Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

OBJECTIVE: To assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility. DESIGN: Randomised controlled trial. SETTING: Three public hospitals in Southern Adelaide. PARTICIPANTS: 320 elderly patients (mean age 83 years) in acute hospital beds (212 randomised to intervention, 108 to control). INTERVENTIONS: A transitional care facility where all patients received a single assessment from a specialist elder care team and appropriate ongoing therapy. MAIN OUTCOME MEASURES: Length of stay in hospital, rates of readmission, deaths, and patient's functional level (modified Barthel index), quality of life (assessment of quality of life), and care needs (residential care scale) at four months. RESULTS: From admission, those in the intervention group stayed a median of 32.5 days (95% confidence interval 29 to 36 days) in hospital. In the control group the median length of stay was 43.5 days (41 to 51 days) (95% confidence interval for difference 6 to 16 days). Patients in the intervention group took a median of 21 days (6 to 27 days) longer to be admitted to permanent care than those in the control group. In both groups few patients went home (14 (7%) in the intervention group v 9 (9%) in the control group). There were no significant differences in death rates (28% v 27%) or rates of transfer back to hospital (28% v 25%). CONCLUSIONS: For frail elderly patients who are awaiting a residential care bed transfer out of hospital to an off-site transitional care unit with focus on aged care "unblocks beds" without adverse effects.