Consensus and controversies on post-acute care decision making and referral to geriatric rehabilitation: A national survey

Abstract

Background: Transitioning older hospital patients to the appropriate type of post-acute care has become an urgent clinical issue within the context of changing demographics and limited duration of hospital stay. Objective: Consensus on assessments that guide post-acute care decision making would benefit potential patients and support cooperation between settings. Design: A national web-based questionnaire focusing on professional contributions, patient involvement and the use of triage items and measures. Participants: Hospital and geriatric rehabilitation professionals in the Netherlands participated as respondent groups, representing ‘sending’ and ‘receiving’ professionals. Methods: A comprehensive questionnaire was used with open, multiple choice and closed questions, exploring in detail how assessment of hospital patients in need of a post-acute care decision was performed. Descriptive statistics were applied together with deductive coding of qualitative data. Results: A total of 104 hospital liaison nurses (66.7 %) and 52 GR professionals (33.3 %) participated. Respondents were reasonably satisfied with the current triage practice. Hospital liaison nurses valued their operational responsibility for triage. Geriatric rehabilitation professionals wanted active involvement in decision making and deemed hospital paramedic expertise sub-optimally applied. ‘Too little involvement’ of patients and families was felt by 50.0 % of the GR respondents versus 15.5 % of hospital respondents. The importance of half (47.8 %) of the triage items was rated differently between respondent groups. When discussing complex cases between sending and receiving professionals, views were felt as complementary. Conclusions: Both sending and receiving professionals expressed moderate satisfaction with post-acute care decision making, whereas their views on triage assessments differed according to setting and role. The patients’ voice may be insufficiently heard in triage decisions. Shared expertise and a consensual approach can develop when triage consultation is facilitated by both hospitals and PAC facilities. This study offers ingredients to reach a multi-professional view on post-acute care decision making and referral to geriatric rehabilitation.

Keywords

• Discharge planning
• Decision making
• Discharge transfer
• Geriatric rehabilitation
• Patient transfer
• Skilled nursing facilities