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