Background The Health Service Executive (HSE) developed an Urgent and Emergency Care (UEC) Operational Plan in 2023. One UEC action was an aim to transfer “clinically appropriate” patients to alternative care settings e.g. Transitional Care Beds (TCBs) to relieve pressure caused by high occupancy rates in acute hospitals. Inclusion criteria for TCB use is ill defined and we sought to evaluate their usage. Methods Retrospective analysis of characteristics and readmission rates (RAR) of patients discharged from a tertiary hospital to TCB from Oct 1st, 2023 - Jan 1st, 2024. Results 158 patients were discharged from hospital to TCBs. 49% (n=77) were female, mean [SD] age 77.82 [10.09] years. The median length of stay (LOS) was 15 days. 50% (n=79) were discharged from surgical services, 40.5% (n=64) from medical teams, 8% (n=13) from oncology services, 7% (n=11) from geriatric medicine and 1% (n=2) from ED. 27% (n=43) had a “fall” documented as their discharge diagnosis. 32% (n=51) of patients were readmitted within 90 days, 11% (n=18) within 30 days and 4% (n=6) within 14 days. 30% (n=15) were readmitted directly from TCB. Average time between discharge and readmission was 44.7 days. Median LOS on readmission was 10 (IQR 15.5 days). 9% (n=14) had an eventual discharge to long term care (LTC) either from a subsequent admission or transitioned directly from TCB. 6% (n=10) of patients died. Conclusion Of those readmitted, one third were directly from TCBs suggesting discharge to TCB may have been premature and patient selection inappropriate subsequently resulting costly readmissions. Although interventions are needed to relieve capacity pressure in hospitals, greater emphasis needs to be placed on access for patients to designated rehabilitation programmes. We should aim to support older adults following acute hospital admissions by carrying out comprehensive geriatric assessment to maximise independence and reduce likelihood of hospital readmission or transition to LTC.

中文翻译：

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反弹：医院对过渡护理床位的依赖——对患者造成伤害？再入院率回顾


背景 卫生服务执行局 (HSE) 于 2023 年制定了紧急护理 (UEC) 操作计划。UEC 的一项行动旨在将“临床上合适”的患者转移到替代护理环境，例如过渡护理床 (TCB)，以缓解造成的压力急症医院的高入住率。 TCB 使用的纳入标准尚不明确，我们试图评估其使用情况。方法 回顾性分析2023年10月1日—2024年1月1日某三级医院出院转TCB患者的特征及再入院率（RAR）。结果 158例患者出院转TCB。 49% (n=77) 为女性，平均 [SD] 年龄 77.82 [10.09] 岁。中位住院时间 (LOS) 为 15 天。 50% (n=79) 从外科服务部门出院，40.5% (n=64) 从医疗团队出院，8% (n=13) 从肿瘤科服务部门出院，7% (n=11) 从老年医学部门出院，1% (n=11) 从老年医学部门出院=2）来自ED。 27% (n=43) 的出院诊断记录有“跌倒”记录。 32% (n=51) 的患者在 90 天内重新入院，11% (n=18) 在 30 天内重新入院，4% (n=6) 在 14 天内重新入院。 30% (n=15) 直接从 TCB 重新入院。出院和再次入院之间的平均时间为 44.7 天。再入院的中位 LOS 为 10（IQR 15.5 天）。 9% (n=14) 最终出院到长期护理 (LTC)，要么是随后入院，要么直接从 TCB 转入。 6% (n=10) 的患者死亡。结论 在重新入院的患者中，三分之一直接来自 TCB，这表明出院到 TCB 可能为时过早，并且患者选择不适当，随后导致了昂贵的再入院。尽管需要采取干预措施来缓解医院的容量压力，但需要更加重视患者接受指定康复计划的机会。 我们的目标应该是通过进行全面的老年评估来支持急性入院后的老年人，以最大限度地提高独立性并减少再次入院或过渡到长期护理的可能性。