康复和老医疗联络服务RALS的作用.ppt

Improving the Care of Older People in General Medical Units and their transition into the Sub-acute programme – the role of the Rehabilitation and Aged Liaison Service (RALS)改善普通病房老年患者的服务, 并改善与亚急性服务的衔接 – 康复和老年联合服务项目的作用 Introduction to RALS康复和老年联合服务项目简介 The Rehabilitation and Aged Liaison Service (RALS) provides specialist geriatric, senior allied health and nursing staff input in the assessment and management of older patients in the General Medical Units and assists with their transition into sub-acute care. It forms an integral part of the General Medical multi-disciplinary team. The service was established in April 2008 at Monash Medical Centre (MMC, Clayton) and commenced in May 2009 at Dandenong Hospital. 康复和老年联合服务项目(RALS)是老年医学专家、老年人联合服务人员、护理人员等在普通病房给老年患者提供病情评估和疾病管理服务，并帮助老年患者转到亚急性服务 RALS在普通病房建立多学科团队 蒙纳仕大学医学中心在2008年4月开始这项服务，2009年5月在丹迪农医院开展这项服务 The RALS team康复和老年年和服务的团队 General Medicine RALS clinician (liaison position) Full time Social worker (Monash Medical Centre) Occupational therapist (Dandenong Hospital) Geriatrician Part time 2 Geriatricians at Monash Medical Centre 1 Geriatrician at Dandenong Hospital 1 full time Geriatric trainee at Dandenong Hospital Manager 普通病房的RALS医师（联合位置） 全职 社会工作者（蒙纳仕医学中心） 功能康复师（丹迪农医院） 老年医学专家 兼职 蒙纳仕医学中心2人 丹迪农医院1人 丹迪农医院1名老年医学学员 管理人员 What is the role of RALS?康复和老年联合服务项目的任务 Improve the model of care and clinical outcomes for older general medical patients. Reduce multiple assessment steps by completing required assessments. Improve continuity of patient care from acute (hospital) to sub-acute (hospital and community) programmes or services. Improve communication between patients, their families and the medical teams. Improve understanding of and patient access to available sub-acute services. 改善普通病房老年患者的照顾模式，并改善他们的健康结果 对所需要的各种检查要求，减少重复检查步骤 改善从急性服务（医院）到亚急性服务（医院与社区）的连续性 改善患者、家庭、医务团队之间的沟通 提高对亚急性服务的了解，并提高对亚急性服务的可及性 What does RALS do?康复和老年联合服务的工作 Attend daily multi-disciplinary meetings. Work closely with the treating team to op