Inpatient elderly care: reducing re-admission rates

Abstract

In our hospital, when demand for medical beds overwhelms capacity, patients are often ‘out-lied’ into other specialties beds to free up capacity. An observational study compared outcomes of patients admitted into an elderly care ward and outlier beds in our hospital over 14 days. Six weeks after completion of the initial study, inpatient geriatric services were expanded, and some medical outlier beds were incorporated into a new ward—the study was repeated on this new ward. 38, 26, and 35 patients with a mean age of 79, 85 and 80 years were admitted to the medical ward, outlier beds, and new medical ward respectively. Mean number of medications, comorbidities, female-to-male ratio, destination of discharge, and mortality was similar in all three cohorts. Mean length of stay was 23 days, 42 days, and 24 days. Three month re-admission rates were 25%, 50%, and 13%, respectively on the established medical ward, outlier beds, and new medical ward. The length of stay and re-admission rates for elderly patients in outlier beds were higher than patients on the medical ward, despite similar demographics and destination of discharge. Our data suggests that outlying elderly patients is hugely inefficient.