Aims: Investigate the association between nutritional risk and the incidence of Hospital Related Harms (HRH) in individuals undertaking rehabilitation in a home-based inpatient bed substitution model called Better-at-Home (BAH). To describe the relationship between nutritional risk and HRH in patients enrolled in the rehabilitation and Geriatric Evaluation and Management (GEM) arms of BAH.
Method: Single-centre, retrospective cohort study of adults ≥18 years participating in BAH between January 1 to March 31 2021. Those receiving palliative care, living in residential care and readmitted to BAH within 30 days were excluded. Participants were divided into four subgroups: low nutritional risk within GEM, low nutritional risk within rehabilitation, moderate-high nutritional risk within GEM and moderate-high nutritional risk within rehabilitation using the Malnutrition Universal Screening Tool (MUST). Outcome measures included delirium, pressure-injuries, falls, transfers and readmission within 30 days. P-value of <0.05 was considered significant.
Results: Of 175 participants, 71 (41.1%) had moderate-high nutritional risk. Patients with moderate-high nutritional risk were more likely, than those with low nutritional risk, to be admitted with delirium (p=0.014) and readmitted to an acute ward (p=0.003) and BAH within 30 days of discharge (p=0.05.) GEM patients, regardless of nutritional risk, were more likely to experience ≥ 1 adverse outcomes compared to rehabilitation patients (p=0.006.)
Conclusions: Moderate-high nutritional risk was associated with HRH in this home-based rehabilitation program; however, factors such as frailty, multi-morbidity and functional impairment likely confound this relationship. Larger prospective studies are required to characterise this relationship in this inpatient bed substitution model of care.