Discharge

Introduction Factors contributing to frailty result in increased hospitalisations, with 5- 10% of patients attending Accident and Emergency department living with frailty, and 30% of those patients admitted to acute medical units (Conroy, 2013). Hospital admissions result in functional decline and deconditioning (Get It Right First Time, 2021). The number of people in the UK over the age of 85 is set to double in the next 20 years and treble in the next 30 (Office of National Statistics, 2013). Their needs are best met in the community with a multi-disciplinary approach. Method Patients, residing in Benfleet and Leigh-on-sea, discharged from Geriatric wards at Southend Hospital were identified during ward MDT meetings. Inclusion criteria: • Recurrent admissions • Prolonged hospital stay • Clinical Frailty Score > 5 • Social support Using this criteria, 216 patients were included. 7 day readmission and 30 day readmission data was collected and compared to readmission rate prior to intervention. Intervention On discharge patients were linked with Frailty Nurses within their Primary Care Network and were reviewed within 48- 72 hours of discharge. Community support was provided via MDT, with involvement from consultant geriatrician. Concerns that could result in readmission were highlighted during these meeting, with patients being seen in Day Assessment Unit for review of sub-acute frailty syndrome if appropriate. Results Following intervention of utilising community MDT there was a reduction in rate of readmission. 9 patients (4.1%) were readmitted within 7 days of discharge and 14 patients (6.4%) were readmitted within 30 days, in comparison to 7.6% and 19.3%, respectively, prior to commencement of MDT. Conclusion This concludes that utilising community MDT with review following discharge has positive impact in reducing readmission rates. Highlighting potential risks of readmissions allows the MDT to address issues within the community and use bridging services appropriately.

Effect of Early Intervention By Physiotherapy And Occupational Therapy On Older Inpatient Population

S Kotak¹, C Miller ²

¹ Senior Physiotherapist, University Hospitals of Leicester NHS Trust

²Consultant Geriatrician, University Hospitals of Leicester NHS Trust

Background: Currently, on inpatient medical wards at University Hospitals of Leicester NHS Trust, the first contact by therapy teams (physiotherapy and occupational therapy) is made when patients become medically optimised for discharge. This is due to a number of reasons such as staffing and resource shortages.

Aim: Analyse the effects of early intervention by therapy on patients on a geriatric medicine inpatient ward at a large, teaching hospital. It is hypothesised that earlier intervention can improve patient and service outcomes.

Method: A data sheet was created to capture baseline information including mobility/care needs prior to admission, date of initial contact by therapy, mobility/care on discharge, length of stay and discharge destination. Data was collected over two phases; initial therapy contact at point of patient being medically optimised for discharge, and then with the planned intervention of proactive therapy input early in a patient’s admission.

Results: The data shows an improvement in all measured patient outcomes in the intervention group. The average time from admission to therapy first contact reduced from 6.4 days to 2 days. The average length of stay reduced from 16.3 days to 7.4 days in the intervention group. 70% of patients left the hospital with a reduction in their mobility status in the control group, whereas only 32% of patients left with worse mobility in the intervention group. 41% of patients in the control group left with new or increased care provision compared to 36% in the intervention group. The data also showed that a higher proportion of patients were mobilised by ward staff and less patient were discharged to 24 hour care settings in the intervention group.

Conclusion: Therapy (with the help of the wider multi-disciplinary team) should proactively identify patients in need of therapy input as soon as safely possible during an inpatient journey. This shows that adopting this approach leads to improvements for both our patients and our service.

Introduction: Older patients are vulnerable to falls after discharge as hospitalization could induce declines in physical function, mobility, and muscle strength. Falls may cause readmissions and subsequent healthcare burden. However, such incidence rates and costs have not been studied. This study aimed to investigate the incidence and costs of fall-related readmissions in older patients.

Method: A population-based retrospective cohort study was conducted among patients aged 65 or over and discharged from public hospitals in Hong Kong from 2007 to 2017. The administrative data for inpatient admission were obtained from the Hospital Authority Data Collaboration Lab. The fall-related readmissions within 12 months following discharge were identified by the International Classification of Diseases code of diagnosis. The incidence rates were calculated in terms of person-years. The costs were computed based on the public ward maintenance fees adopted since 2007.

