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Surgical Infections Oct 2016Surgical site infection (SSI) is the most common type of healthcare-associated infection, contributing to substantial annual morbidity, costs, and deaths. In the United... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical site infection (SSI) is the most common type of healthcare-associated infection, contributing to substantial annual morbidity, costs, and deaths. In the United States it is the number one reason for hospital re-admission after surgery. Relatively little attention has been paid to the proportion of SSIs that occur after discharge. This paper systematically reviews two decades of publications to characterize better the proportion of SSIs that are identified after discharge and the need for better early detection and treatment.
METHODS
A restricted systematic literature search was conducted in PubMed to identify English-language studies published after 1995 that include the occurrence of pre-discharge and post-discharge SSIs. The data abstracted were the date of publication, country of origin, procedure, study design, surveillance system, population size, follow-up rate, and SSI counts and proportions. Descriptive statistics and forest plots were used to characterize the data set, represent the overall proportion of SSIs occurring after discharge, and assess the heterogeneity of the studies.
RESULTS
A total of 55 articles met the inclusion criteria, with data from 1,432,293 operations and 141,347 SSIs based on studies from 15 countries. The overall proportion of operations leading to SSI was 9.9%. Of the 141,347 infections, 84,984 (60.1%) appeared after discharge. The proportion of SSIs after discharge differed among studies, from 13.5 to 94.8, and was heterogeneous for all studies and for most individual surgery types.
CONCLUSION
Post-discharge SSIs constitute the majority of these infections and pose a substantial disease burden for surgical patients globally and for different surgery types. Further examination is warranted to determine the methodologic and clinical factors moderating the proportion of post-discharge SSIs.
Topics: Humans; Patient Discharge; Surgical Wound Infection
PubMed: 27463235
DOI: 10.1089/sur.2015.241 -
BMJ Open Aug 2017Many studies have assessed the predictors of morbidity/mortality of patients with traumatic brain injury (TBI) in acute care. However, with the increasing rate of... (Review)
Review
INTRODUCTION
Many studies have assessed the predictors of morbidity/mortality of patients with traumatic brain injury (TBI) in acute care. However, with the increasing rate of survival after TBI, more attention has been given to discharge destinations from acute care as an important measure of clinical priorities. This study describes the design of a systematic review compiling and synthesising studies on the prognostic factors of discharge settings from acute care in patients with TBI.
METHODS AND ANALYSIS
This systematic review will be conducted on peer-reviewed studies using seven databases including Medline/Medline in-Process, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PsycINFO, CINAHL and Supplemental PubMed. The reference list of selected articles and Google Scholar will also be reviewed to determine other relevant articles. This study will include all English language observational studies that focus on adult patients with TBI in acute care settings. The quality of articles will be assessed by the Quality in Prognostic Studies tool.
ETHICS AND DISSEMINATION
The results of this review will provide evidence that may guide healthcare providers in making more informed and timely discharge decisions to the next level of care for patient with TBI. Also, this study will provide valuable information to address the gaps in knowledge for future research.
TRIAL REGISTRATION NUMBER
Trial registration number (PROSPERO) is CRD42016033046.
Topics: Brain Injuries, Traumatic; Humans; Patient Discharge; Prognosis; Treatment Outcome
PubMed: 28860230
DOI: 10.1136/bmjopen-2017-016694 -
Journal of Nursing Care Quality 2019This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge.
BACKGROUND
This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge.
PURPOSE
Improving patient flow and timely bed capacity is a global issue. Criteria-led discharge enables accelerated patient discharge in accordance with patient selection.
METHODS
A systematic review was conducted to identify literature on criteria-led discharge from 2007 to 2017. The quality of articles was appraised using a tool for disparate studies. Two reviewers extracted relevant data independently.
RESULTS
Fifteen studies were identified that showed no increase in patient readmission or complication rates with criteria-led discharge, demonstrating patient safety. The quality of the patient discharge was unremarkable. None of the studies showed an increase in length of stay.
CONCLUSIONS
The safety, quality, and length of stay for patients discharged through criteria-led discharge are inextricably linked to the process adopted for its implementation.
Topics: Humans; Length of Stay; Patient Discharge; Patient Readmission; Patient Selection; Time Factors
PubMed: 30198948
DOI: 10.1097/NCQ.0000000000000356 -
Journal of Nursing Care Quality 2020Patient flow, from emergency department admission through to discharge, influences hospital overcrowding. We aimed to improve patient flow by increasing discharge lounge...
BACKGROUND
Patient flow, from emergency department admission through to discharge, influences hospital overcrowding. We aimed to improve patient flow by increasing discharge lounge (DL) usage.
LOCAL PROBLEM
Patients need to receive a continuum of nursing care to encourage compliance with follow-up care after discharge from the acute care setting.
METHODS
Baseline data revealed inefficient use of the DL. We targeted the medical-surgical unit with the lowest DL use and trialed interventions over sequential Plan-Do-Study-Act cycles.
