P299: Structured scoring of supporting nursing tasks in post-acute care to enhance early supported discharge in geriatric rehabilitation. The BACK-HOME study

Abstract

Introduction: The aim of this study was to evaluate if the use of a structured scoring of supporting nursing tasks in the evening and night, leads to earlier discharge home in geriatric rehabilitation patients. Methods: A preand post-implementation cohort design was followed. One cohort (n = 200) was assessed before and the other (n = 283) after the implementation of the scorecard. The implementation consisted of weekly filling out a validated structured scorecard for identifying the supporting nursing tasks, discussing them in the multidisciplinary team-meeting, in order to establish if discharge home was possible with help in less than 3 nursing tasks within 2 weeks. Results: Both cohorts were comparable in age, gender and reasons for admission (mean age 80 years (SD:10); 69% females). Reason for admission were stroke (23%), joint replacement (13%), traumatic injuries (32%), and other (32%). Participants from the post-implementation cohort were discharged home earlier, within 48 days (SD:26) compared with 56 days (SD:31) in the preimplementation cohort; P =0.044. 28% of the participants that were able to be discharged home according to the supporting nursing tasks, were discharged within 2 weeks. Reasons for discharge delay were: no realized home adjustments (47%), diminished cognition participant (29%) and impaired general condition participant or informal caregiver (65%). Conclusion: The use of a scorecard for discharge planning may lead to earlier discharge home. After being indicated for discharge, this is often not realised within 2 weeks. An early inventarisation of the possibilities and barriers in the home situation is needed to avoid discharge delay.