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Alarslan G, Mennes R, Kieft R, Heinen M. Patients involvement in the discharge process from hospital to home: A patient's journey. J Adv Nurs 2024; 80:2462-2474. [PMID: 38050898 DOI: 10.1111/jan.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 12/07/2023]
Abstract
AIMS The aims of the study were to gain insight in the transfer process from hospital to homecare or rehabilitation centre from a patient's perspectives and to describe the experienced involvement, information provision and information needs patients. DESIGN A multiple case study with a phenomenological approach. METHODS Observations and interviews were employed, between May 2019 and August 2019, to capture the patient's perspectives and experiences on involvement, information provision and needs. Observations were executed during the discharge process from hospital to homecare (n = 6) or revalidation centre (n = 1) and during admission interviews with community nurses (n = 6). Interviews were conducted at the patient's home and the revalidation centre. RESULTS Eight themes were identified within three phases of the transfer process. The Sign-up phase contained two themes: 'organizing follow-up care' and 'planning the moment of discharge from the hospital'. The two themes in the Transfer phase were, 'verbal information provision' and 'written information provision'. Four themes were identified in the End phase: 'nursing supplies', 'medication', 'the electronic patient portal' and 'continuation of (para)medical care'. CONCLUSIONS Patient participation in the transition process from the hospital to follow-up care can be improved. This study indicates that unsafe situations could be prevented by patient involvement and clear perceptions of the role and responsibilities of patients, family and healthcare professionals. IMPLICATIONS TO PATIENT CARE Patient and family involvement has the potential to improve transition of care and techniques for shared decision-making can be applied to a greater extent. IMPACT This paper highlights that patients and families should be acknowledged as key figures in the transfer process and gives direction to healthcare professionals on how to increase involvement in the transfer process by actively inviting patients to participate in the transfer process. REPORTING METHOD COREQ guidelines for qualitative reporting. No patient or public contribution. CONTRIBUTION TO GLOBAL CLINICAL COMMUNITY This paper gives insights in patients' and families' perspectives on transition of nursing care and their involvement during the whole transfer process. This paper gives direction how to improve patient participation during the discharge process from hospital to follow-up care.
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Affiliation(s)
- Güven Alarslan
- Department of Social Sciences, Wageningen University and Research, Wageningen, The Netherlands
| | - Rosa Mennes
- Radboud Institute for Healthcare Sciences, IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Maud Heinen
- Radboud Institute for Healthcare Sciences, IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands
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Morschek L, Schultz JH, Wigbels R, Gebhardt N, Derreza-Greeven C, Friederich HC, Noll A, Unger I, Nikendei C, Bugaj TJ. Thrown in at the deep end: a qualitative study with physicians on the purpose and challenges of discharge interviews. Postgrad Med 2024; 136:180-188. [PMID: 38357911 DOI: 10.1080/00325481.2024.2319566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Against the backdrop of poor discharge communication in hospitals, this study explores the purpose of discharge interviews from the physicians' perspective and the challenges they are confronted with. Discharge interviews are legally required in Germany as part of the discharge management. Led by the ward physician, the discharge interview should summarize relevant information about the hospital stay, medication, lifestyle interventions and follow-up treatment. METHODS Semi-structured interviews with n = 12 physicians were conducted at Heidelberg University Hospital between February and April 2020. Qualitative content analysis was carried out using MAXQDA. RESULTS Physicians reported gaining information, providing information, and answering open-ended questions as the purpose of the discharge interview. Challenges in conducting discharge interviews were related to finding a common language, patient-related challenges, conditions of everyday ward life, and lack of training. Physicians reported receiving no explicit training on discharge interviews. While professional experience seems to mitigate the lack of training, some physicians expressed a prevailing sense of insecurity. CONCLUSION The lack of preparation for discharge interviews in medical school makes it particularly challenging for physicians to translate their theoretical knowledge into patient-centered discharge communication. Medical training on discharge interviews should be expanded in terms of theoretical input on the ideal content, its purpose and potential (e.g. in reducing readmissions), as well as practical exercises.
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Affiliation(s)
- Lorena Morschek
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Ricarda Wigbels
- Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Nadja Gebhardt
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Cassandra Derreza-Greeven
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
- DZPG (German Centre for Mental Health - Partner Site Heidelberg/Mannheim/Ulm)
| | - Alexandra Noll
- Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Inga Unger
- Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Quillatupa N, Covenas CS. A Culturally Competent Approach to Discharge Planning and Transfer of Care. Cureus 2023; 15:e50235. [PMID: 38192920 PMCID: PMC10773675 DOI: 10.7759/cureus.50235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
Culturally competent discharge planning and transfer of care play a leading role in communication and the effective provision of high-quality care to patients from diverse sociocultural backgrounds. However, no standardization has been established. Here, we present the case of a Spanish-speaking patient discharged with instructions in English on two separate occasions, which resulted in readmission and deleterious outcomes. We emphasize the need to provide a safe and culturally competent transition of care.
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Affiliation(s)
- Norka Quillatupa
- Geriatrics, University of California, Los Angeles (UCLA) - Kern Medical, Bakersfield, USA
| | - Cecilia S Covenas
- Family Medicine, Rio Bravo Family Medicine Program, Bakersfield, USA
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Bolster-Foucault C, Holyoke P. Resource Utilization Groups in transitional home care: validating the RUG-III/HC case-mix system in hospital-to-home care programs. BMC Health Serv Res 2023; 23:1324. [PMID: 38037101 PMCID: PMC10687885 DOI: 10.1186/s12913-023-10150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Transitional hospital-to-home care programs support safe and timely transition from acute care settings back into the community. Case-mix systems that classify transitional care clients into groups based on their resource utilization can assist with care planning, calculating reimbursement rates in bundled care funding models, and predicting health human resource needs. This study evaluated the fit and relevance of the Resource Utilization Groups version III for Home Care (RUG-III/HC) case-mix classification system in transitional care programs in Ontario, Canada. METHODS We conducted a retrospective analysis of clinical assessment data and administrative billing records from a cohort of clients (n = 1,680 care episodes) in transitional home care programs in Ontario. We classified care episodes into established RUG-III/HC groups based on clients' clinical and functional characteristics and calculated four case-mix indices to describe care relative resource utilization in the study sample. Using these indices in linear regression models, we evaluated the degree to which the RUG-III/HC system can be used to predict care resource utilization. RESULTS A majority of transitional home care clients are classified as being Clinically complex (41.6%) and having Reduced physical functions (37.8%). The RUG-III/HC groups that account for the largest share of clients are those with the lowest hierarchical ranking, indicating low Activities of Daily Living limitations but a range of Instrumental Activities of Daily Living limitations. There is notable heterogeneity in the distribution of clients in RUG-III/HC groups across transitional care programs. The case-mix indices reflect decreasing hierarchical resource use within but not across RUG-III/HC categories. The RUG-III/HC predicts 23.34% of the variance in resource utilization of combined paid and unpaid care time. CONCLUSIONS The distribution of clients across RUG-III/HC groups in transitional home care programs is remarkably different from clients in long-stay home care settings. Transitional care programs have a higher proportion of Clinically complex clients and a lower proportion of clients with Reduced physical function. This study contributes to the development of a case-mix system for clients in transitional home care programs which can be used by care managers to inform planning, costing, and resource allocation in these programs.
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Affiliation(s)
- Clara Bolster-Foucault
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, 2001 McGill College, Montreal, QC, Canada.
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, Canada.
| | - Paul Holyoke
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, Canada
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Teixeira MJC, Khouri M, Martinez E, Bench S. Implementing a discharge process for patients undergoing elective surgery: Rapid review. Int J Orthop Trauma Nurs 2023; 48:101001. [PMID: 36805314 DOI: 10.1016/j.ijotn.2023.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/14/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Hospital discharge is a 'vulnerable stage' in care. A delayed, inappropriate or poorly planned discharge increases hazards and costs, inhibiting recovery, and often leading to unplanned readmission. New discharge processes could boost practice, reduce the length of stay, and, consequently, reduce costs and improve patients' quality of life. AIM To identify technology based interventions that have been implemented to facilitate a safe and timely discharge procedure after elective surgery, and to describe implementation barriers and facilitators and patient satisfaction. METHOD This rapid review followed a restricted systematic review framework, searching Medline, EMBASE, CINAHL, PsychINFO, and ClinicalTrials.gov. for relevant studies published from 2015 to 2021 in English. RESULTS Eleven studies were included. Most interventions were machine-learning-based, and only one study reported patient involvement. Effective leadership, team work and communication were stated as implementation facilitators. The main barriers to implementation were: lack of support from leaders, poor clinical documentation, resistance to change, and financial and logistical concerns. None of the studies evaluated patient satisfaction. CONCLUSIONS Findings highlight factors that support the implementation of technology based interventions aimed at a safe and timely discharge process following elective surgery. Nurses play an important role in the provision of information, and in the development and implementation of discharge processes.
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Affiliation(s)
- Maria J C Teixeira
- Nursing Research Department, Royal National Orthopaedic Hospital NHS Trust, London, UK; London South Bank University, London, UK; Nuffield Health, The Manor Hospital, Oxford, UK.
| | - Ma'ali Khouri
- Institute of Orthopaedics Library, University College London, London, UK
| | - Evangeline Martinez
- Functional and Restorative Services, London Spinal Cord Injury Research Centre, Royal National Orthopaedic Hospital NHS Trust, London, UK; University College London, London, UK
| | - Suzanne Bench
- London South Bank University, London, UK; ACORN A Centre of Research for Nurses & Midwives, Guys and St Thomas's NHS Trust, Lond, UK
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Hladkowicz E, Dumitrascu F, Auais M, Beck A, Davis S, McIsaac DI, Miller J. Evaluations of postoperative transitions in care for older adults: a scoping review. BMC Geriatr 2022; 22:329. [PMID: 35428193 PMCID: PMC9013054 DOI: 10.1186/s12877-022-02989-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background Most people having major surgery are over the age of 65. The transition out of hospital is a vulnerable time for older adults, particularly after major surgery. Research on postoperative transitions in care is growing, but it is not clear how postoperative transitions are being evaluated. The objective of this scoping review was to synthesize processes and outcomes used to evaluate postoperative transitions in care for older adults. Methods We conducted a scoping review that included articles evaluating a postoperative transition in care among adults aged > 65 having major elective surgery. We searched Medline (Ovid), EMBASE (Ovid), CINHAL, and Cochrane Central Register of Controlled Trials (CENTRAL) from their respective inception dates to April 6, 2021. We also searched The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov from their respective inception dates to April 6, 2021. Screening and data extraction was completed by reviewers in duplicate. Data relevant to study design and objective, intervention description, and process or outcome evaluations were extracted. Process evaluations were categorized using the Ideal Transitions in Care Framework, and outcome evaluations were categorized using the Institute for Healthcare Improvement Triple Aim Framework. Results After screening titles and abstracts and full-text article review, we included 20 articles in our final synthesis. There was variability in the processes and outcomes used to evaluate postoperative transitions in care. The most common outcomes evaluated were health service utilization (n = 9), including readmission and Emergency Department visits, experiential outcomes (n = 9) and quality of life (n = 7). Process evaluations included evaluating the education provided to patients to promote self-management (n = 6), coordination of care among team members (n = 3) and outpatient follow-up (n = 3). Only two articles measured frailty, one article used theory to guide their evaluations and no articles engaged knowledge users. Conclusions There is inconsistency in how postoperative transitions in care were evaluated. There is a need to use theories and to engage key stakeholders involved in postoperative transitions in care, including older adults and their caregivers, to identify the most appropriate approaches for developing and evaluating interventions to meaningfully improve care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02989-6.
