Using Case Costing to Evaluate the Potential Impact of a Reintegration Unit on an Acute-Care Hospital's Capacity and Resources.

The Ontario Ministry of Health funded a reintegration unit to transition hospitalized patients who no longer required acute care to alternate level of care (ALC), such as long-term care. In its first year, 102 (3.5%) patients of the hospital's waiting-for-ALC population were transferred, with 37.3% transferred on the day of ALC readiness. The reintegration unit reduced direct hospital costs by $861,000. Using case costing, we modelled optimized scenarios including all transfers on the day of ALC readiness and increased transfers to the reintegration unit; this helped reduce avoided direct costs by $2.3-$5.4 million. Acute-care bed capacity could have increased by 11%. We outline strategies to optimize future performance of the reintegration unit.

A randomized clinical trial to assess the impact on an emergency response system on anxiety and health care use among older emergency patients after a fall.

OBJECTIVES: Personal emergency response systems (PERSs) are reported to reduce anxiety and health care use and may assist in planning the disposition of older patients discharged from the emergency department (ED) to home. This study measured the impact of a PERS on anxiety, fear of falling, and subsequent health care use among older ED patients. METHODS: This study was a randomized controlled trial comparing PERS use with standard ED discharge planning in subjects 70 years of age or older discharged home after a fall. Outcome assessors were blinded to the study objectives. Anxiety and fear of falling were measured at baseline and 30 days using the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) and modified Falls Efficacy Scale (mFES). Return to the ED, hospitalization, and length of stay were recorded after 30 and 60 days. RESULTS: Eighty-six subjects were randomized and completed follow up (43 per group). There was no important difference in mean reduction in anxiety (mean change treatment - control, +0.35; 95% confidence interval [CI] = -1.5 to 0.76; p = 0.55) or fear of falling (mean change, +4.5; 95% CI = -6.7 to 15.7; p = 0.70). Return visits to the ED occurred in eight of 43 patients in both the control and treatment groups (risk difference, 0.0%; 95% CI = -16% to 16%). Hospitalization occurred in six of 43 in the control group versus three of 43 in the treatment group (risk difference treatment - control = -7.0%; 95% CI = -19.8% to 5.9%). CONCLUSIONS: In contrast to previous studies, there was no evidence that a PERS reduced anxiety, fear of falling, or return to the ED among older persons discharged from the ED.