Comprehensive Discharge Planning for the Hospitalized Elderly

TLDR

The study examined how a nurse‑specialist–led comprehensive discharge plan for elderly patients affects outcomes and costs. A randomized clinical trial at the University of Pennsylvania enrolled 276 elderly patients and 125 caregivers, measuring hospital stay, readmission intervals, rehospitalization rates, and care charges at 2, 6, and 12 weeks post‑discharge. The intervention reduced readmissions, rehospitalization days, and related costs for medical patients within six weeks, but had no effect on surgical patients, supporting its benefit for elderly care.

Abstract

Objective: To study the effects of a comprehensive discharge planning protocol, designed specifically for the elderly and implemented by nurse specialists, on patient and caregiver outcomes and cost of care. Design: Randomized clinical trial. Setting: Hospital of the University of Pennsylvania. Patients: 276 patients and 125 caregivers. Patients were 70 years and older and were placed in selected medical and surgical cardiac diagnostic-related groups. Measurements: Group differences in patient outcomes (length of initial hospital stay, length of time between initial hospital discharge and readmission, and rehospitalization rates) and charges for care (charges for initial hospitalization, rehospitalizations, health services after discharge, and nurse specialist services) were measured 2, 6, and 12 weeks after discharge. Results: From the initial hospital discharge to 6 weeks after discharge, patients in the medical intervention group had fewer readmissions, fewer total days rehospitalized, lower readmission charges, and lower charges for health care services after discharge. No differences in these outcomes were found between the surgical intervention and control groups during this period. Conclusions: Study findings support the need for comprehensive discharge planning designed for the elderly and implemented by nurse specialists to improve their outcomes after hospital discharge and to achieve cost savings. The findings also suggest that this intervention had its greatest effect in delaying or preventing rehospitalization of patients in the medical intervention group during the first 6 weeks after discharge.