Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE (Open Access)

Structured interdisciplinary bedside rounds do not reduce length of hospital stay and 28-day re-admission rate among older people hospitalised with acute illness: an Australian study

Elizabeth Huynh A , David Basic A D , Rinaldo Gonzales A and Chris Shanley A B C
+ Author Affiliations
- Author Affiliations

A University of New South Wales, Aged Care Research Unit, Liverpool Hospital, LMB 7103, Liverpool BC 1871, NSW 2170, Australia. Email: e.huynh@student.unsw.edu.au; Rinaldo.Gonzales@sswahs.nsw.gov.au

B Centre for Applied Nursing Research, Western Sydney University, LMB 1797, Penrith, NSW 2751, Australia. Email: c.shanley@westernsydney.edu.au

C Ingham Institute of Applied Medical Research, PO Box 3151 (Westfields Liverpool), Liverpool, NSW 2170, Australia.

D Corresponding author. Email: David.Basic@sswahs.nsw.gov.au

Australian Health Review 41(6) 599-605 https://doi.org/10.1071/AH16019
Submitted: 27 January 2016  Accepted: 21 September 2016   Published: 25 November 2016

Journal compilation © AHHA 2017 Open Access CC BY-NC-ND

Abstract

Objective Structured interdisciplinary bedside rounds (SIBR) are being implemented across many hospitals in Australia despite limited evidence of their effectiveness. This study evaluated the effect of SIBR on two interconnected outcomes, namely length of stay (LOS) and 28-day re-admission.

Methods In the present before-after study of 3644 patients, twice-weekly SIBR were implemented on two aged care wards. Although weekly case conferences were shortened during SIBR, all other practices remained unchanged. Demographic, medical and frailty measures were considered in appropriate analyses.

Results There was no significant difference in median (interquartile range) LOS before and during SIBR (8 (5–15) vs 8 (4–15) days respectively; P = 0.51). In an adjusted analysis, SIBR had no effect on LOS (hazard ratio 0.97; 95% confidence interval 0.90–1.05). The presence of dementia or delirium, or the ability to speak English, did not modify the effect of SIBR (P > 0.05 for all). Similarly, SIBR had no effect on 28-day re-admission rates (20.3% vs 19.0% before and during SIBR respectively; P = 0.36).

Conclusions Although ineffective interdisciplinary communication is associated with negative outcomes for patients and healthcare services, models of care that aim to improve communication are not necessarily effective in reducing LOS or early re-admission. Clinical services implementing SIBR are encouraged to independently evaluate their effects.

What is known about the topic? Ineffective interdisciplinary communication may harm patients and increase LOS. Only two publications have evaluated the implementation of SIBR, a new model of care that aims to improve interdisciplinary communication and collaboration. One paper reported that SIBR reduced unadjusted LOS and in-hospital mortality, whereas the other found that SIBR improved teamwork, communication and staff efficiency.

What does this paper add? The effect of SIBR among acutely unwell older people on aged care wards is unknown. The present study is the first to evaluate the effects of SIBR in this population. It shows that the implementation of SIBR did not reduce LOS or early re-admission, and suggests that existing communication strategies may have weakened the effects of SIBR.

What are the implications for practitioners? Policies and practice that promote the addition of communication strategies, such as SIBR, may not be effective in all patient populations. More research is needed to determine whether SIBR reduce these and other outcomes, particularly for services with weaker communication frameworks and protocols.

