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Mueller, Stephanie K., Kyla Giannelli, Robert Boxer, and Jeffrey L. Schnipper. "Readability of patient discharge instructions with and without the use of electronically available disease-specific templates." Journal of the American Medical Informatics Association 22, no. 4 (April 16, 2015): 857–63. http://dx.doi.org/10.1093/jamia/ocv005.
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Abstract Objective Low health literacy is common, leading to patient vulnerability during hospital discharge, when patients rely on written health instructions. We aimed to examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge. Materials and Methods We performed a retrospective cohort study of 233 patients discharged from a large tertiary care hospital to their homes following the implementation of a web-based “discharge module,” which included the optional use of diagnosis-specific templated discharge instructions. We compared the readability of discharge instructions, as measured by the Flesch Reading Ease Level test (FREL, on a 0–100 scale, with higher scores indicating greater readability) and the Flesch–Kincaid Grade Level test (FKGL, measured in grade levels), between discharges that used templated instructions (with or without modification) versus discharges that used clinician-generated instructions (with or without available templated instructions for the specific discharge diagnosis). Results Templated discharge instructions were provided to patients in 45% of discharges. Of the 55% of patients that received clinician-generated discharge instructions, the majority (78.1%) had no available templated instruction for the specific discharge diagnosis. Templated discharge instructions had higher FREL scores (71 vs. 57, P < .001) and lower FKGL scores (5.6 vs. 7.6, P < .001), compared to clinician-generated discharge instructions. Discussion The use of electronically available templated discharge instructions was associated with better readability (a higher FREL score and a lower FKGL score) than the use of clinician-generated discharge instructions. The main reason for clinicians to create discharge instructions was the lack of available templates for the patient’s specific discharge diagnosis. Conclusions Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion.
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Beardsley, James R., Regina H. Schomberg, Steven J. Heatherly, and Beth S. Williams. "Implementation of a Standardized Discharge Time-out Process to Reduce Prescribing Errors at Discharge." Hospital Pharmacy 48, no. 1 (January 2013): 39–47. http://dx.doi.org/10.1310/hpj4801-39.
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Background To reduce prescribing errors occurring on discharge from the hospital, a standardized discharge time-out process was implemented on a general medicine service at Wake Forest Baptist Medical Center. In the time-out process, the multidisciplinary care team reviewed the patient's medical records together to determine the optimal discharge medication regimen. This regimen was recorded on a time-out form and then was used to develop the patient's discharge documents. Objective To evaluate the impact of a standardized discharge time-out process on prescribing errors that occur as patients are discharged from a general medicine service. Methods The medical records of all patients discharged from a general medicine service during 60-day periods before (“pre-group”) and after (“post-group”) implementation of a standardized discharge time-out process were retrospectively reviewed by an internal medicine physician to determine the presence of discharge prescribing errors. Results There were 142 and 124 evaluable patients in the pre- and post-groups, respectively. Compliance with the time-out process was 93% in the post-group. At least 1 prescribing error was detected in 49 (34.5%) of the discharges in the pre-group and 17 (13%) of the discharges in the post-group ( P < .0001). All of the errors noted in the post-group occurred in discharges in which a clinical pharmacist was not involved. Conclusions A multidisciplinary, standardized discharge time-out process was associated with a dramatic reduction in prescribing errors when patients were discharged from a general medicine service. The time-out process is one strategy to improve patient safety at hospital discharge.
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Williams, Teresa, and Gavin Leslie. "Delayed discharges from an adult intensive care unit." Australian Health Review 28, no. 1 (2004): 87. http://dx.doi.org/10.1071/ah040087.
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Objective: Intensive Care Unit (ICU) services are expensive, and therefore appropriate utilisation is imperative. Delayed discharges impact on the efficiency and effectiveness of ICU services. This study examines the prevalence and reasons for delayed discharge. Method: Cross sectional study. We enrolled a prospective sample of all patients admitted to a 22-bed ICU over a 6-month period. Medical staff in ICU informed nursing shift coordinators when patients could be discharged. Nursing shift coordinators maintained a record of discharge times, delays and reasons for delay. Discharge was considered delayed if the patient was not relocated from the ICU within 8 hours of being considered eligible by ICU medical staff. Results: Of 652 recorded discharges, 176 were delayed (27%). Unavailable ward beds (81%) were cited as the main reason for delay in discharge. Median delay time was 21.3 hours (range, 10 minutes to 26 days). These delays were predicted by greater patient acuity on ICU admission, patient deterioration while waiting for transfer to the ward, principal admitting diagnosis, discharge destination and weekend discharge. Conclusion: Improvement in bed management and discharge processes (the only factors directly controllable by the hospital) is essential to reduce delays in discharge from ICU. Reducing discharge delays would free up beds for other admissions; may result in a cost saving for the hospital through more efficient resource utilisation; and, ultimately, would benefit patients.
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Bowen, Alex, Rohit Kumar, John Howard, and Andrew E. Camilleri. "Nurse led discharge: improving efficiency, safely." Clinical Governance: An International Journal 19, no. 2 (April 1, 2014): 110–16. http://dx.doi.org/10.1108/cgij-03-2013-0007.
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Purpose – The purpose of this paper is to demonstrate that nurse led discharge (NLD) could improve the efficiency of simple discharges from a short stay surgical ward without compromising patient safety. Design/methodology/approach – A protocol for NLD was designed and implemented. Introduction of the protocol was audited and re-audited prospectively. Findings – Introduction of the nurse led discharge protocol significantly reduced the rate of delayed discharge (p>0.001). The protocol successfully identified all patients for whom a NLD would be inappropriate and no patients discharged by the nursing team were re-admitted. Research limitations/implications – No formal measure of staff and patient satisfaction with the new protocol was performed. Practical implications – The nursing team are now able to more effectively manage patient flow through the short stay surgical ward. Mismatch between demand for beds and capacity has reduced. Social implications – Patient experience has been improved by the release of time to care for our nurses and the elimination of unnecessary delay in discharge. Originality/value – Formal protocol driven NLD can be a safe way of improving efficiency in patient flow. This pattern of discharge could be applied in many hospital systems.
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Lee, M. S., D. A. Nunez, and H. J. Lamont. "Audit of a Change in Otolaryngology Discharge Letters Using the Scottish Intercollegiate Guidelines Network (Sign) Recommendations." Scottish Medical Journal 47, no. 5 (October 2002): 109–11. http://dx.doi.org/10.1177/003693300204700504.
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Hospital and general practitioners should establish good communications so that continuity of care can be maintained when patients are discharged from hospital. A discharge letter was routinely prepared utilizing the standardized morbidity registration forms by the house surgeon for delivery to the patient s general practitioner. The authors developed a new discharge letter, which was sent under separate cover to the general practitioner. The two discharge letters were assessed utilising data fields recommended by the Scottish Intercollegiate Guidelines Network (SIGN). A total of 162 consecutive paediatric patient discharges were identified. The mean number of items present in the existing and the new discharge letters were 13.7 + 1.8 and 12.2 + 3 respectively. The new discharge letter met the SIGN guidelines more closely than the existing discharge letter.
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Roberts, Debra E., Robert G. Holloway, and Benjamin P. George. "Post-acute care discharge delays for neurology inpatients." Neurology: Clinical Practice 8, no. 4 (July 16, 2018): 302–10. http://dx.doi.org/10.1212/cpj.0000000000000492.
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BackgroundHospital stays for patients discharged to post-acute care are longer and more costly than routine discharges. Issues disrupting patient flow from hospital to post-acute care facilities are an underrecognized strain on hospital resources. We sought to quantify the burden of medically unnecessary hospital days for inpatients with neurologic illness and planned discharge to post-acute care facilities.MethodsWe conducted a retrospective evaluation of hospital discharge delays for patients with neurologic disease and plans for discharge to post-acute care. We identified 100 sequential hospital admissions to an academic neurology inpatient service that were medically ready for discharge from December 4, 2017, to January 25, 2018. For each patient, we quantified the number of medically unnecessary hospital days, or all days in the hospital following the determination of medical discharge readiness.ResultsAmong 100 patients medically ready for discharge with plans for post-acute care disposition (47 female, mean age 72.5 years, mean length of stay 12.3 days), 50 patients were planned for discharge to skilled nursing, 37 to acute rehabilitation, 10 to hospice/palliative care, and 3 to other facilities. There was a total of 1,226 patient-days, and 480 patient-days (39%) occurred following medical readiness for discharge. Medically unnecessary days ranged from 0 to 80 days per patient (mean 4.8, median 2.5, interquartile range 1–5 days).ConclusionUnnecessary hospital days represent a large burden for patients with neurologic illness requiring post-acute care on discharge. These discharge delays present an opportunity to improve hospital-wide patient flow.