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Kinugasa Y, Saitoh M, Ikegame T, Ikarashi A, Kadota K, Kamiya K, Kohsaka S, Mizuno A, Miyajima I, Nakane E, Nei A, Shibata T, Yokoyama H, Yumikura S, Yumino D, Watanabe N, Isobe M. Quality Indicators in Patient Referral Documents for Heart Failure in Japan. Int Heart J 2022; 63:278-285. [PMID: 35296618 DOI: 10.1536/ihj.21-617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined quality indicators (QIs) for heart failure (HF) in patients' referral documents (PRDs).We conducted a nationwide questionnaire survey to identify information that general practitioners (GPs) would like hospital cardiologists (HCs) to include in PRDs and that HCs actually include in PRDs. The percentage of GPs that desired each item included in PRDs was converted into a deviation score, and items with a deviation score of ≥ 50 were defined as QIs. We rated the quality of PRDs provided by HCs based on QI assessment.We received 281 responses from HCs and 145 responses from GPs. The following were identified as QIs: 1) HF cause; 2) B-type natriuretic peptide (BNP) or N-terminal pro-BNP concentration; 3) left ventricular ejection fraction or echocardiography; 4) body weight; 5) education of patients and their families on HF; 6) physical function, and 7) functions of daily living. Based on QI assessment, only 21.7% of HCs included all seven items in their PRDs. HCs specializing in HF and institutions with many full-time HCs were independently associated with including the seven items in PRDs.The quality of PRDs for HF varies among physicians and hospitals, and standardization is needed based on QI assessment.
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Affiliation(s)
- Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | | | - Aoi Ikarashi
- Department of Cardiovascular Medicine, St Luke's International Hospital
| | | | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St Luke's International Hospital.,Leonard Davis Institute for Health Economics, University of Pennsylvania
| | - Isao Miyajima
- Department of Clinical Nutrition, Chikamori Hospital
| | - Eisaku Nakane
- Cardiovascular Center, the Tazuke Kofukai Medical Research Institute, Kitano Hospital
| | - Azusa Nei
- Toho University Medical Center Ohashi Hospital
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | | | | | | | | | - Mitsuaki Isobe
- Sakakibara Heart Institute.,Tokyo Medical and Dental University
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Development of a Primary Care Transitions Clinic in an Academic Medical Center. J Gen Intern Med 2022; 37:582-589. [PMID: 34327654 PMCID: PMC8321504 DOI: 10.1007/s11606-021-07019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 06/29/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Transitions of care experiences leave patients vulnerable to adverse outcomes, including readmissions, worsening symptoms, and reductions in functional status. AIM To describe and evaluate a primary care transitions clinic that serves patients with medical and/or social needs that must be addressed prior to establishment of primary care. SETTING Brigham Health, an academic medical center in Boston, MA. PROGRAM DESCRIPTION The transitions clinic opened within an existing primary care practice in January 2019. It employs one full-time nurse care coordinator and one full-time medical assistant, and is staffed by one primary care physician (PCP) or nurse practitioner each weekday afternoon. Both medical and social diagnoses that require follow-up post-discharge are addressed. Patients with any insurance are seen as many times as necessary until PCP care is established. PROGRAM EVALUATION In the year after its establishment (January 20, 2019, to January 19, 2020), the transitions clinic received 498 referrals (73.2% from the emergency department (ED), 23.3% from inpatient), with 207 patients ultimately seen. Patients were seen 5 (median; IQR 4-6) work days post-discharge, with 2 (median; IQR 1-3) visits per patient. Patients seen in the transitions clinic had significantly fewer ED visits than a comparator cohort referred to Brigham Health Primary Care after ED or hospital discharge in the year prior (January 20, 2018, to January 20, 2019). Patients seen in the transitions clinic additionally had significantly fewer ED visits and hospitalizations in the three months post-referral than in the three months pre-referral. The most common social determinants addressed by the clinic's nurse coordinator were insurance, transportation, and housing. DISCUSSION A primary care transitions clinic can provide accessible, attentive care post-discharge with positive effects on healthcare utilization. Availability of a multidisciplinary team that can see patients for repeated visits until establishment of PCP care was a key success factor for the transitions clinic.
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Kucharczuk C, Lightheart E, Kodan A, Haynes C, Rabatin S, Burke J, Senger J, Lee L, Brinley S, Decena MA, Cruz JM, Hirsh R, McCauley K. Standardized Discharge Planning Tool Leads to Earlier Discharges and Fewer Readmissions. J Nurs Care Qual 2022; 37:54-60. [PMID: 33734187 DOI: 10.1097/ncq.0000000000000558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In an inpatient setting, aspects of discharge planning are often left to the provider's memory, leading to errors, inefficiencies, and avoidable costs. METHODS A multidisciplinary team of oncology practitioners used process improvement methodologies to redesign the discharge planning process. INTERVENTIONS The primary intervention was an evidence-based discharge planning tool, called the discharge navigator, used from admission through discharge. RESULTS Thirty-day unplanned readmission rates decreased by 29.0% from preimplementation (March 2017 through August 2017) to postimplementation (September 2017 through March 2020). The percentage of patients discharged before noon increased 76.2%. A comparable service not utilizing the intervention saw lesser or no improvement in these measures. CONCLUSION The tool provided a systematic approach to discharge planning. Key design elements included a centralized location within the electronic health record and an electronic shortcut to populate the tool. Although developed for a specialized population, most elements are applicable to any hospitalized patient.
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Affiliation(s)
- Colleen Kucharczuk
- Departments of Advanced Practice (Dr Kucharczuk and Mss Kodan, Haynes, Rabatin, Senger, Lee, and Decena), Quality and Safety (Ms Lightheart), Inpatient Pharmacy (Dr Brinley), Clinical Resource Management (Ms Cruz), and Medicine (Dr Hirsh), Hospital of University of Pennsylvania, Philadelphia; Division of Hospital Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Ms Burke); and University of Pennsylvania School of Nursing, Philadelphia (Dr McCauley)
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Eden EL, Rothenberger S, DeKosky A, Donovan AK. The Safe Discharge Checklist: A Standardized Discharge Planning Curriculum for Medicine Trainees. South Med J 2021; 115:18-21. [PMID: 34964055 DOI: 10.14423/smj.0000000000001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Hospital discharge is a challenging time for residents, requiring the completion of many tasks to ensure safe transitions for patients. Despite recognition of the importance of hospital discharge planning, formal curricula are lacking. We sought to improve medicine residents' comfort and skills with discharge planning and enhance the quality of care by introducing a standardized approach to discharge on the medicine wards. METHODS The intervention included a didactic, a bedside rounds component, and a discharge checklist. Interns were surveyed at the end of rotations to measure confidence, attitudes, and frequency of completing discharge planning tasks. Results were compared with a control group of experienced interns from the previous academic year. Clinical outcomes included hospital readmission and emergency department return rates and patient satisfaction scores in discharge-related domains. RESULTS Study interns reported similar confidence to control group interns with discharge planning and endorsed completing four of five discharge tasks more frequently than control interns. There were no differences in clinical outcomes. CONCLUSIONS We did not identify changes in clinical outcomes, although this finding likely reflects the multifactorial nature of hospital readmissions. Interns exposed to the curriculum early in the academic year had a higher reported frequency of completing key discharge tasks and similar confidence around discharge, when compared with end-of-the-year interns. These improvements suggest that the curriculum led to a change in culture surrounding discharge planning and perhaps accelerated learning of skills associated with discharge best practices.
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Affiliation(s)
- Elizabeth L Eden
- From the University of Pittsburgh Medical Center, and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Scott Rothenberger
- From the University of Pittsburgh Medical Center, and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Allison DeKosky
- From the University of Pittsburgh Medical Center, and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anna K Donovan
- From the University of Pittsburgh Medical Center, and the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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D'Souza PJJ, Devasia T, Paramasivam G, Shankar R, Noronha JA, George LS. Effectiveness of self-care educational programme on clinical outcomes and self-care behaviour among heart failure peoples-A randomized controlled trial: Study protocol. J Adv Nurs 2021; 77:4563-4573. [PMID: 34286863 DOI: 10.1111/jan.14981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/27/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effectiveness of a self-care education programme on clinical outcomes, self-care behaviour and knowledge on heart failure (HF) among peoples with HF. DESIGN Randomized controlled trial. METHODS The participants (N = 160) will be randomly assigned (1:1) to the intervention and the control arms using block randomization. The participants assigned to the intervention arm will receive educational intervention on HF self-care comprising video-assisted teaching with teach-back technique, tailored teaching at discharge and a guide on self-care followed by telephonic calls and text messages after discharge for 6 months along with standard care. The participants in the control arm will receive only a guide on self-care with standard care. The clinical outcomes such as health-related quality of life, hospital readmissions, N-terminal pro-brain natriuretic peptide levels, symptom perception, functional status, left ventricular ejection fraction, Seattle HF score, self-care behaviour and knowledge on HF will be measured at the baseline, after 1 and 6 months of the intervention. DISCUSSION Several studies conducted on self-care education interventions have shown positive effects, whereas few studies have shown no effect on the people outcomes. Providing the printed self-care guide alone may not improve behaviour associated with self-care and clinical outcomes. These peoples need continuous reinforcement on self-care. If this self-care educational intervention shows beneficial effects, it will contribute to the clinical practice and improve clinical outcomes. IMPACT This research will contribute to the evidence on the effectiveness of an educational intervention on self-care among peoples with HF. The results would assist the nurses caring for peoples with HF. They can also implement this intervention for improving the peoples' self-care behaviour. TRIAL REGISTRATION The trial is registered with the Clinical Trial Registry India and the reference ID number CTRI/2019/10/021724.
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Affiliation(s)
- Prima J J D'Souza
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ganesh Paramasivam
- Department of Cardiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ravi Shankar
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Judith A Noronha
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Linu S George
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
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Variation in 30-Day Readmission Rates from Inpatient Rehabilitation Facilities to Acute Care Hospitals. J Am Med Dir Assoc 2021; 22:2461-2467. [PMID: 33984292 DOI: 10.1016/j.jamda.2021.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To quantify the rate of readmission from inpatient rehabilitation facilities (IRFs) to acute care hospitals (ACHs) during the first 30 days of rehabilitation stay. To measure variation in 30-day readmission rate across IRFs, and the extent that patient and facility characteristics contribute to this variation. DESIGN Retrospective analysis of an administrative database. SETTING AND PARTICIPANTS Adult IRF discharges from 944 US IRFs captured in the Uniform Data System for Medical Rehabilitation database between October 1, 2015 and December 31, 2017. METHODS Multilevel logistic regression was used to calculate adjusted rates of readmission within 30 days of IRF admission and examine variation in IRF readmission rates, using patient and facility-level variables as predictors. RESULTS There were a total of 104,303 ACH readmissions out of a total of 1,102,785 IRFs discharges. The range of 30-day readmission rates to ACHs was 0.0%‒28.9% (mean = 8.7%, standard deviation = 4.4%). The adjusted readmission rate variation narrowed to 2.8%‒17.5% (mean = 8.7%, standard deviation = 1.8%). Twelve patient-level and 3 facility-level factors were significantly associated with 30-day readmission from IRF to ACH. A total of 82.4% of the variance in 30-day readmission rate was attributable to the model predictors. CONCLUSIONS AND IMPLICATIONS Fifteen patient and facility factors were significantly associated with 30-day readmission from IRF to ACH and explained the majority of readmission variance. Most of these factors are nonmodifiable from the IRF perspective. These findings highlight that adjusting for these factors is important when comparing readmission rates between IRFs.
