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Interprofessional Intervention to Improve Geriatric Consultation Timing on an Acute Medical Service
Author(s) -
Puelle Margaret,
Wiggins Jocelyn,
Khateeb Rafina,
Firn Janice,
Saul D'Anna,
Chang Robert,
Min Lillian
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15582
Subject(s) - medicine , geriatrics , intervention (counseling) , comorbidity , confidence interval , family medicine , physical therapy , emergency medicine , nursing , psychiatry
Objectives To determine whether an interprofessional intervention would improve the use and timing of a geriatric consultation on a hospitalist service. Design Difference‐in‐differences (DID), which measures the difference in improvement over time between intervention and control team patients attributable to the intervention. Setting 1,000‐bed U.S. academic medical center. Participants Individuals aged 60 and older admitted to a general medicine hospitalist service (N=7,038; n = 718 on intervention teams, n = 686 historical controls, n = 5,634 on control teams (concurrent and historic). Intervention On 2 of 11 hospitalist teams, a geriatrician attended multidisciplinary discharge rounds twice weekly and advised on the benefits of a geriatric consultation for individuals aged 60 and older. Measurements Primary outcome was percentage of hospitalizations resulting in a geriatric consultation. Secondary outcome was days to geriatric consultation. Both outcomes were controlled for age, sex, comorbidity, mean daily intensity of inpatient care utilization, and admission in the prior 30 days. In the primary analysis, length of stay was controlled. Results Intervention participants were more likely to have a geriatric consultation (DID = 2.35% absolute percentage points, 95% confidence interval (CI) = 0.59–4.39%) and to have a consultation sooner (DID = 3.61 fewer days, 95% CI = −1 to −7). Conclusion An interprofessional intervention that focused on hospitalist ordering practices increased use of appropriate geriatric consultation and decreased time to consultation. This model of interprofessional effort is effective. Future adaptations are needed to target scarce geriatric resources without increasing overall use. J Am Geriatr Soc 66:2372–2376, 2018 .