CALS study

• Research type

  Research Study

• Full title

  Discharge from secondary into primary care for elderly patients: clinical decision making and risk management

• IRAS ID

  184747

• Research summary

  Unnecessary length of stay in hospital for elderly patients can increase physical deterioration through the risks
  associated with lack of physical activity and incur potentially avoidable use of hospital resources. Once they have
  received treatment in hospital elderly patients can be difficult to discharge due to their multiple morbidities and an
  understandable concern on the part of hospital clinicians to ensure that all health needs have been attended to before
  they leave hospital. An ever aging population is becoming increasingly able to manage with the support of primary care
  and social care to remain at home. However, elderly patients who have entered hospital with a manageable level of
  physical ability can find it severely reduced by a long length of hospital stay which may have been incurred by what an
  experienced geriatrician would deem ‘unnecessary’ additional tests and investigations.
  However, an unnecessary length of stay in hospital for any patient whether elderly or not increases risks to the patient of hospital infections and uses additional resources. These resources are then not available to other patients and the
  effective running of the hospital is reduced.
  A mixed methods approach will investigate both qualitatively and quantitatively clinicians’ decision making regarding
  the discharge of elderly patients with a view to developing an educational tool. The purpose of the tool will be to assist
  clinicians in dealing with these complex patients and assist in preserving physical function so that patients can return
  to their homes as soon as possible.
  Qualitative interviews (N=40) will be conducted with secondary care decision making clinicians from a range of
  specialities (including: cardiology, neurology, A&E) and decision making levels (consultants, senior registrars, junior
  doctors, senior nurses) who have responsibility for discharging patients. Currently, medicine is the only department
  able to refer patients to the CALS service, therefore 20 interviewees will be sampled from Medicine (CALS clinicians)
  and 20 from other specialities (nonCALS
  clinicians).
  Data from approximately 6,000 patients at North Bristol Trust will be obtained from anonymised hospital records. This
  data will be used to populate a decision tree formed from a mapping of the care pathways conducted by using
  qualitative data.

• REC name

  N/A

• REC reference

  N/A