Acute care delivery for the geriatric patient: an innovative approach.

As the elderly population and expenditures for health care continue to grow rapidly in the United States, how to provide high-quality, cost-effective geriatric care is becoming a pressing question. To address this question, Choate-Symmes Health Services, Inc, established 10-bed Geriatric Special Care Units (GSCUs) in its two suburban Boston hospitals. Care on the GSCUs is delivered under a primary nursing model and involves comprehensive assessment, development of individual care plans emphasizing independence and activity, an interdisciplinary patient care team, and family participation in care planning. Patients were randomly assigned to either the GSCU or a traditional adult medical/surgical unit; outcomes were studied through questionnaires and medical record data. Researchers anticipated improved functional ability, less frequent use of restraints, fewer complications, shorter lengths of stay, and less frequent readmission to the hospital or admission to nursing homes for GSCU patients. The article presents preliminary results, discusses implementation issues, and describes plans for continued study.