INTERVENTIONS
After surveying the nursing staff, we assessed the influence of 3 interventions on DL usage: educating staff on patient eligibility, engaging a recruitment scout, and displaying a visual cue notifying staff when a patient's discharge order was written.
RESULTS
The unit's average DL use increased from 18% to 36%, while hospital overcrowding and discharge turnaround time decreased.
CONCLUSION
The DL is an effective tool to improve patient flow and decrease hospital overcrowding.
Topics: Beds; Crowding; Hospitalization; Humans; Medical-Surgical Nursing; Patient Discharge; Quality Improvement; Time Factors
PubMed: 32433147
DOI: 10.1097/NCQ.0000000000000469 -
European Heart Journal. Acute... Oct 2020In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information... (Review)
Review
In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information imparted to subsequent healthcare providers (HCPs) may be sub-optimal. A French group of cardiologists, lipidologists and diabetologists decided to establish a consensus to optimize the discharge letter after hospitalization for acute myocardial infarction. The aim is to improve both the timeframe and the quality of the content transmitted to subsequent HCPs, including information regarding baseline assessment, procedures during hospitalization, residual risk, discharge treatments, therapeutic targets and follow-up recommendations in compliance with European Society of Cardiology guidelines. A consensus was obtained regarding a template discharge letter, to be released within two days after patient's discharge, and containing the description of the patient's history, risk factors, acute management, risk assessment, discharge treatments and follow-up pathway. Specifically for post acute MI patients, tailored details are necessary regarding the antithrombotic regimen, lipid-lowering and anti-diabetic treatments, including therapeutic targets. Lastly, the follow-up pathway needs to be precisely mentioned in the discharge letter. Additional information such as technical descriptions, imaging, and quality indicators may be provided separately. A template for a standardized discharge letter based on 8 major headings could be useful for implementation in routine practice and help to improve the quality and timing of information transmission between HCPs after acute MI.
Topics: Communication; Consensus; Humans; Myocardial Infarction; Patient Discharge
PubMed: 30990337
DOI: 10.1177/2048872619844444 -
Exploring discharge prescribing errors and their propagation post-discharge: an observational study.International Journal of Clinical... Oct 2016Background Discharge prescribing error is common. Little is known about whether it persists post-discharge. Objective To explore the relationship between discharge... (Observational Study)
Observational Study
Background Discharge prescribing error is common. Little is known about whether it persists post-discharge. Objective To explore the relationship between discharge prescribing error and post-discharge medication error. Setting This was a prospective observational study (March-May 2013) at an adult academic hospital in Ireland. Method Patients using three or more chronic medications pre-admission, with a clinical pharmacist documented gold-standard pre-admission medication list, having a chronic medication stopped or started in hospital and discharged to home were included. Within 10-14 days after discharge a gold standard discharge medication was prepared and compared to the discharge prescription to identify differences. Patients were telephoned to identify actual medication use. Community pharmacists, general practitioners and hospital prescribers were contacted to corroborate actual and intended medication use. Post-discharge medication errors were identified and the relationship to discharge prescribing error was explored. Main outcome measured Incidence, type, and potential severity of post-discharge medication error, and the relationship to discharge prescribing. Results Some 36 (43 %) of 83 patients experienced post-discharge medication error(s), for whom the majority (n = 31, 86 %) were at risk of moderate harm. Most (58 of 66) errors were discharge prescribing errors that persisted post-discharge. Unintentional prescription of an intentionally stopped medication; error in the dose, frequency or formulation and unintentional omission of active medication are the error types most likely to persist after discharge. Conclusion There is a need to implement discharge medication reconciliation to support medication optimisation post-hospitalisation.
Topics: Aged; Cross-Sectional Studies; Female; Humans; Ireland; Male; Medication Errors; Medication Reconciliation; Middle Aged; Patient Discharge; Prospective Studies
PubMed: 27473712
DOI: 10.1007/s11096-016-0349-7 -
Progress in Cardiovascular Diseases 2016Heart failure (HF) is a growing healthcare burden and one of the leading causes of hospitalizations and readmission. Preventing readmissions for HF patients is an... (Review)
Review
Heart failure (HF) is a growing healthcare burden and one of the leading causes of hospitalizations and readmission. Preventing readmissions for HF patients is an increasing priority for clinicians, researchers, and various stakeholders. The following review will discuss the interventions found to reduce readmissions for patients and improve hospital performance on the 30-day readmission process measure. While evidence-based therapies for HF management have proliferated, the consistent implementation of these therapies and development of new strategies to more effectively prevent readmissions remain areas for continued improvement.
Topics: Evidence-Based Medicine; Heart Failure; Humans; Kaplan-Meier Estimate; Monitoring, Ambulatory; Patient Discharge; Patient Readmission; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States
PubMed: 26432556
DOI: 10.1016/j.pcad.2015.09.004 -
Anaesthesia Feb 2022Patient-centred outcomes are increasingly recognised as crucial measures of healthcare quality. Days alive and at home up to 30 days after surgery (DAH ) is a...
