Authors (including presenting author) :
Lui NF, Liu HF, Fung HO, Clancey J, Tsui CY, Fung HT, Chu SY, Ma WL
Affiliation :
Department of Occupational Therapy Department, Queen Elizabeth Hospital
Introduction :
Occupational therapists practicing in acute care hospitals play a crucial role in discharge planning. At Queen Elizabeth Hospital, Home Discharge Readiness Scale (HDRS) is commonly used in acute stroke unit and neurosurgical unit as a standardised discharge planning assessment. It assessed patients on their level of readiness from a scale of 1 to 6 to be discharged home. Higher scores equate to high preparedness. It helps identify potential return to home barriers and promotes discharge-related communication with patients, caregivers and physicians.
Objectives :
In this study, we aimed to: 1. Determine the cut-off score that is disease-specific to predict discharge destination; 2. Identify the factor(s) that contribute the most to home discharge.
Methodology :
This was a retrospective study performed in 2019. Between March to November, data from 100 patients in the acute stroke unit and 120 patients in the neurosurgery unit who received occupational therapy care were conveniently sampled from the clinical database. Patient’s demographic information, functional status, HDRS score and discharge destination were recorded. ROC analysis was used to calculate the optimal cut off score for direct discharge. Cramer’s V Coefficient was used to detect the factors associated with direct discharge home.
Result & Outcome :
The optimal cutoff score for HDRS to differentiate patients from direct discharge to needing further rehabilitation was 3.5 in both stroke and neurosurgical patients. In stroke patients, it gives a sensitivity of 0.803, specificity of 0.898, and AUC of 0.865 (95% confidence interval [CI], 0.797- 0.933). For neurosurgical patients, the sensitivity was 0.819, specificity of 0.833, and AUC of 0.885 (95% CI, 0.821- 0.949). Among the three factors (patient, carer and environment), higher patient and home environment scores showed strong association with direct home discharge in both stroke (Cramer’s V=0.741 and 0.654 respectively, P= 0.00) and neurosurgery patients (Cramer’s V=0.601 and 0.616 respectively, P= 0.00).
