Discharge care quality on transition from hospital to residential aged care after hip fracture: paired next-of-kin and staff responses.

BACKGROUND

Hip fractures are common among residential aged care (RAC) residents and associated with a larger burden of mortality and functional impairment. RAC residents are often prioritised for early discharge back to RAC and are at risk of disjointed care and limited support in their functional recovery.

AIM: To compare next-of-kin and RAC staff perspectives on the discharge care transition from hospital following hip fracture surgery, using routinely collected questionnaire data from a geriatrician-led virtual service. A secondary aim was to describe clinical outcomes including mobility, readmission and mortality rates.

METHODS

This prospective descriptive study was conducted between 1/5/22 and 30/4/23 in an Australian metropolitan region. Paired responses from next-of-kin and RAC staff were analysed to assess agreement on key aspects of discharge care planning, discharge processes and post-discharge outcomes.

RESULTS

We analysed 94 paired responses (next-of-kin and RAC staff) for 47 older persons. Low levels of agreement were observed in goal-setting, timing of discharge, discharge summaries, pain management and mobility. Agreement was highest at conclusion of the virtual care service when 79% pairs felt the older person's care needs were being met at the RAC facility. Limited mobility improvements were observed, with 19% regaining baseline mobility within a median of 18.5 days after surgery. The 30-day readmission rate was 13%, and 12-month mortality was 34%.

CONCLUSION

While there was high agreement that care needs were eventually met at the RAC facility, gaps remain in pre-discharge communication and post-discharge mobility and pain management. Clinicians should address communication on discharge to enhance transition of care from the hospital.