Dr Jim Wong is a Geriatric Advanced Trainee working at the Townsville Hospital. After graduating from the University of Adelaide in 2011, he undertook internship at the Royal Adelaide Hospital (RAH) followed by Basic Physician Training at the Lyell McEwin Hospital. He also has over 12 months experience in Community Psychiatry and Acute Psychiatry. His interest includes community services for the elderly and development of hospital avoidance pathways and models of care.
Geriatric Evaluation And Management Criteria Formulation – An Analysis Of Outcomes In The Rehabilitation Wards In A Regional Australian Hospital
Geriatric Evaluation and Management Units (GEMU) have always provided the mainstay of implementation of appropriate geriatric services to the elderly population and can reduce mortality in the elderly frail population.1 However, GEMU admission criteria has always been determined via anecdotal or case by case means. With beds costing up to $700 per day, it is vital that appropriate patients are selected on a regular basis in order to optimize exposure to this population in the context of limited resources.
Our aim is to evaluate key clinical factors to facilitate formulation of a screening system for GEMU admissions to ensure better use of limited medical resources and improve the functional gain of patients.
We conducted a retrospective study of 106 admissions (mean age 84, SD=4.2) between April to June 2018. 13 variables incorporating cognitive screens, baseline and current functional status, and certain comorbidities were analyzed. Partition modelling analysis was used to determine which variables could significantly affect outcomes, and hence, measure the effect of these variables against the standard geriatric population in terms of length of stay, readmission rates, and discharge destination. Chi square analysis was utilized to determine statistical significance.
We determined that factors predominantly affecting length of hospital stay are physiotherapy status, number of comorbidities, dementia, and anaemia. Variables affecting re-admission rates and time are congestive cardiac failure (CCF), dementia, mild cognitive impairment (MCI), Mini Mental State Examination (MMSE), dependence in activities of daily living, and anaemia. By applying our formulated screening criteria to the dataset, the criteria-specified patients would have reduced number of hospital re-admissions over 12 months (0.875 versus 1.42 admissions) and reduced average length of stay (21.5 versus 26.83 days), with a difference of 5.33 days per patient.
We recommend a multimodal approach involving the following criteria for GEMU patient selection: fully independent baseline, Haemoglobin ≥110g/L, MMSE ≥25, no diagnosed dementia or MCI, current physiotherapy status of ≤1x assist, have supportive family at home and not from nursing home; which when applied to our patient population, resulted in a benefit to the hospital healthcare budget of $6,033,591 per annum in the context of a 24 bed GEMU.
1 Saltvedt I, Mo ES, Fayers P, Kaasa S, Sletvold O. Reduced Mortality in treating sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial. J Am Geriatr Soc. 2002 May;50(5):792-8
Readmissions In The Elderly – An Analysis Of Outcomes In Elderly Patients In The Acute Geriatric Wards Of A Tertiary Hospital In Regional Australia
Introduction: Hospital readmission is commonly identified as one of the primary causative factors for morbidity and mortality in the geriatric population. With acute medical beds costing up to $800 per day, Australia’s healthcare system is one of increasing financial constraints, and with hospital readmissions exacerbating overall length of stay, identification of key factors contributing to risk of readmissions is crucial in terms of formulating a targeted approach to minimising readmissions in the elderly. Although similar studies have been conducted overseas (1)(2), there are no current publications done on the Australian population at this stage.
Aim: To assess and evaluate key factors leading to readmissions in the elderly, as well as timeframes associated with different conditions, such that further clinical correlation can be made with certain medical conditions to ascertain how quickly community supports will need to be implemented in order to avoid further hospital admissions.
Method: Retrospective study of 450 readmissions between 1st July 2015 to 30th June 2017 were studied. 33 variables were analysed. Partition modelling was used to identify significant variables. Chi square analysis was utilized to determine statistical significance.
Results: Total of 440 readmissions met inclusion criteria (mean age 85, SD = 11.4, male = 42%, n = 188). Mean length of time between admissions was 54.8 days. Partition modelling analysis enabled us to determine not only how long it took for key geriatric syndromes took to represent, but also predict based upon comorbidities, demographic and recurrence of admissions, how quickly supports needed to be implemented in order to prevent a future readmission. Additionally, we have proven efficacy of home supports in terms of preventing readmissions.
Our recommendation is that support services should be instituted within 6 days post discharge for common geriatric syndromes, to minimize risk of readmission, with falls and dementia being the areas where most benefit can be found. This study also identified the health care budget benefit that can potentially be achieved via early implementations of the above recommendations.