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Taylor N1,2, Lawler K3, Brusco N4, Peiris C5, Harding K3, Coker F6, Scroggie G3, Wilton A3, Shields N5
1La Trobe University, Allied Health, Bundoora, Australia, 2Eastern Health, Allied Health Clinical Research Office, Box Hill, Australia, 3Eastern Health, Box Hill, Australia, 4Cabrini Institute, Malvern, Australia, 5La Trobe University, Bundoora, Australia, 6Monash University, Clayton, Australia
Background: Geriatric Evaluation and Management (GEM) provides inpatient care for people with complex conditions associated with ageing, cognitive dysfunction, chronic illness and disability. There is evidence from systematic reviews that GEM reduces the risk of functional decline at discharge and reduces the risk of discharge to residential care at 1 year. Providing additional Saturday allied health services for inpatient rehabilitation can help patients get better quicker, with cost savings for the health service. However, it is not known if providing an additional day of allied health services per week in GEM can also reduce length of stay and improve health outcomes.
Purpose: To assess if providing additional Saturday allied health services on a GEM ward reduced length of stay and improved health outcomes.
Methods: A controlled before-and-after trial alongside a health economic analysis was completed on two GEM wards in a public health network in Australia. Participants included all patients discharged from the two wards during the 6-month pre-intervention (N=331) and intervention (N=462) periods. Saturday allied health services (physiotherapy, occupational therapy, social work and an on-call service for other allied health professions) were provided on the intervention ward in addition to usual Monday to Friday staffing. There were no Saturday allied health services on the comparison ward. Primary outcomes were length of stay and functional independence (FIM). Cost-effectiveness was evaluated using FIM change and total cost. Secondary outcomes included discharge destination and readmissions.
Results: There were no between-ward differences in length of stay and FIM in the pre-intervention period. There was an unplanned change in medical leadership in the comparison ward early in the intervention period. In the intervention period, comparison ward mean length of stay was 7.8 days (95% CI 4.7 to 10.8) lower, FIM discharge score was 6.5 units (95%CI 2.0 to 11.0) lower and readmission rate increased (Incidence Rate Ratio 0.64, 95% CI 0.36 to 1.13) in the 30 days after discharge, compared to the intervention ward. In the intervention period there was no significant between-ward difference for total cost inclusive of the GEM admission and the 30 days after discharge. There was a non-significant additional cost of $AUD 1,772 for each 1-point gain in FIM in the intervention ward.
Conclusion(s): Providing additional allied health services on a Saturday to a GEM ward did not reduce length of stay or total cost, but may have reduced readmissions in the 30 days following discharge. Observations in the comparison ward which may have been influenced by a change in medical leadership suggest that reductions in length of stay should be considered in the context of whether these changes were achieved at the expense of discharging patients with a lower level of functional independence which may be associated with higher rates of readmission.
Implications: The results do not provide support for the provision of additional weekend allied health services on a GEM ward in this setting. Observations in the comparison ward suggest discharge practices that focus on length of stay alone can be misleading.
Keywords: Rehabilitation, Geriatrics, Rehabilitation
Funding acknowledgements: Staffing for additional Saturday allied health services funded by Eastern Health
Purpose: To assess if providing additional Saturday allied health services on a GEM ward reduced length of stay and improved health outcomes.
Methods: A controlled before-and-after trial alongside a health economic analysis was completed on two GEM wards in a public health network in Australia. Participants included all patients discharged from the two wards during the 6-month pre-intervention (N=331) and intervention (N=462) periods. Saturday allied health services (physiotherapy, occupational therapy, social work and an on-call service for other allied health professions) were provided on the intervention ward in addition to usual Monday to Friday staffing. There were no Saturday allied health services on the comparison ward. Primary outcomes were length of stay and functional independence (FIM). Cost-effectiveness was evaluated using FIM change and total cost. Secondary outcomes included discharge destination and readmissions.
Results: There were no between-ward differences in length of stay and FIM in the pre-intervention period. There was an unplanned change in medical leadership in the comparison ward early in the intervention period. In the intervention period, comparison ward mean length of stay was 7.8 days (95% CI 4.7 to 10.8) lower, FIM discharge score was 6.5 units (95%CI 2.0 to 11.0) lower and readmission rate increased (Incidence Rate Ratio 0.64, 95% CI 0.36 to 1.13) in the 30 days after discharge, compared to the intervention ward. In the intervention period there was no significant between-ward difference for total cost inclusive of the GEM admission and the 30 days after discharge. There was a non-significant additional cost of $AUD 1,772 for each 1-point gain in FIM in the intervention ward.
Conclusion(s): Providing additional allied health services on a Saturday to a GEM ward did not reduce length of stay or total cost, but may have reduced readmissions in the 30 days following discharge. Observations in the comparison ward which may have been influenced by a change in medical leadership suggest that reductions in length of stay should be considered in the context of whether these changes were achieved at the expense of discharging patients with a lower level of functional independence which may be associated with higher rates of readmission.
Implications: The results do not provide support for the provision of additional weekend allied health services on a GEM ward in this setting. Observations in the comparison ward suggest discharge practices that focus on length of stay alone can be misleading.
Keywords: Rehabilitation, Geriatrics, Rehabilitation
Funding acknowledgements: Staffing for additional Saturday allied health services funded by Eastern Health
Topic: Disability & rehabilitation; Older people
Ethics approval required: Yes
Institution: Eastern Health
Ethics committee: Eastern Health Human Research Ethics Committee
Ethics number: LR83-2016
All authors, affiliations and abstracts have been published as submitted.
