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Real-life implementation of guidelines on the hospital-to-home transition for older patients: a cohort study in general practice
- Authors:
- HURTAUD Aline, et al
- Journal article citation:
- Age and Ageing, 49(1), 2020, p.46–51.
- Publisher:
- Oxford University Press
Background: hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7 days. The relevance and feasibility of these guidelines have not previously been assessed. Objective: to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors’ association with 30-day readmissions. Design: a prospective multicentre cohort study. Setting: primary care (general practice) in France. Subjects: a sample of GPs and the same number of patients aged 75 or over having consulted within 30 days of hospital discharge. Methods: the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7 days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses. Results: seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53–76) consulted their GP within 7 days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27–50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07–0.91]). Conclusions: compliance with the French guidelines on hospital-to-home transitions is insufficient. (Edited publisher abstract)
Intermediate care or integrated care: the Scottish perspective on support provision for older people
- Author:
- PETCH Alison
- Journal article citation:
- Journal of Integrated Care, 11(6), December 2003, pp.7-14.
- Publisher:
- Emerald
Looks at how the concept of intermediate care appears to have been rejected in Scotland in favour of an emphasis on integrated care. The article explores the apparent divergence in the broader context of policy variation post-devolution and against the aspirations for a whole-system approach.
Back home after discharge
- Author:
- -
- Journal article citation:
- Care Plan, 4(3), March 1998, pp.27-28.
- Publisher:
- Positive Publications/ Anglia Polytechnic University, Faculty of Health and Social Work
Details best practice in preparing and monitoring care following the older person's return home.
A perfect storm: care transitions for vulnerable older adults discharged home from the emergency department without a hospital admission
- Authors:
- CADOGAN Mary P., PHILLIPS Linda R., ZIMINSK Carolyn E.
- Journal article citation:
- Gerontologist, 56(2), 2016, pp.326-334.
- Publisher:
- Oxford University Press
Purpose of the Study: The purpose of the study was to describe, from the perspectives of emergency department (ED) providers, factors that influence quality and safety of transitions home from the ED for vulnerable older adults. Design and Methods: A grounded theory approach was used to analyse data from 9 focus groups conducted with ED staff that included representatives from nursing, medicine, pharmacy, social work, and respiratory therapy. Results: From the perspectives of these care providers, 5 antecedent concepts contribute to the perceived quality and safety of transitions from the ED to home. These 5 concepts include the nature of geriatric presentations, provider knowledge, consumer knowledge, the ED resource base, and health care system fractures. Co-occurrence and interaction among the 5 identified antecedents set up conditions for what one focus group participant described as a perfect storm. Implications: Older adults discharged home from the ED without a hospital admission are an increasingly important but understudied group within the transitional care literature. Although they share some similarities with those undergoing different health transitions, their unique needs and the specific characteristics of ED care require a novel approach. The model that emerged in this study provides direction for understanding the complex and interrelated aspects of their transitional care needs. (Edited publisher abstract)
Intermediate care: what do we know about older people's experiences?
- Author:
- PETCH Alison
- Publisher:
- Joseph Rowntree Foundation
- Publication year:
- 2003
- Pagination:
- 37p.,bibliog.
- Place of publication:
- York
Traditionally ‘intermediate care’ has often been used to refer to a range of services at the boundary of primary and secondary care, although there have been differing assumptions as to the goal of intermediate care, the intensity of support provision and the appropriate target groups. Confusingly, intermediate care has also been used within the hospital as a term for units located between the intensive care unit and the general ward. The current form of intermediate care provision started to shape up with the NHS Plan. This proposed a range of intermediate care services designed to bridge between hospital and home and to: help people recover and regain independence more quickly; bring about swifter hospital discharge when people are ready to leave; and avoid unnecessary long-term care.
Care services for later life: transformation and critiques
- Editors:
- WARNES Anthony M., WARREN Lorna, NOLAN Michael
- Publisher:
- Jessica Kingsley
- Publication year:
- 2000
- Pagination:
- 531p.,bibliog.
- Place of publication:
- London
Collection of essays exploring care for the elderly in a time of social and demographic change. Explores the assumptions and values underlying current provision including the rationing of care and the new National Service Framework, and then examines specific areas such as the experience of older people in ethnic minorities, the use of telematics, the care of the dying, and entering into residential care.
