The evaluation of an intermediate care--geriatric evaluation unit in a Veterans Administration Hospital

In response to the increasing care needs of geriatric patients and attendant hospital costs, the Nashville Veterans Administration Medical Center, which has 393 beds and admits 8400 patients annually, initiated an Intermediate Care Service in 1988. A geriatric team was formed, sharing staff and resources from existing units. To determine the efficacy of intermediate care, automated data sources at the Nashville Veterans Administration Medical Center provided data on discharge status, length of stay, and diagnoses of patients in both the acute and intermediate care units. The first year's experience indicated that careful communication and education of nursing staff was required to initiate the Intermediate Care Service with no staff resigning. An interdisciplinary team facilitated better patient care and discharge planning. Among 190 patients discharged from this service, 57% were discharged home and 22% into nursing homes; this can be compared to those discharged from acute care units of the hospital: 84% home and 4% to a nursing home; 20% of the patients in the Intermediate Care Service were discharged to a lower level of care than the initial hospital discharge plan had indicated. A 1.4-day decrease in average length of stay in the hospital has occurred since initiation of the Intermediate Care Service.