Hospital protocols for the inpatient care of older adults: results from a statewide survey

Abstract

Objectives: To assess the prevalence of protocols or guidelines for selected domains of inpatient care for older adults; to explore associations between hospital characteristics and adoption of these guidelines or protocols.

Design: Telephone- and Web-based questionnaire.

Setting: General acute care hospitals in Pennsylvania.

Participants: Chief nursing officers, directors of nursing, other hospital executives.

Measurements: Questionnaire items assessed the presence of written protocols or guidelines for selected processes of inpatient care; written guidelines, protocols, or pathways for hip fracture care; and inpatient geriatric consultation.

Results: Responses were obtained from 103 of 147 hospitals (70%) between June 21, 2009, and October 12, 2009. The prevalence of written protocols for general hospital practices (e.g., dosing of preoperative antibiotics, deep venous thrombosis prophylaxis) ranged from 84 of 98 (86%) to 90 of 97 (93%) respondents. Twenty of 95 (21%) and 16 of 94 (17%) respondents reported guidelines for the assessment of risk factors for delirium and for routine screening for delirium. Sixty-six of 92 respondents (72%) reported the presence of a written protocol, guideline, or pathway for hip fracture, and 61 of 100 respondents (39%) confirmed availability of inpatient geriatric consultation. No systematic differences were found in survey responses between facilities on the basis of geriatric consultation availability, hospital size, or teaching status.

Conclusion: Hospitals vary in their adoption of protocols and guidelines for the care of older adults. Broad opportunities may exist to improve the quality of inpatient care for older adults through better dissemination and implementation of guidelines and protocols for selected geriatric conditions.