Geriatrician-led Interdisciplinary Rounds to decrease Hospital readmissions

TL;DR

A geriatrician-led team caring for older veterans did not reduce hospital readmissions or mortality despite managing sicker patients.

Contribution

Demonstrates that geriatric-led interdisciplinary care maintains outcomes in older adults with higher comorbidities.

Findings

AFHS patients had similar 30-day readmission and mortality rates as non-AFHS patients.

Patients in AFHS had higher Charlson and CAN scores but similar length of stay.

Qualitative feedback from patients and caregivers was positive.

Abstract

Age-Friendly Health Care Systems (AFHS) framework is used as a way to care for Older Adults¹. Older patients occupy nearly half of the inpatient beds in community hospitals². We wanted to determine if a Geriatrician-led interdisciplinary team was associated with changes in key performance indicators.

Veterans 75 years or older assigned to a ten-bed virtual capacity, inpatient medical ward evaluated by a Geriatric led interdisciplinary (GEC) team utilizing the mentation, mobility, what matters, medications framework (4Ms) from the AFHS, generating a Geriatric Assessment note. Patients were excluded if admitted with a decompensated psychiatric disease or needed intensive or step-down level of care. After the initial evaluation, the GEC discussed daily until discharge. A total of 233 Veterans admitted to the AFHS was compared against 418 age-matched Veterans not admitted to AFHS (non-AFHS) during the same period (10/1/2023 – 6/30/2024; n = 651 total) on their length-of-stay (LOS), and 30-day readmission and mortality rates using multivariate linear and logistic regression where applicable adjusted for Charlson comorbidity and care assessment needs (CAN) scores.

Veterans admitted to the AFHS had a similar age but significantly higher Charlson and CAN scores. LOS, 30-day readmission, and mortality rates were similar between the two groups. Qualitative interviews of both patients and caregivers were also positive.

In this Geriatric led AFHS improvement teamwork, we found that it had similar rates of mortality and readmissions in older veterans admitted to the medical ward despite the AFHS having a sicker population.