BIOGRAPHY
Dr Ian Scott is consultant general physician and Director of Internal Medicine and Clinical Epidemiology at Princess Alexandra Hospital in Brisbane. He is Associate Professor of Medicine at University of Queensland and Adjunct Associate Professor of Medicine at Monash University. He has research interests in evidence-based medicine, quality improvement, health technology assessment and guideline development, and has co-authored more than 170 articles in peer-reviewed journals. He is a member of Queensland Policy and Advisory Committee on new Technology (QPACT) and sits on the Executive Committee of the CSANZ/NHFA Acute Coronary Syndrome Guidelines Update for 2015 in addition to various working groups of Royal Australasian College of Physicians, Queensland Health, and the Australian Commission of Quality and Safety in Health Care.
ABSTRACT Objectives: To identify causes of prolonged discharge delays among non-acute in-patients admitted to a tertiary general medicine service; quantify occupied bed days (OBDs); and propose strategies for eliminating avoidable delays.
Methods: Retrospective study of patients admitted between January 1st 2012 and May 31st 2015 and discharged as non-acute cases requiring maintenance care and who incurred a total non-acute length of stay ≥28 days. Detailed chart review ascertained serial causes of discharge delay and their attributable OBDs. Literature reviews and feedback from multidisciplinary staff identified potential strategies for minimizing delays.
Results: 131 patients incurred long-stays for whom delays were identified that accounted for 5420 (90%) of 6033 non-acute OBDs. Lack of available residential care beds was the most frequent cause, accounting for 44% of OBDs. Waits for outcomes of guardianship applications accounted for 13% of OBDs while guardian appointments, Public Trustee applications and funding decisions for equipment or care packages each consumed between 4% and 5% of OBDs. Family and/or carer refusal of care accounted for 7%. Waits for aged care assessment assessments, social worker reports, geriatrician/psychiatrist reviews and confirmation of enduring power of attorney each accounted for between 1% and 3% of OBDs. Of 30 proposed remedial strategies, those rated as high priority were: greater access to interim care/respite care beds and residential care for patients with special needs; dedicated agency officers for hospital guardianship applications and greater inter-agency collaboration and harmonisation of assessment and decision processes; formal requests to patients and family to accept care options and attend mediation meetings; and establishment of a long stay executive committee which monitors all long stay patients and escalates matters requiring external arbitration and advocacy to senior managers.
Conclusions: Delayed discharges of non-acute patients requiring maintenance care result principally from impaired access to residential care, administrative delays involving external agencies, and patient/family refusal of care. Remedial actions are possible but require concerted managerial response.
ABSTRACT
Diagnosing And Managing Type II MI
|
