[Skip to Content]
[Skip to Content Landing]

Case 8: Care Transitions in the Context of a Patient Resistant to Discharge to a Subacute Rehabilitation Care Facility Following Surgery

Learning Objectives
1. Describe the importance of anticipatory discharge planning
2. Conduct interdisciplinary assessment for discharge
0.25 Credit CME

A 76-year-old woman with a history of progressive weight loss and fatigue is admitted to the hospital after colonoscopy showed complete obstruction of the sigmoid colon. Biopsy of the mass confirmed a diagnosis of ovarian adenocarcinoma, and CT scan indicated metastases to the liver. On admission, she appears frail and cachectic but is awake, alert, and oriented. BMI is 19 kg/m2. Her temperature is 37.2°C (99°F), pulse is 68/min and regular, respirations are 16/min, and blood pressure is 125/70 mm Hg. She has marked muscle atrophy and weakness and is unable to ambulate. The patient undergoes surgical resection of the mass followed by a diverting colostomy. On the third postoperative day, she develops a cough and fever. A chest radiograph confirms right upper lobe pneumonia. Intravenous (IV) antibiotics are started.

Please finish the activity before taking the quiz.
Close

Resources

Citations

Sign in to take quiz and track your certificates

To help improve the quality of its educational content and meet applicable education accreditation requirements, the content provider will receive record of your participation and responses to this activity.

AGS logo

The American Geriatrics Society (AGS) is a not-for-profit society dedicated to improving the health, independence and quality of life of older people. Learn more

Activity Information

Copyright @2020 by the American Geriatrics Society and the American Board of Medical Specialties. All rights reserved.

All content in this Site, including site layout, design, images, programs, text, and other information (collectively, the “Content”) is the property of the American Geriatrics Society (AGS) and is protected by copyright and other intellectual property laws.

You may not copy, display, reproduce, retransmit, store, distribute, disseminate, modify, publish, broadcast, circulate, create derivative works from, or sell or license any part of the Content, products, or services obtained from this Site in any medium to anyone, including but not limited to others in the same company or organization, without the express prior written permission of AGS, except as otherwise expressly permitted under applicable law or as described in these Terms and Conditions or relevant license or subscriber agreement.

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Geriatrics Society and the American Board of Medical Specialties. The American Geriatrics Society is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement: The American Geriatrics Society designates this enduring continuing medical educational activity for a maximum of 0.25 AMA PRA Category 1 Credits™.

Financial Disclosure Statement: As an ACCME accredited provider of Continuing Medical Education, the American Geriatrics Society must ensure balance, independence, objectivity and scientific rigor in all of our educational activities. We have implemented a process wherein everyone who is in a position to control the content of an education activity has disclosed to us all financial relationships with ineligible company within the prior 24 months. Ineligible companies are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. AGS then reviews the disclosure information to determine which financial relationships are relevant and mitigates relevant financial relationships with ineligible companies to prevent commercial bias in the content.

Advisory Panel

The following members of the advisory panel had no relevant financial relationships with ineligible companies to disclose:

• Ruben Azocar, MD

• George Drach, MD

• Sandhya Lagoo-Deenadayalan, MD, PhD

• Andrew Lee, MD

• Mike Malone MD

• Myron Miller, MD

• Arvind Nana, MD

• Tom Robinson, MD

• Victoria Tang MD, MAS

The following members of the advisory panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of planning decisions by persons without relevant financial relationships and recusal from any aspect of planning and content related to the financial relationship:

• Kevin Biese MD, MAT is a paid consultant for Call 9 Telemedicine Medical Advisor and Bristol Meyers Squibb/ Pfizer

• Daniel Mendelson, MS, MD is a paid consultant for Point Click Care Touchscreen

Writing Panel

The following members of the writing panel had no relevant financial relationships with ineligible companies to disclose:

• Tomas Griebling, MD

• Joseph Hejkal, MD

• Melissa Hornor, MD

• Jason Johanning, MD

• Sushila Murthy, MD, MPH

• Tony Rosen, MD, MPH

• Kate Schenning, MD, MPH

The following members of the writing panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of content by persons without relevant financial relationships:

• Charles Brown, MD is a paid consultant for and receives grants from Medtronic

• Badrinath Konety, MD, MBA is a paid consultant for NxThera, and Bristol Myers Squibb, Opko and receives grant funding from Photocure, Genentech, and Genomic Health

Reviewers:

The following reviewers had no relevant financial relationships with ineligible companies to disclose:

• Shamsuddin Akhtar, MD

• Patrick Kortebein, MD

• Joseph LoCicero, MD

Support Statement

This CME activity is supported by a grant from the John A. Hartford Foundation.

Provider Contact Information

For questions regarding the content of this activity assistance, contact info.amger@americangeriatrics.org or 212-308-1414.

Policy on Privacy and Confidentiality

Please click here to read the American Geriatrics Society's privacy policy.

References:
1.
NY Department of Health.  Suggested model for transitional care planning. https://www.health.ny.gov/professionals/patients/discharge_planning/discharge_transition.htm
2.
Burke  RE, Coleman  EA.  Interventions to decrease hospital readmissions: keys for cost-effectiveness.  JAMA Intern Med. 2013;173(8):695–698. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1672275Google Scholar
3.
National Transitions of Care Coalition.  Elements of Excellence in Transitions of Care (TOC) Checklisthttps://static1.squarespace.com/static/5d48b6eb75823b00016db708/t/5d49bc833b48f80001f154bc/1565113475856/TOC_Checklist.pdf
4.
Coleman  E.  Discharge Preparation Checklist. Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2013/01/care-about-your-care-discharge-checklist---care-transition-plan.html
Close
Close

Name Your Search

Save Search
Close
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
Close