Results: In total, 611,349 older patients with a mean (SD) age of 75.3(7.6) were analyzed. Within 12 months after discharge, 18,608 patients (3.0%) had 20,666 fall-related readmissions, giving an incidence rate of 35.2 per 1000 person-years. Meanwhile, such rates (per 1000 person-years) were 44.7 for women, 25.5 for men, 20.5 for patients aged 65-74, 41.0 for patients aged 75-84, and 76.2 for patients aged ≥85. The annual cost exceeded HKD 145.6 million (USD PPP 23.9 million in 2018) for older patients, and the mean cost per fall-related readmission was HKD 7,048 (USD PPP 1,158).

Conclusion: The fall-related hospital readmissions were important adverse events during the transitional period and caused a considerable healthcare burden to the patients, family caregivers, and the health system. Health professionals are suggested to implement interventions during hospitalizations or at the early stage after discharge to reduce falls, particularly for women and patients aged ≥75. For instance, increasing physical activity during the hospital stay can be considered for fall prevention.

Introduction

People with Parkinson’s disease (PwP) are more likely to be admitted to hospital and have longer lengths of stay than those without Parkinson’s disease (PD). Parkinson’s UK and NICE have proposed standards of care for inpatients with PD, including that PD specialists are alerted when PwP are admitted to hospital. 66% of UK hospitals don’t have an alert system in place, including King’s Mill Hospital (KMH).

Audit

Over a 6 month period, referrals to the PD service in KMH were audited. 128 referrals were made; 5 per week on average. Hospital-wide, around 12 PwP are admitted weekly. Therefore under 50% are referred for specialist input. 64% of patients had been in hospital over 24 hours before referral. 16 patients were referred to the PD service more than once during admission, reflecting ongoing management difficulties.

Intervention

The digital transformation team completed software changes to create an electronic alert when PwP are admitted to hospital. The local system for recording admission details and electronic prescribing, NerveCentre, can now generate an electronic list showing all inpatient PwP. A multi-disciplinary virtual PD ward round was introduced. Using NerveCentre, all PwP can be remotely reviewed and triaged. Proactive, positive interventions from the specialist PD team include: constipation management, osteoporosis screening, speech and language therapist review, cognitive assessment, issuing dysphagia cards, and advance care planning. NerveCentre enables remote medication reviews and audit of prescribing, ensuring that any breaches of the ‘Get It On Time’ campaign are reported via Datix, with relevant learning shared. The virtual ward round provides training opportunities for specialist registrars, junior doctors, and newly appointed PD specialist nurses.

Conclusion

The electronic flag permits more comprehensive, proactive and timely inpatient reviews of PwP. The interventions from this project enable the Trust to meet Parkinson’s UK recommendations and hopefully improves the inpatient experience of PwP.

Introduction:

Large numbers of geriatric inpatients within acute settings are deemed medically safe for discharge (MSFD) but stranded within the hospital due to a lack of community services and social care packages, leading to increasing length of patient stay and reduced hospital flow. These patients do not require inpatient care and would otherwise be discharged to their home or residential care. This project aimed to identify these patients and rationalise their medical input to mirror a community setting (without routine daily medical reviews).

Methods:

MSFD patient were identified by the multi-disciplinary team (MDT). Patients identified received standard nursing and therapy input, alongside daily MDT discussion at a board round to progress discharge planning. If the MDT expressed concern about a MSFD patient, they would receive a medical review. A sticker placed in the notes identified patients deemed MSFD.

Results:

A 3-week trial on a 19-bedded geriatric ward showed 46% of bed days were occupied by MSFD patients. On average, 8 MSFD patients did not require daily review. 0.6 unplanned reviews/day were needed due to MDT concern, saving an average of 7.4 patient reviews/day, equating to 3.3 hours/day doctor time saved.

Conclusions:

Doctor time saved allowed redistribution of staff to busier wards with more unwell patients, with no detriment to patient care noted. The trust formalised a SOP and the MSFD pathway was introduced across the geriatric medicine department. A MSFD ward has now been opened, to cohort patients awaiting discharge to community pathways. This ward should require minimal doctor input to allow continued redistribution of medical staff across the hospital, as well as facilitating patient flow by admitting patients who reside on the acute frailty unit who require increased community care.