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ABSTRACT

Objectives: To identify the factors associated with inappropriate admission (IA) and inappropriate length of stay (ILOS) of patients with long term neurological conditions (LTNCs). To identify the actions necessary to prevent inappropriate admissions and lengths of stay.
Methods: A prospective survey of patients admitted to one of two acute hospitals, with a LTNC, were recruited. The appropriateness of the admission and duration of stay was determined by an expert panel. Services were examined to determine appropriate service provision, for patients were an IA or ILOS had taken place.
Results: A total of 119 patients were recruited. 32 patients (27.8%) were admitted inappropriately and 72 (62.6%) had an ILOS. Patients who lived on their own were at greater risk of an IA. Patients who lived on their own, required home care support, had speech problems and who required inpatient physiotherapy or referral to social services were at greater risk of an ILOS. A number of patients were admitted to hospital when community social support and specialist nursing support would have enabled them to remain at home. Prompt provision of community services e.g. Intermediate Care Services, or support from a specialist neurological nurse would have facilitated an earlier discharge for a number of patients.
Conclusion: With better use of community health and social care services it appears that a large number of IA and ILOS can be avoided. However, limited resources, delays in provision and a lack of communication between primary and secondary services present a problem. There is increasing recognition that specialist community nurses are well placed to, and are essential in avoiding IA and facilitating appropriate discharge. Community nurses may also contribute considerable to ensuring effective communication between primary and secondary services.

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