A descriptive study on reasons for prolonged hospital stay in a tertiary hospital in Singapore

Sensitivity and specificity of three screening tools for frailty in hospitalized older adults

AIM

To determine the test accuracy, including sensitivity, specificity, positive predictive value, negative predictive value and area under curve, of three frailty screening tools in identifying the risk of frail outcomes among hospitalized older patients.

DESIGN

Prospective longitudinal study.

METHODS

The screening tools [Frail-PPS (Frail-Physical, Psychological and Social), Frailty Assessment Measure (FAM), and Identification of seniors at-risk hospitalized patients (ISAR-HP)] were administered by ward nurses to patients aged 65 years and older within 24 h of admission to an acute hospital. Sensitivity, specificity, positive predictive value, negative predictive value and area under curve analysis of the three tools in the context of three frail outcomes, (a) functional decline at three months after discharge-defined as a decline of at least one point on the Katz Index, (ii) requiring a full-time caregiver upon discharge, and (iii) death by three months after discharge, was assessed.

RESULTS

Of 366 patients enrolled in the study, 78 (21.3%) experienced one or more frail outcomes, with 65 (17.76%) experiencing functional decline, 61 (16.67%) requiring a full-time caregiver upon discharge and 8 (2.19%) dying by three months. Frail-PPS had sensitivity 12.5% to 31.4% and specificity 91.2% to 94.8%, varying by the considered frail outcome. Similarly, FAM had sensitivity 12.5% to 29.4% and specificity 90.9% to 94.1%, and ISAR-HP had sensitivity 2.9% to 19.2% and specificity 92.2% to 99.1%. positive predictive value of the FAM, Frail-PPS and ISAR-HP ranged from 3.0 to 45.5%, 3.1 to 50.0% and 3.9 to 23.6% respectively, while their negative predictive value ranged from 87.1% to 97.9%, 87.7% to 97.9% and 92.2% to 99.4% respectively. The area under curve values were moderate for the Frail-PPS (0.56 to 0.75), FAM (0.58 to 0.70) and ISAR-HP (0.71 to 0.77) for the three outcomes.

CONCLUSIONS

With high specificity and negative predictive values, as well as low sensitivity, FAM and Frail-PPS may be beneficial in identifying older individuals who are not frail, minimizing unnecessary further assessment and intervention.

Discharge Delay: How Can We Help Ourselves, Patients, and Families

PURPOSE/OBJECTIVES

Discharge delays are frustrating to patients, staff, and families. Case managers need a better understanding of what type of patient may experience a discharge delay so they can better prepare patients and families or avoid the discharge delay before it happens.

PRIMARY PRACTICE SETTINGS

Hospital.

FINDINGS/CONCLUSIONS

Discharge delays are exasperating to all involved, as they take up precious time and resources of case managers and make patients and families feel like there is an unclear plan. There are actions a case manager can take to lessen the burden of a discharge delay. Actions such as having a rapid discharge plan once the home environment is deemed inappropriate and making sure families and patients are communicated with frequently about their plan of care can decrease or avoid a discharge delay.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Case managers need to know how to identify a patient who might experience a delay in their discharge early, so they can assist the patient and family to ease their stress by explaining limitations and realistic timelines. By identifying a patient who will be experiencing a delay in their discharge due to postacute lack of staffing, care managers can alert families that finding other options for discharge might be more satisfactory. By screening a patient and identifying their needs early, a discharge delay can be shortened or avoided.