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Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.38638.441933.63 (Published 10 November 2005) Cite this as: BMJ 2005;331:1110
  1. Maria Crotty, professor of rehabilitation and aged care (maria.crotty{at}flinders.edu.au)1,
  2. Craig H Whitehead, geriatrician1,
  3. Rachel Wundke, extended practice nurse (aged care)1,
  4. Lynne C Giles, clinical epidemiologist1,
  5. David Ben-Tovim, director2,
  6. Paddy A Phillips, professor of medicine3
  1. 1 Department of Rehabilitation and Aged Care, Flinders University, Repatriation General Hospital, Daw Park SA 5041, Australia
  2. 2 Clinical Epidemiology and Health Outcomes Unit, Flinders Medical Centre, Flinders Drive, Bedford Park SA 5042, Australia
  3. 3 Department of Medicine, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
  1. Correspondence to: M Crotty
  • Accepted 19 August 2005

Abstract

Objective To assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility.

Design Randomised controlled trial.

Setting Three public hospitals in Southern Adelaide.

Participants 320 elderly patients (mean age 83 years) in acute hospital beds (212 randomised to intervention, 108 to control).

Interventions A transitional care facility where all patients received a single assessment from a specialist elder care team and appropriate ongoing therapy.

Main outcome measures Length of stay in hospital, rates of readmission, deaths, and patient's functional level (modified Barthel index), quality of life (assessment of quality of life), and care needs (residential care scale) at four months.

Results From admission, those in the intervention group stayed a median of 32.5 days (95% confidence interval 29 to 36 days) in hospital. In the control group the median length of stay was 43.5 days (41 to 51 days) (95% confidence interval for difference 6 to 16 days). Patients in the intervention group took a median of 21 days (6 to 27 days) longer to be admitted to permanent care than those in the control group. In both groups few patients went home (14 (7%) in the intervention group v 9 (9%) in the control group). There were no significant differences in death rates (28% v 27%) or rates of transfer back to hospital (28% v 25%).

Conclusions For frail elderly patients who are awaiting a residential care bed transfer out of hospital to an off-site transitional care unit with focus on aged care “unblocks beds” without adverse effects.

Footnotes

  • Contributors MC and CHW designed and supervised the study. RW collected the data. LCG analysed the data. DB-T and PAP gave research and health service advice. All authors contributed to drafting and critically revising the article. MC is guarantor.

  • Funding South Australian Department of Human Services and Common-wealth Department of Health and Aged Care (National Demonstration Hospital Program Phase 4).

  • Competing interests None declared.

  • Ethical approval Repatriation General Hospital's research and ethics committee, Flinders Medical Centre's clinical research ethics committee, and Noarlunga Health Services' ethics committee.

  • Accepted 19 August 2005
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