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

doi:10.1136/bmj.38638.441933.63

BMJ, doi: 10.1136/bmj.38638.441933.63, (Published 2 November 2005)

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

Maria Crotty ¹^*, Craig H Whitehead ¹, Rachel Wundke ¹, Lynne C Giles ¹, David Ben-Tovim ², Paddy A Phillips ³

¹ Department of Rehabilitation and Aged Care, Flinders University, Repatriation General Hospital, Daw Park SA 5041, Australia
² Clinical Epidemiology and Health Outcomes Unit, Flinders Medical Centre, Flinders Drive, Bedford Park SA 5042, Australia
³ Department of Medicine, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia

^* Correspondence to: maria.crotty{at}flinders.edu.au.

Objective To assess the effectiveness of moving patients whoare waiting in hospital for a long term care bed to an off-sitetransitional care facility.

Design Randomised controlled trial.

SettingThree public hospitals in Southern Adelaide.

Participants 320elderly patients (mean age 83 years) in acute hospital beds(212 randomised to intervention, 108 to control).

InterventionsA transitional care facility where all patients received a singleassessment from a specialist elder care team and appropriateongoing therapy.

Main outcome measures Length of stay in hospital,rates of readmission, deaths, and patient's functional level(modified Barthel index), quality of life (assessment of qualityof life), and care needs (residential classification scale)at four months.

Results From admission, those in the interventiongroup stayed a median of 32.5 days (95% confidence interval29 to 36 days) in hospital. In the control group the medianlength of stay was 43.5 days (41 to 51 days) (95% confidenceinterval for difference 6 to 16 days). Patients in the interventiongroup took a median of 21 days (6 to 27 days) longer to be admittedto permanent care than those in the control group. In bothgroups few patients went home (14 (7%) in the intervention groupv 9 (9%) in the control group). There were no significant differencesin death rates (28% v 27%) or rates of transfer back to hospital(28% v 25%).

Conclusions For frail elderly patients who are awaitinga residential care bed transfer out of hospital to an off-sitetransitional care unit with focus on aged care "unblocks beds"without adverse effects.

(Accepted 19 August 2005)

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