A score to predict the development of adverse clinical events after transition from acute hospital wards to post-acute care settings

Adverse clinical events (ACEs) are common in post-acute hospital care. We aimed at developing and validating a method, able to be administered in hospital wards, for identifying elderly patients at increased risk of ACEs after transferral to Post-Acute Care (PAC) facilities. This was a prospective observational study, including 502 patients admitted to 19 PACs in Northern Italy from July 1st to August 14th 2009. A standardized form was used to collect data. Variables showing stable association with ACEs in testing group were used to derive the score. The relative risk (RR) of developing ACEs according to the score was measured in the validation group. Age >87 years, delirium, pressure sore, indwelling bladder catheter, malnutrition, and acute infection on admission were identified as stable ACE predictors. A score of 1 was assigned to each predictor. Subjects were classified as having low (score =0), medium-low (score =1), medium-high (score =2-3), or high (score >4) risk of ACEs. The RR of developing >1 ACE increased progressively from low (RR: 1) to medium-low (RR: 1.5, 95% CI: 1.1-1.9), medium-high (RR: 1.6, 95% CI: 1.3-2.1), and high (RR: 1.8, 95% CI: 1.4-2.3) risk score. The RR of being not discharged to home increased monotonically from 1.0 in low-risk to 2.7 in high-risk groups. In conclusion, this study proposes a method, able to be administered in hospital wards, for identifying patients at increased risk of ACEs after transferral to PAC. The score might also be used to identify people who will not return to home after PAC discharge.