The planning tool "In-Hospi-TOOL" embedded in the electronic patient record was tested in seven Swiss hospitals between 2017 and 2019. Using an interrupted time series approach, it was investigated how the length of hospital stay, the number of readmissions as well as the discharge and mortality rates of elderly multimorbid persons changed through the use of the planning tool. The control group consisted of 75 hospitals that did not use the planning tool. The "In-HospiTOOL" includes an initial medical assessment in the emergency department, a daily assessment by doctors, nurses and social workers in the hospital, and the provision of discharge services by doctors and nurses. The discharge services informed patient-e-s about the most important findings during their hospital stay, pending diagnoses, changes in the medication schedule, strategies in case of clinical deterioration, and next appointments.
Hospital discharge is an inherently complex interprofessional task. It requires effective teamwork to prepare patient-e-s for a safe transition from the hospital. As the treatment of multimorbid patients is becoming increasingly complex, innovative approaches are needed. Previous interventions have shown inconsistent results, thus, standardized procedures have not yet been widely implemented.
The main goal was to increase transparency of inpatient transition processes and to generate in-depth knowledge about interprofessional collaboration in order to improve hospital discharge planning. The aim was to thus contribute to safely shortening the hospital stay of elderly multimorbid patients.
The "In-HospiTOOL" was used in about two thirds of patient-e-s during the intervention phase. The average length of hospital stay of the elderly multimorbid patient-e-s was reduced by half a day in the intervention group in contrast to the control group. At the same time, there was no negative effect on readmissions, in-hospital mortality rates and the proportion of patient-e-s discharged home. The project led to a rethinking and a change in institutional culture regarding interprofessional collaboration between health and social care professionals.
Significance of the results for research and practice:
The implementation of an innovative interprofessional discharge planning tool in acute care hospitals led to a reduction in length of stay among a vulnerable patient population without negatively affecting readmission rates and other outcomes. This study suggests that a close patient-centered interprofessional collaboration initiative to improve hospital discharge planning is challenging but feasible. Given the findings, future approaches should support consistent patient- centered care through interprofessional teams.
Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay – the In-HospiTOOL study
