23SUPPORTED DISCHARGE THE KEY TO REDUCING HOSPITAL EMERGENCY ATTENDANCES AND ADMISSIONS

Abstract

Topic: The Supported Discharge Service (SDS) at The University Hospital of South Manchester (UHSM) enables frail, older patients timely discharge with increased social and health input. The multi-disciplinary team consisting of case managers, health care support workers and therapists together with a Geriatrician led MDT aims to improve quality of life through disease self-management and increased patient independence. These together with the family/NOK support the team provide aim to reduce readmissions in a high-risk patient cohort. On service review these mainly occurred out of working hours, weekdays 9-5pm. Intervention: In June 2014 SDS became a 10 hour, 7 day service. The number of ED attendances, hospital admissions and community service referrals for each patient in the 6 months pre and post being managed by the SDS were collected. All readmissions including the likelihood of avoidability were discussed. Future admission avoidance interventions were implemented or fed back to the trust. Improvement: Overall the SDS reduced ED attendances by 29%, admissions by 24% with a 1 day shorter length of stay (LOS) and increased community referrals by 29% in those patients at highest risk. Specifically the readmission rate whilst on the service decreased by 36% with the extended working times. Discussion: Studies have previously shown SDS do not show a reduction in readmissions but do reduce LOS (Ram et al 2004). However these were stroke or COPD specific. At UHSM we have shown a SDS can significantly reduce hospital attendances and admissions and thus financial costs. The increase in community service referral, together with the Geriatrician input and specifically trained nursing and support staff is key to providing the necessary support and advice for patients, relatives and carers. It is essential this service is available 7 days per week which may be difficult to implement with financial and workforce constraints.