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BMJ Open Jun 2019To understand how different outcomes are achieved from adult patients receiving hospital discharge letters from inpatient and outpatient settings. (Review)
Review
OBJECTIVE
To understand how different outcomes are achieved from adult patients receiving hospital discharge letters from inpatient and outpatient settings.
DESIGN
Realist review conducted in six main steps: (1) development of initial theory, (2) searching, (3) screening and selection, (4) data extraction and analysis, (5) data synthesis and (6) programme theory (PT) refinement.
ELIGIBILITY CRITERIA
Documents reporting evidence that met criteria for relevance to the PT. Documents relating solely to mental health or children aged <18 years were excluded.
ANALYSIS
Data were extracted and analysed using a realist logic of analysis. Texts were coded for concepts relating to context, mechanism, outcome configurations (CMOCs) for the intervention of patients receiving discharge letters. All outcomes were considered. Based on evidence and our judgement, CMOCs were labelled 'positive' or 'negative' in order to clearly distinguish between contexts where the intervention does and does not work.
RESULTS
3113 documents were screened and 103 were included. Stakeholders contributed to refining the PT in step 6. The final PT included 48 CMOCs for how outcomes are affected by patients receiving discharge letters. 'Patient choice' emerged as a key influencer to the success (or not) of the intervention. Important contexts were identified for both 'positive' CMOCs (eg, no new information in letter) and 'negative' CMOCs (eg, letter sent without verifying patient contact details). Two key findings were that patient understanding is possibly greater than clinicians perceive, and that patients tend to express strong preference for receiving letters. Clinician concerns emerged as a barrier to wider sharing of discharge letters with patients, which may need to be addressed through organisational policies and direction.
CONCLUSIONS
This review forms a starting point for explaining outcomes associated with whether or not patients receive discharge letters. It suggests several ways in which current processes might be modified to support improved practice and patient experience.
Topics: Communication; Delivery of Health Care; Humans; Patient Discharge; Quality Improvement
PubMed: 31182447
DOI: 10.1136/bmjopen-2018-027588 -
Journal For Healthcare Quality :... 2020Patients discharged against medical advice (AMA) have disproportionately high health care costs and increased morbidity, mortality, and hospital readmissions. Although...
BACKGROUND
Patients discharged against medical advice (AMA) have disproportionately high health care costs and increased morbidity, mortality, and hospital readmissions. Although patient risk factors for discharge AMA are known, there are little data regarding physician discharge practices surrounding AMA discharges.
METHODS
We performed a cross-sectional analysis of patients discharged AMA from a large, urban, academic medical center. Our study predictors included patient demographics and admission characteristics: primary service team, time of discharge, documentation of anticipated AMA discharge, and length of stay. The primary outcomes were physician discharge practices including a scheduled follow-up appointment, documentation of informed consent, documentation of a risk/benefit discussion, and notification of the attending physician. Our coprimary outcome was the incidence of 30-day hospital readmission.
RESULTS
Among AMA discharges, 33% had follow-up appointments scheduled upon discharge. There was documentation of a risk/benefit discussion (69%), informed consent (63%), and notification of the attending physician (72%) in most discharges. Physician discharge practices were not associated with 30-day hospital readmission.
CONCLUSIONS
Adherence to discharge best practices in AMA discharges was inconsistent and suboptimal, particularly for scheduling follow-up appointments, but was not associated with hospital readmission. Our results highlight the difficulty in facilitating safe transitions of care for patients discharged AMA.
Topics: Academic Medical Centers; Adult; Aged; Attitude of Health Personnel; Cross-Sectional Studies; Female; Guideline Adherence; Humans; Male; Middle Aged; New York City; Patient Discharge; Patient Readmission; Physicians; Retrospective Studies; Risk Factors; Treatment Refusal
PubMed: 31688424
DOI: 10.1097/JHQ.0000000000000227 -
General Hospital Psychiatry 2018The therapeutic discharge of patients assessed as misrepresenting suicidal ideation, though in the best interests of the patient, physician, and health care system, is... (Review)
Review
OBJECTIVE
The therapeutic discharge of patients assessed as misrepresenting suicidal ideation, though in the best interests of the patient, physician, and health care system, is an inherently risk-assuming action. The rationale and conduct of the therapeutic discharge has been written on previously. Here, we propose a method of documenting the therapeutic discharge in a way that is useful and teachable.