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Salehi V, Hanson N, Smith D, McCloskey R, Jarrett P, Veitch B. Modeling and analyzing hospital to home transition processes of frail older adults using the functional resonance analysis method (FRAM). APPLIED ERGONOMICS 2021; 93:103392. [PMID: 33639319 DOI: 10.1016/j.apergo.2021.103392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/15/2021] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
The main purpose of this study was to model and analyze hospital to home transition processes of frail older adults in order to identify the challenges within this process. A multi-phase, multi-sited and mixed methods design was utilized, in which, Phase 1 included collecting semi-structured interviews and focus group data, and Phase 2 consisted of six patient/caregiver dyad prospective case studies. This study was conducted in three hospitals in three cities in a single province in Canada. The Functional Resonance Analysis Method (FRAM) was employed to model daily operations of the transition process. The perspectives of both healthcare providers and patients/caregivers were used to build the FRAM model. The transition model was then tested using a customized version of the FRAM. The six patient/caregiver cases were used in the process of testing the FRAM model. The results of building the FRAM model showed that five categories of functions contributed to the transition model, including admission, assessment, synthesis, decision-making, and readmission. The outcomes of using the customized version of the FRAM revealed challenges affecting the transition process including waitlists for geriatric units, team-based care, lack of a discharge planner, financial concerns, and follow-up plans. The findings of this study could assist managers and other decision makers to improve the transition processes of frail older adults by addressing these challenges. The FRAM method employed in this study can be applied widely to identify work practices that are more or less successful, so that procedures and practices can be adapted to nudge healthcare processes towards paths that will yield better outcomes.
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Affiliation(s)
- Vahid Salehi
- Faculty of Engineering and Applied Science, Memorial University of Newfoundland, St. John's, Canada.
| | - Natasha Hanson
- Research Services, Horizon Health Network, Saint John Regional Hospital, Saint John, Canada
| | - Doug Smith
- Faculty of Engineering and Applied Science, Memorial University of Newfoundland, St. John's, Canada
| | - Rose McCloskey
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, Canada
| | - Pamela Jarrett
- Department of Geriatric Medicine, Horizon Health Network, St. Joseph's Hospital, Saint John, Canada
| | - Brian Veitch
- Faculty of Engineering and Applied Science, Memorial University of Newfoundland, St. John's, Canada
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14
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Dalal AK, Piniella N, Fuller TE, Pong D, Pardo M, Bessa N, Yoon C, Lipsitz S, Schnipper JL. Evaluation of electronic health record-integrated digital health tools to engage hospitalized patients in discharge preparation. J Am Med Inform Assoc 2021; 28:704-712. [PMID: 33463681 PMCID: PMC7973476 DOI: 10.1093/jamia/ocaa321] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/01/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate the effect of electronic health record (EHR)-integrated digital health tools comprised of a checklist and video on transitions-of-care outcomes for patients preparing for discharge. MATERIALS AND METHODS English-speaking, general medicine patients (>18 years) hospitalized at least 24 hours at an academic medical center in Boston, MA were enrolled before and after implementation. A structured checklist and video were administered on a mobile device via a patient portal or web-based survey at least 24 hours prior to anticipated discharge. Checklist responses were available for clinicians to review in real time via an EHR-integrated safety dashboard. The primary outcome was patient activation at discharge assessed by patient activation (PAM)-13. Secondary outcomes included postdischarge patient activation, hospital operational metrics, healthcare resource utilization assessed by 30-day follow-up calls and administrative data and change in patient activation from discharge to 30 days postdischarge. RESULTS Of 673 patients approached, 484 (71.9%) enrolled. The proportion of activated patients (PAM level 3 or 4) at discharge was nonsignificantly higher for the 234 postimplementation compared with the 245 preimplementation participants (59.8% vs 56.7%, adjusted OR 1.23 [0.38, 3.96], P = .73). Postimplementation participants reported 3.75 (3.02) concerns via the checklist. Mean length of stay was significantly higher for postimplementation compared with preimplementation participants (10.13 vs 6.21, P < .01). While there was no effect on postdischarge outcomes, there was a nonsignificant decrease in change in patient activation within participants from pre- to postimplementation (adjusted difference-in-difference of -16.1% (9.6), P = .09). CONCLUSIONS EHR-integrated digital health tools to prepare patients for discharge did not significantly increase patient activation and was associated with a longer length of stay. While issues uncovered by the checklist may have encouraged patients to inquire about their discharge preparedness, other factors associated with patient activation and length of stay may explain our observations. We offer insights for using PAM-13 in context of real-world health-IT implementations. TRIAL REGISTRATION NIH US National Library of Medicine, NCT03116074, clinicaltrials.gov.
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Affiliation(s)
- Anuj K Dalal
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Denise Pong
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael Pardo
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Catherine Yoon
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Stuart Lipsitz
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey L Schnipper
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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15
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Gilmore-Bykovskyi A, Block L, Kind AJH. Bridging the Hospital-Skilled Nursing Facility Information Continuity Divide. JAMA Netw Open 2021; 4:e2035040. [PMID: 33443578 PMCID: PMC8045143 DOI: 10.1001/jamanetworkopen.2020.35040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrea Gilmore-Bykovskyi
- School of Nursing, University of Wisconsin-Madison, Madison
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Laura Block
- School of Nursing, University of Wisconsin-Madison, Madison
| | - Amy J H Kind
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Madison VA Geriatrics Research Education and Clinical Center, William S. Middleton VA Hospital, Madison, Wisconsin
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16
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Holden RJ, Abebe E. Medication transitions: Vulnerable periods of change in need of human factors and ergonomics. APPLIED ERGONOMICS 2021; 90:103279. [PMID: 33049545 PMCID: PMC7606579 DOI: 10.1016/j.apergo.2020.103279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 06/06/2023]
Abstract
We present a novel view of transitions from the lens of patient ergonomics (the "science of patient work"), which posits that patients and other non-professionals perform effortful work towards health-related goals. In patient work transitions, patients experience changes in, for example, health, task demands, work capacity, roles and responsibilities, knowledge and skills, routines, needs and technologies. Medication transitions are a particularly vulnerable type of patient work transitions. We describe two cases of medication transitions-new medications and medication deprescribing-in which the patient work lens reveals many accompanying changes, vulnerabilities, and opportunities for human factors and ergonomics.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Ephrem Abebe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
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17
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Gandhi AB, Onukwugha E, McRae J, Alfandre D. Healthcare Resource Utilization Following a Discharge Against Medical Advice: An Analysis of Commercially Insured Adults. J Hosp Med 2020; 15:716-722. [PMID: 33231545 PMCID: PMC8034675 DOI: 10.12788/jhm.3516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/04/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND A discharge against medical advice (DAMA) is associated with adverse health outcomes. Its association with postdischarge healthcare resource utilization (HcRU) outside an inpatient setting is unknown. This information can help us understand how a DAMA may affect healthcare-seeking behavior following a hospital stay. We evaluated the relationship between a DAMA and 30-day postdischarge HcRU. METHODS This retrospective cohort study uses a 10% random sample of enrollees in the IQVIA PharMetrics® Plus database. We included individuals aged 18 to 64 years with an inpatient admission during 2007-2015 and continuous insurance coverage. We defined comparison groups as DAMA and routine discharge. Both groups were matched on baseline covariates. We quantified the association between a DAMA and 30-day HcRU, as well as 90-day for sensitivity analysis, with use of generalized linear models for binary outcomes (inpatient readmissions, emergency department [ED] visits) and count outcomes (physician office visits, nonphysician outpatient encounters, prescription drug fills). RESULTS Of the 457,530 individuals in the unmatched sample, 2,245 (0.5%) had a DAMA. In the matched sample, a DAMA was positively associated with an ED visit (adjusted odds ratio, 2.28; 95% confidence interval, 1.90-2.72) but not with an inpatient readmission. There were no differences between groups based on the count outcomes. A DAMA was positively associated with 90-day HcRU (ie, inpatient readmission, ED visit, and prescription drug fills). CONCLUSION The relationship between a DAMA and HcRU varied with the HcRU category and postdischarge time interval. This examination of HcRU in the inpatient and outpatient settings provides important information about outcomes following a DAMA.
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Affiliation(s)
| | - Eberechukwu Onukwugha
- University of Maryland School of Pharmacy, Baltimore, Maryland
- Corresponding Author: Eberechukwu Onukwugha, PhD, MS; ; Telephone: 410-706-8981
| | - Jacquelyn McRae
- University of Maryland School of Pharmacy, Baltimore, Maryland
| | - David Alfandre
- VA National Center for Ethics in Health Care, NYU School of Medicine, New York, New York
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18
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Campbell-Enns HJ, Campbell M, Rieger KL, Thompson GN, Doupe MB. No Other Safe Care Option: Nursing Home Admission as a Last Resort Strategy. THE GERONTOLOGIST 2020; 60:1504-1514. [PMID: 32589225 PMCID: PMC7681216 DOI: 10.1093/geront/gnaa077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing homes are intended for older adults with the highest care needs. However, approximately 12% of all nursing home residents have similar care needs as older adults who live in the community and the reasons they are admitted to nursing homes is largely unstudied. The purpose of this study was to explore the reasons why lower-care nursing home residents are living in nursing homes. RESEARCH DESIGN AND METHODS A qualitative interpretive description methodology was used to gather and analyze data describing lower-care nursing home resident and family member perspectives regarding factors influencing nursing home admission, including the facilitators and barriers to living in a community setting. Data were collected via semistructured interviews and field notes. Data were coded and sorted, and patterns were identified. This resulted in themes describing this experience. RESULTS The main problem experienced by lower-care residents was living alone in the community. Residents and family members used many strategies to avoid safety crises in the community but experienced multiple care breakdowns in both community and health care settings. Nursing home admission was a strategy used to avoid a crisis when residents did not receive the needed support to remain in the community. DISCUSSION AND IMPLICATIONS To successfully remain in the community, older adults require specialized supports targeting mental health and substance use needs, as well as enhanced hospital discharge plans and improved information about community-based care options. Implications involve reforming policies and practices in both hospital and community-based care settings.
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Affiliation(s)
| | - Megan Campbell
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kendra L Rieger
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Genevieve N Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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19
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Glans M, Kragh Ekstam A, Jakobsson U, Bondesson Å, Midlöv P. Risk factors for hospital readmission in older adults within 30 days of discharge - a comparative retrospective study. BMC Geriatr 2020; 20:467. [PMID: 33176721 PMCID: PMC7659222 DOI: 10.1186/s12877-020-01867-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The area of hospital readmission in older adults within 30 days of discharge is extensively researched but few studies look at the whole process. In this study we investigated risk factors related, not only to patient characteristics prior to and events during initial hospitalisation, but also to the processes of discharge, transition of care and follow-up. We aimed to identify patients at most risk of being readmitted as well as processes in greatest need of improvement, the goal being to find tools to help reduce early readmissions in this population. METHODS This comparative retrospective study included 720 patients in total. Medical records were reviewed and variables concerning patient characteristics prior to and events during initial hospital stay, as well as those related to the processes of discharge, transition of care and follow-up, were collected in a standardised manner. Either a Student's t-test, χ2-test or Fishers' exact test was used for comparisons between groups. A multiple logistic regression analysis was conducted to identify variables associated with readmission. RESULTS The final model showed increased odds of readmission in patients with a higher Charlson Co-morbidity Index (OR 1.12, p-value 0.002), excessive polypharmacy (OR 1.66, p-value 0.007) and living in the community with home care (OR 1.61, p-value 0.025). The odds of being readmitted within 30 days increased if the length of stay was 5 days or longer (OR 1.72, p-value 0.005) as well as if being discharged on a Friday (OR 1.88, p-value 0.003) or from a surgical unit (OR 2.09, p-value 0.001). CONCLUSION Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit. Our findings indicate patients at most risk of being readmitted as well as discharging routines in most need of improvement thus laying the ground for further studies as well as targeted actions to take in order to reduce hospital readmissions within 30 days in this population.
