Background: Medicare patients account for over 50% of hospital days at a cost of over $1 trillion per year. Yet, hospitalization of older adults often results in poor outcomes. Furthermore, the number of geriatric healthcare providers dedicated to the care of hospitalized vulnerable older adults is currently insufficient.
Purpose: Our objective was to create an age-friendly care model by integrating geriatric-focused practices into a standard medicine unit at a large tertiary hospital.
Description: A 40-bed medicine (non-telemetry) unit in Northshore university hospital a 738 licensed beds tertiary hospital was designated as the Geriatric Care Model starting June 2017. Initial steps included identification (from the ED by the hospitalist in charge) and cohorting of the target population, which included patients 75 years and older that had a history of or presented with a geriatric syndrome (fall, frailty, pressure ulcer, failure to thrive, dementia and delirium). The Geriatric Care Model consisted of a multidisciplinary team approach and a focus on geriatric best practices. The unit was staffed by non-geriatric trained personnel and did not utilize any additional resources. An ACGME certified Geriatrician-Hospitalist was assigned as the physician lead for the unit but directly cared for up to a quarter of the census (10-12 patients). Each day the team (nurse manager, nurses, case managers, social worker, pharmacist, nurse practitioners), led by the geriatrician-hospitalist conducted bedside daily multidisciplinary rounds on all patients on the unit. Daily rounds included a checklist of geriatric-focused best practices including early mobilization, cognitive status, VTE prophylaxis, pain management, history of bowel movement, and a medication review. In addition, brief “tuck-in rounds” were conducted in the afternoon on all patients on the unit to ensure engagement with patients and caregivers. Preliminary data comparing four months prior to and after initiation of the Geriatric Care Model found: an increase in the percentage of patients over 65 (65% vs. 68%) and 75 (46% vs. 52%) years of age; a decrease in average number of bedrest orders (27.0 vs. 24.5) and time to physical therapy (4.73 vs. 4.22 days); a decrease in the use of benzodiazepines (48.75 vs. 39.25 average per month); and increased physician documentation of delirium (1.0 vs. 9.5 patients/month). While the population on the unit was older, risk adjusted readmission rates remained the same (1.05 vs. 1.02) and mortality decreased (0.38 vs. 0.28).
Conclusions: The Geriatric Care Model highlights an innovative approach to “Geriatricize” a medicine care model without increased resource utilization.