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Related Experiment Videos

[The geriatric team in transitional patient management]

P Oster1, T Nikolaus, G Schlierf

  • 1Geriatrisches Zentrum Bethanien am Klinikum, Universität Heidelberg.

Zeitschrift Fur Gerontologie Und Geriatrie
|March 1, 1995
PubMed
Summary

A multidisciplinary transition team improves geriatric care by coordinating nursing and therapeutic services before and after hospital discharge. This integrated approach ensures seamless patient support in both inpatient and outpatient settings.

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Area of Science:

  • Geriatric Medicine
  • Healthcare Management
  • Nursing Care

Context:

  • The study examines the role and effectiveness of a multidisciplinary transition team in managing geriatric patient care.
  • Focuses on the integration of nursing and therapeutic services during the pre- and post-discharge phases.
  • Highlights the importance of geriatric assessment in guiding care transitions.

Purpose:

  • To evaluate the structure and function of a transition team in geriatric care.
  • To assess the coordination of nursing and therapeutic interventions during hospital discharge and outpatient follow-up.
  • To determine the effectiveness of collaboration between inpatient and outpatient services.

Summary:

  • A geriatric transition team, comprising nurses, occupational therapists, physiotherapists, social workers, and a physician, provides care.

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  • Care is delivered through a combination of inpatient services and outpatient follow-up for up to four weeks post-discharge.
  • The team's interventions are based on comprehensive geriatric assessments, ensuring tailored patient support.

    • Impact:

    • Demonstrates the value of a structured, multidisciplinary approach to geriatric care transitions.
    • Suggests that effective cooperation between hospital and community-based services is crucial for successful patient outcomes.
    • Provides a model for optimizing nursing and therapeutic care coordination in post-discharge settings.