Abstract
A systematic and early biopsychosocial assessment of older patients in acute care hospitals is necessary for a proactive and effective discharge plan in order to identify patients at risk for a care deficit after hospitalization. Our study aim was to adapt the, “Post Acute Care Discharge“ (PACD) Scores developed in Geneva for use in the Cantonal Hospital of Aarau and evaluate as screening instruments in selected medical patients in a medical university clinic. Among 308 patients admitted from home with urinary tract infections, falls, syncope or heart failure day 1 PACD ≥ 8 had a sensitivity of 90% and a specificity of 62% and day 3 PACD ≥ 8 a sensitivity of 80% and a specificity of 60% to identify a nursing care deficit. The PACD is used as a screening instrument to identify patients at risk and therefore facilitate a structured, interdisciplinary and patient-centered analysis of the situation and discharge plan.
Highlights
In Switzerland, 17.2% of the total population comprises adults older than 65 years of age with an increasing tendency [1]
Even in medically stable respiratory tract infection patients with a structured triage and discharge plan, organizational reasons were responsible in 50% of the cases for delayed discharge [8]
A prolonged hospital stay due to nursing and organizational reasons was evident in 42.7% of medically stable patients with decompensated heart failure [9]
Summary
In Switzerland, 17.2% of the total population comprises adults older than 65 years of age with an increasing tendency [1]. Simonet et al [5] reported that the most frequent cause for delayed hospital discharge was the non-availability of a bed in a postacute care institution. According to Boutin-Foster et al [6], 30% of delayed hospital discharges were due to non-medical reasons. For inpatients with respiratory tract infections, nursing care reasons such as waiting for a free bed in a post-acute institution have become significantly more important [7]. Even in medically stable respiratory tract infection patients with a structured triage and discharge plan, organizational reasons were responsible in 50% of the cases for delayed discharge [8]. A prolonged hospital stay due to nursing and organizational reasons was evident in 42.7% of medically stable patients with decompensated heart failure [9]. A systematic review recognized older age, cognitive deficiency, difficulties with ADL and IADL before admission, and depression as the strongest predictors of functional decline [27]
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