title: Where to go if not the hospital? Reviewing geriatric bed utilization in an acute care hospital in Singapore.
abstract: OBJECTIVE
  Singapore is one of the fastest-aging countries in the world, and the demand for acute hospital care for older adults is expected to triple in the next 25 years. Hence, it is crucial to understand the opportunities in reducing potentially avoidable bed days (PABD), which are days spent in acute hospitals delivering only non-acute services. We aimed to access the prevalence, causes and consequences of PABD among geriatric patients.
  
  
  METHODS
  We examined all hospitalizations from 1 August through 31 December 2013 in the geriatric wards of an acute hospital in Singapore. PABD were identified using a modified Appropriateness Evaluation Protocol. Non-acute services were classified as subacute care, rehabilitative care, long-term care or social care. Hospitalization patterns were determined based on the presence or absence of non-acute services, and multinomial logistic regression was used to determine predictors of different patterns.
  
  
  RESULTS
  Of the 273 bed days used by 254 patients, 49% were potentially avoidable. The most common non-acute services provided were rehabilitative care (19%), subacute care (12%) and long-term care (8%). New acute issues arose after the admission conditions subsided in 2.4% of hospitalizations, 61% of which were nosocomial infections. Being socially at risk as assessed on admission predicted the development of new acute issues (sensitivity = 62%; specificity = 88%).
  
  
  CONCLUSIONS
  In the present study, almost half of the bed days were potentially avoidable. New acute issues can arise after PABD, which are dangerous to these frail older adults. Proactive discharge planning and increasing access to intermediate and long-term care services are required to reduce PABD. Geriatr Gerontol Int 2017; 17: 1575-1583.
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
authors.forename: Ke
authors.initials: K
authors.lastname: Zhou
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.|Department of Medicine, National University Health System, Singapore.
authors.forename: Arpana R
authors.initials: AR
authors.lastname: Vidyarthi
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.|Geriatric Education and Research Institute, Singapore.|Department of Geriatric Medicine, Alexandra Health System, Singapore.
authors.forename: Chek Hooi
authors.initials: CH
authors.lastname: Wong
authors.affiliation: Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.|Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Matchar
mesh_terms: D000368:Aged; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D012846:Singapore; D019467:Subacute Care / Q000706:statistics & numerical data*
keywords: appropriateness of hospital use; geriatric patients; health services; hospital-acquired conditions