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Baker, Joni, and Cydreese Aebi. "Comparison of readmission data between different categories of antipsychotic drugs at a state psychiatric hospital in Oregon." Mental Health Clinician 7, no. 3 (May 1, 2017): 124–30. http://dx.doi.org/10.9740/mhc.2017.05.124.
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Abstract Introduction: This chart review utilizes readmission rates and mean time to readmission as markers of drug efficacy to compare different categories of long-acting injectable antipsychotics (LAIAs), antipsychotic polypharmacy, and clozapine to oral antipsychotic monotherapy (OM) at a state psychiatric hospital in Oregon (Oregon State Hospital). Methods: Charts were reviewed for patients discharged between October 20, 2011, and September 23, 2015, with a diagnosis of schizophrenia spectrum or mood disorder. Admission dates, discharge dates, and discharge antipsychotics were reviewed for each patient dating back to 1991. Discharge antipsychotics were categorized into groupings of LAIAs, antipsychotic polypharmacy, and clozapine and compared with OM to assess readmission data within 1, 3, and 5 years of discharge. The primary end point was readmission rate, measured as a percentage, and the secondary end point was mean time to readmission (MTR), measured in days. Results: Of 1088 patients reviewed, there were 2031 patient discharges associated with antipsychotic agents and 1258 readmissions. Patients discharged on LAIA monotherapy or clozapine generally had a lower readmission rate, and patients discharged on antipsychotic polypharmacy generally had a higher readmission rate. Statistical significance for these findings varied over time frames and subgroup analyses. The most notable finding for the secondary end point was a significantly shorter MTR for patients discharged on clozapine for all diagnoses and the subgroup analysis of schizoaffective disorder. Discussion: These results are only a reflection of the patient population at this hospital, and additional reviews at other facilities with different patient characteristics could clarify applicability to other patient populations.
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Pilcher, D. V., G. J. Duke, C. George, M. J. Bailey, and G. Hart. "After-Hours Discharge from Intensive Care Increases the Risk of Readmission and Death." Anaesthesia and Intensive Care 35, no. 4 (August 2007): 477–85. http://dx.doi.org/10.1177/0310057x0703500403.
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Despite reports showing night discharge from an intensive care unit (ICU) is associated with increased mortality, it is unknown if this has resulted in changes in practice in recent years. Our aim was to determine prevalence, trends and effect on patient outcome of discharge timing from ICU throughout Australia and New Zealand. Two datasets from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD) were examined: 1. All submissions to the APD from 1.1.2003 to 31.12.2004 to determine contemporary practices. 2. Forty hospitals which had submitted continuous data between 1.1.2000 and 31.12.2004 to determine trends in practice over time. Outcomes investigated were hospital mortality and ICU readmission rate. Between 1.1.2003 and 31.12.2004, the ANZICS APD reported 76,690 patients discharged alive from ICU; 13,968 (18.2%) were discharged after-hours (between 1800 and 0559 hours). After-hours discharges had a higher readmission rate (6.3% vs. 5.1%; P= <0.0001) and higher mortality (8.0% vs. 5.3%; P= <0.0001). Peak readmission (8.6%) and mortality rates (9.7%) were seen in patients discharged between 0300 and 0400 hours. After-hours discharge was a predictor of mortality (odds ratio 1.42, 95% confidence interval 1.32-1.52; P= <0.0001) in multivariate analysis. Between 2000 and 2004, after-hours discharges increased (P=0.0015) with seasonal peaks during winter. The risk of death increased as the proportion of patients discharged after-hours rose. After-hours discharge from ICU is associated with increased risk of death and readmission to ICU. It has become more frequent. The risk of death increases as more after-hours discharges occur.
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Ochuko-Emore, M. "Discharge destination of patients from a psychogeriatric unit." European Psychiatry 26, S2 (March 2011): 845. http://dx.doi.org/10.1016/s0924-9338(11)72550-0.
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ObjectivesTo determine the discharge destination of patients admitted to a psychogeriatric unit.MethodsRecords of all patients discharged from an in-patient psychogeriatric unit between 1st July 2009 and 30th June 2010 were examined. The diagnosis, residence at admission, length of stay and discharge destination were recorded.ResultsThere were ninety-four discharges over the study period. Four of the patients were admitted and discharged twice. The mean age was 76.7 years (range 65–95 years). 52.1% (n = 49) were diagnosed with dementia and 47.9% (n = 45) with functional mental illness. The average length of stay was 67.4 days for dementia compare to 74.2 days for functional mental illness. 17.1% (n = 6/32) of patients with dementia and 84.2% (n = 32/38) of patients with functional mental illness resident at home at the time of admission were discharged home.ConclusionThis finding suggests that patients with functional mental illness are more likely to be discharge back to their homes compared with patients with dementia.
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Ghosh, Arnab Kumar, and Said Ibrahim. "4301 Racial/Ethnic variations in discharge destination after inpatient care: A risk-adjusted analysis of a large regional dataset." Journal of Clinical and Translational Science 4, s1 (June 2020): 88–89. http://dx.doi.org/10.1017/cts.2020.278.
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OBJECTIVES/GOALS: While there are many well-documented factors for racial/ethnic variation in discharge destination, less is known about the role hospital processes play. We hypothesize that variation in hospital processes -defined as the patient length of stay (LOS) adjusted for known confounders - explains racial/ethnic variation in discharge destination. METHODS/STUDY POPULATION: Our sample was 176,686 discharges from 165 hospitals in 2014 using the New York State Inpatient Dataset from the Healthcare Cost and Utilization Project, merged with the 2014 American Hospital Association Annual Survey to build a file of inpatient discharges with patient, disease and socio-economic characteristics. We excluded patients under 18 years, those with LOS of zero, those who died, those admitted to critical access hospitals, and patients from hospitals that lacked sufficient number of minority patients. We used a generalized linear mixed effects model to create an in-hospital risk-adjusted LOS by modelling the relationship between the interaction of race and discharge destination and LOS, controlling for known confounders such as patient, disease and between-hospital characteristics. RESULTS/ANTICIPATED RESULTS: Mean age of sample was 56.5 years, 57.3 % female, 54.9% white, 18.9% black and 13.1% Hispanic; 64.3% were discharged home, 15.8% to a skilled nursing or other intermediate care facility, 15.5% to home with home care and 2.4% left against medical advice. The top 3 discharge diagnoses were vaginal delivery (6.3% of discharges), psychosis (4.7%), and major joint replacement (2.9%). In adjusted analysis compared to white patients, black and Hispanic patients did not have an risk of increased LOS after being discharged to non-home destinations vs. discharged home, (black patients, adjusted OR [AOR], 0.97; 95% CI: 0.94-1.00, p = 0.08; Hispanic patients, AOR, 1.01; 95% CI: 0.98 – 1.05, p = 0.5). However, being black compared to white and discharge to non-home destinations significantly increased LOS. DISCUSSION/SIGNIFICANCE OF IMPACT: In this large sample of patients admitted for inpatient care in 2014 in New York, we found no independent effect between race and discharge destination on a patient’s LOS after controlling for patient, disease and between-hospital characteristics. However race/ethnicity increased LOS, suggesting its effect may play a role on in-hospital processes CONFLICT OF INTEREST DESCRIPTION: Dr. Ghosh has no relevant relationships with commercial interests to disclose Dr. Ibrahim has no relevant relationships with commercial interests to disclose
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Kirk, Elinor, M. K. Prasad, and Ahmed H. Abdelhafiz. "Hospital Readmissions: Patient, Carer and Clinician Views." Acute Medicine Journal 5, no. 3 (July 1, 2006): 104–7. http://dx.doi.org/10.52964/amja.0142.
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Aim: To explore patients, carers, and clinician views and identify factors, which affect the likelihood of hospital readmission. Methods: A cross sectional retrospective study of adult medical patients readmitted to hospital within 28 days of discharge. Medical and nursing records were reviewed and patients and their carers were interviewed regarding their views about their discharge and readmission. Data were collected regarding demographic, social and medical profiles. Results: Seventy-seven patients were readmitted over a five-week period out of 1289 patients discharged during the previous five weeks, representing a 6% readmission rate. Mean (SD) age of readmitted patients was 71.3 (14.6) years. Forty patients (51.9%) were aged ≥75 and 39 (50.6%) were males. Mean (SD) number of comorbidities was 3.68 (1.82). Mean (SD) number of medications was 7.79 (4.14). Most common reasons for readmission were exacerbation of chronic obstructive pulmonary disease and acute coronary syndrome. Mean (SD) time to readmission was 11.6 (8.2) days. Fifty (64.9%) patients were readmitted within 14 days of discharge. Forty eight (62.3%) patients were readmitted with the same medical condition as their previous discharge. Fifty (64.9%) patients and 45 (66.2%) carers felt that discharge was appropriate. Forty five (58.0%) patients and 44 (57.0%) carers thought that readmission was unavoidable. Clinicians considered 56 (72.7%) discharges appropriate and 55 (71.5%) readmissions unavoidable. A trend towards higher readmission rate among patients ≥ 75 years was noted (7.2% vs 5.1%, p=0.1). Conclusion: Although the majority of discharges are appropriate, up to a third of readmissions may be avoidable in the views of carers, patients and clinicians. Patients and carers should be consulted regarding readiness for discharge before leaving hospital.