METHOD
After describing some other types of note-writing that can be needed in the care of deceptive patients, we describe an approach to each of the major sections of an initial consultation/encounter note as it applies to the therapeutic discharge.
RESULTS
Each note section is handled slightly differently than ordinarily. The history of present illness follows the sequence, rather than the re-organization of the information obtained. The past medical history requires and reflects a more granular chart review than is usually warranted. The mental status exam is less cross-sectional than usual. The assessment and plan incorporates several components that reflect a reasoning process specific to the therapeutic discharge.
CONCLUSION
While labor-intensive, the documentation approach advocated for and exemplified here reaffirms aspects of one's identity as a physician, ensures responsible execution of a risk-involving decision, and potentially simplifies subsequent patient encounters.
Topics: Documentation; Humans; Malingering; Mental Disorders; Patient Discharge; Suicidal Ideation
PubMed: 29309988
DOI: 10.1016/j.genhosppsych.2017.12.007 -
British Journal of Community Nursing Apr 2021Over the past 30 years, the Government has been promoting the transition of care from the acute setting to the community setting. Within the community setting, district... (Review)
Review
Over the past 30 years, the Government has been promoting the transition of care from the acute setting to the community setting. Within the community setting, district nurses are described in the latest reports as endorsers of the care close to home. However, with the surge in hospital discharge, the district nursing workforce is faced with further pressure to cope with the drive to move care into the community. The purpose of this extended literature review (ELR) was to deconstruct the available data on the challenges and hurdles experienced by district nurses to manage hospital discharge. On reviewing the selected data, it was found that fragmented communication between secondary and primary sectors poses problems for effective care in the community. Additionally, the lack of understanding of the district nursing service and its remits creates obstacles for effective hospital discharge. Some practical solutions to resolve these problems are proposed.
Topics: Communication; Humans; Nurses, Community Health; Patient Discharge
PubMed: 33797967
DOI: 10.12968/bjcn.2021.26.4.184 -
Nursing For Women's Health Jun 2021To improve key discharge metrics and achieve more consistency in clinical care, a team at our large health care system developed and implemented the use of an obstetric...
To improve key discharge metrics and achieve more consistency in clinical care, a team at our large health care system developed and implemented the use of an obstetric milestone pathway (OMP). The OMP was integrated into daily multidisciplinary discharge rounds, during which nurses discussed the plan of care and progress toward discharge for each woman and her newborn. The OMP provided nursing staff with a tool for implementing a plan of care and for preparing a woman and her newborn for discharge. Use of the OMP was associated with a decrease in clinical errors, improved patient satisfaction scores, and decreased costs related to length of stay. By using Six Sigma techniques and gaining participation of front-line staff, our team developed a clinical pathway intended to improve the quality, safety, and efficiency of maternal/newborn care.
Topics: Evidence-Based Practice; Female; Health Plan Implementation; Humans; Infant, Newborn; Length of Stay; Patient Care Team; Patient Discharge; Pregnancy; Teaching Rounds
PubMed: 33905672
DOI: 10.1016/j.nwh.2021.03.002 -
Urologic Oncology Feb 2022Hospital readmission is associated with adverse outcomes and increased cost, and as such, has been identified as a metric for surgical quality and a target for shifts in...
PURPOSE
Hospital readmission is associated with adverse outcomes and increased cost, and as such, has been identified as a metric for surgical quality and a target for shifts in health policy. However, the disposition of patients who undergo radical cystectomy for bladder cancer and the association between discharge locations and readmission rates is poorly understood. Understanding the patterns and characteristics of readmission after radical cystectomy will help inform discharge planning and expectations and may have long-term impacts on quality and cost of care delivery. We hypothesize that patients will have varying readmission rates based on their discharge location.
