981 FIONA STANLEY FREMANTLE HOSPITAL GROUP'S CHOICE PROJECT SUPPORTS EARLY DISCHARGES AND MINIMISES LENGTH OF STAY FOR FRAIL PATIENT

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Abstract Background In 2019, Fiona Stanley Fremantle Hospital Group (Western Australia) launched a project to support earlier than usual discharges for frail elderly patients. This project was branded CHOICE—Consider Home Over Inpatient Care Every time. Introduction Evidence suggests that older adults admitted to hospital are at greater risk of further complications and declining health than those cared for at home. Our problem is that the decision to prolong admission can be influenced by our perception of risk which can delay discharges and increase risks for deconditioning, functional decline, hospital acquired complications and early entry into residential care. Method CHOICE implemented 2 key strategies improve patient outcomes and reduce health care costs by minimising LOS: 1. Promotion of a home-first culture began in April 2019 using staff education, training and positive reinforcement. A focus was on positive risk taking behaviours that keep the unique values of our patients at the forefront of all decisions. 2. The CHOICE Team launched in November 2019 to support early diversion of care and assessment into the community. Key elements included an Allied Health led Discharge to Assess service, rapid response Geriatrician clinic and a Nursing outreach service. Results Outcomes achieved in the 20/21 financial year were compared against pre CHOICE (2018) data for patients aged greater than 75 years on target wards 1,756 bed days were saved for patients returning home 22% reduction in discharges directly into care facilities 444 additional home discharges 91% of surveyed patients (n100) felt completely satisfied having their health assessments completed at home Readmission rates did not increase. Conclusion The CHOICE model has been shown to be more cost-effective and clinically effective than traditional practice. CHOICE is now embedded into the operational budget with workforce costs offset by bed day savings and an increase in activity based funding.

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