Clinical Interventions in Aging (Nov 2018)
Structured interdisciplinary bedside rounds, in-hospital deaths, and new nursing home placements among older inpatients
Abstract
David Basic,1 Elizabeth Huynh,2 Rinaldo Gonzales,1 Chris Shanley3 1Department of Geriatric Medicine, Aged Care Research Unit, Liverpool Hospital, Liverpool BC, NSW 1871, Australia; 2Department of Geriatric Medicine, Aged Care Research Unit, Liverpool Hospital, University of NSW, Liverpool BC, NSW 1871, Australia; 3Department of Geriatric Medicine, Centre for Applied Nursing Research, Western Sydney University and Ingham Institute of Applied Medical Research, Aged Care Research Unit, Liverpool Hospital, Liverpool BC, NSW 1871, Australia Purpose: Ineffective interdisciplinary communication is linked to many adverse consequences of hospitalization. This study evaluated the effect of SIBR, a model of care that encourages interdisciplinary communication and patient and family participations, on in-hospital deaths and new nursing home (NH) placements.Materials and methods: This before-after study included 3,673 consecutive inpatients of mean age 83.8 years, of whom 93.2% were admitted through the emergency department. After each twice-weekly SIBR session, an interdisciplinary care plan was implemented and recorded on a datasheet attached to the bedside record. Staff unable to participate in SIBR were asked to view the datasheet and to follow the care plan. Logistic regression models were computed for in-hospital deaths and new NH placements.Results: Although SIBR implementation had no effect on in-hospital deaths (OR, 1.00; 95% CI, 0.77–1.29), SIBR increased NH placements among those who survived the hospitalization (n=3,346) in both unadjusted (14.6% vs 9.1%; P<0.001) and adjusted (OR, 1.75; 95% CI, 1.38–2.23) analyses.Conclusion: Although the mechanisms between SIBR implementation and NH placement remain uncertain, SIBR may encourage patients and families to make decisions on placement earlier than they would have otherwise. Models of care aiming to improve communication should be evaluated across diverse services and settings to determine effectiveness and to monitor for adverse findings. Keywords: aged, communication, death, inpatients, nursing homes, safety
