A PROSPECTIVE-STUDY OF THE PROCESS OF ASSESSMENT AND CARE MANAGEMENT IN THE DISCHARGE OF ELDERLY PATIENTS FROM HOSPITAL

Assessment and care management (ACM) of elderly patients prior to disc harge from hospital has been in place since 1993. It involves a comple x multi-disciplinary assessment of needs which may delay discharge fro m hospital. We prospectively studied the process of ACM in a group of patients discharged from hospital over a three month period. The times taken for completion of the necessary reports, and any delays in the process were recorded. The times of each individual step in the proces s were correlated to overall length of stay and to the length of the c are management process. The effect of intercurrent illnesses or other delays was studied. Of the available sample (n=83), 16 patients died a nd two required long term hospital care. The median length of stay of the remainder (n=65) was 36 days (range 5-149 days). The median time f rom the start of the ACM process to discharge was 22 days (0-89 days). The strongest correlation with total length of stay was the time from admission until ACM commenced (rho=0.661, p<0.0001). The time spent i n the ACM process was related strongly to the time taken for the Care Manager to process the applications (rho=0.682, p<0.0001). Delay was r ecorded in 17 (24%) cases, resulting in an increased length of stay (p <0.001). While care management may help in appropriate placement after hospital discharge, these results suggest that it is prone to delays outside the hospital setting. Such delays result in patients waiting i n hospital for care packages to be set up in the community. This has i mplications for acute hospital services.