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Young, Daniel L., Elizabeth Colantuoni, Lisa Aronson Friedman, Jason Seltzer, Kelly Daley, Binqing Ye, Daniel J. Brotman, and Erik H. Hoyer. "Prediction of Disposition within 48-hours of Hospital Admission Using Patient Mobility Scores." Journal of Hospital Medicine 15, no. 9 (December 18, 2019): 540–43. http://dx.doi.org/10.12788/jhm.3332.
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Delayed hospital discharges for patients needing rehabilitation in a postacute setting can exacerbate hospital-acquired mobility loss, prolong functional recovery, and increase costs. Systematic measurement of patient mobility by nurses early during hospitalization has the potential to help identify which patients are likely to be discharged to a postacute care facility versus home. To test the predictive ability of this approach, a machine learning classification tree method was applied retrospectively to a diverse sample of hospitalized patients (N = 805) using training and validation sets. Compared with patients discharged to home, patients discharged to a postacute facility were older (median, 64 vs 56 years old) and had lower mobility scores at hospital admission (median, 32 vs 41). The final decision tree accurately classified the discharge location for 73% (95%CI:67%-78%) of patients. This study emphasizes the value of systematically measuring mobility in the hospital and provides a simple decision tree to facilitate early discharge planning.
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Cornes, Michael P., Graham Danks, Sanna Elgaddal, Mohammed Jawad, Jayne Tonks, Elisabeth Ries, Clare Ford, and Rousseau Gama. "Early availability of laboratory results increases same day ward discharge rates." Clinical Chemistry and Laboratory Medicine (CCLM) 56, no. 11 (October 25, 2018): 1864–69. http://dx.doi.org/10.1515/cclm-2018-0261.
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Abstract Background: Delayed discharge reduces hospital efficiency and inconveniences patients. Most hospitals discharge in the afternoon, whereas the most common admission time is mid-morning. Consequently, new patients wait for the beds of patients who are fit to be discharged. Earlier discharge may, therefore, improve patient flow. We investigated the impact of early phlebotomy with early availability of laboratory results on patient discharge rates and discharge time. Methods: Discharge rates, discharge time and sample turnaround time were assessed before (1 October 2014 to 31 December 2014) and after (1 October 2015 to 31 December 2015) introduction of earlier phlebotomy with availability of laboratory results prior to the ward rounds on two surgical wards. Results: Following the intervention, over 95% of results were available before 8:30 am in 2015 as compared to less than 1% in 2014. Specimen turnaround times were similar in both study periods. Even after adjustment for age, gender, admission type and length of admission, the same day discharge rate was higher in 2015 compared to 2014 (60% vs. 52%; p<0.002), but time of discharge was unchanged. Conclusions: Early availability of blood results prior to ward rounds increased ward discharges but did not affect discharge time.
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Aslet, MED, DRA Yates, and S. Wasawo. "Improving the day case rate for laparoscopic cholecystectomy via introduction of a dedicated clinical pathway." Journal of Perioperative Practice 30, no. 6 (September 16, 2019): 156–62. http://dx.doi.org/10.1177/1750458919862701.
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Day case laparoscopic cholecystectomy is a safe and economical procedure. However, successful discharge on the same day of the procedure has been difficult to achieve at our institution. This study introduced a standardised anaesthetic pathway aiming to increase same day discharges. This led to an overall increase in same day discharges from 42.0% to 54.1%. When the pathway was fully followed, 71% of patients were discharged on the same day. When the pathway was not followed at all, the same day discharge rate was 0%. Our study successfully demonstrates that small enhancements to perioperative care can accelerate patient recovery and improve same day discharges.
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Shah, Nandi, and Kristen Kulasa. "Diabetes Medication Reconciliation at Hospital Discharge." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A424. http://dx.doi.org/10.1210/jendso/bvab048.866.
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Abstract Background: During hospital discharge, patients are at high risk for medication discrepancies as they transition from hospital to home. This study aims to evaluate the prevalence of medication errors at hospital discharge for diabetes medications in patients who received an endocrinology consultation for diabetes and explore interventions to improve the accuracy of discharge medication reconciliation. Methods: All patients (n=3018) who received an endocrinology consultation for diabetes at a tertiary care medical center from October 2017 to December 2019 were included. A retrospective chart review was performed to collect the following information on each patient: primary service from which the patient was discharged, hospital site, month and year of discharge date, and whether each patient’s medication reconciliation for diabetes medications at hospital discharge was in agreement with the inpatient diabetes team’s recommendations. Patients who were discharged on medications discordant from those recommended by the inpatient diabetes service were subcategorized into three groups: 1) one medication incorrect 2) more than one medication incorrect and 3) the primary service did not notify the consult team of patient’s discharge or request final recommendations for diabetes medications prior to discharge. Based on the findings of this study, an educational intervention was implemented in November 2019 to the Hospital Medicine services regarding diabetes discharge medication reconciliation. Results: Of the 3018 patients who received an endocrinology consultation for diabetes at a tertiary university medical center, 2279 patients (76%) were discharged on correct medications, 165 patients (5%) were discharged with one incorrect medication, 443 patients (15%) were discharged with more than one incorrect medication, and 121 patients (4%) were discharged without final discharge recommendations from the diabetes service. There was no significant variation based on discharging service or month of the year. After an educational intervention was implemented in November 2019 to the Hospital Medicine service on the existence and use of a comprehensive diabetes discharge order set, the percentage of patients discharged on correct medications improved to 92% (11/12 patients) compared to prior 81% (44/54 patients). Conclusion: Despite detailed discharge medication recommendations including patient education detailing the recommended regimen by the endocrinology diabetes service, a significant number of patients were discharged by providers across all services on diabetes medications discrepant with the diabetes service’s recommendations. Educational efforts improved the rate of correct medications at discharge on the Hospital Medicine service, and additional educational interventions with other services may be helpful in improving medication reconciliation accuracy.
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Hall, J. N., J. P. Graham, M. McGowan, and A. H. Cheng. "MP08: What’s the plan?: Improving ED patient discharge communication through patient-centred discharge handouts." CJEM 19, S1 (May 2017): S67—S68. http://dx.doi.org/10.1017/cem.2017.174.
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Introduction: Discharge from the Emergency Department (ED) is a high-risk period for communication failures. Clear verbal and written discharge instructions at patient-level health literacy are fundamental to a safe discharge process. As part of a hospital-wide quality initiative to measure and improve discharge processes, and in response to patient feedback, the St. Michael’s Hospital ED and patient advisors co-designed and implemented patient-centred discharge handouts. Methods: The design and implementation of discharge handouts was based on a collaborative and iterative approach, including stakeholder engagement and patient co-design. Discharge topics were based on the 10 most common historical ED diagnoses. ED patient advisors and the hospital’s plain language review team co-designed and edited materials for readability and comprehension. Process mapping of ED workflow identified opportunities for interventions. Multidisciplinary ED stakeholders co-led implementation, including staff education, training and huddles for feedback. Patient telephone surveys to every 25th patient presenting to the ED meeting the study inclusion criteria (16 years of age or older, directly discharged from the ED, speaks English, has a valid telephone number, and has capacity to consent) were conducted both pre- (June-Sept 2016) and post- (Oct-Dec 2016) implementation. Results: Stakeholder engagement and co-design took place over 10 months. Education was provided across one MD staff meeting, four RN inservices, and at monthly learner orientation. 44846 patients presented to the ED and 25600 met the study inclusion criteria. 935 surveys (response rate=97%; declined n=30) were completed to date. Pre-implementation (n=467), 9.2% (n=43) of patients received printed discharge materials and 71% (n=330) understood symptoms to look for after leaving the ED. Post-implementation (n=468), 44% (n=207) of patients received printed discharge materials with 97% (n=200) finding the handouts helpful and 82% (n=385) understanding symptoms to look for after leaving the ED. Conclusion: Through the introduction of patient co-designed and patient-centred discharge handouts, we have found a marked improvement in patient understanding, and consequently safer discharge practices. Future efforts will focus on optimizing discharge communication, both verbal and written, tailored to individual patient preferences.
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Meo, Nicholas, Joshua M. Liao, and Ashok Reddy. "Hospitalized After Medical Readiness for Discharge: A Multidisciplinary Quality Improvement Initiative to Identify Discharge Barriers in General Medicine Patients." American Journal of Medical Quality 35, no. 1 (May 5, 2019): 23–28. http://dx.doi.org/10.1177/1062860619846559.
