A pre-discharge ward for acute medical patients

We describe and evaluate a ward developed to facilitate the discharge planning of general medical patients.

A 15-bed pre-discharge ward (PDW) with a ward coordinator was established in 1995, as a counterpoise to a medical assessment unit (MAU).

Data, analysed after the first year, included diagnosis, physiotherapy and occupational therapy referrals, length of stay and discharge destination.

During its first year, 810 patients were admitted to the PDW; 39% were male, their mean age was 75 years (range, 16-99; standard deviation, 11.3). Respiratory illness (24%) was the commonest diagnosis, 62% required physiotherapy, 51% occupational therapy and 35% needed increased social support. Discharge was as follows: 681 (84.1%) patients were discharged to their admission address, 34 (4.2%) were taken over by the department for care of the elderly, 29 (3.6%) discharged to relatives, 23 (2.8%) to residential or nursing homes, 22 (2.7%) returned to acute medical beds, 12 (1.5%) to general practitioner beds and nine patients (1.1%) died. The average length of stay during a three-month period (October-December) for all acute medical patients was 7.47 days before the MAU and PDW were opened and 7.32 days afterwards.

The PDW provides multidisciplinary assessment and focused discharge planning for patients of general physicians. This did not prolong their stay in acute medical beds.