The escalating needs of elderly patients within acute care settings demand innovative approaches to healthcare. The Yale Geriatric Care Program was designed as a pioneering, nursing-centered strategy to boost geriatric nursing expertise throughout a hospital environment. This model focuses on integrating specialized geriatric care into the standard practices of medical and surgical units, ultimately aiming to improve patient outcomes and healthcare delivery for older adults.
This descriptive study examined the implementation of the Geriatric Care Program within a university teaching hospital. The program was introduced to a prospective group of 244 patients, all aged 70 and over, across four non-intensive care units over a period from July 1990 to July 1991. This initiative sought to proactively address the complex healthcare requirements of older patients during their hospital stay.
The core of the Geriatric Care Program is an integrated team approach. This involves primary nurses working alongside unit-based geriatric resource nurses, gerontological nurse specialists, and geriatric physicians. This multidisciplinary team structure is designed to provide comprehensive geriatric support. The program’s interventions included proactive surveillance to identify vulnerable older patients upon admission. Furthermore, it incorporated unit-specific geriatric education sessions for all nursing staff, specialized training and support for the geriatric resource nurses, and regularly scheduled (twice-weekly) meetings of the Geriatric Care Team to discuss patient cases and care plans.
The Yale Geriatric Care Program demonstrated successful implementation across the four targeted units. The interventions provided a wide range of support, from clarifying patient care goals in a significant majority of cases (92%) to delivering specific recommendations for managing common geriatric issues. These issues included immobility (41%), bladder and bowel management (41%), pressure ulcer prevention and treatment (25%), confusion assessment and management (25%), and medication adjustments (18%). Notably, 68% of the specific recommendations made by the Geriatric Care Team were documented as being put into practice by the nursing staff, showing a strong translation of recommendations into direct patient care.
Despite its successes, the program faced implementation hurdles. Initial challenges included recruiting and retaining geriatric resource nurses, largely due to existing high nursing turnover rates and the substantial time commitment the role demanded. Communication breakdowns and inconsistent application of recommendations between different nursing shifts also posed obstacles. Furthermore, fostering effective communication between nursing and medical staff required ongoing attention to ensure seamless care coordination.
In conclusion, the Geriatric Care Program at Yale represents an innovative and successfully implemented model for integrating specialized geriatric nursing care into the routine care of older patients in acute medical and surgical units. By focusing on a nursing-centered approach and team-based care, this program offers a valuable framework for enhancing the quality of hospital care for the growing elderly population. While initial challenges were encountered, the program’s documented success in implementing recommendations and improving patient care pathways highlights its potential for broader adoption and positive impact on geriatric healthcare within hospital settings. Further evaluations are essential to fully assess the long-term effectiveness and cost implications of this pioneering intervention.