Introduction

Ineffective interprofessional communication may have negative effects on the provision of efficient health care and on patient outcomes.1,2 These include unexpected occurrences of deaths, serious physical or psychological injuries to patients,3 hospital-acquired infections,4 medication errors5 and increased lengths of stay (LOS).6

Interdisciplinary care refers to practices characterised by a high degree of collaboration and information exchange among health professionals in order to enhance patient care. Although interdisciplinary care may occur at the bedside,7,8 some interdisciplinary care lacks physician involvement,7 whereas other interdisciplinary care tends to be unscheduled, unstructured and geographically fragmented. Medical and other personnel may move from one patient or ward to the next in unpredictable patterns, resulting in missed opportunities to exchange information and coordinate care.9,10

The use of regular, structured interdisciplinary bedside rounds (SIBR) is a new model of care that aims to improve interprofessional communication and collaboration.9 This patient- and family-centred approach brings members of the interdisciplinary team to the patient’s bedside, thus engaging the bedside nurse, the patient and the family. All rounds are attended by a senior doctor. Participants in SIBR give and receive information according to a structured communication protocol that incorporates a safety checklist, after which a care plan is formulated and verbalised. The patient and the family are encouraged to ask questions and correct misinformation.9

Only two publications have evaluated the association between implementation of SIBR and outcomes. In a before-after study in Atlanta (USA), Stein et al.9 reviewed the effects of implementation of daily SIBR, together with other reforms, on a high-acuity 24-bed medical unit (called an accountable care unit). After 1 year, unadjusted in-hospital mortality decreased from 2.3% to 1.1% (P = 0.004) and LOS decreased from 5.0 to 4.5 days (P = 0.001). Gausvik et al.11 examined staff perceptions of SIBR on an acute care unit for older people in Ohio (USA). The implementation of SIBR was associated with higher ratings for teamwork, communication and staff efficiency.

Despite this scarcity of evidence and the resource cost associated with SIBR, the Clinical Excellence Commission (CEC) is strongly encouraging the implementation of SIBR across hospitals in New South Wales (NSW), Australia, under the ‘In Safe Hands’ program.12

The relationship between LOS and quality of care remains unclear, and publications exist to support either a shorter13 or longer LOS14 with better quality of care. However, what is clear is that healthcare policy makers expect service providers to improve efficiency and reduce LOS year on year. This is driven largely by the rising demand for hospital services, increasing queues in emergency departments and the high bed occupancy rates in most hospitals.15 However, excessive reductions in LOS may be harmful because discharge before medical and functional stability may result in early unplanned re-admission or the use of emergency department services.16,17

Although many early re-admissions are not preventable, at least 25% are linked to substandard care.18,19 Unplanned re-admissions are arguably an indicator of the quality of acute care.19,20 They are associated with financial penalties for hospital providers in the US and are used as a purchasing adjuster in NSW to stimulate performance improvements through funding signals.18 Unplanned re-admissions to NSW hospitals are slowly increasing,18 and it remains unclear whether in-hospital interventions are effective in reversing this trend. A systematic review of 17 trials in older people found that only three studies showed significant benefits,21 suggesting that traditional interventions are mostly ineffective.

The aim of the present study was to evaluate the effects of SIBR on two interconnected outcomes, namely LOS and early (28-day) re-admission. By improving interprofessional communication and engaging the patient and the family soon after admission to formulate and verbalise a care plan, we hypothesised that SIBR would reduce LOS, if not both outcomes.


Methods

Participants

The present before-after study was undertaken at a university hospital in Sydney (NSW, Australia). Participants were consecutive patients discharged from two side-by-side 25-bed aged care wards (5A and 5B). Most patients had been admitted on the basis of targeting criteria that included delirium, deconditioning, functional decline, gait abnormality and falls, malnutrition, multiple medical diagnoses, polypharmacy and multiple unplanned admissions.22

The control (before) group included 1682 patients discharged between 1 January 2013 and 30 April 2014, whereas the intervention (after) group included 1962 patients discharged between 1 July 2014 and 30 September 2015. Those discharged between 1 May and 30 June 2014, during which time aged care staff were trained to perform SIBR, constituted a training group. The present study was approved by the South Western Sydney Local Health District Human Research Ethics Committee (Approval no. 14/334 LNR).

Intervention

During the training period, aged care staff participated in simulated SIBR off the ward (with community volunteers) and on both wards (with admitted patients). Project leads from the CEC supervised the training. The SIBR form, incorporating a structured communication protocol and a safety checklist, was designed and modified during this time. Because most older people have complex care needs, the SIBR form was tailored to address both acute and chronic issues relevant to aged care, such as delirium, dementia, bladder and bowel function, pressure care and falls risk (Table 1).


Table 1.  Structured interdisciplinary bedside round communication protocol
EDD, estimated date of discharge; NUM, nurse unit manager
T1

On 1 July 2014, both wards commenced SIBR twice weekly. Two of the four medical teams participated on Monday and Thursday, and the other two participated on Tuesday and Friday. During SIBR days, each team started on a separate ward (one on 5A and the other on 5B) and changed over after approximately 30 min. All rounds started at 1130 hours to allow prior patient assessments through usual activities. Based on staff availability, the rounds were attended by senior doctors (consultant and/or registrar), the nurse unit manager, the bedside nurse and allied health professionals. Family members and non-family carers were encouraged to attend.

Most rounds occurred at the patient’s bedside and each interaction lasted approximately 3–5 min. During this time, participants gave and received information according to the communication protocol (Table 1). Although staff were encouraged to adhere to this protocol, some flexibility was inevitable (e.g. following a question by the patient). Following input from the patient and the family, a care plan was formulated and verbalised. The information was recorded on a datasheet (mostly by the nurse unit manager) and attached to the bedside record.

Other aged care practices

Aged care practices before and during SIBR included journey board rounds, case conferences and medical team ward rounds. A journey board round is a process whereby members of the interdisciplinary team exchange and document information (on a whiteboard) to facilitate a coordinated approach to care and discharge planning. These 30- to 45-min unstructured rounds were held in a conference room each weekday at 0830 hours. Although it was anticipated that the board rounds would be briefer during SIBR, for the most part they were unchanged. Conversely, the weekly case conferences were shorter during SIBR. Whereas all patients were discussed before SIBR, a limit of five patients per ward was imposed during SIBR, with any staff member able to nominate patients for discussion. The medical team ward rounds remained unchanged.

Measures

Data were collected on patient demographics, referral source, premorbid frailty, medical diagnoses, patient and family participation during SIBR, in-hospital mortality, LOS and date of re-admission to hospital or re-presentation to the emergency department. Pre-SIBR data were extracted from a clinical database maintained by the aged care service for many years.

Premorbid frailty was defined as the level of frailty present 1 month before admission and was determined using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS).23 The CSHA-CFS is a subjective scale that classifies people into one of seven ordinal categories. At the two extremes of the scale, those in Category 1 are very fit, energetic and motivated, whereas those in Category 7 are completely dependent in the activities of daily living or are terminally ill.

Medical diagnoses were based on version 5.1 of the Australian Refined Diagnosis Related Groups classification system.24 Up to 15 active diagnoses were coded per patient (those affecting physical, social or psychological function, or those needing medication changes, investigations or increased monitoring to treat symptoms and guide management).

Data on re-admission to hospital and re-presentation to the emergency department were gathered from local health district electronic medical records that included seven hospitals. The LOS was defined as the difference in days between the date of arrival to Ward 5A or 5B and the discharge date.

Statistical analyses

Cox proportional hazards regression was used to model LOS. Risk factors for prolonged LOS in the literature (age, dementia, delirium and function)2527 were forced into the model. Other variables were considered for inclusion based on biological plausibility, significance and confounding (between SIBR and LOS). To evaluate whether the effect of SIBR on LOS was modified by the presence of dementia or delirium, or the ability to speak English, appropriate interaction terms were tested in the multivariate model. Between-groups comparisons were made using t-tests for continuous normally distributed variables, Fisher’s exact tests for dichotomous variables and Wilcoxon rank sum tests for ordinal variables. Mantel–Haenszel trend analysis was used to evaluate the trend between admission from a high-care residential aged care facility (HC-RACF) and CSHA-CFS category. The study was powered to detect a 0.9-day decrease in mean LOS (Type 1 error 0.05, Type 2 error 0.20). Analyses were performed using SAS version 9.4 (SAS Institute).


Results

Characteristics of participants

The study population was multicultural, with 58.8% born in culturally and linguistically diverse countries. Most (93.2%) were admitted through the emergency department and were acutely unwell, with a median of seven active diagnoses. Participant characteristics are given in Table 2.


Table 2.  Characteristics of study participants before and during implementation of structured interdisciplinary bedside rounds (SIBR)
Data are given as the mean ± s.d. or as percentages. BPSD, behavioural and psychological symptoms of dementia; CALD, culturally and linguistically diverse; COPD, chronic obstructive pulmonary disease; CSHA-CFS, Canadian Study of Health and Aging Clinical Frailty Scale; HC-RACF, high-care residential aged care facility; LC-RACF, low-care residential aged care facility
Click to zoom

Patient characteristics by admission domicile (HC-RACF vs other)

Compared with other patients, HC-RACF residents were older (mean age 85.2 vs 83.4 years) and were more likely to be within the higher CSHA-CFS categories. In addition, HC-RACF residents had higher rates of dementia (53.8% vs 36.6%) and delirium (52.4% vs 36.3%), shorter LOS (median 6 vs 9 days) and higher rates of in-hospital mortality (14.4% vs 7.0%; P < 0.001 for all). Patients from an HC-RACF who died had a median LOS of 5.5 days.

Patient and family participation

In all, 2964 (65.7%) patients participated to some extent during 4508 documented SIBR. At least one member of the family was present in 913 of 4508 (20.3%) documented rounds (data recorded only for SIBR Sessions 1–8 per patient). Although 22.7% of SIBR Sessions 1 were attended by the family, only 14.4% of SIBR Sessions 8 were attended by the family.

Length of stay

There was no significant difference in the median (interquartile range) LOS before and during SIBR (8 (5–15) vs 8 (4–15) days respectively; P = 0.51). In multivariate analysis, the implementation of SIBR had no significant effect on LOS (Table 3). Older people and those residing in an HC-RACF had shorter LOS. The effect of SIBR on LOS was not modified by dementia, delirium or the ability to speak English (P > 0.05 for all).


Table 3.  Cox proportional hazards regression model for length of hospital stay
Data for 307 patients (9.7%) were censored due to in-hospital death. Dementia, delirium, age and Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS) data were forced into the model: 3179 of 3644 patients (87.2%) had complete data for variables in the model. BPSD, behavioural and psychological symptoms of dementia; CI, confidence interval; HC-RACF, high-care residential aged care facility; HR, hazard ratio; SIBR, structured interdisciplinary bedside rounds
T3

Re-admissions to hospital and re-presentations to the emergency department

Before SIBR, 312 (20.3%) patients discharged alive were re-admitted within 28 days of discharge, whereas during SIBR 338 (19.0%) were re-admitted (P = 0.36). Similarly, there was no significant difference in the 28-day rates of re-presentation to the emergency department before (n = 108; 7.0%) and during (n = 129; 7.2%) SIBR (P = 0.84).

Missing data

Frailty or diagnostic data were missing in 465 patients (12.8%). Those with missing data were less likely to have been admitted through the emergency department (88.4% vs 93.9%; P < 0.001); they also had shorter LOS (median 7 vs 8 days; P = 0.002) and were less likely to die in hospital (3.4% vs 9.7%; P < 0.001). However, all other characteristics were similar between those with and without missing data.


Discussion

The present large before-after study found that the implementation of SIBR among older people hospitalised with acute illness did not reduce LOS or the 28-day re-admission rate.

Although the results of the present study differ from those published by Stein et al.,9 direct comparison of the studies is problematic. For example, Stein et al.9 did not define the characteristics of their study population and the results from adjusted analyses were not reported. In addition, in the study of Stein et al.,9 SIBR were implemented together with other features of an accountable care unit, making it difficult to isolate the effect of SIBR. Furthermore, whereas we implemented SIBR twice weekly, Stein et al.9 conducted it daily. Because of competing clinical demands, we did not believe that we could sustain daily SIBR on a long-term basis. However, we believed that we could overcome some of the potential disadvantages of less frequent rounding through other communication strategies. Detailed SIBR information was recorded on a datasheet and attached to the bedside record. Staff on non-SIBR days were encouraged to view the datasheet and to follow the care plan. We continued several other communication practices, including weekday journey board rounds, medical team ward rounds and modified weekly case conferences. These practices may have provided sufficient interdisciplinary communication, potentially obviating the additional benefits of SIBR. Units without a strong culture of regular interdisciplinary communication may have different experiences with SIBR.

Although our communication strategies may explain the ineffectiveness of SIBR, other potential reasons should be considered. First, conventional models of interdisciplinary care among older people reduce outcomes strongly related to LOS, including hospital-related falls28 and functional decline at discharge,29,30 suggesting that additional improvements through SIBR may be limited. Second, evidence indicates that hospital discharge planning for frail older people can be improved if interdisciplinary interventions include and educate the family.31 Although only 20.3% of the SIBR in the present study were attended by a member of the family, the effect of SIBR on LOS was not modified by the presence of dementia or delirium, or the ability to speak English (patient groups most likely to benefit from family attendance). Finally, 3- to 5-min SIBR interactions may not be long enough to have an effect on outcomes. However, Stein et al.9 reported a significant reduction in LOS despite reviewing up to 24 patients during 1 h.

Although SIBR did not reduce LOS or re-admission in the present study population, this may not be the case in other patient groups and settings. LOS is determined by a complex network of multiple supply and demand factors that include organisational culture, hospital bed availability, the numbers and mix of personnel, the accessibility of subacute services, an individual patient’s needs and the customs and cultures of the local population.32 Any of these factors may affect the relationship between SIBR and LOS. Although early unplanned hospital re-admissions are increasingly associated with the quality of acute care,19 on an operational level they are indicators of the total chain of care, rather than on the performance of the hospital and its processes alone.16

Older patients and those residing in an HC-RACF had shorter LOS. Residential aged care facilities provide a familiar and structured environment that allows many patients to be discharged before they recover fully.33 Although functional and cognitive impairments should not be used to exclude HC-RACF residents from in-patient care, those with severe impairment are unlikely to benefit. The high prevalence of functional and cognitive impairments in the HC-RACF patients in the present study, together with earlier and higher in-hospital mortality, explained their shorter LOS. We are uncertain why older patients had shorter LOS. Although the patients from HC-RACFs were significantly older than other patients in the present study, the mean difference in age was only 1.8 years. Age is not a consistent predictor of LOS in the literature.26

The focus of the present study was on the effect of SIBR on specific quantitative outcomes because of the lack of literature in this area. However, SIBR should not be dismissed without considering their possible effects on other outcomes. Sites evaluating the qualitative outcomes of SIBR have reported improved staff satisfaction, reduction in staff turnover and improved patient–clinician communication.11,3437

The present study has several limitations. First, although a before-after study is inferior to a randomised controlled study, the reforms at the hospital made the latter unachievable. However, with the exception of shortened weekly case conferences during SIBR, all other practices remained unchanged. We adjusted for many variables and included a measure of frailty (CSHA-CFS; Table 3). Because the CSHA-CFS mixes items such as comorbidity, cognitive impairment and disability,23 it may have captured unmeasured variables that affected LOS.38 Second, the population of older people is more diverse than our single hospital sample, and hence the results of the present study cannot be extrapolated to all older in-patients and settings. Finally, 12.8% of the patients in the present study had missing frailty or diagnostic data. Although all other measures were fully complete, missing data may have affected the quantitative values given in Table 3. However, we believe that our qualitative conclusions are valid.

Despite these limitations, the present study has several strengths: the sample was large and all data were ascertained prospectively. Further, consecutive patients admitted to the aged care service were studied. Among all non-probability samples, consecutive sampling is the best because it is most representative of the underlying study base.


Conclusion

Despite the scarcity of peer-reviewed evidence and the associated resource cost, SIBR are being widely implemented. Although ineffective interdisciplinary collaboration is associated with negative outcomes, models of care aiming to improve collaboration are not necessarily effective in reducing LOS or early re-admission across all services and settings. Clinical services implementing SIBR are encouraged to independently evaluate the effects of SIBR on these and other outcomes.


Competing interests

None declared.



Acknowledgements

The authors acknowledge the following geriatricians for their contributions to data collection and data entry: Benyamen Benyamen, Leemin Chan, David Conforti, Angela Khoo, Florence Loh, Colin Macarthur, Nyoka Ruberu, Milan Simic and Nalini Thayaparan. The authors also acknowledge the community volunteers (for their assistance during the training period), the project leads from the CEC and all staff on the aged care wards for helping develop the communication protocol and implementing SIBR.


References

[1]  Department of Health. Executive summary of creating an interprofessional workforce: an education and training framework for health and social care in England. 2007. Available at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078593 [verified 26 January 2016].

[2]  World Health Organization. Framework for action on interprofessional education and collaborative practice. 2010. Available at: http://www.who.int/hrh/resources/framework_action/en/ [verified 11 October 2016].

[3]  Martin JS, Ummenhofer W, Manser T, Spirig R. Interprofessional collaboration among nurses and physicians: making a difference in patient outcome. Swiss Med Wkly 2010; 140 w13062

[4]  Boev C, Xia Y. Nurse–physician collaboration and hospital-acquired infections in critical care. Crit Care Nurse 2015; 35 66–72.
Nurse–physician collaboration and hospital-acquired infections in critical care.CrossRef |

[5]  Manojlovich M, DeCicco B. Healthy work environments, nurse–physician communication, and patients’ outcomes. Am J Crit Care 2007; 16 536–43.

[6]  Friedman DM, Berger DL. Improving team structure and communication: a key to hospital efficiency. Arch Surg 2004; 139 1194–8.
Improving team structure and communication: a key to hospital efficiency.CrossRef |

[7]  Begue A, Overcash J, Lewis R, Blanchard S, Askew TM, Borden CP, Semos T, Yagodich AD, Ross P. Retrospective study of multidisciplinary rounding on a thoracic surgical oncology unit. Clin J Oncol Nurs 2012; 16 E198–202.
Retrospective study of multidisciplinary rounding on a thoracic surgical oncology unit.CrossRef |

[8]  Dutton RP, Cooper C, Jones A, Leone S, Kramer ME, Scalea TM. Daily multidisciplinary rounds shorten length of stay for trauma patients. J Trauma 2003; 55 913–9.
Daily multidisciplinary rounds shorten length of stay for trauma patients.CrossRef |

[9]  Stein J, Payne C, Methvin A, Bonsall JM, Chadwick L, Clark D, Castle BW, Tong D, Dressler DD. Reorganizing a hospital ward as an accountable care unit. J Hosp Med 2015; 10 36–40.
Reorganizing a hospital ward as an accountable care unit.CrossRef |

[10]  Weller J, Boyd M, Cumin D. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgrad Med J 2014; 90 149–54.
Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare.CrossRef |

[11]  Gausvik C, Lautar A, Miller L, Pallerla H, Schlaudecker J. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. J Multidiscip Healthc 2015; 8 33–7.
Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction.CrossRef |

[12]  Clinical Excellence Commission. In safe hands. 2016. Available at: http://cec.health.nsw.gov.au/quality-improvement/team-effectiveness/insafehands [verified 11 October 2016].

[13]  Thomas JW, Guire KE, Horvat GG. Is patient length of stay related to quality of care? Hosp Health Serv Adm 1997; 42 489–507.
| 1:STN:280:DyaK1c%2FmtlKjtw%3D%3D&md5=4d5ad33373a2f2e256c833c763015873CAS |

[14]  Kossovsky MP, Sarasin FP, Chopard P, Louis-Simonet M, Sigaud P, Perneger TV, Gaspoz JM. Relationship between hospital length of stay and quality of care in patients with congestive heart failure. Qual Saf Health Care 2002; 11 219–23.
Relationship between hospital length of stay and quality of care in patients with congestive heart failure.CrossRef | 1:STN:280:DC%2BD38jisFWhuw%3D%3D&md5=4298dc7701383ba5634e0113a9384ba6CAS |

[15]  O’Connell TJ, Ben-Tovim DI, McCaughan BC, Szwarcbord MG, McGrath KM. Health services under siege: the case for clinical process redesign. Med J Aust 2008; 188 S9–13.

[16]  Heggestad T. Do hospital length of stay and staffing ratio affect elderly patients’ risk of readmission? A nation-wide study of Norwegian hospitals. Health Serv Res 2002; 37 647–65.
Do hospital length of stay and staffing ratio affect elderly patients’ risk of readmission? A nation-wide study of Norwegian hospitals.CrossRef |

[17]  Kaboli PJ, Go JT, Hockenberry J, Glasgow JM, Johnson SR, Rosenthal GE, Jones MP, Vaughan-Sarrazin M. Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals. Ann Intern Med 2012; 157 837–45.
Associations between reduced hospital length of stay and 30-day readmission rate and mortality: 14-year experience in 129 Veterans Affairs hospitals.CrossRef |

[18]  Bolevich Z, Smith B. Unplanned hospital readmissions. 2015. Available at: http://www.health.nsw.gov.au/Performance/Documents/201503-unplanned-readmissions.pdf [verified 11 October 2016].

[19]  Ashton CM, Del Junco DJ, Souchek J, Wray NP, Mansyur CL. The association between the quality of inpatient care and early readmission. A meta-analysis of the evidence. Med Care 1997; 35 1044–59.
The association between the quality of inpatient care and early readmission. A meta-analysis of the evidence.CrossRef | 1:STN:280:DyaK2svnvVagtw%3D%3D&md5=a1e5553afb5f6b72b02fc6d638de6826CAS |

[20]  Franklin PD, Noetscher CM, Murphy ME, Lagoe RJ. Using data to reduce hospital readmissions. J Nurs Care Qual 1999; 14 67–85.
Using data to reduce hospital readmissions.CrossRef |

[21]  Linertova R, Garcia-Perez L, Vazquez-Diaz JR, Lorenzo-Riera A, Sarria-Santamera A. Interventions to reduce hospital readmissions in the elderly: in-hospital or home care. A systematic review. J Eval Clin Pract 2011; 17 1167–75.
Interventions to reduce hospital readmissions in the elderly: in-hospital or home care. A systematic review.CrossRef |

[22]  Wieland D, Rubenstein LZ. What do we know about patient targeting in geriatric evaluation and management (GEM) programs? Aging Clin Exp Res 1996; 8 297–310.
What do we know about patient targeting in geriatric evaluation and management (GEM) programs?CrossRef | 1:STN:280:DyaK2s7hvVenug%3D%3D&md5=872122c206a9baa29945626ac19202caCAS |

[23]  Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173 489–95.
A global clinical measure of fitness and frailty in elderly people.CrossRef |

[24]  Australian Refined Diagnosis Related Groups. Hospital casemix protocol 2008-09, number of separations, average length of stay, patient days and average charges, by AR-DRG version 5.1, public hospitals, private hospitals and day surgeries. Available at: https://health.gov.au/internet/main/publishing.nsf/Content/647C11F217FEDC1FCA257BF0001ED9AF/$File/HCP%20Annual%20Report%200809.pdf [verified 7 October 2016].