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Affiliation(s)
- Maria Glans
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden. .,Department of Medications, Region Skåne Office for Hospitals in Northeastern Skåne, SE-291 85, Kristianstad, Sweden.
| | - Annika Kragh Ekstam
- Department of Orthopaedics, Region Skåne Office for Hospitals in Northeastern Skåne, SE-291 85, Kristianstad, Sweden
| | - Ulf Jakobsson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden
| | - Åsa Bondesson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, SE-291 85, Kristianstad, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden
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20
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Benipal H, Holbrook A, Paterson JM, Douketis J, Foster G, Thabane L. Predictors of oral anticoagulant-associated adverse events in seniors transitioning from hospital to home: a retrospective cohort study protocol. BMJ Open 2020; 10:e036537. [PMID: 32963065 PMCID: PMC7509956 DOI: 10.1136/bmjopen-2019-036537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Oral anticoagulants (OACs) are widely prescribed in older adults. High OAC-related adverse event rates in the early period following hospital discharge argue for an analysis to identify predictors. Our objective is to identify and validate clinical and continuity of care variables among seniors discharged from hospital on an OAC, which are independently associated with OAC-related adverse events within 30 days. METHODS AND ANALYSIS We propose a population-based retrospective cohort study of all adults aged 66 years or older who were discharged from hospital on an OAC from September 2010 to March 2015 in Ontario, Canada. The primary outcome is a composite of the first hospitalisation or emergency department visit for a haemorrhage or thromboembolic event or mortality within 30 days of hospital discharge. A Cox proportional hazards model will be used to determine the association between the composite outcome and a set of prespecified covariates. A split sample method will be adopted to validate the variables associated with OAC-related adverse events. ETHICS AND DISSEMINATION The use of data in this project was authorised under section 45 of Ontario's Personal Health Information Protection Act, which does not require review by a research ethics board. Results will be disseminated via peer-reviewed publications and presentations at conferences and will determine intervention targets to improve OAC management in upcoming randomised trials. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT02777047; Pre-results.
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Affiliation(s)
- Harsukh Benipal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anne Holbrook
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Division of Clinical Pharmacology & Toxicology, McMaster University, Hamilton, Ontario, Canada
| | - J Michael Paterson
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - James Douketis
- Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Saint Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Saint Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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21
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Manning‐Bennett AT, Sallis JA, Thomas VB, Johnson JL. Examining the role of pharmacists in medication handover–facilitating opioid substitution therapy through transitions of care. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Arkady T. Manning‐Bennett
- Division of Pharmacy Flinders Medical Centre SA Pharmacy Bedford Park Australia
- Clinical and Health Sciences University of South Australia Adelaide Australia
| | - James A. Sallis
- Division of Pharmacy Flinders Medical Centre SA Pharmacy Bedford Park Australia
| | - Vinod B. Thomas
- Division of Pharmacy Flinders Medical Centre SA Pharmacy Bedford Park Australia
| | - Jacinta L. Johnson
- Division of Pharmacy Flinders Medical Centre SA Pharmacy Bedford Park Australia
- Clinical and Health Sciences University of South Australia Adelaide Australia
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22
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Evans D, Usery J. Implementation and Assessment of a Pharmacy-Led Inpatient Transitions of Care Program. South Med J 2020; 113:320-324. [PMID: 32483643 DOI: 10.14423/smj.0000000000001101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate pharmacist involvement in the inpatient transition of care (TOC) process for patients hospitalized with type 1 diabetes mellitus, type 2 diabetes mellitus, or chronic obstructive pulmonary disease. METHODS A pharmacist screened patients admitted with one or more of the qualifying conditions within 48 hours of admission to perform medication reconciliation. During medication reconciliation, the pharmacist removed any duplicate or nonindicated medications and added any omitted medications. The pharmacist also reviewed the discharge summary to ensure medication optimization upon discharge. RESULTS Pharmacist involvement in the admission and discharge reconciliation processes of the 50 identified patients was 100% and 44%, respectively. A medication-related problem was identified in 96% (n = 48) of patients, representing 338 pharmacist-mediated interventions with an average of 6.8 ± 4.0 (range 0-16) interventions per patient. Of those 338 interventions, 298 drug discrepancies were identified and corrected, with an average of 6.0 ± 3.7 (range 0-15) discrepancies per patient. Average time spent was 66 ± 22 (range 30-130) minutes with each patient. Of the 50 patients enrolled, 12 were readmitted within 30 days. CONCLUSIONS This pilot study demonstrated an improved medication reconciliation process with pharmacist involvement, expanding the body of evidence that pharmacists can enhance TOC management in an inpatient setting. These results highlight the utility of a pharmacist in the implementation and refinement of TOC services and provides impetus for a team-based approach when patients experience a TOC.
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Affiliation(s)
- David Evans
- From the Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock
| | - Justin Usery
- From the Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock
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23
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Munchhof A, Gruber R, Lane KA, Bo N, Rattray NA. Beyond Discharge Summaries: Communication Preferences in Care Transitions Between Hospitalists and Primary Care Providers Using Electronic Medical Records. J Gen Intern Med 2020; 35:1789-1796. [PMID: 32242311 PMCID: PMC7280409 DOI: 10.1007/s11606-020-05786-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ineffective transitions of care continue to be a source of risk for patients. Although there has been widespread implementation of electronic medical record (EMR) systems, little is currently known about hospitalists' and primary care providers' (PCPs) direct communication preferences at discharge using messaging capabilities in a shared EMR system. OBJECTIVE We examined how hospitalists and PCPs with a shared EMR prefer to directly communicate at the time of hospital discharge by identifying preferred modes, information prioritization, challenges, facilitators, and proposed solutions. DESIGN A sequential, explanatory mixed methods study with surveys and semi-structured interviews. PARTICIPANTS Thirty-eight academic hospitalists and 63 PCPs working in outpatient clinics in a single safety net hospital system with a shared EMR. MAIN APPROACH Descriptive statistics were used to analyze survey responses. Interviews were analyzed using immersion/crystallization and a mixture of inductive and deductive thematic analysis. KEY RESULTS PCPs preferred direct communication at discharge through a message within the EMR while hospitalists preferred a message within the EMR and email. Qualitative results identified key themes related to patient care and direct communication: value of direct communication, safety, social determinants of health, and clinical judgment. Both groups prioritized direct communication for high-risk medications, pending and follow-up studies, and high-risk patients that hospitalists were concerned about. Overall, both hospitalists and PCPs reported that ensuring patient safety, flagging patients with social challenges, and expressing concerns about patients based on clinical judgment were key communication priorities. CONCLUSIONS Hospitalists and primary care providers report considerable overlap in preferences for direct communication at the time of hospital discharge through a shared EMR. Specifically, both groups reported similar concerns regarding patient safety and continuity during transitions. Direct messaging within the EMR could enable "closed loop" communication that helps ensure safe transitions of care for high-risk patients.
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Affiliation(s)
- Amy Munchhof
- Department of General Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. .,Hospital Medicine Eskenazi Medical Group, Eskenazi Health Hospital, Indianapolis, IN, USA.
| | - Rachel Gruber
- Regenstrief Institute Inc., Center for Health Services Research, Indianapolis, IN, USA
| | - Kathleen A Lane
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Na Bo
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Nicholas A Rattray
- Department of General Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute Inc., Center for Health Services Research, Indianapolis, IN, USA.,Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Anthropology, Indiana University-Purdue University, Indianapolis, IN, USA
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24
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Fuller TE, Pong DD, Piniella N, Pardo M, Bessa N, Yoon C, Boxer RB, Schnipper JL, Dalal AK. Interactive Digital Health Tools to Engage Patients and Caregivers in Discharge Preparation: Implementation Study. J Med Internet Res 2020; 22:e15573. [PMID: 32343248 PMCID: PMC7218608 DOI: 10.2196/15573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/16/2019] [Accepted: 02/04/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Poor discharge preparation during hospitalization may lead to adverse events after discharge. Checklists and videos that systematically engage patients in preparing for discharge have the potential to improve safety, especially when integrated into clinician workflow via the electronic health record (EHR). OBJECTIVE This study aims to evaluate the implementation of a suite of digital health tools integrated with the EHR to engage hospitalized patients, caregivers, and their care team in preparing for discharge. METHODS We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify pertinent research questions related to implementation. We iteratively refined patient and clinician-facing intervention components using a participatory process involving end users and institutional stakeholders. The intervention was implemented at a large academic medical center from December 2017 to July 2018. Patients who agreed to participate were coached to watch a discharge video, complete a checklist assessing discharge readiness, and request postdischarge text messaging with a physician 24 to 48 hours before their expected discharge date, which was displayed via a patient portal and bedside display. Clinicians could view concerns reported by patients based on their checklist responses in real time via a safety dashboard integrated with the EHR and choose to open a secure messaging thread with the patient for up to 7 days after discharge. We used mixed methods to evaluate our implementation experience. RESULTS Of 752 patient admissions, 510 (67.8%) patients or caregivers participated: 416 (55.3%) watched the video and completed the checklist, and 94 (12.5%) completed the checklist alone. On average, 4.24 concerns were reported per each of the 510 checklist submissions, most commonly about medications (664/2164, 30.7%) and follow-up (656/2164, 30.3%). Of the 510 completed checklists, a member of the care team accessed the safety dashboard to view 210 (41.2%) patient-reported concerns. For 422 patient admissions where postdischarge messaging was available, 141 (33.4%) patients requested this service; of these, a physician initiated secure messaging for 3 (2.1%) discharges. Most patient survey participants perceived that the intervention promoted self-management and communication with their care team. Patient interview participants endorsed gaps in communication with their care team and thought that the video and checklist would be useful closer toward discharge. Clinicians participating in focus groups perceived the value for patients but suggested that low awareness and variable workflow regarding the intervention, lack of technical optimization, and inconsistent clinician leadership limited the use of clinician-facing components. CONCLUSIONS A suite of EHR-integrated digital health tools to engage patients, caregivers, and clinicians in discharge preparation during hospitalization was feasible, acceptable, and valuable; however, important challenges were identified during implementation. We offer strategies to address implementation barriers and promote adoption of these tools. TRIAL REGISTRATION ClinicalTrials.gov NCT03116074; https://clinicaltrials.gov/ct2/show/NCT03116074.
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Affiliation(s)
| | - Denise D Pong
- Brigham and Women's Hospital, Boston, MA, United States
| | | | - Michael Pardo
- Brigham and Women's Hospital, Boston, MA, United States
| | - Nathaniel Bessa
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | - Robert B Boxer
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Jeffrey Lawrence Schnipper
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Anuj K Dalal
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Taylor T, Altares Sarik D, Salyakina D. Development and Validation of a Web-Based Pediatric Readmission Risk Assessment Tool. Hosp Pediatr 2020; 10:246-256. [PMID: 32075853 DOI: 10.1542/hpeds.2019-0241] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Accurately predicting and reducing risk of unplanned readmissions (URs) in pediatric care remains difficult. We sought to develop a set of accurate algorithms to predict URs within 3, 7, and 30 days of discharge from inpatient admission that can be used before the patient is discharged from a current hospital stay. METHODS We used the Children's Hospital Association Pediatric Health Information System to identify a large retrospective cohort of 1 111 323 children with 1 321 376 admissions admitted to inpatient care at least once between January 1, 2016, and December 31, 2017. We used gradient boosting trees (XGBoost) to accommodate complex interactions between these predictors. RESULTS In the full cohort, 1.6% of patients had at least 1 UR in 3 days, 2.4% had at least 1 UR in 7 days, and 4.4% had at least 1 UR within 30 days. Prediction model discrimination was strongest for URs within 30 days (area under the curve [AUC] = 0.811; 95% confidence interval [CI]: 0.808-0.814) and was nearly identical for UR risk prediction within 3 days (AUC = 0.771; 95% CI: 0.765-0.777) and 7 days (AUC = 0.778; 95% CI: 0.773-0.782), respectively. Using these prediction models, we developed a publicly available pediatric readmission risk scores prediction tool that can be used before or during discharge planning. CONCLUSIONS Risk of pediatric UR can be predicted with information known before the patient's discharge and that is easily extracted in many electronic medical record systems. This information can be used to predict risk of readmission to support hospital-discharge-planning resources.