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Reducing the length of hospitalization is a shared priority for patients, clinicians, and other health care stakeholders. However, patients can remain hospitalized after being “medically ready” for discharge, accumulating delayed discharge bed days (DDBDs). As part of a quality improvement initiative, the authors developed a method to measure DDBD and define discrete barriers to discharge identified by inpatient clinicians. Patients with delayed discharge had a higher rate of in-hospital complications compared to those who were discharged routinely. To identify modifiable barriers among patients with delayed discharges, 2 patient subgroups were defined: prolonged hospitalization (>19 DDBDs, top quintile accumulated) and extended hospitalization (≤19 DDBDs). Patients with prolonged hospitalization were more likely than those with extended hospitalization to have financial ( P < .001) or behavioral ( P < .001) barriers, homelessness ( P < .05), and impairment of decision-making capacity ( P < .01). Understanding the characteristics and discharge barriers of patients who are hospitalized despite medical readiness may increase appropriateness of inpatient resources.
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Huang, Luke Y. I., Samuel J. Fogarty, Arnold C. T. Ng, and William Y. S. Wang. "Rates and predictors of general practitioner (GP) follow-up postdischarge from a tertiary hospital cardiology unit: a retrospective cohort study." BMJ Open 9, no. 10 (October 2019): e031627. http://dx.doi.org/10.1136/bmjopen-2019-031627.
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ObjectivePrevious studies in cardiac patients noted that early patient follow-up with general practitioners (GPs) after hospital discharge was associated with reduced rates of hospital readmissions. We aimed to identify patient, clinical and hospital factors that may influence GP follow-up of patients discharged from a tertiary cardiology unit.DesignSingle centre retrospective cohort study.SettingAustralian metropolitan tertiary hospital cardiology unit.Participants1079 patients discharged from the hospital cardiology unit within 3 months from May to July 2016.Outcome measuresGP follow-up rates (assessed by telephone communication with patients’ nominated GP practices), demographic, clinical and hospital factors predicting GP follow-up.ResultsWe obtained GP follow-up data on 983 out of 1079 (91.1%) discharges in the study period. Overall, 7, 14 and 30-day GP follow rates were 50.3%, 66.5% and 79.1%, respectively. A number of patient, clinical and hospital factors were associated with early GP follow-up, including pacemaker and defibrillator implantation, older age and having never smoked. Documented recommendation for follow-up in discharge summary was the strongest predictor for 7-day follow-up (p<0.001).ConclusionAfter discharge from a cardiology admission, half of the patients followed up with their GP within 7 days and most patients followed up within 30 days. Patient and hospital factors were associated with GP follow-up rates. Identification of these factors may facilitate prospective interventions to improve early GP follow-up rates.
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Walters, Dustin M., Alykhan S. Nagji, George J. Stukenborg, Melissa R. Peluso, Matthew D. Taylor, Benjamin D. Kozower, Christine L. Lau, and David R. Jones. "Predictors of Hospital Discharge to an Extended Care Facility after Major General Thoracic Surgery." American Surgeon 80, no. 3 (March 2014): 284–89. http://dx.doi.org/10.1177/000313481408000324.
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Failure to anticipate the need to discharge patients to rehabilitation centers and skilled nursing facilities results in expensive delays in the discharge of patients after surgery. Early identification of patients at high risk for discharge to these extended care facilities could mitigate these delays and expenditures. The purpose of this study was to identify preoperative patient factors associated with discharge to extended care facilities after major general thoracic surgery. Discharge records were identified for all patients undergoing major general thoracic surgery admitted to a university hospital between January 2006 and May 2009 who had a stay of longer than one day. The following risk factors were selected a priori based on clinical judgment: age, preoperative albumin, pre-operative Zubrod score, history of peripheral vascular disease, and use of home oxygen. Multiple logistic regression analysis was used to estimate the statistical significance and magnitude of risk associated with each predictor of patient discharge to extended care facilities. Of the 1646 patients identified, 68 (4.1%) were discharged to extended care facilities. Hospital length of stay was on average six days longer for patients discharged to these facilities than for patients discharged home ( P < 0.0001). Multivariate analysis demonstrated that advanced age, lower preoperative albumin, and increased preoperative Zubrod score were statistically significant predictors of discharge to extended care facilities. Age, preoperative nutritional status, and functional status are strong predictors of patient discharge to extended care facilities. Early identification of these patients may improve patient discharge planning and reduce hospital length of stay after major thoracic surgery.
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Wariyapola, C., E. Littlehales, K. Abayasekara, D. Fall, V. Parker, and G. Hatton. "Improving the quality of vascular surgical discharge planning in a hub centre." Annals of The Royal College of Surgeons of England 98, no. 04 (April 1, 2016): 275–79. http://dx.doi.org/10.1308/rcsann.2016.0093.
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Introduction Discharge planning improves patient outcomes, reduces hospital stay and readmission rates, and should involve a multidisciplinary team (MDT) approach. The efficacy of MDT meetings in discharge planning was examined, as well as reasons for delayed discharge among vascular surgical inpatients. Methods Dedicated weekly MDT meetings were held on the vascular ward in Royal Derby Hospital for three months. Each patient was presented to the discharge planning meeting and an expected date of discharge was decided prospectively. Patients who were discharged after this date were considered ‘delayed’ and reasons for delay were explored at the next meeting. Results Overall, 193 patients were included in the study. Of these, 42 patients (22%) had a delayed discharge while 29 (15%) had an early discharge. The main reasons for delay were awaiting beds (30%), social (14%) and medical (45%). In 64%, the cause for delay was avoidable. Two-thirds (67%) of all delays were >24 hours. This totalled 115 bed days, of which 67 could have been avoided. However, 32 bed days were saved by early discharge. This equates to a net loss of 35 bed days, at a net cost of £2,936 per month or £35,235 per year. The MDT meetings also improved the quality of discharge planning; the variability between expected and actual discharge dates decreased after the first month. Conclusions Discharge planning meetings help prepare for patient discharge and are most effective with multidisciplinary input. The majority of delayed discharges from hospital are preventable. The main causes are awaiting transfers, social services input and medical reasons (eg falls). There is an obvious financial incentive to improve discharge planning. The efficiency of the MDT at discharge planning improves with time and this should therefore be continued for best results.
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Kimmel, Lara A., Anne E. Holland, Melissa J. Hart, Elton R. Edwards, Richard S. Page, Raphael Hau, Andrew Bucknill, and Belinda J. Gabbe. "Discharge from the acute hospital: trauma patients’ perceptions of care." Australian Health Review 40, no. 6 (2016): 625. http://dx.doi.org/10.1071/ah15148.
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Objective The involvement of orthopaedic trauma patients in the decision-making regarding discharge destination from the acute hospital and their perceptions of the care following discharge are poorly understood. The aim of the present study was to investigate orthopaedic trauma patient experiences of discharge from the acute hospital and transition back into the community. Methods The present qualitative study performed in-depth interviews, between October 2012 and November 2013, with patients aged 18–64 years with lower limb trauma. Thematic analysis was used to derive important themes. Results Ninety-four patients were interviewed, including 35 discharged to in-patient rehabilitation. Key themes that emerged include variable involvement in decision-making regarding discharge, lack of information and follow-up care on discharge and varying opinions regarding in-patient rehabilitation. Readiness for discharge from in-patient rehabilitation also differed widely among patients, with patients often reporting being ready for discharge before the planned discharge date and feeling frustration at the need to stay in in-patient care. There was also a difference in patients’ perception of the factors leading to recovery, with patients discharged to rehabilitation more commonly reporting external factors, such as rehabilitation providers and physiotherapy. Conclusion The insights provided by the participants in the present study will help us improve our discharge practice, especially the need to address the concerns of inadequate information provision regarding discharge and the role of in-patient rehabilitation. What is known about the topic? There is no current literature describing trauma patient involvement in decision-making regarding discharge from the acute hospital and the perception of how this decision (and destination choice; e.g. home or in-patient rehabilitation) affects their outcome. What does this paper add? The present large qualitative study provides information on patients’ opinion of discharge from the acute hospital following trauma and how this could be improved from their perception. Patients are especially concerned with the lack of information provided to them on discharge, their lack of involvement and understanding of the choices made with regard to their discharge and describe concerns regarding their follow-up care. There is also a feeling from the patients that they are ready to leave rehabilitation before their actual planned discharge date, a concept that needs further investigation. What are the implications for practitioners? The patient insights gained by the present study will lead to a change in discharge practice, including increased involvement of the patient in the decision-making in terms of discharge from both the acute and rehabilitation hospitals and a raised awareness of the need to provide written information and follow-up telephone calls to patients following discharge. Further research into many aspects of patient discharge from the acute hospital should be considered, including the use of rehabilitation prediction tools to ensure patient involvement in decision-making and a discharge and/or follow-up coordinator to ensure patients are aware of how to access information after discharge.
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Emmanuel, A., E. Chohda, C. Botfield, and J. Ellul. "Accelerated discharge within 72 hours of colorectal cancer resection using simple discharge criteria." Annals of The Royal College of Surgeons of England 100, no. 1 (January 2018): 52–56. http://dx.doi.org/10.1308/rcsann.2017.0149.