Patient-centred outcomes are increasingly recognised as crucial measures of healthcare quality. Days alive and at home up to 30 days after surgery (DAH ) is a validated and readily obtainable patient-centred outcome measure that integrates much of the peri-operative patient journey. However, the minimal difference in DAH that is clinically important to patients is unknown. We designed and administered a 28-item survey to evaluate the minimal clinically important difference in DAH among adult patients undergoing inpatient surgery. Patients were approached pre-operatively or within 2 days postoperatively. We did not study patients undergoing day surgery or nursing home residents. Patients ranked their opinions on the importance of discharge home using a Likert scale (from 1, not important at all to 6, extremely important) and the minimum number of extra days at home that would be meaningful using this scale. We recruited 104 patients; the survey was administered pre-operatively to 45 patients and postoperatively to 59 patients. The mean (SD) age was 53.5 (16.5) years, and 51 (49%) patients were male. Patients underwent a broad range of surgery of mainly intermediate (55%) to major (33%) severity. The median minimal clinically important difference for DAH was 3 days; this was consistent across a broad range of scenarios, including earlier discharge home, complications delaying hospital discharge and the requirement for admission to a rehabilitation unit. Discharge home earlier than anticipated and discharge home rather than to a rehabilitation facility were both rated as important (median score = 5). Empirical data on the minimal clinically important difference for DAH may be useful to determine sample size and to guide the non-inferiority margin for future clinical trials.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Minimal Clinically Important Difference; Patient Discharge; Postoperative Care; Postoperative Period; Surveys and Questionnaires; Treatment Outcome
PubMed: 34797923
DOI: 10.1111/anae.15623 -
American Journal of Health-system... Mar 2018Barriers to and clinical implications of patient nonadherence to filling discharge medication prescriptions from the emergency department (ED) were evaluated. (Observational Study)
Observational Study
PURPOSE
Barriers to and clinical implications of patient nonadherence to filling discharge medication prescriptions from the emergency department (ED) were evaluated.
METHODS
This was a retrospective, observational analysis of patients discharged from the ED from April 2013 through May 2015 with medication prescriptions. Patients age 18-89 years who were seen in the ED and did not retrieve discharge medication prescriptions from the onsite, 24-hour ED discharge pharmacy were included in this study. Patients who did not pick up prescriptions were called and asked about barriers to prescription filling. These charts were then retrospectively reviewed and categorized. The primary study outcome was the frequency of nonadherence to filling discharge medications prescribed during the ED visit at the ED outpatient pharmacy. Secondary outcomes included identifying barriers to medication adherence, the rate of return ED visits within 30 days of ED discharge, and the rate of 30-day hospital admissions. Associations between patient and medication variables and the rates of return ED visits within 30 days of discharge and 30-day hospital admissions were analyzed.
RESULTS
Of the 4,444 patients discharged from the ED with a prescription to be filled at the satellite pharmacy, 510 were nonadherent. Of these patients, 505 had complete chart information available for evaluation. A large proportion of nonadherent patients revisited the ED within 30 days of ED discharge. Multivariate logistic regression found payer class, ethnicity, and sex were independently associated with return ED visits.
CONCLUSION
The majority of patients who received a prescription during an ED visit filled their discharge medications. Sex, ethnicity, and payer class were independently associated with nonadherence.
Topics: Adult; Drug Prescriptions; Emergency Service, Hospital; Ethnicity; Female; Humans; Insurance Coverage; Male; Medication Adherence; Middle Aged; Patient Discharge; Retrospective Studies; Sex Factors; Young Adult
PubMed: 29472514
DOI: 10.2146/ajhp170198 -
Narrative Inquiry in Bioethics 2020Hospitalization is a distressing time for patients and their care partners. While in the hospital, they are often thinking about how they will manage their healthcare...
Hospitalization is a distressing time for patients and their care partners. While in the hospital, they are often thinking about how they will manage their healthcare once they leave the hospital. The hospital providers are tasked with conducting discharge planning with the patient and their care partners to ensure a smooth transition from the hospital. However, as the narratives in this symposium illustrate, the patients and their care partners often feel too little attention paid to ensuring their unique needs are met, including their preferences for where they go when they leave the hospital. Patients and their care partners desire increased and improved communication with healthcare providers, including those in the hospital as well as insurers, as they attempt to take control of their discharge through self-advocacy. While these are three common themes across the stories, the authors share a variety of views, circumstances, and opinions that speak to the variability in patients' discharge experiences and preferences.
Topics: Communication; Hospitalization; Humans; Narration; Patient Advocacy; Patient Discharge; Patient Preference; Patient Transfer
PubMed: 33583855
DOI: 10.1353/nib.2020.0071