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Article Abstract
Background/aims: Subacute complex discharge units (CDUs) offer intermediary person-centred care between acute hospital and community services by providing specialised care for patients with complex medical and functional needs. However, several elements of clinical practice were affected during the COVID-19 pandemic. We aimed to determine the impact of several case mix factors on length of stay and how this impact changed across three phases: pre-COVID-19 (2019), during COVID-19 (2021) and late-stage COVID-19 (2023) in our Complex Discharge Unit.
Materials And Methods: Before collecting data, our institution's Research and Innovation Office approved the study (reference number: 8900, on the 23rd of May 2024). All patients (920) who were admitted to our 23-bed Complex Discharge Unit in 2019 (320 patients), 2021(205 patients) and 2023 (395 patients) were evaluated. Data was inspected visually, and variables that predicted length of stay were included in a Poisson regression model to predict the length of stay.
Results: An analysis of the relationship between year, age, medicolegal issues and length of stay, adjusting for several confounding variables (mobility status, healthcare-acquired infection, long-term care status, need for an increase in homecare package and need for a new homecare package) was carried out as there was an interaction. Charlson's Comorbidity (CCI) score and delirium were not predictive of length of stay. Medicolegal issues increased length of stay by a factor of 1.46 (95% CI 1.39-1.52, p < 0.001). For every 1-year increase in age, length of stay increased by a factor of 1.006 in 2019 (95% CI 1.004-1.01, p < 0.001), 0.988 in 2021 (95% CI 0.987-0.99, p < 0.001), and 1.004 in 2023 (95% CI 1.002-1.01, p < 0.001).
Discussion And Conclusion: Multimorbidity and delirium did not predict length of stay, while legal issues delayed discharges. On a unit with a baseline longer than average length of stay, there have been progressive improvements in length of stay over time, maybe hastened and retained from lessons learned from the pandemic.
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