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Introduction Short hospital stays and accelerated discharge within 72 hours following colorectal cancer resections have not been widely achieved. Series reporting on accelerated discharge involve heterogeneous patient populations and exclude important groups. Strict adherence to some discharge requirements may lead to delays in discharge. The aim of this study was to evaluate the safety and feasibility of accelerated discharge within 72 hours of all elective colorectal cancer resections using simple discharge criteria. Methods Elective colorectal cancer resections performed between August 2009 and December 2015 by a single surgeon were reviewed. Perioperative care was based on an enhanced recovery programme. A set of simplified discharge criteria were used. Outcomes including postoperative complications, readmissions and reoperations were compared between patients discharged within 72 hours and those with a longer postoperative stay. Results Overall, 256 colorectal cancer resections (90% laparoscopic) were performed. The mean patient age was 70.8 years. The median length of stay was 3 days. Fifty-eight per cent of all patients and sixty-three per cent of patients undergoing laparoscopic surgery were discharged within 72 hours. Accelerated discharge was not associated with adverse outcomes compared with delayed discharge. Patients discharged within 72 hours had significantly fewer postoperative complications, readmissions and reoperations. Open surgery and stoma formation were associated with discharge after 72 hours but not age, co-morbidities, neoadjuvant chemoradiation or surgical procedure. Conclusions Accelerated discharge within 72 hours of elective colorectal resection for cancer is safely achievable for the majority of patients without compromising short-term outcomes.
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Hibbert, Geoffrey. "Patient Discharge Criteria." AORN Journal 84, no. 3 (September 2006): 367. http://dx.doi.org/10.1016/s0001-2092(06)63908-2.
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Newman, Kevin. "Patient Discharge Criteria." AORN Journal 84, no. 3 (September 2006): 367. http://dx.doi.org/10.1016/s0001-2092(06)63909-4.
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Shaheen, Kenneth W. "Patient Discharge Instructions." Plastic Surgical Nursing 24, no. 4 (October 2004): 174–75. http://dx.doi.org/10.1097/00006527-200410000-00009.
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Polster, Debra. "Patient discharge information." Nursing 45, no. 5 (May 2015): 42–49. http://dx.doi.org/10.1097/01.nurse.0000463652.55908.75.
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&NA;. "Patient discharge information." Nursing 45, no. 5 (May 2015): 49–50. http://dx.doi.org/10.1097/01.nurse.0000465115.69426.4c.
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Anthony, Mary K., and Diane C. Hudson-Barr. "Successful Patient Discharge." Journal of Nursing Administration 28, no. 3 (March 1998): 48–55. http://dx.doi.org/10.1097/00005110-199803000-00010.
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Ochuko-Emore, M. "Antipsychotics medication on discharge for in-patients with dementia: a one year study." European Psychiatry 26, S2 (March 2011): 493. http://dx.doi.org/10.1016/s0924-9338(11)72200-3.
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IntroductionConcerns regarding the use of antipsychotics in people with dementia have been widely reported. However, there is paucity of studies examining antipsychotics prescribed on discharged from psychogeriatric in-patient units.ObjectivesTo determine the extent and types of antipsychotic medication prescribed for patients with dementia discharged from an in-patient psychogeriatric unit.MethodsThis was a retrospective study. Data from all in-patients with dementia discharged from a psychogeriatric unit between July 2009 and June 2010 were analysed. Antipsychotics administered to patients in the unit and antipsychotics prescribed on discharge were recorded.ResultsDuring the study period, a total of 49 patients with dementia were discharged. Thirty-eight patients (77.6%) received antipsychotic as in-patients; four of these patients (10.5%) had two antipsychotics. Thirty-two patients (65.3%) were discharged on antipsychotic medication with two (6.3%) of the patients on two antipsychotics. Of the antipsychotics prescribed on discharge, 75% were atypical and 25% typical.ConclusionAlmost two third of patients with dementia were discharged from the in-patient psychogeriatric unit on antipsychotic medication. A drive to reduce antipsychotic medication prior to discharge is needed.
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Singh, Sarguni, Megan Eguchi, Sung-Joon Min, and Stacy Fischer. "Outcomes of Patients With Cancer Discharged to a Skilled Nursing Facility After Acute Care Hospitalization." Journal of the National Comprehensive Cancer Network 18, no. 7 (July 2020): 856–65. http://dx.doi.org/10.6004/jnccn.2020.7534.
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Background: After discharge from an acute care hospitalization, patients with cancer may choose to pursue rehabilitative care in a skilled nursing facility (SNF). The objective of this study was to examine receipt of anticancer therapy, death, readmission, and hospice use among patients with cancer who discharge to an SNF compared with those who are functionally able to discharge to home or home with home healthcare in the 6 months after an acute care hospitalization. Methods: A population-based cohort study was conducted using the SEER-Medicare database of patients with stage II–IV colorectal, pancreatic, bladder, or lung cancer who had an acute care hospitalization between 2010 and 2013. A total of 58,770 cases were identified and patient groups of interest were compared descriptively using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Logistic regression was used to compare patient groups, adjusting for covariates. Results: Of patients discharged to an SNF, 21%, 17%, and 2% went on to receive chemotherapy, radiotherapy, and targeted chemotherapy, respectively, compared with 54%, 28%, and 6%, respectively, among patients discharged home. Fifty-six percent of patients discharged to an SNF died within 6 months of their hospitalization compared with 36% discharged home. Thirty-day readmission rates were 29% and 28% for patients discharged to an SNF and home, respectively, and 12% of patients in hospice received <3 days of hospice care before death regardless of their discharge location. Conclusions: Patients with cancer who discharge to an SNF are significantly less likely to receive subsequent oncologic treatment of any kind and have higher mortality compared with patients who discharge to home after an acute care hospitalization. Further research is needed to understand and address patient goals of care before discharge to an SNF.
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Segel, Sally, Jason Hashima, William Thomas Gregory, Alison Edelman, Hong Li, and Jeanne-Marie Guise. "A New Approach to Postpartum Rounds: Patient-Centered Collaborative Care Improves Efficiency." Journal of Graduate Medical Education 2, no. 1 (March 1, 2010): 67–72. http://dx.doi.org/10.4300/jgme-d-09-00060.1.
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Abstract Objective At our institution, traditional postpartum rounds were time consuming and inefficient with a low percentage (approximately 12%) of patients meeting the goal of being discharged by 11:00 am. A patient-centered collaborative care (PCCC) initiative was implemented to improve discharge efficiency, staff communication, and patient satisfaction. We investigated whether this paradigm shift to PCCC could improve clinical inefficiencies and timely discharge. Methods The PCCC rounding system was created by a representative group of physicians, residents, nurses, case managers, and social workers. An intervention study was conducted to examine the impact of PCCC during which physicians, residents, medical students, nurses, case managers, and social workers made rounds together. Efficiency data were collected for patients whose infants were delivered by the obstetric service for a 1-month period before and 6 months after implementing PCCC. Comparisons were made on the time of discharge and whether Foley catheter removal affected discharge time. χ2 test, Wilcoxon 2-sample test, and Pearson correlation coefficient were used where appropriate. Results Three hundred five patients were included in this analysis, of which 156 participated in traditional postpartum rounds and 149 in PCCC rounds. Discharge efficiency significantly improved with PCCC rounds, with 20.8% of patients being discharged by 11:00 am as compared to 11.5% for traditional postpartum rounds (P = .03). Early Foley catheter removal was significantly associated with time to discharge order (Pearson correlation coefficient, 0.22; P = .01) and discharge time (Pearson correlation coefficient, 0.28; P = .002). Conclusions Patient-centered collaborative care rounds improve the efficiency of postpartum care and discharge time.
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Barone, James E. "Does Fever at the Time of Discharge Have Any Impact on the Incidence of Readmission?" American Surgeon 74, no. 12 (December 2008): 1151–53. http://dx.doi.org/10.1177/000313480807401204.
