A Case-Control Study of the Sub-Acute Care for Frail Elderly (SAFE) Unit on Hospital Readmission, Emergency Department Visits and Continuity of Post-Discharge Care

Abstract

Objectives: In Canada, alternate-level-of-care (ALC) beds in hospitals may be used when patients who do not require the intensity of services provided in an acute care setting are waiting to be discharged to a more appropriate care setting. However, when there is a lack of care options for patients waiting to be discharged, it contributes to prolonged hospital stays and bottlenecks in the health care system manifested as "hallway medicine." We examined the effectiveness of a function-focused transitional care program, the Sub-Acute care for Frail Elderly (SAFE) Unit, in reducing the length of stay (LOS) in hospital, as well as post-discharge acute care use and continuity of care. Design: Case-control study. Setting and Participants: A 450-bed nursing home located in Ontario, Canada, where the SAFE Unit is based. The study population included frail, older patients aged 60 years and older who received care in the SAFE Unit between March 1, 2018, and February 28, 2019 (n ¼ 153) to controls comprising of other hospitalized patients (n ¼ 1773). Methods: We linked facility-level to provincial health administrative databases on hospital admissions and emergency department (ED) visits, and the Ontario Health Insurance Plan claims database for physician billings to investigated the LOS during the index hospitalization, 30-day odds of post-discharge ED visits, hospital readmission, and follow-up with family physicians. Results: SAFE patients had a median hospital LOS of 13 days [interquartile range (IQR): 8e19 days], with 75% having fewer than 1 day in an ALC bed. In comparison, the median LOS in the control group was 15 days (IQR: 10e24 days), with one-third of those days spent in an ALC bed (median: 5 days, IQR: 3 e10 days). SAFE patients were more likely (64.1%) to be discharged home than control patients (46.3%). Both groups experienced similar 30-day odds of ED visits, hospital readmission and follow-up with a family physician. Conclusions and Implications: Frail older individuals in the SAFE Unit experienced shorter hospital stays, were less likely to be discharged to settings other than home and had similar 30-day acute care outcomes as control patients post-discharge.

Readmission rates and predictors of avoidable readmissions in older adults in a tertiary care centre

“…[ 10 31 ] Another study found the odds of readmission reduced by 56% when discharge plans were sent to primary care physicians. [ 18 ] Therefore, primary care and family physicians play a vital role in improving transition care resulting in reduced hospital readmissions,[ 26 32 ] and their turnover can affect readmission rates. [ 33 ] We conducted the first study analyzing avoidable readmissions among older adults in India.…”

“…[ 2 ] As liaisons between the various healthcare practitioners involved in patient care, primary care physicians can play a vital role in post-discharge care and reduce hospital readmissions by providing continuing care. [ 26 27 ]…”

Facilitating Equitable Subacute-to-Home Transitions for Patients Receiving Palliative and/or End-of-Life Care: A Literature Review

“…In an aging population, increasing numbers of individuals experience extended periods with frailty and multimorbidity toward the end of life (Tunnard et al, 2021). Subacute settings provide specialized levels of care to patients with longer periods of frailty, deterioration, and complex conditions who do not require the intensity of care provided in acute settings (Menzies & Hanger, 2011;Reyes-Ortiz et al, 2015;Robert et al, 2021;Sinn et al, 2016;Tunnard et al, 2021;Walker et al, 2015). Subacute care aims to provide continuity of care for patients as an intermediate step between acute care and home (Robert et al, 2021).…”

“…Subacute settings provide specialized levels of care to patients with longer periods of frailty, deterioration, and complex conditions who do not require the intensity of care provided in acute settings (Menzies & Hanger, 2011;Reyes-Ortiz et al, 2015;Robert et al, 2021;Sinn et al, 2016;Tunnard et al, 2021;Walker et al, 2015). Subacute care aims to provide continuity of care for patients as an intermediate step between acute care and home (Robert et al, 2021). However, while interventions exist to improve the hospital-to-home transition, these have generally focused on acute care.…”

Layanan Kesehatan Masyarakat (Posyandu) Untuk Lansia

“…Individu dalam kelompok bothstudy dikecualikan jika mereka dibawah 60 tahun, kehilangan informasi usia dan jenis kelamin, dan tidak memenuhi syarat untuk didanai oleh publik Ontario Health Insurance Plan (OHIP). ( Robert, H. Sun, Sinden, Spruin, & T. Hsu, 2020) Melalui wawancara yang saya lakukan terhadap nenek saya yaitu nikmah ammar, yang bisa di panggil ibu nikmah, sekarang berusia 75 tahun kelahiran 16 april 1945 dan pendidikan terakhir SMA, bertempat tinggal di Situbondo bersama kakak kandung ibu saya (paman saya). Dari informasi yang saya dapatkan dari nenek saya mengenai penyakitnya, nenek saya menderita penyakit asma yang mana sering sekali kambuh apa bila melakukan kegiatan-kegiatan yang berat.…”