Abstract
Introduction: Early supported discharge (ESD) is well established as a model of health service delivery for people with stroke, allowing patients to return home sooner than otherwise would be possible to receive home-based rehabilitation, more than would be possible with standard community care. Emerging evidence indicates that ESD also reduces the length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints.
Methods: A qualitative interview and focus group study was carried out at University Hospital Limerick (UHL) from November 2021 to January 2022. Purposeful sampling was used to recruit older adults who had been admitted to UHL and discharged home and their family carers for interview. Phone interviews took place with patients and their family carers following a semi-structured interview guide. For Healthcare Professionals (HCPs), snowball purposeful sampling was used to recruit those working with older adults in the acute and community settings. Focus groups for HCPs were moderated by A-MM. Braun and Clarke’s approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021).
Results: Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified:
1. Pre-ESD experiences of providing and receiving older adult inpatient care - identifying barriers to timely care; poor communication between HCPs themselves and HCPs and patients/families; and the impact of COVID-19 on health services for older adults.
2. Navigating discharge procedures from acute hospital services - discussing the impact of limited resources, both personnel and processes; the multifactorial nature of delayed discharges and subsequent adverse outcomes for patients; and the lack of integration between acute and community services in terms of IT and resources.
3. A vision for more integrated model of care and a medical ESD team - highlighting the need for ESD follow up to be timely; to be provided by senior staff with specialist skills; and the overall positive attitude towards an ESD team for older adults.
Discussion: This study provided insight into the current discharge experiences of older adult care in the acute setting, the potential role for ESD in this population and the key factors that would need to be considered for the running of an ESD service for older adults admitted to hospital with medical complaints.
Conclusion: This research highlights the barriers and facilitators to ESD for older medical inpatients from the perspectives of key stakeholders. Given the adverse outcomes associated with prolonged hospital stay, these findings will help inform the development of a cohort study, examining patient and process outcomes for older adults admitted to hospital with medical complaints who receive an ESD intervention.