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Affiliation(s)
- Thom Taylor
- Nicklaus Children's Research Institute, .,Nicklaus Children's Health System, Miami, Florida; and.,Research Facilitation Laboratory, Northrop Grumman, Monterey, California
| | | | - Daria Salyakina
- Nicklaus Children's Research Institute.,Nicklaus Children's Health System, Miami, Florida; and
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Lapointe-Shaw L, Bell CM, Austin PC, Abrahamyan L, Ivers NM, Li P, Pechlivanoglou P, Redelmeier DA, Dolovich L. Community pharmacy medication review, death and re-admission after hospital discharge: a propensity score-matched cohort study. BMJ Qual Saf 2019; 29:41-51. [DOI: 10.1136/bmjqs-2019-009545] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 01/09/2023]
Abstract
BackgroundIn-hospital medication review has been linked to improved outcomes after discharge, yet there is little evidence to support the use of community pharmacy-based interventions as part of transitional care.ObjectiveTo determine whether receipt of a postdischarge community pharmacy-based medication reconciliation and adherence review is associated with a reduced risk of death or re-admission.DesignPropensity score-matched cohort study.SettingOntario, CanadaParticipantsPatients over age 66 years discharged home from an acute care hospital from 1 April 2007 to 16 September 2016.ExposureMedsCheck, a publicly funded medication reconciliation and adherence review provided by community pharmacists.Main outcomeThe primary outcome was time to death or re-admission (defined as an emergency department visit or urgent rehospitalisation) up to 30 days. Secondary outcomes were the 30-day count of outpatient physician visits and time to adverse drug event.ResultsMedsCheck recipients had a lower risk of 30-day death or re-admission (23.4% vs 23.9%, HR 0.97, 95% CI 0.95 to 1.00, p=0.02), driven by a decreased risk of death (1.7% vs 2.1%, HR 0.79, 95% CI 0.73 to 0.86) and rehospitalisation (11.0% vs 11.4%, HR 0.96, 95% 0.93–0.99). In a post hoc sensitivity analysis with pharmacy random effects added to the propensity score model, these results were substantially attenuated. There was no significant difference in 30-day return to the emergency department (22.5% vs 22.8%, HR 0.99, 95% CI 0.96 to 1.01) or adverse drug events (1.5% vs 1.5%, HR 1.03, 95% CI 0.94 to 1.12). MedsCheck recipients had more outpatient visits (mean 2.11 vs 2.09, RR 1.01, 95% CI 1.00 to 1.02, p=0.02).Conclusions and relevanceAmong older adults, receipt of a community pharmacy-based medication reconciliation and adherence review was associated with a small reduced risk of short-term death or re-admission. Due to the possibility of unmeasured confounding, experimental studies are needed to clarify the relationship between postdischarge community pharmacy-based medication review and patient outcomes.
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Berger RE, Yang S, Weiner J, Gace D, Finn K. Measuring Patient Preferences and Clinic Follow-Up Utilizing an Embedded Discharge Appointment Scheduler: A Pilot Study. Jt Comm J Qual Patient Saf 2019; 45:580-585. [PMID: 31281091 DOI: 10.1016/j.jcjq.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scheduling timely outpatient follow-up appointments is part of a high-quality discharge process. In many centers, residents and hospitalists schedule follow-up appointments, often without patient input due to time constraints. METHODS A needs assessment was conducted to quantify clinician time spent making discharge appointments and to identify barriers to successful appointment scheduling. A four-week pilot intervention subsequently embedded a discharge scheduler responsible for scheduling discharge appointments into five house staff teams. The goals of the pilot were to incorporate patients' scheduling preferences when making appointments, to improve appointment attendance, and to reduce administrative burden on residents. Results were analyzed using chi-square and Fisher's exact tests. RESULTS Patients expressed a strong preference to be involved in scheduling follow-up appointments. In the intervention, there was a statistically significant increase in successfully scheduled appointments (66.7% vs. 87.7%; p < 0.0001) and attendance at follow-up appointments (43.9% baseline vs. 62.9% intervention; p = 0.011), a statistically significant reduction in rescheduled appointments (16.7% baseline vs. 4.9% intervention; p = 0.008), a nonsignificant trend toward increased number of canceled appointments (7.6% baseline vs. 17.5% intervention; p = 0.088), and no significant difference in no-show rates (18.2% baseline vs. 14.7% intervention; p = 0.544). Of residents involved in the pilot, 100% reported that the scheduler improved their ability to care for patients. CONCLUSION This pilot suggests that adding a nonclinical team member tasked with scheduling discharge appointments improved alignment of the discharge process with patients' preferences and may be of value to residents, hospitalists, and the health care system.
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Brooke BS, Beckstrom J, Slager SL, Weir CR, Del Fiol G. Discordance in Information Exchange Between Providers During Care Transitions for Surgical Patients. J Surg Res 2019; 244:174-180. [PMID: 31299433 DOI: 10.1016/j.jss.2019.06.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/26/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The exchange of health information between primary care providers (PCPs) and surgeons is critical during transitions of care for older patients with multiple comorbidities; however, it is unknown to what extent this process occurs. This study was designed to characterize the extent to which factors associated with older patient's recovery, such as functional status, cognitive status, social status, and emotional factors, are shared among PCPs and surgical providers during care transitions. MATERIALS AND METHODS We prospectively identified 15 patients aged over 60 y with ≥3 comorbidities referred for general and vascular surgery procedures at a Veterans Administrative and academic medical center. Semistructured Critical Decision Method interviews were conducted with patients along with their surgical providers and referring PCPs. Thematic content analysis was performed independently by five reviewers on the cognitive processes associated with functional status, cognitive status, social status, and emotional factors. Interrater reliability between providers and patients was assessed using Cohen's kappa. RESULTS Forty-seven Critical Decision Method interviews were conducted, which included 20 paired interviews between a PCP and a surgeon and 16 paired interviews that involved a patient and a provider. The majority of patients reported experiencing poor information exchange between their PCP and surgeon (58%) and feeling they were primarily responsible for communicating their own health information during care transitions (67%). In paired interviews between PCPs and surgeons, there was nearly perfect agreement for the shared knowledge of cognitive (kappa: 0.83) and emotional (kappa 1) factors. In contrast, there was only minimal agreement for shared knowledge of functional status (kappa 0.38) and social status (kappa: 0.34). CONCLUSIONS Information exchange between PCPs and surgical providers is often discordant during transitions of surgical care for medically complex older patients, particularly when it pertains to communicating their functional or social status.
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Affiliation(s)
- Benjamin S Brooke
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Julie Beckstrom
- Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stacey L Slager
- Pharmacotherapy Outcomes Research Center, University of Utah School of Pharmacy, Salt Lake City, Utah
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah
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A Multidisciplinary Discharge Timeout Checklist Improves Patient Education and Captures Discharge Process Errors. Qual Manag Health Care 2019; 27:63-68. [PMID: 29596265 DOI: 10.1097/qmh.0000000000000168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To design and implement a discharge timeout checklist, and to assess its effects on patients' understanding as well as the potential impact on preventable medical errors surrounding hospital discharges to home. METHODS Based on the structure successfully used for surgical procedures and using the Model for Improvement framework, we designed a discharge checklist to review and assess patients' understanding of discharge medications, catheters, home care plans, follow-up, symptoms, and who to call with problems after discharge. In parallel, we developed a process of integrating the checklist into the discharge process after routine discharge procedures were completed. We used the checklists to assess patients' level of understanding and need for additional education as well as changes in discharge documentation; we also noted whether good catches of significant errors in the discharge process occurred. RESULTS Over 6 months of study, 190 discharge timeouts out of 429 eligible discharges were completed. Additional education was provided in 53 of 190 discharge timeouts (27.8%), with 62% of this education being related to medications. Twenty-one (11.1%) discharge timeouts resulted in at least one change to the discharge documentation or a good catch. CONCLUSIONS A multidisciplinary discharge timeout directly involving the patient can be effective in targeting additional areas for patient education and in potentially reducing preventable adverse events.
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Karamchandani K, Fitzgerald K, Carroll D, Trauger ME, Ciccocioppo LA, Hess W, Prozesky J, Armen SB. A Multidisciplinary Handoff Process to Standardize the Transfer of Care Between the Intensive Care Unit and the Operating Room. Qual Manag Health Care 2019; 27:215-222. [PMID: 30260929 DOI: 10.1097/qmh.0000000000000187] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Critically ill patients are at high risk for adverse events on transfer between intensive care unit and operating room. Patient safety concerns were raised within our institution during such transfers, and absence of a standardized patient handoff process was identified as an area of concern. METHODS The current state of the patient transfer processes between the intensive care units (ICUs) and the operating rooms (ORs) was mapped and failure modes were identified. A multidisciplinary team was convened and a standardized handoff process and tool (checklist) was developed. Adherence to the process and care team satisfaction was assessed at the end of a 60-day pilot period. RESULTS The process was successfully implemented hospital-wide covering all adult and pediatric ICUs. We observed a 90% compliance rate with ICU to the OR transfers and 95% compliance rate with transfers from OR to the ICU during the 60-day pilot period. The care team expressed overall satisfaction with the process and identified potential areas of improvement. CONCLUSION A standardized patient handoff process between the ICU and the ORs can be successfully implemented in a large academic medical center. Universal application of this quality improvement tool can reduce patient harm, improve communication between providers, and enhance patient safety.
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Affiliation(s)
- Kunal Karamchandani
- Departments of Anesthesiology & Perioperative Medicine (Drs Karamchandani and Carroll and Ms Prozesky) and Surgery (Drs Fitzgerald and Armen), Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania; and Department of Quality Systems Improvement (Mss Trauger and Ciccocioppo) and Surgical Anesthesia Intensive Care Unit (Mr Hess), Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
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Johnson PC, Xiao Y, Wong RL, D'Arpino S, Moran SMC, Lage DE, Temel B, Ruddy M, Traeger LN, Greer JA, Hochberg EP, Temel JS, El-Jawahri A, Nipp RD. Potentially Avoidable Hospital Readmissions in Patients With Advanced Cancer. J Oncol Pract 2019; 15:e420-e427. [PMID: 30946642 DOI: 10.1200/jop.18.00595] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Patients with cancer often prefer to avoid time in the hospital; however, data are lacking on the prevalence and predictors of potentially avoidable readmissions (PARs) among those with advanced cancer. METHODS We enrolled patients with advanced cancer from September 2, 2014, to November 21, 2014, who had an unplanned hospitalization and assessed their patient-reported symptom burden (Edmonton Symptom Assessment System) at the time of admission. For 1 year after enrollment, we reviewed patients' health records to determine the primary reason for every hospital readmission and we classified readmissions as PARs using adapted Graham's criteria. We examined predictors of PARs using nonlinear mixed-effects models with binomial distribution. RESULTS We enrolled 200 (86.2%) of 232 patients who were approached. For these 200 patients, we reviewed 277 total hospital readmissions and identified 108 (39.0%) of these as PARs. The most common reasons for PARs were premature discharge from a prior hospitalization (30.6%) and failure of timely follow-up (28.7%). PAR hospitalizations were more likely than non-PAR hospitalizations to experience symptoms as the primary reason for admission (28.7% v 13.0%; P = .001). We found that married patients were less likely to experience PARs (odds ratio, 0.30; 95% CI, 0.15 to 0.57; P < .001) and that those with a higher physical symptom burden were more likely to experience PARs (odds ratio, 1.03; 95% CI, 1.01 to 1.05; P = .012). CONCLUSION We observed that a substantial proportion of hospital readmissions are potentially avoidable and found that patients' symptom burdens predict PARs. These findings underscore the need to assess and address the symptom burden of hospitalized patients with advanced cancer in this highly symptomatic population.
