Evaluation of a novel sub-acute Hospital in the Home model for providing inpatient geriatric and rehabilitation services
Anya Suzuki A , Greg Kyle
B * , Clare Webb A , Ruth Cox A , Laurelie Wishart B C , Melissa McCusker D , Alex McConnell A , Sally Courtice A , Elizabeth C. Ward B C and Leo Ross A
A
B
C
D
Abstract
To report on the development and implementation of a multidisciplinary, sub-acute Geriatric Evaluation and Management Rehabilitation Hospital in the Home (GEMRHITH) model of care with the initial 2 years’ service outcome data (October 2019 – September 2021).
A retrospective analysis was conducted using hospital centralised data, and the GEMRHITH internal service database. Descriptive statistics were used to describe the patient population. Student’s t-test was used for comparative data.
Over 2 years, GEMRHITH admitted 617 patients (13%, n = 82 directly from the emergency department). Median age was 82 years (range, 32–102 years), with 60.5% (n = 373) being female and 39.5% (n = 244) presenting with moderate frailty. Most patients (79.6%, n = 491) entered from a medical speciality (28.5%, n = 178 from neurology). Average GEMRHITH stay was 6 days (range, 1–33 days). Average bed occupancy was 5.3 virtual beds. There was an average of 26 discharges per month with 97% of patients (n = 598) discharged to their own home. Transfers back to the emergency department with the same diagnosis-related group were low (3.6%). The 7–28 day re-admission rate was 2.3%. Service safety was high, with only eight hospital-acquired complications reported in seven patients. Significant improvements were noted for total and sub-scale Functional Independence Measure scores (P < 0.001).
The addition of rehabilitation and geriatric care to traditional HITH services provides opportunities for multidisciplinary teams to support a larger cohort of patients with various medical and surgical conditions and functional abilities, to efficiently transition home from hospital settings. There were minimal complications and occupied bed stays were saved within a hospital.
Keywords: care continuum, geriatric evaluation and management, hospital bed occupancy, hospital in the home, length of stay, pragmatic evaluation, rehabilitation, sub-acute care.
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