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PAPERS:
Andrea Steiner, Bronagh Walsh, Ruth M Pickering, Rose Wiles, Jilly Ward, Julia I Brooking, and David J Torgerson
Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit • Commentary: Problems with randomised consent • Authors' reply
BMJ 2001; 322: 453-460 [Abstract] [Full text]
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[Read Rapid Response] Geriatricians should be involved in the management of older people in Intermediate Care
Ian Reeves   (26 February 2001)

Geriatricians should be involved in the management of older people in Intermediate Care 26 February 2001
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Ian Reeves,
Training Research Fellow
Academic Dept of Geriatric Medicine, Glasgow Royal Infirmary

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Re: Geriatricians should be involved in the management of older people in Intermediate Care

Editor - The paper by Steiner et al(1) (BMJ 24th February – Therapeutic nursing or unblocking beds?) illustrates the complexity of discharging patients from "acute care" in traditional hospital settings to "Intermediate Care", which in this study was a nurse-led unit. (NLU) The government has made Intermediate Care a priority (2), but which doctors should provide medical care for these patients is not specified. In contrast, the buildings where these patients might stay is discussed in some detail.

The trial clearly showed that patients in the NLU had fewer of the following; minor medical reviews, major medical reviews, tests and investigations, and changes to medications. These findings were "as expected", indicating that less ‘doctor input’ to these patients was a planned part of the model of care used. It appears that doctors’ input to the patients in the NLU was on an ‘as needed’ basis, rather than as a regular service from a geriatrician or other doctor. They also recorded that 21% of patients required transfer from the NLU, back to acute care, presumably for more intensive medical and nursing input. This high rate may reflect the lack of a geriatrician in the NLU. There is evidence that geriatricians are an important component of the multi-disciplinary care of older people - the meta analysis of Comprehensive Geriatric Assessment, showed that medical control was associated with improved mortality and a higher proportion of patients living independently. (3) The government, and future trials of Intermediate Care, should acknowledge this important effect and provide adequate resources for geriatricians to assist Intermediate Care units in the complex management of older patients

References.

1. Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute Intermediate Care Unit. A Steiner, B Walsh, R M Pickering, R Wiles, J Ward, J I Brooking for the Southampton NLU evaluation team. BMJ 2001; 322: 453-60.

2. The Department of Health. The NHS plan: a plan for investment, a plan for reform. London Stationery Office, 2000

3. Comprehensive Geriatric Assessment: A meta-analysis of controlled trials. Stuck A E, SIU A L, Wieland, G D, Adamms J, Rubenstein L Z. Lancet. 1993 (342) 1032-1036