Sustainability and Scalability of the Hospital Elder Life Program at a Community Hospital
Open accessAbstract
The Hospital Elder Life Program (HELP), an effective intervention to prevent delirium in older hospitalized adults, has been successfully replicated in a community teaching hospital as a quality improvement project. This article reports on successfully sustaining the program over 7 years and expanding its scale from one to six inpatient units at the same hospital. The program currently serves more than 7,000 older patients annually and is accepted as the standard of care throughout the hospital. Innovations that enhanced scalability and widespread implementation included ensuring dedicated staffing for the program, local adaptations to streamline protocols, continuous recruitment of volunteers, and more‐efficient data collection. Outcomes include a lower rate of incident delirium; shorter length of stay (LOS); greater satisfaction of patients, families, and nursing staff; and significantly lower costs for the hospital. The financial return of the program, estimated at more than $7.3 million per year during 2008, comprises cost savings from delirium prevention and revenue generated from freeing up hospital beds (shorter LOS of HELP patients with and without delirium). Delirium poses a major challenge for hospital quality of care, patient safety, Medicare no‐pay conditions, and costs of hospital care for older persons. Faced with rising numbers of elderly patients, hospitals can use HELP to improve the quality and cost‐effectiveness of care.
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Although HELP is cost effective, it requires substantial training and monitoring of a large team of volunteers, which can serve as a barrier to adoption, especially in safety-net facilities with limited resources.
“Although the HELP program is cost effective, it requires substantial training and monitoring of a large team of volunteers, which can serve as a barrier to adoption, especially in safety-net facilities with limited resources, serving high-risk patient populations [21-23].”
From A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study (2019) · cites this paper as [22]
The Introduction reports HELP’s cost-effectiveness. Methods (Maintaining quality and Dissemination process) describe standardized volunteer training and supervision of a large volunteer pool; Results (Challenges and successes encountered) describe recruitment and staffing challenges. The paper does not establish that these requirements are a barrier to adoption specifically in resource-limited safety-net facilities. (LLM, conf=0.87)
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- Authors
- Rubin, F. H., Neal, K., Fenlon, K., Hassan, S., & Inouye, S. K.
- Affiliations
- Shadyside Hospital (US)
- Hebrew SeniorLife (US)
- Beth Israel Deaconess Medical Center (US)
- ORCID
- Inouye, Sharon K.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2011-02
- Volume
- 59
- Issue
- 2
- Pages
- 359-365
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC3588581
- OpenAlex
- W1607329473
- Cited by
- 186
- References
- 19
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 12 · 2023: 6 · 2022: 9 · 2021: 14 · 2020: 11 · 2019: 13 · 2018: 17 · 2017: 11 · 2016: 12 · 2015: 12 · 2014: 24 · 2013: 15 · 2012: 12
- FWCI
- 14.33
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institute on Aging (K24AG000949)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- Hospital Elder Life Program, delirium prevention, program sustainability, scalability, community teaching hospital, quality improvement, length of hospital stay, hospital costs, cost reduction, program staffing, volunteer recruitment, patient satisfaction, nursing satisfaction, patient safety
- MeSH terms
- Activities of Daily Living, Aged, Delirium, Hospitals, Community, Humans, Patient Care Planning, Quality Assurance, Health Care, Retrospective Studies, Geriatric Assessment
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