Interprofessional Intervention to Improve Geriatric Consultation Timing on an Acute Medical Service

Objectives: To determine whether an interprofessional intervention would improve the use and timing of a geriatric consultation on a hospitalist service.

Design: Difference-in-differences (DID), which measures the difference in improvement over time between intervention and control team patients attributable to the intervention.

Setting: 1,000-bed U.S. academic medical center.

Participants: Individuals aged 60 and older admitted to a general medicine hospitalist service (N=7,038; n = 718 on intervention teams, n = 686 historical controls, n = 5,634 on control teams (concurrent and historic).

Intervention: On 2 of 11 hospitalist teams, a geriatrician attended multidisciplinary discharge rounds twice weekly and advised on the benefits of a geriatric consultation for individuals aged 60 and older.

Measurements: Primary outcome was percentage of hospitalizations resulting in a geriatric consultation. Secondary outcome was days to geriatric consultation. Both outcomes were controlled for age, sex, comorbidity, mean daily intensity of inpatient care utilization, and admission in the prior 30 days. In the primary analysis, length of stay was controlled.

Results: Intervention participants were more likely to have a geriatric consultation (DID = 2.35% absolute percentage points, 95% confidence interval (CI) = 0.59-4.39%) and to have a consultation sooner (DID = 3.61 fewer days, 95% CI = -1 to -7).

Conclusion: An interprofessional intervention that focused on hospitalist ordering practices increased use of appropriate geriatric consultation and decreased time to consultation. This model of interprofessional effort is effective. Future adaptations are needed to target scarce geriatric resources without increasing overall use. J Am Geriatr Soc 66:2372-2376, 2018.