CHOICE – Consider Home Over Inpatient Care Every time

Adam Horrocks1, Vesna Milasinovic1

1Fiona Stanley Fremantle Hospitals Group (FSFHG), Perth, Australia

Internationally there is growing evidence that older adults admitted to hospital are at greatest risk of further complications and declining health than those cared for at home. In response, the CHOICE Initiative was launched (2019) to transform the way we care for elderly patients across FSFHG. This initiative has focused on embedding a culture where we Consider Home Over Inpatient Care Every time (CHOICE) and includes delivery of a new Discharge to Assess (DTA) service. Building a CHOICE culture through promotion and education has empowered staff to weigh up the perceived risks of discharge against known risks of admission. This has been a driving force to promote and refine practices which reduce length of stay (LOS).

The DTA care model has focused on assessing and optimising elderly patients, in relation to function, cognition, falls risk and social care needs within their home environment. This eliminates delays patients endure when awaiting inpatient assessments that could be better completed after discharge and is linked to improved patient outcomes, more appropriate prescription of home care, reduced hospital costs and improved hospital capacity.

The CHOICE Initiative has reduced LOS (30%) and increased the proportion of elderly patients discharged home within the first 72 hours. 79% of surveyed staff reported improved confidence in facilitating earlier than usual discharges and 91% of surveyed patients reported it to be completely beneficial having their assessments completed at home rather than hospital. This supports moving away from traditional practice and towards providing earlier than usual care in the community.


Vesna Milasinovic graduated from Curtin University in 2011 and has previous experience working in residential aged care, and various tertiary and secondary hospitals in Perth, WA. Vesna has worked in a variety of clinical areas, with majority of experience working in geriatric care. Vesna is currently working as the Senior Occupational Therapist in the CHOICE Project since its launch in 2019, and is involved with the development of this new service aimed to create a culture change of embedding a Home First mindset and delivering a Discharge to Assess model of care.

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