Abstract
Introduction
“Pathway three delirium” is a short-term placement in a care home specific to North Yorkshire, for patients diagnosed with delirium during hospital admission, who are medically fit but have not recovered cognitively enough for discharge home. The goal is to allow extra time to recover from delirium, to allow return to patients’ own homes. At this placement, patients are followed up by the acute hospital liaison team.
Aims
To assess final discharge destinations after pathway three delirium placement.
To analyse characteristics between discharge groups.
Methods
We analysed electronic records of patients on this pathway between August 2020 and November 2021. Data was gathered on age, gender, prior cognitive impairment, visual impairment, hearing impairment, living alone, requiring package of care, and alcohol misuse.
Results
64 patients were included, 39 females (61%), 25 males (39%), average age of 83.7 years.
20 (31%) were discharged home, 26 (41%) remained in residential or nursing homes, 10 (16%) were readmitted to hospital, 8 (12%) discharge location was unknown or “other”.
Average age of those discharged home was 82.65yo, those discharged to residential/nursing homes: 83.88yo, and those readmitted: 85.8yo.
80% of those discharged home were women, compared to 61% of the total group and 50% of those who remained in nursing/residential care.
The discharged home group contained 80% patients who lived alone, versus 58% in the residential/nursing home group, and 30% in readmitted. 25% of the home group had a care package pre-admission: versus 46% in the residential/nursing home group, and 38% across all groups.
Cognitive impairment, sensory impairment and alcohol intake showed no apparent difference across destination.
Conclusions
These findings show that this short-term delirium placement enables some patients to return to their own home. Analysis suggests that younger patients, women and those with apparently less social support were more likely to go home.
Comments
Thank you, very interesting work- I have not experienced this discharge route before! Are there specific criteria for patient suitability for this pathway? Of those discharged to residential and nursing homes- how many of these were new permanent placements?
Thank you. The patients all came onto the pathway were under the liaison psychiatry team in the hospital, and were admitted from their own homes. As all patients on the pathway were initially admitted from their own homes, the discharges to residential and nursing homes would all be new permanent placements.
Thank you. It seems to me your data fits with existing wisdom that delirium predicts cognitive and physical decline for the majority of patients. Do you have data on the median length of stay for patients in this pathway placement?
Yes I would agree. However, without this placement almost all (if not all) of these patients would have needed to have been discharged from their initial hospital admission to a residential / nursing care placement due to ongoing delirium / confusion, so the fact that even some of this cohort could then return to their own homes we saw as a sign of effectiveness. I'm sorry I don't have data for the median length of stay, but the maximum length of funding for this placement was 8 weeks post hospital discharge.