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Affiliation(s)
- P Connor Johnson
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Yian Xiao
- 2 Boston Medical Center, Boston University School of Medicine, Boston, MA
| | | | - Sara D'Arpino
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Samantha M C Moran
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Daniel E Lage
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Brandon Temel
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Margaret Ruddy
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Lara N Traeger
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Joseph A Greer
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Ephraim P Hochberg
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Jennifer S Temel
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Areej El-Jawahri
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Ryan D Nipp
- 1 Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
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Improving the Transition of Care Process for Veterans Hospitalized at Non-VHA Facilities. J Healthc Qual 2019; 41:68-74. [DOI: 10.1097/jhq.0000000000000159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Factors for Self-Managing Care Following Older Adults’ Discharge from the Emergency Department: A Qualitative Study. Can J Aging 2018; 38:76-89. [DOI: 10.1017/s071498081800034x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
RÉSUMÉCette étude avait pour but d’identifier les facteurs qui influent sur la capacité des personnes âgées à prendre en charge leur santé après une consultation au service des urgences (SU). Les questionnaires de l’enquête (n = 380) ont été remplis en SU par des personnes âgées et leurs aidants et visaient à évaluer leur perception de la compréhension de l’information qui leur était fournie. Des entrevues (n = 51) ont été réalisées avec un sous-échantillon de participants au cours des quatre semaines suivant leur consultation au SU et ont examiné les facteurs ayant une incidence sur l’autogestion des problèmes de santé. La perception de la compréhension de l’information reçue en SU (« oui, certainement ») était meilleure lors de la consultation au SU (91 %) que lors du suivi (71 %), lorsque 20 % des participants ne comprenaient pas ou n’étaient pas certains qu’ils avaient compris ce qui leur avait été communiqué en SU. Les patients ont rapporté que l’autogestion de leurs problèmes de santé était influencée par: la communication avec le personnel du SU, la compréhension des attentes suivant le congé de l’hôpital, l’état de santé, la disponibilité des aidants et divers facteurs externes. De plus, les soignants ont aussi mentionné l’appui aux soignants et la résistance des patients aux recommandations. L’utilisation de stratégies adaptées aux aînés en SU (p. ex. recommandations écrites, confirmation de la compréhension des recommandations), particulièrement celles liées à l’identification des personnes à risque et de celles nécessitant davantage de soutiens transitoires ou un meilleur accès ou intégration aux ressources disponibles dans la communauté amélioreraient l’autogestion des problèmes de santé suivant les consultations en SU.
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Lam K, Abrams HB, Matelski J, Okrainec K. Factors associated with attendance at primary care appointments after discharge from hospital: a retrospective cohort study. CMAJ Open 2018; 6:E587-E593. [PMID: 30510042 PMCID: PMC6277252 DOI: 10.9778/cmajo.20180069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Follow-up with a primary care provider within 1-2 weeks of discharge from hospital has been associated with reduced readmissions. We sought to determine appointment attendance with primary care providers postdischarge and identify factors associated with attendance. METHODS We conducted a retrospective cohort study involving general medicine patients who had been discharged from hospital between Sept. 1, 2014, and Dec. 30, 2015, from 2 Ontario academic hospitals, and who had been supported by a transitional care specialist and advised to see a primary care provider within 1 week. Attendance was determined by self-report during follow-up by telephone. We used multivariable logistic regression to assess whether patient factors (e.g., comorbidity) or system factors (e.g., booking the appointment before discharge) predicted attendance. We used Cox proportional hazards modelling to assess whether attendance predicted readmission within 30 days. RESULTS Of the 214 patients included in our study, 35% (n = 75) attended a primary care appointment within 1 week of discharge; 52% (n = 124) of patients attended an appointment within 2 weeks. After adjusting for age, sex and comorbidity, significant predictors of attendance were booking the appointment before discharge (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.07-4.40), familiarity with the primary care provider (OR 5.43, 95% CI 2.25-14.1) and inclusion of a reminder, callback number and appointment time in the discharge summary (OR 15.3, 95% CI 2.09-326). Predictors of nonattendance were the presence of a home support worker (OR 0.38, 95% CI 0.17-0.80) and a booked specialist appointment before discharge (OR 0.37, 95% CI 0.18-0.73). Attendance was not associated with reduced readmissions (hazard ratio 0.66, 95% CI 0.40-1.09). INTERPRETATION Timely follow-up with PCPs postdischarge remains challenging. Efforts to improve attendance should focus on reinforcing need for follow-up and coordinating follow-up before discharge, particularly for those poorly connected with the health care system.
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Affiliation(s)
- Kenneth Lam
- Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont.
| | - Howard B Abrams
- Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont
| | - John Matelski
- Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont
| | - Karen Okrainec
- Department of Medicine (Lam, Abrams, Okrainec), University of Toronto; Division of General Internal Medicine (Abrams, Okrainec), University Health Network; Biostatistics Research Unit (Matelski), University Health Network, Toronto, Ont
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Turner K, Weinberger M, Renfro C, Ferreri S, Trygstad T, Trogdon J, Shea CM. The role of network ties to support implementation of a community pharmacy enhanced services network. Res Social Adm Pharm 2018; 15:1118-1125. [PMID: 30291004 DOI: 10.1016/j.sapharm.2018.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/10/2018] [Accepted: 09/25/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Limited evidence exists on how to integrate community pharmacists into team-based care models, as the inclusion of community pharmacy services into alternative payment models is relatively new. To be successful in team-based care models, community pharmacies need to successfully build relationship with diverse stakeholders including providers, care managers, and patients. OBJECTIVES The aims of this study are to: (1) identify the role of network ties to support implementation of a community pharmacy enhanced services network, (2) describe how these network ties are formed and maintained, and (3) compare the role of network ties among high- and low-performing community pharmacies participating in an enhanced services network. METHODS Using a semi-structured interview guide, we interviewed 40 community pharmacy representatives responsible for implementation of a community pharmacy enhanced services program. We analyzed for themes using social network theory to compare network ties among 24 high- and 16 low-performing community pharmacies. RESULTS The study found that high-performing pharmacies had a greater diversity of network ties (e.g., relationships with healthcare providers, care managers, and public health agencies). High-performing pharmacies were able to use those ties to support implementation of NC-CPESN. High- and low-performing pharmacies used similar strategies for establishing ties with patients, such as motivational interviewing and assigning staff members to be responsible for engaging high-risk patients. High-performing pharmacies used additional strategies such as assessing patient preferences to support patient engagement, increasing patient receptivity towards enhanced services. CONCLUSIONS Community pharmacies may vary in their ability to develop relationships with other healthcare providers, care management and public agencies, and patients. As enhanced services interventions that require care coordination are scaled up and spread, additional research is needed to test implementation strategies that support community pharmacies with developing and maintaining relationships across a diverse group of stakeholders (e.g., healthcare providers, care managers, public health agencies, patients).
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Affiliation(s)
- Kea Turner
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA.
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Chelsea Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, USA
| | - Stefanie Ferreri
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, USA
| | - Troy Trygstad
- Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, USA; Community Pharmacy Enhanced Services Network, Community Care of North Carolina, USA
| | - Justin Trogdon
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
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Tong L, Arnold T, Yang J, Tian X, Erdmann C, Esposito T. The association between outpatient follow-up visits and all-cause non-elective 30-day readmissions: A retrospective observational cohort study. PLoS One 2018; 13:e0200691. [PMID: 30016341 PMCID: PMC6049937 DOI: 10.1371/journal.pone.0200691] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 07/02/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As an effort to reduce hospital readmissions, early follow-up visits were recommended by the Society of Hospital Medicine. However, published literature on the effect of follow-up visits is limited with mixed conclusions. Our goal here is to fully explore the relationship between follow-up visits and the all-cause non-elective 30-day readmission rate (RR) after adjusting for confounders. METHODS AND RESULTS To conduct this retrospective observational study, we extracted data for 55,378 adult inpatients from Advocate Health Care, a large, multi-hospital system serving a diverse population in a major metropolitan area. These patients were discharged to Home or Home with Home Health services between June 1, 2013 and April 30, 2015. Our findings from time-dependent Cox proportional hazard models showed that follow-up visits were significantly associated with a reduced RR (adjusted hazard ratio: 0.86; 95% CI: 0.82-0.91), but in a complicated way because the interaction between follow-up visits and a readmission risk score was significant with p-value < 0.001. Our analysis using logistic models on an adjusted data set confirmed the above findings with the following additional results. First, time matter. Follow-up visits within 2 days were associated with the greatest reduction in RR (adjusted odds ratio: 0.72; 95% CI: 0.63-0.83). Visits beyond 2 days were also associated with a reduction in RR, but the strength of the effect decreased as the time between discharge and follow-up visit increased. Second, the strength of such association varied for patients with different readmission risk scores. Patients with a risk score of 0.113, high but not extremely high risk, had the greatest reduction in RR from follow-up visits. Patients with an extremely high risk score (> 0.334) saw no RR reduction from follow-up visits. Third, a patient was much more likely to have a 2-day follow-up visit if that visit was scheduled before the patient was discharged from the hospital (30% versus < 5%). CONCLUSIONS Follow-up visits are associated with a reduction in readmission risk. The timing of follow-up visits can be important: beyond two days, the earlier, the better. The effect of follow-up visits is more significant for patients with a high but not extremely high risk of readmission.
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Affiliation(s)
- Liping Tong
- Advocate Health Care, Downers Grove, IL, United States of America
| | - Tim Arnold
- Cerner Corporation, North Kansas City, MO, United States of America
| | - Jie Yang
- University of Illinois at Chicago, Department of Mathematics, Statistics, and Computer Science, Chicago, IL, United States of America
| | - Xinyong Tian
- Advocate Health Care, Downers Grove, IL, United States of America
| | - Cole Erdmann
- Cerner Corporation, North Kansas City, MO, United States of America
| | - Tina Esposito
- Advocate Health Care, Downers Grove, IL, United States of America
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Rochester NT, Banach LP, Hoffner W, Zeltser D, Lewis P, Seelbach E, Cuzzi S. Facilitating the Timely Discharge of Well Newborns by Using Quality Improvement Methods. Pediatrics 2018; 141:peds.2017-0872. [PMID: 29643071 DOI: 10.1542/peds.2017-0872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Discharges are a key driver of hospital throughput. Our pediatric hospitalist team sought to improve newborn nursery throughput by increasing the percentage of newborns on our service with a discharge order by 11 am. We hypothesized that implementing a discharge checklist would result in earlier discharge times for newborns who met discharge criteria. METHODS We identified barriers to timely discharge through focus groups with key stakeholders, chart reviews, and brainstorming sessions. We subsequently created and implemented a discharge checklist to identify and address barriers before daily rounds. We tracked mean monthly discharge order times. Finally, we performed chart reviews to determine causes for significantly delayed discharge orders and used this information to modify rounding practices during a second plan-do-study-act cycle. RESULTS During the 2-year period before the intervention, 24% of 3224 newborns had a discharge order entered by 11 am. In the 20 months after the intervention, 39% of 2739 newborns had a discharge order by 11 am, a 63% increase compared with the baseline. Observation for group B Streptococcus exposure was the most frequent reason for a late discharge order. CONCLUSIONS There are many factors that affect the timely discharge of well newborns. The development and implementation of a discharge checklist improved our ability to discharge newborns on our pediatric hospitalist service by 11 am. Future studies to identify nonphysician barriers to timely newborn discharges may lead to further improvements in throughput between the labor and delivery and maternity suites units.
