A hospital-based special care unit for dementia decreased hospital readmission rates for behaviour while reducing rates of falls and occupational violence across medical wards.

BACKGROUND

Hospital-based Special Care Units (SCU) for dementia show promise as effective models of care. However, limited research describes hospital-wide benefits.

OBJECTIVE

To describe patient-level outcomes and hospital service-level outcomes of a SCU.

DESIGN

Pre-post analyses of SCU-patient data and hospital service-unit incident report data.

SETTING, PARTICIPANTS: 2-years of SCU-patient admissions and 4-years of hospital incident-reports from four medical wards (2-years pre-post SCU).

METHODS

Admission and discharge severity of SCU-patients' behaviour was prospectively measured by specialist SCU nurses. One-year hospitalisation rates, length-of-stay, diagnosis and patient demographics were retrospectively obtained from medical records. Hospital service-unit data included 4 years of monthly incident report rates for falls, pressure injury and occupational violence (OV) across four medical wards. Analysis of count data used Poisson and Negative Binomial Regression models.

RESULTS

121 SCU admissions involved 107 unique patients. Median SCU LoS was 23 days (interquartile range [IQR], 13-50), and stabilisation of behaviour severity took 11 days (IQR 6-12). Barriers to discharge related to substitute decision-making and care facility availability. After SCU discharge, yearly hospitalisation rates for 'all-reasons' decreased by 68% (Incident Rate Ratio [IRR], 0.32, 95% CI, 0.23-0.43), and 83% for behaviour-related admissions (IRR 0.17, 95% CI, 0.11-0.28). For hospital service-unit outcomes, falls-per-month decreased by 21% (IRR 0.79, 95% CI 0.64-0.99) after SCU implementation and OV by 26% (IRR, 0.74, 95% CI 0.59-0.94).

CONCLUSIONS

A hospital-based SCU reduced hospital health service demand through decreased SCU-patient readmissions and was associated with decreased falls and OV rates across hospital medical wards.