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Most physicians believe that patients who have fever within 24 hours of the planned date of discharge should be kept in the hospital until the fever resolves. A search of the literature revealed very few articles addressing this topic. The object of this study was to review a number of patient discharges from the surgical service and to document the presence or absence of fever within 24 hours of the time of discharge. The primary end point of the study was to determine the rate of readmission for both patients discharged with fever and those discharged without fever. Secondary end points were to determine whether the readmission was related to the original discharge diagnosis or the presence of fever at the time of discharge. The records of all adult patients with a hospital length of stay of ≥5 days discharged from the surgical and gynecology services from April through July of 2007 were reviewed. Deaths were excluded. The following data elements were recorded: primary discharge diagnosis; age; highest recorded temperature within 24 hours of discharge; date time and cause of readmission within 30 days; and outcome. Fever was defined as a temperature of ≥100° F. Data were entered into an Excel (Microsoft, Redmond, WA) spreadsheet, and statistical analysis was performed using χ2 and Fisher's exact tests using Primer of Biostatistics© (McGraw-Hill, New York, NY). The records of 300 consecutive patients were reviewed. Follow-up was available for 86.7 per cent of the patients, 84.4 per cent of the febrile patients, and 87.1 per cent of the nonfebrile patients. A fever of ≥100° within 24 hours of discharge was noted in 45 (15.0%) patients. The mean fever was 100.5°, with a range of 100° to 102.1°. There were 38 readmissions. Of the 45 patients with fever, seven (15.6%) were readmitted. Of those seven, four readmissions were related to the previous admitting diagnosis. Of the patients who were discharged without fever, 31 (12.2%) were readmitted with 24 of those read-missions for diagnoses related to the first admission. The rate of readmission for fever and nonfever patients was not statistically significantly different (P = 0.697). Similarly, the rate of related versus nonrelated diagnoses in both the fever and nonfever groups was not statistically significantly different (P = 0.351). The presence or absence of fever within 24 hours of patient discharge seems to have no impact on the rate of readmission within 30 days.
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Crilly, Richard G., Sonya Lylwynec, Marita Kloseck, Jan M. Smith, Tyler Olsen, Bill Gold, and Shelley Masse. "Patient Outcomes after Discharge from a Geriatric Day Hospital." Canadian Journal on Aging / La Revue canadienne du vieillissement 24, no. 3 (2005): 305–9. http://dx.doi.org/10.1353/cja.2005.0076.
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ABSTRACTEvidence suggests that frailer older patients benefit from a continuum of care rather than the admit/discharge model of our health system. This study examined patient outcomes after discharge from a geriatric day hospital (GDH) to determine what proportion continues to do well, what proportion declines, how the two groups differ, and if factors predictive of deterioration can be identified. Using telephone survey and Goal Attainment Scaling methodologies, the goals of 151 patients discharged from a GDH between 6 and 18 months previously were examined to determine whether GDH achievements were maintained or lost. All but 5 patients improved between GDH admission and discharge; after discharge, 39 per cent deteriorated. The need for more support in the community was predictive of deterioration, probably reflecting patient frailty. Number of medical diagnoses or medications were not predictive. Frailer older patients tend not to maintain goals achieved in a GDH after discharge and may benefit from ongoing maintenance.
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Choudhary, Voleti, G. Chandrashekar, Pranav K. Subaraya, S. V. Satheesh, Sri Krishna, and Michael Rakoff. "Electronic Discharge Summary to Speed Patient Discharge." American Journal of Medical Quality 26, no. 3 (March 7, 2011): 241–42. http://dx.doi.org/10.1177/1062860610391647.
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Barnes, Sean, Eric Hamrock, Matthew Toerper, Sauleh Siddiqui, and Scott Levin. "Real-time prediction of inpatient length of stay for discharge prioritization." Journal of the American Medical Informatics Association 23, e1 (August 7, 2015): e2-e10. http://dx.doi.org/10.1093/jamia/ocv106.
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Abstract Objective Hospitals are challenged to provide timely patient care while maintaining high resource utilization. This has prompted hospital initiatives to increase patient flow and minimize nonvalue added care time. Real-time demand capacity management (RTDC) is one such initiative whereby clinicians convene each morning to predict patients able to leave the same day and prioritize their remaining tasks for early discharge. Our objective is to automate and improve these discharge predictions by applying supervised machine learning methods to readily available health information. Materials and Methods The authors use supervised machine learning methods to predict patients’ likelihood of discharge by 2 p.m. and by midnight each day for an inpatient medical unit. Using data collected over 8000 patient stays and 20 000 patient days, the predictive performance of the model is compared to clinicians using sensitivity, specificity, Youden’s Index (i.e., sensitivity + specificity – 1), and aggregate accuracy measures. Results The model compared to clinician predictions demonstrated significantly higher sensitivity ( P < .01), lower specificity ( P < .01), and a comparable Youden Index ( P > .10). Early discharges were less predictable than midnight discharges. The model was more accurate than clinicians in predicting the total number of daily discharges and capable of ranking patients closest to future discharge. Conclusions There is potential to use readily available health information to predict daily patient discharges with accuracies comparable to clinician predictions. This approach may be used to automate and support daily RTDC predictions aimed at improving patient flow.
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Jiang, Yongwen, Samara Viner-Brown, and Rosa Baier. "Burden of Hospital-Onset Clostridium difficile Infection in Patients Discharged from Rhode Island Hospitals, 2010–2011: Application of Present on Admission Indicators." Infection Control & Hospital Epidemiology 34, no. 7 (July 2013): 700–708. http://dx.doi.org/10.1086/670993.
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Objective.The year 2010 is the first time that the Rhode Island hospital discharge database included present on admission (POA) indicators, which give us the opportunity to distinguish cases of hospital-onset Clostridium difficile infection (CDI) from cases of community-onset CDI and to assess the burden of hospital-onset CDI in patients discharged from Rhode Island hospitals during 2010 and 2011.Design.Observational study.Patients.Patients 18 years of age or older discharged from one of Rhode Island's 11 acute-care hospitals between January 1, 2010, and December 31, 2011.Methods.Using the newly available POA indicators in the Rhode Island 2010 and 2011 hospital discharge database, we identified patients with hospital-onset CDI and without CDI. Adjusting for patient demographic and clinical characteristics using propensity score matching, we measured between-group differences in mortality, length of stay, and cost for patients with hospital-onset CDI and without CDI.Results.In 2010 and 2011, the 11 acute-care hospitals in Rhode Island had 225,999 discharges. Of 4,531 discharged patients with CDI (2.0% of all discharges), 1,211 (26.7%) had hospital-onset CDI. After adjusting for patient demographic and clinical characteristics, discharged patients with hospital-onset CDI were found to have higher mortality rates, longer lengths of stay, and higher costs than those without CDI.Conclusions.Our results highlight the burden of hospital-onset CDI in Rhode Island. These findings emphasize the need to track longitudinal trends to tailor and target population-health and quality-improvement initiatives.
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Turner, Matthew, Shaun Love, Fergus Douds, and Anyssa Zebda. "Audit of follow-up within 7 days on discharge from the mental health unit, Forth Valley Royal Hospital." BJPsych Open 7, S1 (June 2021): S225—S226. http://dx.doi.org/10.1192/bjo.2021.602.
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AimsTo determine compliance with the new discharge policy of review within 7-days for all General Adult Psychiatry patients discharged from Forth Valley Royal Hospital.BackgroundIt is well established that there is an increased risk of suicide following discharge from Inpatient Psychiatric Wards. This risk is significantly increased in the first month, and particularly high in the first week.In their 2016 Guidance, NICE recommends follow-up within 7 days of discharge. It is not known whether seven day follow-up reduces suicide risk but it is clearly an opportunity for risk assessment and management during a particularly risky period.This standard was adopted by the General Adult Wards in Mental Health Unit at Forth Valley Royal Hospital in April 2019.MethodAll discharges from Wards 1, 2 and 3, Forth Valley Royal Hospital were reviewed during three distinct, month-long periods:November 2018 (prior to the introduction of the new discharge policy)May 2019 (shortly after the introduction of the new discharge policy)September 2019 (six months after the introduction of the new discharge policy)A list was obtained from Medical Records of all General Adult patients discharged in these periods. The paper and electronic records were checked for each patient, and the first scheduled care episode post discharge was taken as follow-up.ResultIn the1st round of audit (November 2018): 41 patients were discharged and 26 patients (64%) received follow-up within 7 days.In the 2nd round of audit (May 2019): 46 patients were discharged, 39 patients (84%) received follow-up within 7 days.In the 3rd round of the audit (September 2019), 50 patients were discharged and 49 (98%) received follow-up within 7 days.ConclusionThere has been a clear improvement in the provision of follow-up on discharge from the General Adult Psychiatry Wards in Forth Valley Royal Hospital.The new discharge policy was implemented in April 2019 and a “Discharge Pause” was introduced (initially a sticker, now an electronic form) to be completed by the medical team at the point when it was decided to discharge.Community Mental Health Teams have also been reminded of their need to facilitate seven day follow-up as a priority. A flowchart was produced in May 2019, which provided guidance as to who should provide the seven day follow-up.
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Kable, Ashley, Dimity Pond, Carolyn Hullick, Lynnette Chenoweth, Anne Duggan, John Attia, and Christopher Oldmeadow. "An evaluation of discharge documentation for people with dementia discharged home from hospital – A cross-sectional pilot study." Dementia 18, no. 5 (September 6, 2017): 1764–76. http://dx.doi.org/10.1177/1471301217728845.