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Affiliation(s)
- Nicole T Rochester
- Division of Hospital Medicine, Children's National Health System, Washington, District of Columbia.,Holy Cross Hospital, Silver Spring, Maryland.,Department of Pediatrics, School of Medicine, George Washington University, Washington, District of Columbia
| | - Laurie P Banach
- Division of Hospital Medicine, Children's National Health System, Washington, District of Columbia.,Holy Cross Hospital, Silver Spring, Maryland.,Department of Pediatrics, School of Medicine, George Washington University, Washington, District of Columbia
| | - Wendy Hoffner
- Division of Hospital Medicine, Children's National Health System, Washington, District of Columbia.,Holy Cross Hospital, Silver Spring, Maryland.,Department of Pediatrics, School of Medicine, George Washington University, Washington, District of Columbia
| | - Deena Zeltser
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; and
| | - Phyllis Lewis
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Elizabeth Seelbach
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Sandra Cuzzi
- Division of Hospital Medicine, Children's National Health System, Washington, District of Columbia; .,Holy Cross Hospital, Silver Spring, Maryland.,Department of Pediatrics, School of Medicine, George Washington University, Washington, District of Columbia
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Strupp J, Hanke G, Schippel N, Pfaff H, Karbach U, Rietz C, Voltz R. Last Year of Life Study Cologne (LYOL-C): protocol for a cross-sectional mixed methods study to examine care trajectories and transitions in the last year of life until death. BMJ Open 2018; 8:e021211. [PMID: 29666139 PMCID: PMC5905737 DOI: 10.1136/bmjopen-2017-021211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The last year of life constitutes a particularly vulnerable phase for patients, involving nearly all health and social care structures. Yet, little scientific evidence is available that provides insight into the trajectories including the number and types of care setting transitions, transitions into palliative care and the dying phase. Only few studies have focused on difficulties associated with having to move between health and social care settings in the last year of life, although patients face a significant risk of adverse events. The Last Year of Life Study Cologne (LYOL-C) aims to fill this gap. METHODS AND ANALYSIS LYOL-C is a mixed-methods study composed of four steps: (1) Claims data collected by the statutory health insurance funds of deceased persons will be analysed with regard to patient care trajectories, health service transitions and costs in the last year of life. (2) Patient trajectories and transitions in healthcare will additionally be reconstructed by analysing the retrospective accounts of bereaved relatives (n=400) using a culturally adapted version of the Views of Informal Carers-Evaluation of Services Short Form questionnaire and the Patient Assessment of Care for Chronic Conditions Short Form questionnaire adapted for relatives. (3) Qualitative interviews with bereaved relatives (n=40-60) will provide in-depth insight into reasons for transitions and effects on patients' quality of life. (4) Focus groups (n=3-5) with Healthcare Professionals will be conducted to discuss challenges associated with transitions in the last year of life. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Commission of the Faculty of Medicine of Cologne University (#17-188). Results will be submitted for publication in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER The study is registered in the German Clinical Trials Register (DRKS00011925) and in the Health Services Research Database (VfD_CoRe-Net_17_003806).
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Affiliation(s)
- Julia Strupp
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Gloria Hanke
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- Faculty of Human Sciences, Working Area Research Methodology, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Ute Karbach
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Christian Rietz
- Faculty of Human Sciences, Working Area Research Methodology, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
- Center for Integrated Oncology Cologne/Bonn (CIO), University of Cologne, Cologne, Germany
- Clinical Trials Center Cologne (ZKS), University of Cologne, Cologne, Germany
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Sirgo Rodríguez G, Chico Fernández M, Gordo Vidal F, García Arias M, Holanda Peña MS, Azcarate Ayerdi B, Bisbal Andrés E, Ferrándiz Sellés A, Lorente García PJ, García García M, Merino de Cos P, Allegue Gallego JM, García de Lorenzo Y Mateos A, Trenado Álvarez J, Rebollo Gómez P, Martín Delgado MC. Handover in Intensive Care. Med Intensiva 2018; 42:168-179. [PMID: 29426704 DOI: 10.1016/j.medin.2017.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/21/2017] [Accepted: 12/01/2017] [Indexed: 01/12/2023]
Abstract
Handover is a frequent and complex task that also implies the transfer of the responsibility of the care. The deficiencies in this process are associated with important gaps in clinical safety and also in patient and professional dissatisfaction, as well as increasing health cost. Efforts to standardize this process have increased in recent years, appearing numerous mnemonic tools. Despite this, local are heterogeneous and the level of training in this area is low. The purpose of this review is to highlight the importance of IT while providing a methodological structure that favors effective IT in ICU, reducing the risk associated with this process. Specifically, this document refers to the handover that is established during shift changes or nursing shifts, during the transfer of patients to other diagnostic and therapeutic areas, and to discharge from the ICU. Emergency situations and the potential participation of patients and relatives are also considered. Formulas for measuring quality are finally proposed and potential improvements are mentioned especially in the field of training.
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Affiliation(s)
- G Sirgo Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Tarragona, España
| | - M Chico Fernández
- UCI de Trauma y Emergencias (UCITE), Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M García Arias
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - B Azcarate Ayerdi
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - E Bisbal Andrés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - A Ferrándiz Sellés
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - P J Lorente García
- Servicio de Medicina Intensiva, Hospital Universitario General de Castellón, Castellón, España
| | - M García García
- Servicio de Medicina Intensiva, Hospital Universitario Río Hortega, Valladolid, España
| | - P Merino de Cos
- Servicio de Medicina Intensiva, Hospital Can Misses, Ibiza, España
| | - J M Allegue Gallego
- Servicio de Medicina Intensiva, Hospital Universitario Santa Lucía, Cartagena, España
| | | | - J Trenado Álvarez
- Servicio de Medicina Intensiva, Hospital de Terrassa, Terrassa, España
| | - P Rebollo Gómez
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Madrid.
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Blomberg BA, Mulligan RC, Staub SJ, Hanson LC, Drickamer MA, Dale MC. Handing Off the Older Patient: Improved Documentation of Geriatric Assessment in Transitions of Care. J Am Geriatr Soc 2017; 66:401-406. [PMID: 29251766 DOI: 10.1111/jgs.15237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To improve assessment and documentation of function, cognition, and advance care planning (ACP) in admission and discharge notes on an Acute Care of the Elderly (ACE) unit. DESIGN Continuous quality improvement intervention with episodic data review. SETTING ACE unit of an 866-bed academic tertiary hospital. PARTICIPANTS Housestaff physicians rotating on the ACE unit (N = 31). INTERVENTION Introduction of templated notes, housestaff education, leadership outreach, and posted reminders. MEASUREMENTS Documentation of function, cognition, and ACP were assessed through chart review of a weekly sample of the ACE unit census and scored using predefined criteria. RESULTS Medical records (N = 172) were reviewed. At baseline, 0% of admission and discharge notes met minimum documentation criteria for all 3 domains (function, cognition, ACP). Documentation of function and cognition was completely absent at baseline. After the intervention, there was marked improvement in all measures, with 64% of admission notes and 94% of discharge notes meeting minimum documentation criteria or better in all 3 domains. CONCLUSION A quality improvement intervention using geriatric-specific note templates, housestaff training, and reminders increased documentation of function, cognition and ACP for postacute care.
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Affiliation(s)
- Ben A Blomberg
- From the Division of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Rebekah C Mulligan
- From the Division of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Stephen J Staub
- From the Division of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Laura C Hanson
- From the Division of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Margaret A Drickamer
- From the Division of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Maureen C Dale
- From the Division of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Ojeda PI, Kara A. Post discharge issues identified by a call-back program: identifying improvement opportunities. Hosp Pract (1995) 2017; 45:201-208. [PMID: 29110557 DOI: 10.1080/21548331.2017.1401901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The period following discharge from the hospital is one of heightened vulnerability. Discharge instructions serve as a guide during this transition. Yet, clinicians receive little feedback on the quality of this document that ties into the patients' experience. We reviewed the issues voiced by discharged patients via a call-back program and compared them to the discharge instructions they had received. METHODS At our institution, patients receive an automated call forty-eight hours following discharge inquiring about progress. If indicated by the response to the call, they are directed to a nurse who assists with problem solving. We reviewed the nursing documentation of these encounters for a period of nine months. The issues voiced were grouped into five categories: communication, medications, durable medical equipment/therapies, follow up and new or ongoing symptoms. The discharge instructions given to each patient were reviewed. We retrieved data on the number of discharges from each specialty from the hospital over the same period. RESULTS A total of 592 patients voiced 685 issues. The numbers of patients discharged from medical or surgical services identified as having issues via the call-back line paralleled the proportions discharged from medical and surgical services from the hospital during the same period. Nearly a quarter of the issues discussed had been addressed in the discharge instructions. The most common category of issues was related to communication deficits including missing or incomplete information which made it difficult for the patient to enact or understand the plan of care. Medication prescription related issues were the next most common. Resource barriers and questions surrounding medications were often unaddressed. CONCLUSIONS Post discharge issues affect patients discharged from all services equally. Data from call back programs may provide actionable targets for improvement, identify the inpatient team's 'blind spots' and be used to provide feedback to clinicians.
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Affiliation(s)
- Patricia I Ojeda
- a Indiana University School of Medicine, Transitional Residency Program , Indianapolis , IN , USA
| | - Areeba Kara
- b ASPIRE scholar Division of General Internal Medicine , Indiana University Health Physicians, Inpatient Medicine, Assistant Professor of Clinical Medicine IU School of Medicine ,
Indianapolis , IN , USA
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42
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Sharma A, Lo V, Lapointe-Shaw L, Soong C, Wu PE, Wu RC. A time-motion study of residents and medical students performing patient discharges from general internal medicine wards: a disjointed, interrupted process. Intern Emerg Med 2017; 12:789-798. [PMID: 28349373 DOI: 10.1007/s11739-017-1654-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
Patients are at high risk for adverse events after discharge from a hospital admission. As a critical and often time-consuming aspect of care for hospitalized patients, the purpose of this study was to describe the physician time, events and workflow in performing a patient discharge. On General Internal Medicine (GIM) wards at two academic medical centers in Toronto, a time-motion study was performed on 11 residents and 2 medical students performing 32 patient discharges. Using a paper data collection tool, a research associate aimed to capture the distribution of activities and the nature and frequency of workflow interruptions during patient discharges from the perspective of resident and medical student housestaff. Thirty-two GIM patient discharges by the 13 housestaff were observed over a period of 116 h. Discharges required 69.2 ± 41.2 min of housestaff-dedicated time to complete, but spanned over a mean 3.7 h from start to finish. On average, 32.8 min (47.3%) of time spent on discharges was dedicated to documentation activities; 13.5 min (19.6%) to direct patient communication; 10.8 min (15.6%) to communication with other clinicians and providers; 6.5 min (9.4%) to arranging outpatient care; 5.7 min (8.2%) to time in transit and waiting. For each discharge, housestaff were interrupted a mean of 5.5 times and switched tasks 8.7 times. During the discharge process, housestaff mainly dedicated themselves to documentation activities and focused minimally on direct patient communication. Clinicians were also found to experience several workflow inefficiencies and interruptions. The present study can be used to identify opportunities to improve and further focus efforts in characterizing this dynamic process.
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Affiliation(s)
- Arjun Sharma
- OpenLab, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada
| | - Vivian Lo
- OpenLab, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada
| | - Lauren Lapointe-Shaw
- Division of General Internal Medicine, University Health Network, Toronto, ON, Canada
| | - Christine Soong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Eugene Wu
- Division of General Internal Medicine, University Health Network, Toronto, ON, Canada
| | - Robert Clark Wu
- OpenLab, University Health Network, 200 Elizabeth Street, Toronto, ON, Canada.
- Division of General Internal Medicine, University Health Network, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Giraud J, Thevenet M, Haddad R, Bruere I, Leveque S, Mion M, Rieutord A. [A tool for improving the transition between hospital and community care for the elderly]. SOINS. GERONTOLOGIE 2017; 22:34-39. [PMID: 28917335 DOI: 10.1016/j.sger.2017.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The hospital-community interface represents a real challenge in the care of elderly people. A lack of coordination and communication is the main obstacle to ensuring the fluidity of this pathway. On a definite territory, a new hospital-community liaison sheet was developed as the result of a collaborative approach and then evaluated. This simple, useful and effective cross-professional tool, is the first step towards improving communication between these two universes.
