Effectiveness of an inpatient geriatric service in a university hospital.
OBJECTIVE
To assess the effectiveness of an acute interdisciplinary inpatient geriatric service in a university hospital.


METHODS
Prospective randomized control study.


METHODS
Large urban university hospital.


METHODS
40 consecutive inpatients, randomized for inclusion on the geriatric service (study patients, n = 20) or to continue usual hospital care (control patients, n = 20) from among the geriatric consult population.


METHODS
Subjects were followed for changes in length of stay, hospital costs, diagnostic testing, pharmacy use, functional status, discharge disposition, and readmission within 30 days after hospitalization.


RESULTS
Mean age of patients study 79.2 years (control 73.9 years). Sixty percent of study patients went home and 30% to nursing homes (control 20% home, 65% nursing homes) P = .03. Total length of stay mean 20.3 days study (control 32.7 days), length of stay after randomization mean 7.7 days study (control 11.2 days), mean overall hospital costs $23,906 study (control $45,189), and mean hospital costs after randomization study $4,671 (control $9,404) were not significantly different by F-tests due to wide variability. Laboratory use was reduced with mean 4.4 tests study (control 16.9) P = .01 and mean laboratory costs $263 study (control $828) P = .02. Functional ability improved (scale 1-7) with mean improvement study 0.8 (control 0.3) P = .09. Mean number of medications were lower in the study group by 30% P = .02; mean cost of medications at discharge was reduced with study $38 (control $112); and mean pharmacy charges after randomization decreased $462 study (control $1,268) P = .06. Readmission 30 days after discharge was not significantly different (study 21%, control 33%).


CONCLUSIONS
An interdisciplinary acute geriatric service can be cost effective in providing care to elderly patients in a university hospital. It can improve outcomes measured by decreased laboratory and pharmacy usage, improved functional status, and discharge to a lesser level of care without increasing length of stay or early readmission after discharge.
White
S J
SJ
Department of Nursing, Vanderbilt University Medical Center, Nashville, TN 37232-2410.
Powers
J S
JS
Knight
J R
JR
Harrell
D
D
Varnell
L
L
Vaughn
C
C
Brawner
D
D
Burger
M C
MC
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D017046:Cost Savings; D003955:Diagnostic Tests, Routine / Q000191:economics; D005260:Female; D005853:Geriatrics / Q000191:economics*; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D010343:Patient Admission / Q000191:economics*; D010348:Patient Care Team / Q000191:economics*; D011446:Prospective Studies; D013714:Tennessee; D016896:Treatment Outcome