Thursday, April 29, 2010

The value of a proactive geriatrics consult service

This idea goes against the popular hospitalist mindset. At first glance it seems redundant and wasteful. After all, don't hospitalists do geriatric medicine day in and day out? So why bring in another team? Because, at least in one study, it reduced utilization and resulted in better care.

The model was profiled in Today's Hospitalist:

"Geriatrics excels at more nebulous aspects of caring for older patients, not the nitty-gritty treatment of medical illness," Dr. Botkin says. "Many people don’t recognize how important these aspects are and how they add up to providing better care."

...A big factor in the service’s success is that ACE team members are brought in almost immediately, says Dr. Botkin. While hospitalists can call a traditional geriatric consult for a patient with delirium, the ACE team is activated when the admitting hospitalist checks a box on the general admission order set.

...Within a day, the service may be ordering physical therapy, for instance, or phoning family members in California—tasks that Dr. Botkin may not get to for several days.

"When I’m spending 45 minutes managing acute illness," he explains, "the service saves me another 30 minutes making sure the patient won’t be left alone at home after discharge." Just as importantly, he adds, the early intervention helps prevent functional decline.

In other words the hospitalists can't do it all. These patients got better and more efficient care thanks to early involvement of the geriatrics team.

Related post here.

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