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Affiliation(s)
- Julie Giraud
- Hôpital Antoine Béclère AP-HP, 157 rue de la porte de Trivaux, 92141 Clamart, France.
| | - Marie Thevenet
- Hôpital Antoine Béclère AP-HP, 157 rue de la porte de Trivaux, 92141 Clamart, France
| | - Ratiba Haddad
- Hôpital Antoine Béclère AP-HP, 157 rue de la porte de Trivaux, 92141 Clamart, France
| | - Isabelle Bruere
- Hôpital Antoine Béclère AP-HP, 157 rue de la porte de Trivaux, 92141 Clamart, France
| | - Stéphane Leveque
- Réseau de santé Osmose, 20/22 avenue Édouard Herriot, 92350 Le Plessis-Robinson, France
| | - Mathieu Mion
- Hôpital Antoine Béclère AP-HP, 157 rue de la porte de Trivaux, 92141 Clamart, France
| | - André Rieutord
- Hôpital Antoine Béclère AP-HP, 157 rue de la porte de Trivaux, 92141 Clamart, France
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Banerjee R, Suarez A, Kier M, Honeywell S, Feng W, Mitra N, Grande D, Myers J. If You Book It, Will They Come? Attendance at Postdischarge Follow-Up Visits Scheduled by Inpatient Providers. J Hosp Med 2017; 12:618-625. [PMID: 28786427 DOI: 10.12788/jhm.2777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Postdischarge follow-up visits (PDFVs) are widely recommended to improve inpatient-outpatient transitions of care. OBJECTIVE To measure PDFV attendance rates. DESIGN Observational cohort study. SETTING Medical units at an academic quaternary-care hospital and its affiliated outpatient clinics. PATIENTS Adult patients hospitalized between April 2014 and March 2015 for whom at least 1 PDFV with our health system was scheduled. Exclusion criteria included nonprovider visits, visits cancelled before discharge, nonaccepted health insurance, and visits scheduled for deceased patients. MEASUREMENTS The study outcome was the incidence of PDFVs resulting in no-shows or same-day cancellations (NS/SDCs). RESULTS Of all hospitalizations, 6136 (52%) with 9258 PDFVs were analyzed. Twenty-five percent of PDFVs were NS/SDCs, 23% were cancelled before the visit, and 52% were attended as scheduled. In multivariable regression models, NS/SDC risk factors included black race (odds ratio [OR] 1.94, 95% confidence interval [CI], 1.63-2.32), longer lengths of stay (hospitalizations ≥15 days: OR 1.51, 95% CI, 1.22- 1.88), and discharge to facility (OR 2.10, 95% CI, 1.70-2.60). Conversely, NS/SDC visits were less likely with advancing age (age ≥65 years: OR 0.39, 95% CI, 0.31-0.49) and driving distance (highest quartile: OR 0.65, 95% CI, 0.52-0.81). Primary care visits had higher NS/SDC rates (OR 2.62, 95% CI, 2.03-3.38) than oncologic visits. The time interval between discharge and PDFV was not associated with NS/SDC rates. CONCLUSIONS PDFVs were scheduled for more than half of hospitalizations, but 25% resulted in NS/SDCs. New strategies are needed to improve PDFV attendance.
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Affiliation(s)
- Rahul Banerjee
- Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alex Suarez
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melanie Kier
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steve Honeywell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Weiwei Feng
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Grande
- Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Myers
- Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Goldsmith H, Curtis K, McCloughen A. Effective pain management in recently discharged adult trauma patients: Identifying patient and system barriers, a prospective exploratory study. J Clin Nurs 2017; 26:4548-4557. [DOI: 10.1111/jocn.13792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Helen Goldsmith
- Sydney Nursing School; University of Sydney; Sydney NSW Australia
- Trauma Service; St George Hospital; Sydney NSW Australia
| | - Kate Curtis
- Sydney Nursing School; University of Sydney; Sydney NSW Australia
- Trauma Service; St George Hospital; Sydney NSW Australia
- Faculty of Medicine; St George Clinical School; University of New South Wales; Sydney NSW Australia
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Coombs MA, Parker R, de Vries K. Managing risk during care transitions when approaching end of life: A qualitative study of patients' and health care professionals' decision making. Palliat Med 2017; 31:617-624. [PMID: 28618896 PMCID: PMC5476192 DOI: 10.1177/0269216316673476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increasing importance is being placed on the coordination of services at the end of life. AIM To describe decision-making processes that influence transitions in care when approaching the end of life. DESIGN Qualitative study using field observations and longitudinal semi-structured interviews. SETTING/PARTICIPANTS Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3-4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. FINDINGS Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making 'safe' discharge options informed hospital discharge decisions. CONCLUSION While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life.
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Affiliation(s)
- Maureen A Coombs
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Roses Parker
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
| | - Kay de Vries
- School of Health Sciences, University of Brighton, Brighton, UK
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Canary HE, Wilkins V. Beyond Hospital Discharge Mechanics: Managing the Discharge Paradox and Bridging the Care Chasm. QUALITATIVE HEALTH RESEARCH 2017; 27:1225-1235. [PMID: 28682741 DOI: 10.1177/1049732316679811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hospital discharge processes are complex and confusing, and can detrimentally affect patients, families, and providers. This qualitative study investigated pediatric hospital discharge experiences from the perspectives of parents of children with acute and chronic health conditions, primary care providers, and hospitalists. Focus groups and interviews with parents, primary care providers, and hospitalists were used to explore discharge experiences and ideas for improvement offered by participants. Using an iterative approach to analyze data resulted in five major themes for discharge experiences: (a) discharge problems, (b) teamwork, (c) ideal discharge, (d) care chasm, and (e) discharge paradox. The first three themes concern practical issues, whereas the last two themes reflect negative emotional experiences as well as practical problems encountered in the discharge process. Improvements in communication were viewed as a primary strategy for improving the discharge process for better outcomes for patients, their families, and providers.
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48
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Gilliam M, Krein SL, Belanger K, Fowler KE, Dimcheff DE, Solomon G. Novel combined patient instruction and discharge summary tool improves timeliness of documentation and outpatient provider satisfaction. SAGE Open Med 2017; 5:2050312117701053. [PMID: 28491308 PMCID: PMC5406115 DOI: 10.1177/2050312117701053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 02/28/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Incomplete or delayed access to discharge information by outpatient providers and patients contributes to discontinuity of care and poor outcomes. OBJECTIVE To evaluate the effect of a new electronic discharge summary tool on the timeliness of documentation and communication with outpatient providers. METHODS In June 2012, we implemented an electronic discharge summary tool at our 145-bed university-affiliated Veterans Affairs hospital. The tool facilitates completion of a comprehensive discharge summary note that is available for patients and outpatient medical providers at the time of hospital discharge. Discharge summary note availability, outpatient provider satisfaction, and time between the decision to discharge a patient and discharge note completion were all evaluated before and after implementation of the tool. RESULTS The percentage of discharge summary notes completed by the time of first post-discharge clinical contact improved from 43% in February 2012 to 100% in September 2012 and was maintained at 100% in 2014. A survey of 22 outpatient providers showed that 90% preferred the new summary and 86% found it comprehensive. Despite increasing required documentation, the time required to discharge a patient, from physician decision to discharge note completion, improved from 5.6 h in 2010 to 4.1 h in 2012 (p = 0.04), and to 2.8 h in 2015 (p < 0.001). CONCLUSION The implementation of a novel discharge summary tool improved the timeliness and comprehensiveness of discharge information as needed for the delivery of appropriate, high-quality follow-up care, without adversely affecting the efficiency of the discharge process.
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Affiliation(s)
- Meredith Gilliam
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarah L Krein
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Derek E Dimcheff
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Gabriel Solomon
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Improving communication of medication changes using a pharmacist-prepared discharge medication management summary. Int J Clin Pharm 2017; 39:394-402. [PMID: 28285390 DOI: 10.1007/s11096-017-0435-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
Background Discontinuity of care between hospital and primary care is often due to poor information transfer. Medication information in medical discharge summaries (DS) is often incomplete or incorrect. The effectiveness and feasibility of hospital pharmacists communicating medication information, including changes made in the hospital, is not clearly defined. Objective To explore the impact of a pharmacist-prepared Discharge Medication Management Summary (DMMS) on the accuracy of information about medication changes provided to patients' general practitioners (GPs). Setting Two medical wards at a major metropolitan hospital in Australia. Method An intervention was developed in which ward pharmacists communicated medication change information to GPs using the DMMS. Retrospective audits were conducted at baseline and after implementation of the DMMS to compare the accuracy of information provided by doctors and pharmacists. GPs' satisfaction with the DMMS was assessed through a faxed survey. Main outcome measure Accuracy of medication change information communicated to GPs; GP satisfaction and feasibility of a pharmacist-prepared DMMS. Results At baseline, 263/573 (45.9%) medication changes were documented by doctors in the DS. In the post-intervention audit, more medication changes were documented in the pharmacist-prepared DMMS compared to the doctor-prepared DS (72.8% vs. 31.5%; p < 0.001). Most GPs (73.3%) were satisfied with the information provided and wanted to receive the DMMS in the future. Completing the DMMS took pharmacists an average of 11.7 minutes. Conclusion The accuracy of medication information transferred upon discharge can be improved by expanding the role of hospital pharmacists to include documenting medication changes.
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Sinha S, Seirup J, Carmel A. Early primary care follow-up after ED and hospital discharge - does it affect readmissions? Hosp Pract (1995) 2017; 45:51-57. [PMID: 28095063 DOI: 10.1080/21548331.2017.1283935] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES After hospitalization, timely discharge follow-up has been linked to reduced readmissions in the heart failure population, but data from general inpatients has been mixed. The objective of this study was to determine if there was an association between completed follow-up appointments within 14 days of hospital discharge and 30-day readmission amongst primary care patients at an urban academic medical center. Index discharges included both inpatient and emergency room settings. A secondary objective was to identify patient factors associated with completed follow-up appointments within 14 days. METHODS We conducted a retrospective review of primary care patients at an urban academic medical center who were discharged from either the emergency department (ED) or inpatient services at the Weill Cornell Medical Center/New York Presbyterian Hospital from 1 January 2014-31 December 2014. Cox proportional hazard models were used to identify the relationship between follow-up in primary care within 14 days and readmission within 30 days. Logistic regression was used to evaluate the association of patient factors with 14-day follow-up. RESULTS Among 9,662 inpatient and ED discharges, multivariable analysis (adjusting for age, gender, race/ethnicity, insurance, number of diagnoses on problem list, length of stay, and discharge service) showed that follow-up with primary care within 14 days was not associated with a lower hazard of readmission within 30 days (HR = 0.78; 95% CI 0.56-1.09). A higher number of diagnoses on the problem list was associated with greater odds of follow-up for both inpatient and emergency department discharges (inpatient: HR = 1.03, 95% CI 1.02-1.04; ED: HR = 1.02, 95% CI 1.00-1.04). For inpatient discharges, each additional day in length of stay was associated with 3% lower odds of follow-up (HR = 0.97, 95% CI 0.96-0.99). CONCLUSION Early follow-up within 14 days after discharge from general inpatient services was associated with a trend toward lower hazard of 30-day readmission though this finding was not significant. Future studies should focus on identifying additional cohorts of patients in which readmission is reduced by early follow-up, so that access to primary care appointments is not compromised.
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Affiliation(s)
- Sanjai Sinha
- a Weill Department of Medicine , Weill Cornell Medical College , New York , NY , USA
| | - Joanna Seirup
- b Department of Healthcare Policy and Research , Weill Cornell Medical College , New York , NY , USA
| | - Amanda Carmel
- a Weill Department of Medicine , Weill Cornell Medical College , New York , NY , USA
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