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This study evaluated discharge documentation for people with dementia who were discharged home, against expected discharge criteria and determined relationships between compliance scores and outcomes. This cross-sectional study audited discharge documentation and conducted a post discharge survey of carers. There were 73 eligible discharges and clinically significant documentation deficits for people with dementia included: risk assessments of confusion (48%), falls and pressure injury (56%); provision of medication dose-decision aids (53%), provision of contact information for patient support groups (6%) and advance care planning (9%). There was no significant relationship between compliance scores and outcomes. Carer strain was reported to be high for many carers. People with dementia and their carers are more vulnerable and at higher risk of poor outcomes after discharge. There are opportunities for improved provision of medications and risk assessment for people with dementia, provision of information for patient support groups and advanced care planning.
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Ladani, Sonal, Mohammed AbouDaya, William Thornhill, and Nanna Christiansen. "P26 Pharmacy discharge service to facilitate early discharges and to improve the quality of electronic discharge letters (EDL’s)." Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e19.2-e20. http://dx.doi.org/10.1136/archdischild-2020-nppg.35.
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AimThe current discharge process on the paediatric wards involves transcribing medications from one electronic system to another, this has led to errors and compromises patient safety. Discharges are also sometimes delayed due to patients waiting for their medications. The newly implemented discharge service involves pharmacists working closely with the medical team to identify patients for discharge as early as possible and to accurately transcribe medications onto the electronic patient record (EPR).MethodThe pharmacist would attend the consultant-led morning handover or would liaise with the nurse in charge on the ward to establish discharges and transfers for that day or over the weekend if on a Friday. The most urgent discharges and any complex patients were prioritised. The EPR system would be used to generate the EDL’s, transcribe the medicines for discharge and add any other relevant written information. Any medication related issues would be clarified with the medical team. The prescription would be handed over to the medical team to be reviewed and signed. This would then be dispensed and checked by the pharmacy team. The patient/parent or carer would be counselled on their medications. Data was collected from November 2018 – March 2019, this included time informed about discharge, time EDL started, time EDL printed and time EDL completed. Other data collected included if any additional written information was provided to the GP and if any amendments were required after the doctor had reviewed the prescription. The data was inputted into an Excel spreadsheet and was compared against August – October 2018.Results152 discharge prescriptions were included in the service. The data was compared to the data from August – October 2018 which showed more than double of the prescriptions were completed in the morning between 9am-12noon (compared to 12noon-5.30pm) since the service started. Less prescription needed amendments at the point of screening and more prescriptions included additional medication related information. The quality of the prescriptions had improved and completing prescriptions earlier meant timely discharges, improved bed utilisation and improved patient quality. Positive feedback was given by patients, doctors and nurses as well as the rest of the ward teams.ConclusionCommunication has improved between the hospital and community care, as well as patient satisfaction and bed availability. A future development would be to introduce prescribing pharmacists within medical teams to streamline the discharge prescription process further, freeing up medical time and increasing the focus on medicines optimisation for all patients.
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Steuart, Rebecca, Rachel Tan, Katherine Melink, Sofia Chinchilla, Amanda Warniment, Samir S. Shah, and Joanna Thomson. "Discharge Before Return to Respiratory Baseline in Children with Neurologic Impairment." Journal of Hospital Medicine 15, no. 9 (May 20, 2020): 531–37. http://dx.doi.org/10.12788/jhm.3394.
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BACKGROUND: Children with neurologic impairment (NI) are commonly hospitalized with acute respiratory infections (ARI). These children frequently require respiratory support at baseline and are often discharged before return to respiratory baseline. OBJECTIVE: To determine if discharge before return to respiratory baseline is associated with reutilization among children with NI hospitalized with ARI. METHODS: This single-center retrospective cohort study included children with NI aged 1 to 18 years hospitalized with ARI who required increased respiratory support between January 2010 and September 2015. The primary exposure was discharge before return to respiratory baseline. The primary outcome was 30-day hospital reutilization. A generalized estimating equation was used to examine the association between exposure and outcome while accounting for within-patient clustering and patient-level clinical complexity and illness severity. RESULTS: In the 632 hospitalizations experienced by 366 children, children were discharged before return to respiratory baseline in 30.4% of hospitalizations. Compared with those hospitalizations in which children were discharged at baseline, hospitalizations with a discharge before return to respiratory baseline were more likely to be for privately insured, technology-dependent children with respiratory comorbidities. Compared with discharges at respiratory baseline, discharges with increased respiratory support had no difference in 30-day reutilization (32.8% vs 31.8%; P = .81; adjusted OR 0.80, 95% CI 0.51-1.26). CONCLUSIONS: Among children with NI hospitalized with ARI, discharge before return to respiratory baseline was common, but it was not associated with hospital reutilization. Return to respiratory baseline may not be a necessary component of discharge criteria in this population.
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Gouge, Catherine C. "Improving Patient Discharge Communication." Journal of Technical Writing and Communication 47, no. 4 (May 4, 2016): 419–39. http://dx.doi.org/10.1177/0047281616646749.
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Transitional care communication events—such as discharge from hospital—are complex and dynamic: impromptu questions are asked and answered, documents are discussed and signed, and health-care professionals and patients with different knowledge must work together to establish understanding. This article examines a set of patient discharge instructions that bear substantial traces of impromptu conversation in the patient discharge communication process and argues that we need to do more to account for such exchanges as a part of the complex information our documentation must coordinate and make accessible for end users.
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Steel, Peter A. D., David Bodnar, Maryellen Bonito, Jane Torres-Lavoro, Dona Bou Eid, Andrew Jacobowitz, Amos Shemesh, et al. "MyEDCare: Evaluation of a Smartphone-Based Emergency Department Discharge Process." Applied Clinical Informatics 12, no. 02 (March 2021): 362–71. http://dx.doi.org/10.1055/s-0041-1729165.
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Abstract Background Poor comprehension and low compliance with post-ED (emergency department) care plans increase the risk of unscheduled ED return visits and adverse outcomes. Despite the growth of personal health records to support transitions of care, technological innovation's focus on the ED discharge process has been limited. Recent literature suggests that digital communication incorporated into post-ED care can improve patient satisfaction and care quality. Objectives We evaluated the feasibility of utilizing MyEDCare, a text message and smartphone-based electronic ED discharge process at two urban EDs. Methods MyEDCare sends text messages to patients' smartphones at the time of discharge, containing a hyperlink to a Health Insurance Portability and Accountability Act (HIPAA)-compliant website, to deliver patient-specific ED discharge instructions. Content includes information on therapeutics, new medications, outpatient care scheduling, return precautions, as well as results of laboratory and radiological diagnostic testing performed in the ED. Three text messages are sent to patients: at the time of ED discharge with the nurse assistance for initial access of content, as well as 2 and 29 days after ED discharge. MyEDCare was piloted in a 9-month pilot period in 2019 at two urban EDs in an academic medical center. We evaluated ED return visits, ED staff satisfaction, and patient satisfaction using ED Consumer Assessment of Healthcare Providers and Systems (ED-CAHPS) patient satisfaction scores. Results MyEDCare enrolled 27,713 patients discharged from the two EDs, accounting for 43% of treat-and-release ED patients. Of the treat-and-release patients, 27% completed MyEDCare discharge process, accessing the online content at the time of ED discharge. Patients discharged via MyEDCare had fewer 72-hour, 9-day, and 30-day unscheduled return ED visits and reported higher satisfaction related to nursing care. Conclusion EDs and urgent care facilities may consider developing a HIPAA-compliant, text message, and smartphone-based discharge process, including the transmission of test results, to improve patient-centered outcomes.
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Emma, Barbour, Collins Catherine, and Mclister Niamh. "P09 ‘there’s no place like home’: reducing paediatric discharge steps." Archives of Disease in Childhood 103, no. 2 (January 19, 2018): e1.13-e1. http://dx.doi.org/10.1136/archdischild-2017-314584.20.
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AimTo determine the efficiency of dispensing paediatric discharges at dispensary vs ward level.MethodA data collection form was designed for use during a two-phase audit. During the first week of data collection, the turnaround time of dispensing discharges in the dispensary was collected. In the second week, the turnaround time of dispensing discharges at ward level on the paediatric ward was recorded.The dispensary standard of a 60 min turnaround for medium priority discharges1 was used for both weeks. Medical, surgical and ENT prescriptions were all included in the audit.ResultsInformation relating to 23 discharges was collected during week one at dispensary level. In week 2, 21 discharges were assessed.When assessing the minimum and maximum time taken from when a patient was informed of their discharge to medications being given, there was a reduction of 98 min when completed at ward level for minimum time and 75 min for the maximum time.The average turnaround time for dispensing prescriptions was 94 min at dispensary level and 26 min at ward level. Only 57% of discharges completed in the dispensary met the standard turnaround time of 60 min compared to 100% completed at ward level. Discharge prescription turnaround time was decreased by 72% when completed at ward level.In total sixteen discharge steps were identified using the traditional dispensary based method for discharges. These ranged from the patient being told they can go home on the ward round to the prescription being written and sent to pharmacy, and finally returned to the ward for transfer to the patient.The process of dispensing discharges at ward level enabled a reduction of 50% of the sixteen steps, subsequently expediting the discharge process.ConclusionWhen discharges were completed at ward level standards were met 100% of the time and a reduction in eight discharge steps was accomplished. Thus highlighting that a ward level dispensing service is necessary on the paediatric ward in this District General Hospital.ReferenceWallace K. Prescription Tracker System (PTS). Patient services District General Hospital2014.
