The Effectiveness of a Timely Discharge Plan in Older Adults: A Prospective Hospital-Based Cohort Study in Southern Taiwan

Abstract

Background/Purpose: The aim of this study was to explore the effect of a timely discharge plan for community-based long-term care (LTC) in older adults (age 65+ years) admitted to a tertiary teaching hospital. Methods: Older patients in geriatric wards who needed communitybased LTC were enrolled between October 2016 and June 2017. Patients living in Kaohsiung City needing community-based LTC received timely discharge, with LTC assessed and arranged prior to discharge. Patients with the same needs but living in a different administrative area served as the control group and received traditional discharge, with LTC arranged after discharge home. All were assessed by the discharge planning team of nurses, geriatricians, and physical therapists. Rates of 3-day Emergency Department (ED) revisit and 14-day, 30-day, and 180-day readmission after hospitalization were assessed, as was length of hospital stay (LOS) and the time until LTC service delivery. Results: Of the 84 participants (mean=80.5 years, standard deviation=9.3 years, 33.3% female) recruited, 42 received timely discharge. Compared to the control group, the timely discharge group waited significantly less for LCT service post discharge (3.4±7.1 days versus 36.4±20.7 days, p <0.001), had shorter LOS (21.1±13.0 days versus 24.2±25.9 days, p=0.531), and lower rates of ED revisit (2.4% versus 4.8%), readmission within 14 days (4.8% versus 9.5%), 30 days (11.9% versus 23.8%), and 180 days (35.7% versus 47.6%). Conclusion: Timely discharge can significantly shorten the wait for community-based LTC for hospitalized older adults. Further studies should seek to reduce LOS, readmissions and ED revisits. 2663-8851/Copyright © 2019, Asian Association for Frailty and Sarcopenia and Taiwan Association for Integrated Care. Published by Full Universe Integrated Marketing Limited. *Correspondence Dr. Ming-Yueh Chou Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan E-mail: pitychou@gmail.com Dr. Joh-Jong Huang Bureau of Social Affairs, Tainan City Government, Tainan, Taiwan Email: jjhua@seed.net.tw Received 1 February 2019 Accepted 12 February 2019