S65 Early supported discharge scheme (ESDS) for pneumonia & lower respiratory tract infection (LRTI): are there enough suitable patients?

Abstract

Background: Despite the fact that w75% of community acquired pneumonia (CAP) is managed in the community, admissions for pneumonia, influenza & LRTI account for more than 2.3 million bed days/yr in England alone. Strategies to enable increased outpatient care must be safe, acceptable to patients & potentially reduce costs & improve patient outcomes. Current guidelines suggest that patients with CURB-65 >2 require hospitalisation, but up to 70% of pneumonia admissions are CURB-65 =2. Median length of stay (LOS) for CAP is 6e12.9 days. Despite low risk-scores patients may have a prolonged hospital admission due to other reasons for example, comorbidities & social issues. Aim To retrospectively investigate the number of patients that could potentially be discharged with an ESDS, akin to current COPD schemes. Method We performed a retrospective audit of 54 case-notes randomly selected from 462 admissions (with J-codes 10e18) over a 2-month period. Certain inclusion & exclusion criteria were used to assess scheme eligibility (appropriate diagnosis) & scheme suitability. Result(s): Mean age=70 yrs old (range 18e96). Mean CURB-65=1.93 (range 0e4). Of CAP pts (n=38) CURB 0e1=32%, 2=26%, 3e5=34%. Comorbidities were common; COPD (16/54), cancer (13/54), IHD (10/54), dementia (8/54). Eligible for ESDS n=46, suitable n=22/46 (48%). 84% of those eligible for ESDS had comorbidities, but these did not necessarily make patients unsuitable for ESDS. The total potential reduction in LOS with ESDS is 2.75 (1e7) days. With a conservative estimate of 2400 pneumonia admissions annually & a 10-day mean LOS, (a total of 24 000 bed days/yr), 6600 bed days/yr could be saved in our hospital trust alone. Using HES data for annual admissions with pneumonia and influenza (w150 000/yr), this amounts to a potential saving of 412 500 bed days annually in England alone. Conclusion(s): This retrospective audit suggests that a proactive ESDS scheme could enable patients to be provided with high-quality safe, effective, efficient patient-centred care, tailored to their needs, in their own home. This is an opportunity to improve health policy, healthcare delivery/services & reduce admission rates; an area of major strategic importance to the NHS. (Table persented).