Structured scoring of supporting nursing tasks to enhance early discharge in geriatric rehabilitation: The BACK-HOME quasi-experimental study.

INTRODUCTION

In geriatric rehabilitation it is important to have timely discharge of patients, especially if they have low nursing support needs. However, no instruments are available to identify early discharge potential.

OBJECTIVE

To evaluate if weekly scoring of a nursing support scorecard in the evenings/nights and discussing the results in the multidisciplinary team meeting, leads to potential differences in discharge of geriatric rehabilitation patients.

DESIGN

Quasi-experimental study with a reference cohort (n=200) and a Back-Home implementation cohort (n=283).

SETTING/PARTICIPANTS: Patients in geriatric rehabilitation in the four participating skilled nursing facilities in the Netherlands.

METHODS

Implementation of the nursing support scorecard during one year consisted of (1) weekly scoring of the scorecard to identify the supporting nursing tasks during the evenings/nights by trained nurses, and (2) discussion of the results in a multidisciplinary team meeting to establish if discharge home planning was feasible. Data on patients' characteristics and setting before admission were collected at admission; at discharge, the length of stay, discharge destination and barriers for discharge were collected by the nursing staff.

RESULTS

Both cohorts were comparable with regard to median age, gender [reference cohort: 81 (IQR 75-88) years; 66% females vs. Back-Home cohort 82 (IQR 76-87) years; 71% females] and reasons for admission: stroke (23% vs. 23%), joint replacement (12% vs. 13%), traumatic injuries (31% vs. 34%), and other (35% vs. 30%). Overall, the median length of stay for the participants discharged home in the reference cohort was 56 (IQR 29-81) days compared to 46 (IQR 30-96) days in the Back-Home cohort (p=0.08). When no home adjustments were needed, participants were discharged home after 50 (IQR 29.5-97) days in the reference cohort, and after 42.5 (IQR 26-64.8) days in the Back-Home cohort (p=0.03). Reasons for discharge delay were environmental factors (36.7%) and patient-related factors, such as mental (21.5%) and physical capacity (33.9%).

CONCLUSION

Structured scoring of supporting nursing tasks for geriatric rehabilitation patients may lead to earlier discharge from a skilled nursing facility to home, if no home adjustments are needed.