patients are cared for by Dr. Praful Mehta (cell: 313-7233),
Nursing Home Admissions
You will be paged for nursing home admissions when there is a new patient for the nursing home. There are no exclusion criteria for our service, except for Secure Horizon patients. They will tell you where the patient is coming from and diagnoses or if the patient is transferring care from another physician. Patients for rehab treatment (Skilled Nursing patient) will be followed by you. You assign the new patient to a resident or geriatrics fellow based on the list of the resident and patients; the 1st years have one patient, second and third year residents and fellows should have two. If you are rotating after February, assign patients to first and second year residents only.
The continuity resident has 72 hours to see the patient and write the H&P. When you are there on Friday, stop in to briefly observe the new patient with the attending and write a brief note with the diagnoses, noting that a fully H&P will follow. Check out ALL new admissions with the geriatrics fellow on call.
***Patient Family Members - Family members are very involved in the care. Whenever possible have the attending communicate directly with the family members. Make it a point to have every new patient's family member contacted.
NOTE: Fellows are required to call the Geriatrics fellow or attending (235-0202) for the following reasons:
- Any changes to clinical status (if the patient has dysuria, then you need to call the fellows, falls with injury also need to be called)
- ALL hospital transfers
- ALL new admissions
**IMPORTANT: Nurse Practitioner Communication
The NP is available to assist you in the nursing home duties and sub acute duties. Please contact him/her when you need additional help in completing your tasks within the 80 hour work week. For example, you should call the NP to work up a new admission to Morningside on a Tuesday morning as you know you can not get back until Friday. Frequent communication with the NP is a must. You are responsible for keeping within the 80 hour work week. IF you are close to being over your hours, please let the attending know so we can arrange for immediate time off.
Updated GERI Lists
It s a password protected EXCEL file, which is managed by the nurse practitioner at Morningside and the attendings at Parklane West. You should have a paper copy and share any changes with the Morningside NP and the Parklane attending. Please note that at Morningside on Sheet 1, there is detailed information on the patients, on Sheet 3 the brief list of residents with the assigned patient.
Residents attend a weekly geriatrics clinic on Wednesday mornings. Please review the Nix clinic orientation list on this page.
Attendance at the following conferences are required:
Geriatrics Division Grand Rounds
held every Monday, 12pm-1pm, 6th floor conference room, NIX cafeteria. Lunch is provided. Charge your lunch to the NIX Senior Healthcare Center. During their rotation, each resident is required to formally present a case of their choice during M&M on the third Wednesday of the month.