GeriNOT in the Surgical Inpatient Setting.

Abstract

The guideline of the Federal Joint Committee (G-BA) on quality assessment measures for the care of patients with hip fracture makes it mandatory for hospitals to use an appropriate geriatric screening instrument in the context of acute inpatient care. After systematic application of GeriNOT and data collection in the admission process with integration into the Hospital Information System (HIS), it is possible to identify potential risks in geriatric patients with other diagnoses as well.With the integration of GeriNOT into the acute inpatient admission process, it was examined whether vulnerable geriatric patients with other diagnoses could benefit from the early initiation of risk identification.The data base for the present study was a retrospective bicentric collection of electronic case records (May 2014 to April 2015, n = 3,443). From this primary data set, the subgroup of inpatient acute admissions (n = 821) in the orthopaedic/trauma surgery of a study centre was analysed and evaluated with respect to the endpoints "utilisation of needs-based post-inpatient care services" and "new admission to inpatient permanent/short-term care". The predictive power and classification accuracy of GeriNOT of these patients who were 70 years and older to the endpoints were assessed for several groups: total acute admissions, total fractures, hip fracture, and spinal disorders including spinal fractures.A total of 821 patients were admitted as acute inpatients during the study period. The mean age of the patients was 81.4 ± 6.8 years (n = 821; 68.1% women, 31.9% men). The following subgroups were formed and analysed: total fractures (n = 490), spinal disorders (n = 265) including spinal fractures (n = 174), and hip fracture (n = 108). Both in the overall group (n = 821; M = 4.279; SD = 2.180) and in the subgroups, the mean GeriNOT score was above the threshold ≥ 4. The highest score was found in the hip fracture group (M = 4.852; SD = 2.022), and the lowest in the spine fracture group (M = 4.177; SD = 2.171). At admission, if the terms of variables for requiring treatment were "polypharmacy" and "nursing services already used as needed", there were only slight differences in the diagnostic groups. Admissions from short-term and long-term care occurred in the total group in 16.44% of cases, most frequently with 31.48% in the group of hip fractures, compared to spinal diseases with 6.79%. For this group, GeriNOT detected an elevated risk with respect to the defined endpoints. However, only 4.26% of all patients with identified geriatric risk potential received further geriatric care.The results showed increased geriatric risk in all analysed groups, but most pronouncedly within the group of spinal diseases. The HIS-supported use of GeriNOT offers the possibility of systematic risk identification in acute inpatient admission management. The continuous visualisation of results at HIS workstations throughout the workflow could be used as a starting point for the subsequent application of standardized assessment tools and risk-adjusted treatment pathways. These findings could potentially improve outcomes.