Feasibility study for early supported discharge in adults with respiratory infection in the UK

Abstract

Background: Many patients with pneumonia and lower respiratory tract infection that could be treated as outpatients according to their clinical severity score, are in fact admitted to hospital. We investigated whether, with medical and social input, these patients could be discharged early and treated at home.

Objectives: (1) To assess the feasibility of providing an early supported discharge scheme for patients with pneumonia and lower respiratory tract infection (2) To assess the patient acceptability of a study comprising of randomisation to standard hospital care or early supported discharge scheme.

Design: Randomised controlled trial.

Setting: Liverpool, UK. Two University Teaching hospitals; one city-centre, 1 suburban in Liverpool, a city with high deprivation scores and unemployment rates.

Participants: 200 patients screened: 14 community-dwelling patients requiring an acute hospital stay for pneumonia or lower respiratory tract infection were recruited.

Intervention: Early supported discharge scheme to provide specialist respiratory care in a patient's own home as a substitute to acute hospital care.

Main outcome measures: Primary - patient acceptability. Secondary - safety/mortality, length of hospital stay, readmission, patient/carer (or next of kin) satisfaction, functional status and symptom improvement.

Results: 42 of the 200 patients screened were eligible for early supported discharge; 10 were only identified at the point of discharge, 18 declined participation and 14 were randomised to either early supported discharge or standard hospital care. The total hospital length of hospital stay was 8.33 (1-31) days in standard hospital care and 3.4 (1-7) days in the early supported discharge scheme arm. In the early supported discharge scheme arm patient carers reported higher satisfaction with care and there were less readmissions and hospital-acquired infections.

Limitations: A small study in a single city. This was a feasibility study and therefore not intended to compare outcome data.

Conclusions: An early supported discharge scheme for patients with pneumonia and lower respiratory tract infection was feasible. Larger numbers of patients would be eligible if future work included patients with dementia and those residing in care homes.

Trial registration: ISRCTN25542492.

Figure 1

Screening and final recruitment numbers. Note no patients withdrew consent or were lost to follow-up. ‘Missed’ means missed due to logistical reasons e.g. by the time of repeat patient review by the study team the patient was well enough for discharge without ESDS support or the patient was discharged outside of the hours/days of study recruitment.