105IMPLEMENTING A DISCHARGE TO ASSESS (D2A) PATHWAY 2 HELPS PATIENT FLOW AND UNNECESSARY 24 HOUR CARE ADMISSIONS

Abstract

Topic: Marjorie Warren's work transformed the care of chronically sick older people by classifying patients into their care needs, reducing bed days whilst returning patients to the community. In 2017 we are still discussing the best way to do this. The National Audit Office (2015) stated 2.7 million bed days were occupied by patients who no longer required an acute bed. Discharge to assess (D2A) Pathway 2 addresses this by servicing those not fit enough for home but need further input and assessment prior to decision around discharge, without which we risk premature admission to long term care. Intervention: We created a 41 bed D2A unit with a complete multi-disciplinary team and regular geriatrician input. Patients accepted did not require an acute setting, are not suitable for discharge home or for intermediate care. We emphasized the importance of admitting patients from the emergency department and acute admission unit, to aid patient flow and admission avoidance. Improvement: We retrospectively analysed data, including the number of patients returning to their own home from our facility, compared to a similar facility the year before and found an improvement from 67% to 74%. We analysed the number of new 24 hour care admissions in those admitted to the acute sight over 80 years old, over the same 9 months period in 2016 and 2017. Despite a 6.6% increase in admission numbers, we reduced the number of new 24 hour care admissions by 11% (p = 0.049, χ2 =3.89). The median time from referral to transfer was 2.4 days reduced from 3.6 days the year before. Discussion: Setting up a D2A pathway 2 with emphasis on referral from the front door and prompt transfer of care can encourage patient flow whilst also providing rehabilitation for a section of the frailest patients who enter the acute setting, thus helping patients return home.