MATERIALS AND METHODS
An observational analysis of the Nationwide Readmissions Database was performed for all patients who underwent elective radical cystectomy in 2016 to 2017. The patients were grouped by the following criteria: whether they were discharged home, home with care, or to a facility. Univariate analysis was performed using the Chi-square test for categorical variables and the Kruskal-Wallis test for continuous variables. A multivariable logistic regression was conducted to evaluate if discharge locations impact patient readmissions at 30- and 90-days.
RESULTS
The final dataset included 4,947 patients discharged home with care, 2,127 patients discharged to home or self-care, and 1,232 patients discharged to a facility. Discharge to a facility was strongly associated with higher 30-day (OR 1.49, CI 1.26-1.76) and 90-day readmission rates (OR 1.46, CI 1.23-1.74). Additionally, home health care was strongly associated with increased 30-day readmission rates (OR 1.22, CI 1.08-1.37) relative to routine discharge home.
CONCLUSIONS
Our analysis suggests that discharge location independently predicts readmission following RC. Further study with more granular patient- and system-level data may aid in identifying structural characteristics and processes that can reduce readmissions and their associated economic impact, while maintaining quality of care delivered.
Topics: Aged; Cystectomy; Female; Humans; Male; Patient Discharge; Treatment Outcome
PubMed: 34393041
DOI: 10.1016/j.urolonc.2021.07.020 -
International Journal of Cardiology Oct 2016
Topics: Guideline Adherence; Heart Failure; Humans; Patient Discharge; Quality Improvement
PubMed: 27379915
DOI: 10.1016/j.ijcard.2016.06.082 -
Quality Management in Health Care 2019The uncertainty and ambiguity of not knowing how many patients will be discharged impact patient throughput in hospitals, causing concerns for responding to demand for...
BACKGROUND
The uncertainty and ambiguity of not knowing how many patients will be discharged impact patient throughput in hospitals, causing concerns for responding to demand for admissions. Understanding the potential number of patients to be discharged can support caregivers, ability to concentrate on the range of interactions that patients require to ensure early discharge. Accurate forecasting of patients expected to be discharged by noon is beneficial in accommodating patients who need services and in achieving sustainable patient satisfaction.
METHOD
Models to predict patient discharge before noon (DBN) were formulated using Holt's double exponential smoothing and Box-Jenkins' methods with the aim of achieving minimal errors in each model. The models are applied to 24 months of weekly patient discharge historic data in a medical observation unit and a short-stay clinical unit of a health care hospital system located on the East Coast of United States.
RESULTS
DBN prediction outcomes were more accurate when applying Box-Jenkins' method than Holt's method. Analysis revealed that the model of ARIMA(3,1,2) is most suitable for forecasting. Upon the outcomes of forecast error metrics, the study identifies the mean absolute percent error for the ARIMA model is 14%.
CONCLUSION
Box-Jenkins forecasting performance is superior in predicting DBN with the least forecast error. Predicted values are significant to decision-making interventions aimed at taking new patients, improving quality patient care, and meeting patient throughput performance goals.
Topics: Hospital Administration; Humans; Models, Statistical; Patient Discharge; Time Factors; United States
PubMed: 31567847
DOI: 10.1097/QMH.0000000000000224 -
Nursing TimesA recent report by the Parliamentary and Health Service Ombudsman revealed examples of poor hospital discharge to be considered in light of existing guidance. This... (Review)
Review
A recent report by the Parliamentary and Health Service Ombudsman revealed examples of poor hospital discharge to be considered in light of existing guidance. This article summarises the report's findings and recommendations for good practice when discharging patients.
Topics: Aftercare; Communication; Family; Home Care Services; Humans; Patient Discharge; Patient Safety; United Kingdom
PubMed: 27522695
DOI: No ID Found -
Anesthesiology Sep 2015
Topics: Female; Humans; International Classification of Diseases; Male; Malignant Hyperthermia; Medical Records; Patient Discharge
PubMed: 26284868
DOI: 10.1097/ALN.0000000000000761