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Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward *
Author(s) -
Mudge Alison M.,
McRae Prue,
Donovan Peter J.,
Reade Michael C.
Publication year - 2020
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14400
Subject(s) - medicine , delirium , confidence interval , prospective cohort study , incidence (geometry) , intervention (counseling) , emergency medicine , quality of life (healthcare) , vascular surgery , pediatrics , physical therapy , intensive care medicine , cardiac surgery , nursing , physics , optics
Abstract Background Older vascular surgical patients are at high risk of hospital‐associated complications and prolonged stays. Aims To implement a multidisciplinary co‐management model for older vascular patients and evaluate impact on length of stay (LOS), delirium incidence, functional decline, medical complications and discharge destination. Methods Prospective pre‐post evaluation of a quality improvement intervention, enrolling pre‐intervention (August 2012–January 2013) and post‐intervention cohort (September 2013–March 2014). Participants were consenting patients aged 65 years and over admitted to the vascular surgical ward of a metropolitan teaching hospital for at least 3 days. Intervention was physician‐led co‐management plus a multidisciplinary improvement programme targeting delirium and functional decline. Primary outcomes were LOS, delirium and functional decline. Secondary outcomes were medical complications and discharge destination. Process measures included documented consultation patterns. Administrative data were also compared for all patients aged 65 and older for 12 months pre‐ and post‐intervention. Results We enrolled 112 participants pre‐intervention and 123 participants post‐intervention. LOS was reduced post‐intervention (geometric mean 7.6 days vs 9.3 days; ratio of geometric means 0.82 (95% confidence interval CI0.68–1.00), P = 0.04). There was a trend to less delirium (18 (14.6%) vs 24 (21.4%), P = 0.17) and functional decline (18 (14.6%) vs 27 (24.3%), P = 0.06), with greatest reductions in the urgently admitted subgroup. Administrative data showed reduced median LOS (5.2 days vs 6 days, P = 0.03) and greater discharge home (72% vs 50%, P < 0.01). Conclusions Physician‐led co‐management plus a multidisciplinary improvement programme may reduce LOS and improve functional outcomes in older vascular surgical patients.