Abstract
BackgroundDischarge planning is an important component of hospital care. The Blaylock Risk Assessment Screening Score (BRASS) index is an instrument used to identify patients requiring complex discharge planning.Objectives(1) Evaluate the ability of the original BRASS index to predict the risk of complex discharge and hospital mortality. (2) Develop and validate a simplified BRASS index by eliminating redundant variables and re-estimating the predictor weights.DesignProspective cohort study.ParticipantsPatients admitted at the general internal medicine wards of tertiary referral hospital in Turin, Italy, and screened within 48 h using the BRASS index.MethodsThe first phase of the study assessed the performance of the original BRASS index in predicting the risk of complex discharge and hospital mortality, then a simplified score was developed. In the second phase, temporal validation of the simplified BRASS index was performed. The probability of each discharge modality (discharged at home without complications, complex discharge, and dead in hospital) was modeled using polytomous logistic regression. The AUC was used to compare the performance of the different models.Key ResultsAmong 6044 patients in the first phase of the study, 63% were discharged at home without complications, 31% had complex discharge, and 6% died during the hospital stay. The AUC of the simplified BRASS index, compared with the original index were 0.71 vs. 0.70 for complex discharge and 0.83 vs. 0.80 for hospital mortality. In the validation set (3325 patients), the simplified BRASS index discriminates the outcome categories with an AUC of 0.69 and 0.81 for complex discharge and hospital mortality, respectively.ConclusionThe new, simplified BRASS index showed a slightly better performance in predicting the risk of complex discharge and hospital mortality than the original tool and takes less time to be applied. These results were also confirmed in the validation set.
Highlights
Discharge planning is an important component of hospital care
In the first, we assessed the ability of the original Blaylock Risk Assessment Screening Score (BRASS) index in predicting the risk of complex discharge and the correlated event of hospital mortality, a new simplified score was developed by eliminating the redundant variables and re-weighting those retained
In this study, we developed and validated a new, simplified version of the original BRASS index, to improve the screening of patients at risk of complex discharge needing the activation of hospital discharge planning services
Summary
Discharge planning is an important component of hospital care. It has been defined as a series of events that occur shortly after a person is admitted to a health care setting with the aim of facilitating continuity of care, reducing length of hospital stay, reducing unplanned readmission to hospital, ensuring the optimal use of hospital beds, and improving the coordination of services following hospital discharge.[1,2]A systematic review suggests that a discharge plan tailored to each individual patient probably brings a small reduction in hospital length of stay and of the risk of readmission to hospital for older people admitted for different medical conditions. 1 it is important to identify factors that make a patient’s discharge problematic or complex so that the discharge planning and specific actions can be undertaken in timely manner.According to Selker et al, in the general internal medicine wards, 30% of all hospital discharges can be delayed for nonmedical reasons. Among the most frequent causes of delays are the lack or inadequacy of discharge planning and unavailability of post-discharge facilities.[3] Another study reported that 13.5% of all hospital days were judged unnecessary for acute general medicine inpatient care. METHODS: The first phase of the study assessed the performance of the original BRASS index in predicting the risk of complex discharge and hospital mortality, a simplified score was developed. CONCLUSION: The new, simplified BRASS index showed a slightly better performance in predicting the risk of complex discharge and hospital mortality than the original tool and takes less time to be applied. These results were confirmed in the validation set
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