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Wilcock, Michael, and Sally Miles. "UK hospital patient discharge." European Journal of Hospital Pharmacy 24, no. 6 (October 26, 2017): 370. http://dx.doi.org/10.1136/ejhpharm-2017-001419.
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Lees, Liz. "Estimating patient discharge dates." Nursing Management 15, no. 3 (June 2008): 30–35. http://dx.doi.org/10.7748/nm2008.06.15.3.30.c8213.
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Epstein, Andrew S., Anjali V. Desai, and Leonard Saltz. "Effect of discharge to subacute rehabilitation (SAR) on hospitalized patients with progressive gastrointestinal (GI) cancer." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 41. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.41.
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41 Background: SAR may be an alternative when hospice is declined. However, the outcomes of discharges to SAR in cancer patients with progressive (chemotherapy-refractory) disease are not known. We examined the characteristics and outcomes of patients with debility from progressive metastatic GI cancer who were discharged to SAR after an admission to our center. Methods: An institutional electronic database was queried to identify patients of the GI medical oncology service of Memorial Sloan Kettering Cancer Center who had been discharged to a SAR facility. Patient exclusion criteria were: incomplete follow-up, non-metastatic cancer, low grade neuroendocrine tumors, patients receiving first-line chemotherapy or with newly diagnosed cancer awaiting planned chemotherapy, patients off treatment with a remote history of metastatic cancer, and a primary admitting diagnosis representing an acute complication of cancer treatment. Results: From 2008-2014, 22 patients meeting criteria were identified. Median overall survival from the time of discharge to SAR was 0.8 months (range 0.2-5.2 months). Of the 22 patients, 7 (32%) died at the SAR. Twelve (55%) and 19 (86%) died within 1 and 3 months of discharge to SAR, respectively. For 7 patients (32%), documentation indicated that hospice, instead of SAR, had been recommended by clinicians but declined by family. Nine patients (41%) ultimately were transitioned to hospice within 3 months of discharge to SAR. Eight (36%) were readmitted to hospital within 1 month of discharge to SAR. Two (9%) were able to follow up with their medical oncologist for an outpatient appointment after discharge to SAR. None of the 22 patients received further chemotherapy after discharge to SAR. Conclusions: SAR is not a productive alternative to hospice in hospice-eligible patients with GI malignancies.In patients with metastatic GI cancers whose diseases had progressed beyond first-line therapy and who were hospitalized for reasons other than acute reversible toxicity, discharges to SAR were not associated with either prolonged survival or resumption of chemotherapy. These data can help inform decisions and establish goals of care in advanced GI cancer patients.
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Donzé, Jacques D., Stuart Lipsitz, and Jeffrey L. Schnipper. "Risk Factors and Patterns of Potentially Avoidable Readmission in Patients With Cancer." Journal of Oncology Practice 13, no. 1 (January 2017): e68-e76. http://dx.doi.org/10.1200/jop.2016.011445.
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Purpose: Patients with cancer are particularly at risk for readmission within 30-days after discharge. To identify the patients who might benefit from more-intensive discharge interventions, we identified the risk factors associated with 30-day potentially avoidable readmissions. Methods and Materials: We included all consecutive discharges from the oncology division of an academic tertiary medical center in Boston, Massachusetts, between July 1, 2009, and June 30, 2010. Potentially avoidable 30-day readmissions to the index hospital and two other hospitals within its network were identified. We performed a multivariable logistic regression in which the final model included variables found in bivariable testing to be significantly associated with the outcome. Results: Among the 2,916 patients discharged during the study period, 1,086 (37.3%) were readmitted within 30 days. Of these, 341 (31.4% of all readmissions, 11.7% of all discharges) were identified as potentially avoidable. In the multivariable analysis, the following patient factors were associated with a significantly higher risk of a potentially avoidable readmission: total number of medications at discharge, liver disease, last sodium level, and last hemoglobin level before discharge. In addition, potentially avoidable readmissions occurred significantly earlier than unavoidable readmissions (median, 10 v 13 days; P < .001). Conclusion: Almost 40% of patients with cancer had a 30-day readmission, and almost one third of these were deemed potentially avoidable, and several risk factors for this were identified. Interventions at discharge may be prioritized to patients with these risk factors.
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Heale, Patricia A. "Pathway to Patient Discharge Through Multidisciplinary Discharge Rounds." Journal of Obstetric, Gynecologic & Neonatal Nursing 48, no. 3 (June 2019): S49. http://dx.doi.org/10.1016/j.jogn.2019.04.084.
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Hoang, R., K. Sampsel, A. Willmore, K. Yelle-Labre, V. Thiruganasambandamoorthy, and L. Calder. "P085: Remember that patient you saw last week – Characteristics of patients experiencing unanticipated death following emergency department discharge." CJEM 22, S1 (May 2020): S95. http://dx.doi.org/10.1017/cem.2020.291.
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Background: The emergency department (ED) is an at-risk area for medical error. We measured the frequency and characteristics of patients with unanticipated death within 7 days of ED discharge and whether medical error contributed. Aim Statement: This study aimed to calculate the frequency of patients experiencing death within 7 days after ED discharge and determine whether these deaths were related to their index ED visit, were unanticipated, and whether possible medical error occurred. Measures & Design: We performed a single-centre health records review of 200 consecutive cases from an eligible 458,634 ED visits from 2014-2017 in two urban, academic, tertiary care EDs. We included patients evaluated by an emergency physician who were discharged and died within 7 days. Three trained and blinded reviewers determined if deaths were related to the index visit, anticipated or unanticipated, or due to potential medical error. Reviewers performed content analysis to identify themes. Evaluation/Results: Of the 200 cases, 129 had sufficient information for analysis, translating to 44 deaths per 100,000 ED discharges. We found 13 cases per 100,000 ED discharges were related and unanticipated deaths and 18 of these were due to potential medical errors. Over half (52.7%) of 129 patients displayed abnormal vital signs at discharge. Patients experienced pneumonia (27.1%) as their most common cause of death. Patient characteristic themes were: difficult historian, multiple complaints, multiple comorbidities, acute progression of chronic disease, recurrent falls. Provider themes were: failure to consider infectious etiology, failure to admit high-risk elderly patient, missed diagnosis. System themes included multiple ED visits or recent admission, no repeat vital signs recorded. Discussion/Impact: Though the frequency of related and unanticipated deaths and those due to medical error was low, these results highlight opportunities to potentially enhance ED discharge decisions. These data add to the growing body of ED diagnostic error literature and emphasize the importance of identifying potentially high risk patients as well as being cognizant of the common medical errors leading to patient harm.
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Krishna, Lalit Kumar Radha, Sumytra Menon, and Ravindran Kanesvaran. "Applying the welfare model to at-own-risk discharges." Nursing Ethics 24, no. 5 (December 16, 2015): 525–37. http://dx.doi.org/10.1177/0969733015617340.
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“At-own-risk discharges” or “self-discharges” evidences an irretrievable breakdown in the patient–clinician relationship when patients leave care facilities before completion of medical treatment and against medical advice. Dissolution of the therapeutic relationship terminates the physician’s duty of care and professional liability with respect to care of the patient. Acquiescence of an at-own-risk discharge by the clinician is seen as respecting patient autonomy. The validity of such requests pivot on the assumptions that the patient is fully informed and competent to invoke an at-own-risk discharge and that care up to the point of the at-own-risk discharge meets prevailing clinical standards. Palliative care’s use of a multidisciplinary team approach challenges both these assumptions. First by establishing multiple independent therapeutic relations between professionals in the multidisciplinary team and the patient who persists despite an at-own-risk discharge. These enduring therapeutic relationships negate the suggestion that no duty of care is owed the patient. Second, the continued employ of collusion, familial determinations, and the circumnavigation of direct patient involvement in family-centric societies compromises the patient’s decision-making capacity and raises questions as to the patient’s decision-making capacity and their ability to assume responsibility for the repercussions of invoking an at-own-risk discharge. With the validity of at-own-risk discharge request in question and the welfare and patient interest at stake, an alternative approach to assessing at-own-risk discharge requests are called for. The welfare model circumnavigates these concerns and preserves the patient’s welfare through the employ of a multidisciplinary team guided holistic appraisal of the patient’s specific situation that is informed by clinical and institutional standards and evidenced-based practice. The welfare model provides a robust decision-making framework for assessing the validity of at-own-risk discharge requests on a case-by-case basis.