Anne Arundel is rolling out inexpensive improvements that are positively impacting older patients.
More than 45 percent of patients admitted to Anne Arundel Medical Center (AAMC) are ages 65 and over, and we expect that percentage to increase as Baby Boomers age. We’re located in Annapolis, MD, near Chesapeake Bay, which attracts a lot of retirees. While AAMC has taken a number of steps to improve outcomes for older patients, including opening a geriatric inpatient unit, we believe more needs to be done. Too many older Americans suffer from falls, inappropriate medication use, delirium and other avoidable harms.
What We Tried
AAMC volunteered to be one of five pilot organizations in the Age-Friendly Health Systems initiative focusing on the 4M model:
- What Matters – Know and align care with each older adult’s specific health outcome goals and care preferences including, but not limited to end-of-life, and across settings of care.
- Medication – If medications are necessary, use Age-Friendly medications that do not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care.
- Mentation – Prevent, identify, treat, and manage dementia, depression, and delirium across care settings of care.
- Mobility – Ensure that older adults move safely every day in order to maintain function and do What Matters.
We began by educating the nurses and other staff on AAMC’s geriatric inpatient unit about the initiative. Staff enthusiastically embraced the concepts and identified a number of ways to roll out the “4Ms”, including the following:
Integrating 4Ms into shift reports. Nurses and patient care technicians are using the 4Ms to help guide patient handoffs between shifts. This was a simple adjustment to the nursing reports since the 4Ms reflect the traditional head-to-toe assessments nurses conduct.
Incorporating “what matters” into the EHR and whiteboards. We added a section to our electronic health record (EHR) that reminds staff to learn and document what matters to the patient. We also replaced the small whiteboards in patient rooms with larger ones that older patients can read more easily. Front and center on the boards is a section to document “what matters” to the patient.
Team rounding is also helping to drive this mindset. During team meetings, physicians, nurses and care managers discuss how to prioritize each patient’s preferences and needs. For instance, what mattered to one patient was having her dog with her. Since her dog was well-behaved and small, we were able to grant her request and believe she recovered faster than she would have without her pet.
Daily exercise sessions. Now patients are brought together for a 40-minute group session that is part physical therapy (PT), part social gathering. The sessions end with a challenge: “Walk back to your room.” The first day a patient may only walk 10 feet, but most can walk to their room by the third day.
Our patients progress faster in group PT than individual therapy, and family members love the approach. Our patient care technicians also help ensure patients maintain mobility. Physical therapists place orders specifying how many feet a patient needs to walk that day, and the technician is responsible for helping the patient meet that goal.
The pilot on our geriatric inpatient unit began in Summer 2017. By late 2017, we had documented significant improvements, including the following:
Length of stay (LOS). By paying more attention to what matters to patients and ensuring care was coordinated, we were able to reduce average LOS on the pilot unit by 26 hours.
Patient satisfaction. On the pilot unit, patient satisfaction has increased since the pilot began.
By the end of 2018, we intend to spread the 4Ms to a total of nine inpatient units and the ED at AAMC as well as 25 private assisted living facilities.
You don’t have to spend a lot of time thinking about how to improve care for older adults. Seek ideas from staff on how to roll out the 4Ms, and wonderful things can happen.
Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA).