Dr Lara Kimmel1,2, Ms Melissa Webb1, Mr Doug McCaskie1, Assoc Prof Lisa Somerville1,3
1Alfred Health, Melbourne, Australia, 2Monash University, Melbourne, Australia, 3Latrobe University , Melbourne, Australia
Introduction: Predicting discharge destination prior to admission for elective surgery has shown to decrease length of stay (LOS). Additionally, previous trauma research suggests that establishing an agreed discharge plan within 24 hours of admission improves outcomes. The aim of this project was to develop a model to aid in predicting discharge destination following trauma, and thus optimise resource allocation early in the patient stay.
Method: During 2020/2021, Alfred Health partnered with the Transport Accident Commission to provide early, intensive therapy to trauma patients. Data collected included baseline patient characteristics, injury event details and outcomes (LOS and discharge destination). Using 6 months of data, factors with a univariate relationship to discharge destination were included in a multi variate logistic regression model. This model was assessed using measures of discrimination (C-statistic) and calibration [Hosmer-Lemeshow (H-L) statistic].
Results: Six hundred and one patients were included. Increasing age, female gender, having an ICU stay, experiencing post traumatic amnesia, having reduced mobility and having a lower limb, head or spine injury were all included in the final model and were associated with discharge to an inpatient facility rather than home. The C-statistic for the model was 0.91 (p value 0.88, 0.94) with an H-L statistic of Chi2=6.12, p= 0.63.
Conclusion: A model for prediction of discharge destination following trauma was developed with excellent discrimination and calibration. Prospective testing is required but this model could form an integral part in facilitating timely decision making regarding discharge and optimising Allied Health resource allocation in the acute setting.
Lara is the Allied Health Team Leader for the trauma and orthopaedic project which is currently being run at The Alfred. She has been a physiotherapist at the Alfred for over 20 years and has completed a PhD at Monash University on the topic of discharge destination and outcomes following trauma.