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Journal of Hospital Medicine Dec 2015For hospitalized patients, the transition from hospital to home is frequently accompanied by a significant amount of information to absorb. The objective of this work...
For hospitalized patients, the transition from hospital to home is frequently accompanied by a significant amount of information to absorb. The objective of this work was to engage patients, caregivers, and healthcare providers in codeveloping patient-oriented discharge instructions, (ie, a brief transition plan with information that patients want). Overseen by a multidisciplinary advisory team, a participatory action approach using mixed methods was employed. Although formal inclusion and exclusion criteria were not used, deliberate efforts were made to engage groups with language barriers and limited health literacy. Symbols were designed and validated with the patient groups to represent each section of information to make the form more understandable for these patients. A prototype was codesigned using an iterative process. The form has been adapted for use in multiple health settings and is currently undergoing a multisite pilot to evaluate its effect on patient and provider experience.
Topics: Caregivers; Health Personnel; Humans; Patient Care Planning; Patient Discharge
PubMed: 26406116
DOI: 10.1002/jhm.2444 -
Studies in Health Technology and... Oct 2023Discharge letters could be sent to the patients. This poster explores pros and cons of such a procedure.
Discharge letters could be sent to the patients. This poster explores pros and cons of such a procedure.
Topics: Humans; Patient Discharge
PubMed: 37869825
DOI: 10.3233/SHTI230759 -
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 -
Annals of Emergency Medicine Mar 2020We conduct a systematic review with meta-analysis to provide an overview of the different manners of providing discharge instructions in the emergency department (ED)... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
We conduct a systematic review with meta-analysis to provide an overview of the different manners of providing discharge instructions in the emergency department (ED) and to assess their effects on comprehension and recall of the 4 domains of discharge instructions: diagnosis, treatment, follow-up, and return instructions.
METHODS
We performed a systematic search in the PubMed, EMBASE, Web of Science Google Scholar, and Cochrane databases for studies published before March 15, 2018. A quality assessment of included articles was performed. Pooled proportions of correct recall by manner of providing discharge instructions were calculated.
RESULTS
A total of 1,842 articles were screened, and after selection, 51 articles were included. Of the 51 included studies, 12 used verbal discharge instructions only, 30 used written discharge instructions, and 7 used video. Correct recall of verbal, written, and video discharge instructions ranged from 8% to 94%, 23% to 92%, and 54% to 89%, respectively. Meta-analysis was performed on data of 1,460 patients who received verbal information only, 3,395 patients who received written information, and 459 patients who received video information. Pooled data showed differences in correct recall, with, on average, 47% for patients who received verbal information (95% confidence interval 32.2% to 61.7%), 58% for patients who received written information (95% confidence interval 44.2% to 71.2%), and 67% for patients who received video information (95% confidence interval 57.9% to 75.7%).
CONCLUSION
Communicating discharge instructions verbally to patients in the ED may not be sufficient. Although overall correct recall was not significantly higher, adding video or written information to discharge instructions showed promising results for ED patients.
Topics: Comprehension; Emergency Service, Hospital; Humans; Mental Recall; Patient Discharge; Patients
PubMed: 31439363
DOI: 10.1016/j.annemergmed.2019.06.008 -
PloS One 2021The Centers for Medicare and Medicaid Services identified unplanned hospital readmissions as a critical healthcare quality and cost problem. Improvements in hospital...
The Centers for Medicare and Medicaid Services identified unplanned hospital readmissions as a critical healthcare quality and cost problem. Improvements in hospital discharge decision-making and post-discharge care are needed to address the problem. Utilization of clinical decision support (CDS) can improve discharge decision-making but little is known about the empirical significance of two opposing problems that can occur: (1) negligible uptake of CDS by providers or (2) over-reliance on CDS and underuse of other information. This paper reports an experiment where, in addition to electronic medical records (EMR), clinical decision-makers are provided subjective reports by standardized patients, or CDS information, or both. Subjective information, reports of being eager or reluctant for discharge, was obtained during examinations of standardized patients, who are regularly employed in medical education, and in our experiment had been given scripts for the experimental treatments. The CDS tool presents discharge recommendations obtained from econometric analysis of data from de-identified EMR of hospital patients. 38 clinical decision-makers in the experiment, who were third and fourth year medical students, discharged eight simulated patient encounters with an average length of stay 8.1 in the CDS supported group and 8.8 days in the control group. When the recommendation was "Discharge," CDS uptake of "Discharge" recommendation was 20% higher for eager than reluctant patients. Compared to discharge decisions in the absence of patient reports: (i) odds of discharging reluctant standardized patients were 67% lower in the CDS-assisted group and 40% lower in the control (no-CDS) group; whereas (ii) odds of discharging eager standardized patients were 75% higher in the control group and similar in CDS-assisted group. These findings indicate that participants were neither ignoring nor over-relying on CDS.
