Abstract
Background: Singapore faces diverse healthcare challenges, including an aging population with 25% projected to be 65 years old and above by 2030, and rising chronic disease rates. The healthcare system must address the increased demand, manage healthcare costs, and improve accessibility to care. Prolonged hospitalization puts a strain on resources and impacts patient outcomes. Innovative approaches are crucial to optimize care delivery, enhance community-based services, and maintain quality care across all population segments. Early Supported Discharge (ESD) interventions which encompass hybrid models of home visits and teleconsultations have been shown to reduce hospital length of stay in older adults and stroke patients. The use of telemedicine has also shown to promote a sense of safety and security among patients, knowing that a medical professional is keeping track of their health.
Approach: The ESD programme was implemented as a potential key component of Alexandra Hospital’s integrated care pathway. This program transitions stable, lower-acuity patients 2-3 days before their scheduled discharged (termed “D-2” or D-3"), with continued management provided in patient’s home setting for up to three working days. It promotes self-management and ensures appropriate resource allocation, optimizing patient autonomy and care setting. The design and implementation involve a nurse-led, physician-supported and multidisciplinary team including allied health consultation, community care providers, patients and their families. The primary service modality involves home visits for thorough assessment and procedures and/or teleconsultations. This approach enables patients to receive comprehensive remote monitoring in the comfort of their own homes, effectively reducing the need for prolonged inpatient stays.
Results: The ESD programme has demonstrated promising outcomes. Since inception from January 2024 till October 2024, the average length of hospital stay prior to ESD admission was 5.34 days. A total of 132 bed days were saved as seen by the total number of video calls and home visits made, resulting in increased bed capacity within the hospital. Patient satisfaction and experience survey yielded an average score of 9.28 out of 10, reflecting overall positive results. The programme successfully managed lower acuity patients in home settings, with only 2 out of 71 patients (2.8%) requiring readmission to hospital for tertiary level care. These findings suggest that the ESD programme effectively optimizes hospital resource utilization while maintaining high standards of patient care and satisfaction.
Implications: This ESD initiative demonstrates its potential as a vital component in bridging hospital and community care within an integrated pathway. By doing so, the programme seeks to optimize hospital bed utilization while maintaining continuity of care. This strengthens acute hospital care by streamlining processes for suitable patients' transition to home, followed by a seamless transition to community partners once acute medical issues stabilize if the need for such collaboration arises. Early learnings suggest ESD could effectively balance resource optimization with patient-centered care. Future steps include comprehensive outcome analysis, refinement of patient selection criteria, and exploration of ESD's further integration into existing care pathways to enhance overall healthcare delivery.