A UNIVERSITY-AFFILIATED COMMUNITY-HOSPITAL INPATIENT GERIATRICS PROGRAM FUNCTIONING IN AN ADMINISTRATIVE AND EDUCATIONAL CAPACITY

OBJECTIVE: To demonstrate an unusual form of inpatient geriatric asses sment with unique outcomes. DESIGN: A prospective evaluation of patien ts admitted to a community hospital-based inpatient geriatrics unit ut ilizing traditional members of the assessment team along with educatio nal assessment of nurses and satisfaction profiles of patients and/or families. SETTING: A non-profit community hospital in Northeast Washin gton, DC. PARTICIPANTS: All patients older than age 62 admitted to the 42- bed Geriatric Unit during a 41/2 year time period. MEASUREMENTS: Number of total and category recommendations taken by attending physic ians from the Inpatient Geriatric Assessment Team, periodic evaluation of unit nurses' geriatric knowledge base and certification, and patie nt satisfaction through periodic surveys. RESULTS: More than 4500 pati ents have been evaluated during the past 41/2 years. The number of rec ommendations taken by attending physicians has averaged 31.3 to 50.7% during four consecutive chart reviews involving the first 25 consecuti ve patients for the month each performed every six months (n = 100). T he average age of patients evaluated was 77.2 (minimum of 62 and maxim um of 97); 67% were females and 33% males. The average number of recom mendations communicated per patient was 4.1, and the average number ad hered 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, limitati ons, and outcomes. Other than the cost of limited geriatric nurse prac titioner and faculty salary support, the program has been implemented using only current hospital department personnel. The role of the asse ssment team is to educate attending nurses and staff physicians. It ha s not yet been possible to measure objective outcomes. However, the cu rrent program also serves the purpose of introducing a new medical pro gram to a community hospital in a nonthreatening way and offers opport unities for research. In addition, the program offers further opportun ity for expansion and change.