Towards independence and choice: a review of policy guidance and standards of care for elderly people; a documentation review done by the Daphne Heald Research Unit, Royal College of Nursing, for the Clinical Standards Advisory Group, Department of Health
- Author:
- ROYAL COLLEGE OF NURSING
- Publisher:
- Royal College of Nursing
- Publication year:
- 1996
- Pagination:
- 6p.
- Place of publication:
- London
Brief review of services for people aged 70 and over, using hip fractures as a marker condition for the identification of standards relevant to the care and rehabilitation of all older people discharged from hospital.
Delayed discharge, a solvable problem?: the place of intermediate care in mental health care of older people
- Authors:
- PATON J. M., FAHY M. A., LIVINGSTONE G. A.
- Journal article citation:
- Aging and Mental Health, 8(1), January 2004, pp.34-39.
- Publisher:
- Taylor and Francis
The National Service Framework for Older People envisages the development of intermediate care for older people. This study examined the possible role of intermediate care beds within mental health trusts. We interviewed senior clinicians in an inner city old age psychiatry service about the 91 current in-patients on the old age psychiatric wards. Sixty-five were classified as acute patients and the remaining 26 were continuing care patients. Structured instruments were used to collect information regarding neuropsychiatric symptoms, activities of daily living and current met and unmet needs. Where discharge was delayed an assessment was made regarding the appropriateness for an intermediate care setting according to the criteria set by the Department of Health guidelines. A total of 30 (46%) patients' discharges were delayed. Of these, 19 (29%) patients met the DOH criteria for intermediate care; 10 (53%) had dementia, five (26%) affective disorder, and four (21%) with schizophrenia. The 11 other delayed discharges were because of lack of availability of finance for placements. The study found that the prompt discharge of older patients from acute psychiatric care was a significant problem and many of those patients may benefit from the therapeutic and rehabilitative process afforded by intermediate care.
Ensuring the effective discharge of older patients from NHS acute hospitals: thirty-third report of session 2002-03; report, together with formal minutes, oral and written evidence
- Author:
- GREAT BRITAIN. Parliament. House of Commons. Committee of Public Accounts
- Publisher:
- Stationery Office
- Publication year:
- 2003
- Pagination:
- 18p.
- Place of publication:
- London
On any given day, some 3,500 older patients remain in National Health Service (NHS) acute hospitals after medical staff have declared them fit and safe to be discharged, because arrangements are not complete for them to move on. Many delays are for a few days, but about one-third are for more than 28 days. The Department of Health estimate that delayed discharges cost the National Health Service around £170 million a year (or around £0.5 million for every day of the year), and account for 1.7 million lost bed days annually. Reducing delays has become a Government priority, and was the subject of legislation during the winter of 2002–03. Delayed discharge is as much about the availability of services in the community as what happens in hospital. While hospitals can do much to move patients efficiently through the system, they have to retain them longer than is medically necessary if patients cannot be discharged safely to a more appropriate place. Delays can occur at a number of points, and the most common causes are patients awaiting a care home placement or assessment of needs, problems with transfers to further NHS care, or delays in the availability of public funding. To tackle the problem, successful co-ordination is needed between NHS acute Trusts, Primary Care Trusts, local authority social services departments, and independent sector providers and others.
The discharge of older homeless people from hospital
- Author:
- BLOOD Imogen
- Publisher:
- Help the Aged
- Publication year:
- 2003
- Pagination:
- 23p.,bibliog.
- Place of publication:
- London
When older homeless people leave hospital, all too frequently arrangements for their accommodation are inadequate or inappropriate. This can easily mean an early return to hospital, or even needless death. The National Service Framework for Older People, which prioritises the need to improve hospital discharge planning and post-discharge care for older people, does not consider the implications for older people who do not have stable and adequate housing. This report highlights the needs of older homeless people. It also offers practical solutions to ensure that they do not end up back on the streets or in inappropriate housing as a result of leaving hospital. Agencies working together to provide these solutions is an important step to improving the quality of life of this group of very vulnerable older people.