How effective are acute geriatric wards at admitting geriatric patients?

The role of the acute geriatric unit is to ensure prompt access to comprehensive geriatric care for which there is an evidence base.¹ Systems to ensure that appropriate patients are admitted vary from using age as a proxy for appropriateness to selecting patients using specific characteristics suggesting need for geriatric care.^2,3 To assess the effectiveness of access to geriatric care of appropriate patients, an analysis was made of how many hospital bed days in general medicine and geriatric medicine were used by acutely admitted patients with an International Statistical Classification of Diseases (ICD-10) code that would unambiguously signify the need for geriatric care, R54 ‘Senility’. The use of this code varies from hospital to hospital. In some, it is attached to all complex elderly patients to show their nature and attract extra funding if appropriate to the tariff. In others, it is used sparely when there is no obvious diagnosis. However it is used, it is extremely unlikely that a patient with this coding would not have needs appropriately met by a geriatric service.

Hospital episode statistics (HES) were obtained from Northgate Information Solutions Limited, which is responsible, on behalf of the NHS, for this data. Data were obtained for code R54 episodes in general medicine and geriatric medicine wards throughout England. The available data were for the number of patient admissions in any one year to the particular departments and the average length of stay. Hospital bed days were calculated by multiplying the number of episodes by average length of stay. The data available were for episodes not spells, that is to say that patients during one admission (or spell) may have been admitted under general medicine and transferred to geriatric medicine, and so counted as two episodes.

Table 1 shows that patients aged 65 and over with a diagnosis R54 ‘senility’ spent the majority of their time on general medicine wards. In three out of the four years, even patients aged 85 and over with this diagnosis were for at least half of the time looked after on general wards. One wonders what their clinical management in those wards involved. Over the period studied, it was common practice for acute hospital patients to be admitted under general medicine for one or two days and then transferred to an appropriate specialty ward. The bed day data show that patients spent much longer on general medicine wards than would be accounted for by such a model of care. Virtually every acute hospital in England has an acute geriatric ward. Systems need to be improved to allow accessibility of acute geriatric care for appropriate patients. This may involve more beds and staff or more efficient use of current beds and staff including transfer of wards from general medicine to geriatric medicine.⁴

Table 1.

Hospital bed days occupied by patients with diagnosis R54 ‘senility’ in general (internal) medicine (GIM) and geriatric (GER) wards by year and age. Percentages show proportion of time these patients occupied geriatric beds.