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A university-affiliated community hospital inpatient geriatrics program functioning in an administrative and
C A Cefalu1, G Colbourne, M Duffy
1UDepartment of Family Medicine/Providence Hospital, Georgetown University School of Medicine, Colmar Manor, MD 20722, USA.
Objective:
To demonstrate an unusual form of inpatient geriatric assessment with unique outcomes.
Design:
A prospective evaluation of patients admitted to a community hospital-based inpatient geriatrics unit utilizing traditional members of the assessment team along with educational assessment of nurses and satisfaction profiles of patients and/or families.
Setting:
A non-profit community hospital in Northeast Washington, DC.
Participants:
All patients older than age 62 admitted to the 42-bed Geriatric Unit during a 4 1/2 year time period.
Measurements:
Number of total and category recommendations taken by attending physicians from the Inpatient Geriatric Assessment Team, periodic evaluation of unit nurses' geriatric knowledge base and certification, and patient satisfaction through periodic surveys.
Results:
More than 4500 patients have been evaluated during the past 4 1/2 years. The number of recommendations taken by attending physicians has averaged 31.3 to 50.7% during four consecutive chart reviews involving the first 25 consecutive patients for the month each performed every six months (n = 100). The average age of patients evaluated was 77.2 (minimum of 62 and maximum of 97); 67% were females and 33% males. The average number of recommendations communicated per patient was 4.1, and the average number adhered to 1.6/patient. The overall knowledge base and certification in geriatric nursing has increased significantly over a 2.5-year period. Composite monthly unit patient satisfaction survey scores increased as well.
Conclusions:
The program is unique in its development, limitations, and outcomes. Other than the cost of limited geriatric nurse practitioner and faculty salary support, the program has been implemented using only current hospital department personnel. The role of the assessment team is to educate attending nurses and staff physicians. It has not yet been possible to measure objective outcomes. However, the current program also serves the purpose of introducing a new medical program to a community hospital in a nonthreatening way and offers opportunities for research. In addition, the program offers further opportunity for expansion and change.