Background: Patients approved for TACP often remain in hospital unnecessarily until their package commences. Delayed discharges increase the risk of hospital-acquired complications (HAC) and healthcare costs. St Vincent’s Hospital Sydney HITH provides a novel pathway for patients to be transferred home with multidisciplinary care until TACP commences, including before ACAT approval.
Aims: To investigate clinical outcomes of the HITH-to-TACP pathway and evaluate economic savings.
Methods: Retrospective cohort study of inpatients discharged with TACP at a tertiary-level, single centre. Group 1: Patients transferred through HITH-to-TACP (2019-2024). Group 2: Age- and sex-matched controls between 2014-2017 (pre-HITH-to-TACP). Primary outcomes: Hospital length-of-stay (LOS), HAC incidents, 30-day readmissions. Secondary outcomes: LOS on TACP and HITH, TACP functional scores (Barthel Index), destination at TACP conclusion. Economic savings calculated as HITH days x (inpatient bed cost - HITH bed cost).
Results: 296 patients (n=148 per group), median age 84 years, 49% female. Groups had comparable Charlson Comorbidity Index, Clinical Frailty Scales, cognitive impairment and polypharmacy. HITH-to-TACP group had shorter median hospital LOS (9.0 vs 11.0 days, p=0.00014), fewer HAC incidents (13 vs 32) and similar 30-day readmissions (18.9% vs 18.2%). No significant difference in TACP LOS or magnitude of functional improvement. At TACP completion, 81% vs 74% remained at home (OR 1.48, p=0.209). Median HITH LOS was 5 days, saving 728 bed-days and $1,372,903 over the five-year study period.
Conclusions: The HITH-to-TACP pathway reduced hospital LOS, HAC burden and healthcare costs without increasing 30-day readmissions, presenting a cost-effective approach to improve patient flow while maintaining clinical outcomes.