Implementation of inpatient geriatric consultation teams and geriatric resource nurses in acute hospitals: a national survey study.

BACKGROUND

Inpatient geriatric consultation teams are multidisciplinary teams that advice and sensitize health care professionals in the hospital for the care of older patients. Despite the lack of clear evidence that these teams are effective, they were rated highly relevant and introduced in Belgian hospitals in 2007.

OBJECTIVES

To evaluate the implementation and performance of geriatric consultation teams and geriatric resource nurses (GRNs) in Belgium.

DESIGN

A cross-sectional survey was performed in March and April 2010.

SETTING

Acute hospitals.

PARTICIPANTS

Sixty-six hospitals completed the questionnaire (response rate of 68.8%); 63 geriatric consultation teams were included.

METHODS

A newly developed questionnaire was sent to all hospitals. The head of the geriatric department completed the general parts of the questionnaire. The other parts, covering the organization of the consultation teams and geriatric resource nurses, respectively, were completed by the geriatrician or the head nurse of the geriatric consultation team. All data were analysed in a descriptive manner.

RESULTS

The mean number of full time equivalents (FTE) per consultation team was 4.3 (SD±1.3; range 1.9-10.1). The nurse, represented by a mean of 1.7 FTE (SD±0.8), was a core member in almost all teams (n=60; 98.4%). The occupational therapist, geriatrician, dietician, psychologist and speech therapist were core members in more than 59% of the teams. Twenty-seven teams (42.9%) estimated that more than 75% of the patients (≥75 years) were screened for having a geriatric profile. This screening was mostly performed using the Triage Risk Screening Tool (n=23) or the Identification of Seniors At Risk (n=20). A positive screening automatically resulted in a request for a geriatric consultation team intervention in 45 teams (71.4%). Thirty-five teams (55.5%) had an advisory role only, while the other 28 teams (44.5%) had both advisory and executive roles. The median number of patients for whom recommendations were formulated per year, was 423 (Q1=230; Q3=633). Most participants rated the function of GRNs as 'poor' or 'bad'.

CONCLUSION

To increase their impact, inpatient geriatric consultation teams focus on frail older persons using screening tools for detection of high-risk patients. More intense collaboration with GRNs is essential, and the function of GRNs needs further improvement.