Effects of delays in transfer on independence outcomes for older people requiring postacute care in community hospitals in England

BackgroundIntegration of intermediate care (IC) services, particularly between secondary care and IC, has been regarded as a critical organizational factor for an efficient and effective service but has been poorly researched.MethodsThe effects of time to transfer on outcome were investigated for patients transferred to one of seven community hospitals (a common form of IC in England) as part of a multicenter, randomized controlled trial.Patients admitted to hospital with one of the geriatric syndromes (falls, incontinence, confusion, immobility) were recruited when they were medically stable and if the responsible physician considered that IC was required. Patients were divided into three groups: “early transfer” (<2 days); “late transfer” (>2 days); and “no transfer” (control group).Patient independence at 6 months after randomization as measured by the Nottingham Extended Activities of Daily Living Scale (NEADL) score.ResultsThere was a significant difference between the “early transfer” (n = 87), “late transfer” (n = 78), and control (“no transfer”) (n = 121) groups for changes in NEADL scores from baseline to 6 months using analysis of covariance to adjust for baseline variables (p = 0.016). Pairwise comparisons showed a significant difference only between the “early transfer” and control (“no transfer”) groups. Adding time to transfer as a covariate improved the fit of the model, explaining NEADL outcomes, and showed a significant difference in change in NEADL score in favor of the community hospital group (adjusted mean difference, 6.12; 95% confidence interval, 2.59–9.67; analysis of covariance p = 0.001).ConclusionThe time window for between-service transfers to IC that optimizes clinical outcomes for frail older people recovering from an acute illness is small. In this study, a delay of more than 2 days was sufficient for detrimental effects on an independence outcome to be observed.