ABSTRACT
Age Friendly Health Systems (AFHSs) and Age Friendly Universities (AFUs) are distinct entities in the "Age Friendly” ecosystem. While Age Friendly entities function independently, they typically exist in close proximity (e.g., universities and community hospitals);yet they remain isolated in their Age Friendly efforts. We report on a collaboration between a mid-Atlantic Age Friendly University and a new AFHS using case study methodology. Our goal is to inform and inspire key stakeholders responsible for creating innovative healthy aging communities. The collaboration began with a shared stakeholder team who articulated focus areas and overlapping goals. A charter document was developed articulating commitments and responsibilities. Using a Quality Improvement (QI) approach, projects targeted the hospital's older patient needs that linked to the AFHS 4 M's of Matters, Medications, Mobility, and Mentation. University graduate students and faculty volunteered to teach and mentor hospital staff on the QI projects: 1) Get to Know Me Boards filled by staff caring for hospitalized older adults (Matters);2) Medical Intensive Care Unit discharge opioid medication deprescribing (Medication);3) UMove Mobility Screening addressing functional status (Mobility);4) UB-2 Delirium Screening (Mentation). Data collection across projects demonstrated proof-of-concept and identified implementation challenges around communication, screening, data entry, and data extraction from electronic medical records. During Covid-19 pandemic, the collaboration allowed QI projects to conduct multiple Plan-Do-Check-Act cycles while contributing to the Age Friendly goals of both organizations. Partnerships between academic institutions and hospitals foster development of evidence- based healthy aging communities and provide opportunities for continuing education and research.
ABSTRACT
Introduction: Extracorporeal membrane oxygenation (ECMO) is increasingly instituted for patients with severe circulatory or respiratory failure and as bridge to recovery or destination therapies (device implantation or organ transplantation). Morbidity and mortality for those patients is high. Hypothesis: ECMO combined with COVID isolation presents an additional set of challenges for patients, families. Objective: To test feasibility of an early, concurrent, and semi-structured palliative care intervention in improving communication, clarifying goals of care, and highlighting the experience of patients' families. Methods: IRB Approved Qualitative study using content analysis of guided, in-depth discussions with families of COVID-19 patients within 48-72 hours of being cannulated for ECMO between March-October 2020. Scripted template was developed to guide and facilitate goals of care conversations and to ensure consistent communication with family members throughout patients' disease trajectory. Patient demographics, comorbidities, clinical course, length of stay, and discharge disposition was obtained from the institution's COVID-19 Data Warehouse and analyzed using descriptive statistics Setting: Large urban academic medical center. Results: Patients were 44 ± 10 years, Hispanic or Latino 27/43 (63%), white 3 (7%), Black 8 (19%). Palliative care documentation for ECMO acknowledgement meeting was 36/43 (84%). Timely and guided communication demonstrated themes expressed by families including 1) social isolation and related grief of not being at patient's bedside;2) helping children of patients adjust to a new normal;3) coping with multiple family members suffering from COVID-19;4) importance of faith and spirituality;5) need for hope and gratitude 6) futility of prolonged ECMO stay. Survival to discharge 24/43 (56%). There was no statistical difference in hospital survival or length of stay between patients with and without documented palliative care. Conclusions: Early and ongoing palliative care intervention is feasible to support families' acknowledgment of complexity, benefits and limitations of ECMO, and it is useful in highlighting families' experiences, managing expectations and alleviating suffering.