P52 The effect of step-down intermediate care on days lost to delayed discharge from hospital: a controlled interrupted time series analysis

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Abstract

Background

Step-Down Intermediate Care (IC) was developed in Glasgow City and implemented in November 2014. IC units act as a bridging service between hospital and home, for those deemed medically fit for discharge, but who would otherwise spend some time delayed in hospital, usually due to a lack of appropriate care, support or accommodation in the community. The aim of this study was to measure the effect of IC on days delayed.

Methods

Rate of days delayed per 1000 population aged 75 years+ in Glasgow City was compared before and after onset of IC with a 6 month phase-in period, using segmented linear regression with 23-month (January 2013–November 2014) pre- and 13-month (June 2015–June 2016) post- intervention periods. Rate of delayed days for residents of Inverclyde and West Dunbartonshire (I&WD)- areas with similar high levels of deprivation, within NHS GGC, but with no IC in place – were used as a comparison group, as in April 2015 a national target was set to reduce delays.

Results

Between January 2013 and November 2014 rate of days delayed in hospital increased by 41%. Rate of days delayed in I&WD was approximately half that of Glasgow at the start of the study period, however these also increased in the pre intervention period, by 33%. Rates reduced in both areas between November 2014 and June 2015. After accounting for secular changes pre-intervention, Glasgow City saw a level change of −57.66 (-60.85, –54.48) days per 1000 population with no significant change in trend, 0.35 (-0.19, 0.88). However, following adjustment for changes in I&WD, and therefore a factoring out of the new national target, the impact of IC in Glasgow City was found to be a level change of −12.56 (-17.65, –7.47) and a trend change of −0.38 (−0.73, –0.04). This is equivalent to a predicted reduction due to IC of −7.28 days delayed per 1000 popn, in June 2016, and a relative reduction of 18%. Rate of days delayed in Glasgow City continued to increase over time after the introduction of IC, though at a slower rate than if IC had not existed.

Conclusion

The introduction of a national target resulted in a reduction of delayed days. After factoring out this reduction, IC was responsible for a further reduction in delayed days of 18%. The rate of days delayed continued to increase over time after the introduction of IC, though at a slower rate.

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