Early discharge planning for elderly patients in acute hospitals--an intervention study

In an intervention study geriatrically orientated discharge planning was tested at an acute hospital in Uppsala, Sweden. The planning was initiated at an early stage in the care of patients above the age of 75. The geriatric approach implies that the elderly patient's medical, functional and psychosocial needs are taken into consideration. A team consisting of a geriatrician and a qualified district nurse was responsible for the discharge planning in consultation with the patients and their relatives. One health care district formed the intervention group, while two comparable districts became two control groups. The intervention proved to be effective, giving better utilization of acute hospital beds through reduced numbers of bed-blocking patients, shorter waiting times for bed-blockers and reduced expenditure for district health authorities who were financially liable for that group. This was true even when the cost of the intervention was included. The results show how vital it is that discharge planning initiated at an early stage becomes standard practice in the acute care of the elderly. Collaboration with the district nurse is necessary for continuity, exchange of information, optimal assessment of care requirements and planning for discharge and follow-up after return to the home. Geriatric consultation at an early stage in the care episode, with assessment of geriatric-medical factors and rehabilitation requirements can contribute to more efficient care and discharge planning, especially for patients "at risk" at the discharge. In times when economic incentives are gaining increasing significance, a balance must be struck between an efficient use of resources, by choosing the right type of care at the right time, and the needs of the patients, with their right to autonomy and a say in their own care.