Topics: Clinical Decision Rules; Decision Making; Decision Support Systems, Clinical; Education, Medical; Electronic Health Records; Patient Discharge; Patient Readmission; Patients; Students, Medical
PubMed: 33684144
DOI: 10.1371/journal.pone.0247270 -
Healthcare (Amsterdam, Netherlands) Mar 2021Little is known about the follow-up healthcare needs of patients hospitalized with coronavirus disease 2019 (COVID-19) after hospital discharge. Due to the unique...
Little is known about the follow-up healthcare needs of patients hospitalized with coronavirus disease 2019 (COVID-19) after hospital discharge. Due to the unique circumstances of providing transitional care in a pandemic, post-discharge providers must adapt to specific needs and limitations identified for the care of COVID-19 patients. In this study, we conducted a retrospective chart review of all hospitalized COVID-19 patients discharged from an Emory Healthcare Hospital in Atlanta, GA from March 26 to April 21, 2020 to characterize their post-discharge care plans. A total of 310 patients were included in the study (median age 58, range: 23-99; 51.0% female; 69.0% African American). The most common presenting comorbidities were hypertension (200, 64.5%), obesity (BMI≥30) (138, 44.5%), and diabetes mellitus (112, 36.1%). The median length of hospitalization was 5 days (range: 0-33). Sixty-seven patients (21.6%) were admitted to the intensive care unit and 42 patients (13.5%) received invasive mechanical ventilation. The most common complications recorded at discharge were electrolyte abnormalities (124, 40.0%), acute kidney injury (86, 27.7%) and sepsis (55, 17.7%). The majority of patients were discharged directly home (281, 90.6%). Seventy-five patients (24.2%) required any home service including home health and home oxygen therapy. The most common follow-up need was an appointment with a primary care provider (258, 83.2%). Twenty-four patients (7.7%) had one or more visit to an ED after discharge and 16 patients (5.2%) were readmitted. To our knowledge, this is the first large study to report on post-discharge medical care for COVID-19 patients.
Topics: Adult; Aged; COVID-19; Female; Hospitalization; Humans; Male; Middle Aged; Patient Discharge; Patient Transfer
PubMed: 33383393
DOI: 10.1016/j.hjdsi.2020.100512 -
Journal of Patient Safety Mar 2020Prompt, complete, and accurate information transfer at the time of discharge between hospital-based and primary care providers (PCPs) is needed for the provision of safe...
BACKGROUND
Prompt, complete, and accurate information transfer at the time of discharge between hospital-based and primary care providers (PCPs) is needed for the provision of safe and effective care.
PURPOSE OF THE STUDY
To evaluate timeliness, quality, and interventions to improve timeliness and quality of hospital discharge summaries.
DATA SOURCES
PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus database published in English between January 2007 and February 2014 were searched. We also hand-searched bibliographies of relevant articles.
STUDY SELECTION
Observational studies investigating transfer of information at hospital discharge (n = 7) and controlled studies evaluating interventions to improve timeliness and quality of discharge information (n = 12) were included.
DATA EXTRACTION
We extracted data on availability, timeliness, and content of hospital discharge summaries and on the effectiveness of interventions targeting discharge summaries. Results of studies are presented narratively and using descriptive statistics.
DATA SYNTHESIS
Across the studies, discharge summaries were completed within 48 hours in a median of 67% and were available to PCPs within 48 hours only 55% of the time. Most of the time, discharge summaries included demographics, primary diagnosis, hospital course, and discharge instructions. However, information was limited to pending test results (25%), diagnostic tests performed (60%), and postdischarge medications (78%). In 6 interventional studies, implementation of electronic discharge summaries was associated with improvement in timeliness but not quality.
CONCLUSIONS
Delayed or insufficient transfer of discharge information between hospital-based providers and PCPs remains common. Creation of electronic discharge summaries seems to improve timeliness and availability but does not consistently improve quality.
Topics: Hospitals; Humans; Patient Discharge
PubMed: 26741789
DOI: 10.1097/PTS.0000000000000248 -
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 -
Nursing Older People Sep 2016Essential facts Delays in discharging older people from hospital cost the NHS £820 million a year, according to a report from the National Audit Office (NAO).
Essential facts Delays in discharging older people from hospital cost the NHS £820 million a year, according to a report from the National Audit Office (NAO).
Topics: Aged; Demography; England; Humans; Patient Discharge; State Medicine
PubMed: 27682377
DOI: 10.7748/nop.28.8.11.s10 -
Nursing Standard (Royal College of... Jan 2016
Topics: Continuity of Patient Care; Humans; Patient Discharge; Patient Readmission; Time Factors; United Kingdom
PubMed: 26758142
DOI: 10.7748/ns.30.20.17.s21