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Background

Extended hospital stays and complications are common among older adults and may lead to morbidity and loss of independence. Specialized geriatric units have been shown to improve outcomes; but, with the growing numbers of older adults, may be difficult to scale to meet needs.

Purpose

Evaluate a quality improvement initiative that redesigned unit-based workflow and trained interprofessional teams on general medical/surgical units to create care plans for vulnerable older adults using principles of comprehensive geriatric assessment and team management.

Method

Cluster randomized controlled trial of 10 medical/surgical units and intention-to-treat analysis of all patients meeting risk screening criteria.

Results

N=1,384, median age = 80.9 years, 53.5% female. Mean difference in observed versus expected LOS was 1.03 days shorter (p=0.006); incidence of complications (OR 0.45; 95% CI 0.21, 0.98) and transfer to intensive care (OR 0.45; 95% CI 0.25, 0.79) lower among patients admitted to intervention units; incidence of discharge to institutional care was higher (OR 1.43; 95% CI 1.06, 1.93). Mortality during hospitalization (OR 0.64; 95% CI 0.37, 1.11) did not differ between groups.

Conclusion

Reorganizing general medical/surgical units to provide team-based, interprofessional, care can improve outcomes among hospitalized older adults.