A demand-capacity mismatch between rehabilitation need and service provision as a result of the COVID-19 pandemic? Early clinical observations from a large teaching hospital in London.

In this short report the authors characterise inpatient bed occupancy and predicted rehabilitation need of patients cared for in two acute hospitals of a large London NHS Trust during the first wave of the COVID-19 pandemic, including 394 people with confirmed COVID-19. Data were captured on a single day (17th April 2020) from the two Trust hospitals to inform discharge planning in line with national COVID-19 Hospital Discharge Service policy guidance. Our data suggests that the proportion of COVID-19 patients predicted to require rehabilitation upon hospital discharge may be greater than the estimates described in the national COVID-19 Hospital Discharge Service policy guidance; posing the question is there a demand-capacity mismatch between rehabilitation need and service provision as a result of the COVID-19 pandemic?

Benzodiazepines and Geriatrics: What Clinical Practice Strategies Can Be Used to Reduce the Inappropriate Prescribing?

In the elderly, Potentially Inappropriate Prescriptions (PIPs) are quite common and connected with adverse drug events (ADEs), hospital stays, increased medical acuities, and inefficacious healthcare. Benzodiazepines as a class have been identified as an independent risk factor for ADE's and shown to be associated with sedation and impairments in cognition, memory, and balance, lending to an increased risk for falls. Clinically inappropriate medications continue to be prescribed and preferred by many clinicians over non-pharmacological strategies despite continued evidence demonstrating poor outcomes in older adults. Due to the increasing evidence in positive elderly outcomes through the reduction in use of inappropriate drugs, medication reduction strategies are now required policy components in the Centers for Medicare and Medicaid Services regulations along with Medicare Part D. Quality measures now focus on extensive drug reviews with reduction strategies that incorporate use of: the Beers Criteria; multidisciplinary approaches; involving patients and caregivers; and de-prescribing strategies.