Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

Crotty, Maria; Whitehead, Craig; Wundke, Rachel; Giles, Lynne C.; Ben-Tovim, David I.; Phillips, Paddy A.

doi:10.1136/bmj.38638.441933.63

Cited by 43 publications

(82 citation statements)

References 19 publications

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“…The only Australian evaluation of a similar model of a residential transition unit undertaken before the TCP suggested that when all bed-days were counted such units had system efficiency problems. 19 Although transferring older patients who were waiting for a high-level care bed saved 11.5 hospital bed-days it took a median of 21 days more for the older person to reach a residential aged care bed.…”

Section: Models Of Carementioning

confidence: 99%

The distribution of health services for older people in Australia: where does transition care fit?

Giles

Halbert²,

Gray³

et al. 2009

Aust. Health Review

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Section: Models Of Carementioning

confidence: 99%

The distribution of health services for older people in Australia: where does transition care fit?

Giles

Halbert²,

Gray³

et al. 2009

Aust. Health Review

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“…Many models of care may result in the organisation of health services [25][26][27], but a wide range of services is not enough. It is necessary to guide people through the system [28].…”

Section: Discussionmentioning

confidence: 99%

Difficult hospital discharges in internal medicine wards

et al. 2007

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The aim of "coordinated care" (i.e., targeting "at-risk" patients with assessment of medical, functional, social and emotional needs; provision of optimal medical treatment, self-care education, integrated services, monitoring of progress and early signs of problems) is to improve health outcomes and reduce costs. More than 80% of DHDs patients, with specific tailored programmes, may be discharged from hospital, with satisfactory solutions for them and their families.

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“…Temporary transfers have been considered as the solution for delayed discharges (Crotty et al, 2005) but this practice is criticised for not taking into consideration long-term effects in patients and overall cost of care (Coleman, 2003). Populations most at risk for transitional care problems include older people with co-morbidity, dementia, depression, or other mental health disorders.…”

Section: Awaiting Care Home Placementsmentioning

confidence: 99%

“…The idea is that patients should be transferred into temporary care home placements to wait for the service of choice. If the interim bed is rejected, the reason for delay shifts to 'patient or family choice' which is classified as an NHS delay and consequently is not reimbursable.Temporary transfers have been considered as the solution for delayed discharges (Crotty et al, 2005) but this practice is criticised for not taking into consideration long-term effects in patients and overall cost of care (Coleman, 2003). Populations most at risk for transitional care problems include older people with co-morbidity, dementia, depression, or other mental health disorders.…”

mentioning

confidence: 99%

Delayed discharges in mental health beds

Manzano

Goode²

2011

British Journal of Healthcare Management

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The Department of Health has identified a high number of hospital delayed discharges in patients suffering from mental illness. Since 2006, the weekly monitoring of these delays is required for all non-acute and mental health trusts. This article explores the limitations of standardised definitions of 'safe to transfer' for mentally ill patients; the conundrum created by co-morbidity and legal requirements; and the constraints of current categories for delay established by this performance system are exposed.Establishing when and why hospital discharges are delayed is not an easy task. It is embedded with subjectivity and complexity which increases in the context of the intricacy of mental illness and discharge pathways. Considering the constructed nature of delayed discharges, the limitations and over reliance on quantitative data collection must be taken into consideration in the case of quantitative itemisation of mental health needs for Payment by Results tariffs, or when using audit data to construct evidence-based systems of care for people with mental illnesses. 2 IntroductionIn England, concern over increased rates of delayed hospital discharges -often referred to by the media as 'bed-blocking'-has been a feature of the Department of Health policy drivers over recent years. In 2003, following the apparent success of such a system in Scandinavia, England introduced a system of cross-charging (Department of Health, 2003a). This establishes a reimbursement policy to tackle the issue of people unable to leave hospital beds because they are waiting for community services. It placed a financial obligation on councils to reimburse acute hospitals (£100-120 per day) if social care assessments and services are the sole reason for delayed hospital discharges.A significant number of patients admitted to mental health beds have their discharges delayed (National Audit Office, 2007). Although the scope for extending the reimbursement scheme to mental health beds was stated at the time; seven years later, this has not happened. Since 2006, however, weekly monitoring of delays became compulsory for all mental health beds. This article explores how the current monitoring system for delays encounters difficulties when applied to mental health beds. These findings are a starting point to take into consideration if fines are to be implemented for these beds, or in the case of quantitative itemisation of mental health needs for Payment by Results tariffs as announced in the latest White Paper (Department of Health, 2010). 3 Difficulties in Monitoring Mental Health Delayed DischargesEfficient access to social care is a key aspect of improving discharges from acute psychiatric beds but not the only one. Resources identified as fundamental include 'total dependency psychiatric care, day hospitals, inpatient observation facilities and continuing care wards ' (Glasby and Lester, 2004: 753). Although the evidence on mental health delays is criticised for having significant limitations, these are, however, common methodolo...

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Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

Cited by 43 publications

References 19 publications

The distribution of health services for older people in Australia: where does transition care fit?

The distribution of health services for older people in Australia: where does transition care fit?

Difficult hospital discharges in internal medicine wards

Delayed discharges in mental health beds

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