[25]  Basic D, Shanley C. Frailty in an older inpatient population: using the clinical frailty scale to predict patient outcomes. J Aging Health 2015; 27 670–85.
Frailty in an older inpatient population: using the clinical frailty scale to predict patient outcomes.CrossRef |

[26]  Campbell SE, Seymour DG, Primrose WR. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing 2004; 33 110–15.
A systematic literature review of factors affecting outcome in older medical patients admitted to hospital.CrossRef |

[27]  Lang PO, Heitz D, Hedelin G, Drame M, Jovenin N, Ankri J, Somme D, Novella JL, Gauvain JB, Couturier P, Voisin T, De Waziere B, Gonthier R, Jeandel C, Jolly D, Saint-Jean O, Blanchard F. Early markers of prolonged hospital stays in older people: a prospective, multicenter study of 908 inpatients in French acute hospitals. J Am Geriatr Soc 2006; 54 1031–9.
Early markers of prolonged hospital stays in older people: a prospective, multicenter study of 908 inpatients in French acute hospitals.CrossRef |

[28]  von Renteln-Kruse W, Krause T. Incidence of in-hospital falls in geriatric patients before and after the introduction of an interdisciplinary team-based fall-prevention intervention. J Am Geriatr Soc 2007; 55 2068–74.
Incidence of in-hospital falls in geriatric patients before and after the introduction of an interdisciplinary team-based fall-prevention intervention.CrossRef |

[29]  Van Craen K, Braes T, Wellens N, Denhaerynck K, Flamaing J, Moons P, Boonen S, Gosset C, Petermans J, Milisen K. The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc 2010; 58 83–92.
The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis.CrossRef |

[30]  Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J, Rodriguez-Manas L, Rodriguez-Artalejo F. Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ 2009; 338 334–42.
Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis.CrossRef |

[31]  Bauer M, Fitzgerald L, Haesler E, Manfrin M. Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence. J Clin Nurs 2009; 18 2539–46.
Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence.CrossRef |

[32]  Clarke A. Length of in-hospital stay and its relationship to quality of care. Qual Saf Health Care 2002; 11 209–10.
Length of in-hospital stay and its relationship to quality of care.CrossRef | 1:STN:280:DC%2BD38jisFWhtg%3D%3D&md5=0f68a74cc64b756a2fb2299d3a5e2833CAS |

[33]  Ensberg MD, Paletta MJ, Galecki AT, Dacko CL, Fries BE. Identifying elderly patients for early discharge after hospitalization for hip fracture. J Gerontol 1993; 48 M187–95.
Identifying elderly patients for early discharge after hospitalization for hip fracture.CrossRef | 1:STN:280:DyaK3sznsFWluw%3D%3D&md5=83f044db54ec644d3469b4bf1b68375dCAS |

[34]  McVeigh C, Cox J. Parkes 5 aged care rehab In Safe Hands unit. Structured interdisciplinary bedside rounds (SIBR). 2015. Available at: http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0004/266710/6-Clinical-Units-Aged-Care-Rehab-POW-Catherine-McVeigh.pdf/ [verified 26 January 2016].

[35]  Redley B, Barnes S, Campbell D, Stockman K. Evaluating patient participation in interdisciplinary medical ward rounds. 2014. Available at: http://www.isqua.org/docs/default-source/Brazil-Speakers/Brazil-Power-Point-Presentations/b-redley_isqua-oct_2014_sibr.pdf?sfvrsn=0/ [verified 26 January 2016].

[36]  Rowlinson D, Moylan E. In Safe Hands CB4E oncology. 2015. Available at: http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0011/266717/9-Clinical-Units-Oncology-Liverpool-Debbie-Rowlinson-Eugene-Moylan.pdf/ [verified 26 January 2016].

[37]  Wilson S. Our SIBR journey. St Vincent’s Hospital Coronary Care Unit. 2015. Available at: http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0008/266714/8-Clinical-Units-Oncology-St-Vincents-Stephanie-Wilson.pdf/ [verified 26 January 2016]

[38]  Wong CH, Weiss D, Sourial N, Karunananthan S, Quail JM, Wolfson C, Bergman H. Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study. Aging Clin Exp Res 2010; 22 54–62.
Frailty and its association with disability and comorbidity in a community-dwelling sample of seniors in Montreal: a cross-sectional study.CrossRef |


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