Abstract
AimsTo assess the 'Okay to Stay' plan to investigate if this reduces visits to emergency departments, unplanned admissions and elective admission to hospital in elderly patients with long-term health conditions. BACKGROUND: The incidence of long-term conditions is rising as the elderly population increases, resulting in more people from this group attending emergency departments and being admitted to hospital. Okay to Stay is a simple plan for people with long-term conditions to help them remain in their own home if they suffer an acute exacerbation in their health. It was co-designed with professional and patient representatives with the aim of empowering patients and their carers to more effectively manage their long-term conditions. METHODS: Data from 50 patients (20 males, 30 females, mean baseline age 77.5 years) were compared 12 months before implementation of the plan and in the subsequent 12 months, with the significance of effects assessed at the 5 per cent significance level using t-tests.FindingsVisits to emergency departments were reduced by 1.86; unplanned emergency admissions were reduced by 1.28 and planned elective admissions were raised by 0.22 admissions per annum. The reduction in visits to the emergency department was significant (p = 0.009) and the reduction in emergency admissions was significant (p = 0.015). The change in elective admissions was not significant (p = 0.855). The Okay to Stay plan is effective in reducing visits to the emergency department and unplanned hospital admissions in people with long-term conditions. This is a positive step to supporting vulnerable and complex patients who are cared for at home, and facilitates the recognition by the individual of the possibility to stay at home with the support of health professionals. There are potential cost benefits to the investment of initiating an Okay to Stay plan through the avoidance of visits to the emergency department and non-elective admissions to hospital.
Highlights
Fifteen million people in England suffer from long-term conditions, and this group accounts for 70 per cent of all bed days and acute and primary care budgets (Department of Health, 2016)
As the pilot study indicated that Okay to Stay plans were effective in reducing attendance to A&E, emergency admission and calls to the out of hours GP service, the plans were introduced to a wider group of patients with one or more long-term condition, living in their own homes
The Okay to Stay programme has demonstrated a significant reduction in numbers of annual visits to emergency departments, and in the number of unplanned emergency admissions, controlling for multiple comparisons, in a mainly elderly population with multiple co-morbidities at moderate risk of falls
Summary
Fifteen million people in England suffer from long-term conditions, and this group accounts for 70 per cent of all bed days and acute and primary care budgets (Department of Health, 2016). Older people have a longer length of stay than younger patients once admitted to hospital (Sager et al, 1996). The incidence of long-term conditions increases with age, as does frailty; it is estimated that between a quarter and half of people older than 85 years are estimated to be frail (Collard et al, 2012). A number of different initiatives have been trialled to reduce length of hospital stay and readmission rates; including tailored structured discharge plans, which may have a small effect, but overall cost benefits are still inconclusive (Shepperd et al, 2010). A randomised controlled trial comparing a community in-reach rehabilitation and care transition with the ‘usual’ discharge to rehabilitation service on length of hospital stay and readmission rates found no difference between the two approaches (Sahota et al, 2016)
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