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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.

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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™.

Release Date: 10/14/2021

Expiration Date: 02/01/2024

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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.

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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

Accreditation Statement: The American Geriatrics Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement: The American Geriatrics Society designates this Enduring Material activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

     
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