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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 -
The Journal of Surgical Research Oct 2021Ground-level falls (GLF) are typically reported as a minor mechanism of injury; however, they represent a significant portion of hospitalized geriatric trauma patients...
INTRODUCTION
Ground-level falls (GLF) are typically reported as a minor mechanism of injury; however, they represent a significant portion of hospitalized geriatric trauma patients as they can result in multisystem injury in this subset of the population. Our study aimed to analyze trends in geriatric trauma falls on the national level.
METHODS
We performed a 5-y (2011-2015) analysis of the American College of Surgeons National Trauma Data Bank (ACS-NTDB) and included all geriatric trauma patients (age ≥ 65 y) who presented with GLF. GLF was identified using ICD-9 E CODES. Our outcome measures were national incidence of GLF, and overall discharge disposition and trauma center level discharge disposition following GLF. We used Cochran Armitage test and multivariate regression analysis.
RESULTS
We analyzed a total of 1,017,326 geriatric trauma patients, of which 39% had had a fall as a mechanism of injury. Among those who fell, mean age was 78 ± 7, 63% were females, and 85% were whites. The incidence of falls significantly increased over the study period, and was noted to be proportional to age, with a plateau beyond age 85 y old. The rate of discharge to SNF and/or Rehab significantly increased over the study period; however, discharge to home and mortality rates trended downwards over the study period. Discharge to SNF and/or Rehab was significantly lower among level I trauma centers compared to other level trauma centers. Conversely, discharge to home was higher in level I trauma centers compared to other level trauma centers.
CONCLUSION
Around one in three elderly trauma patients were admitted following a GLF with an overall increased incidence of falls over time. Although overall mortality rates decreased, there was an increase in adverse discharge disposition and loss of functional independence over the study period, mostly among those admitted to non-level I trauma centers.
Topics: Accidental Falls; Aged; Aged, 80 and over; Databases, Factual; Female; Humans; Incidence; Male; Patient Discharge; Retrospective Studies; United States; Wounds and Injuries
PubMed: 34034061
DOI: 10.1016/j.jss.2021.02.047 -
JAMA Pediatrics Oct 2014To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This... (Review)
Review
To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process. We then outline a framework within which to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. In the framework, we describe processes to (1) initiate pediatric discharge care, (2) develop discharge care plans, (3) monitor discharge progress, and (4) finalize discharge. We contextualize these processes with a clinical case of a child undergoing hospital discharge. Use of this narrative review will help pediatric health care professionals (eg, nurses, social workers, and physicians) move forward to better understand what works and what does not during hospital discharge for children, while steadily improving their quality of care and health outcomes.
Topics: Aftercare; Child; Child Care; Delivery of Health Care; Goals; Health Education; Hospitals, Pediatric; Humans; Medical Records; Needs Assessment; Patient Care Planning; Patient Care Team; Patient Discharge
PubMed: 25155156
DOI: 10.1001/jamapediatrics.2014.891 -
Pflege Zeitschrift 2017
Topics: Aftercare; Curriculum; Education, Nursing, Baccalaureate; Evidence-Based Nursing; Forecasting; Germany; Humans; Multimorbidity; National Health Programs; Patient Discharge; Patient Readmission
PubMed: 29426077
DOI: No ID Found -
Journal of Advanced Nursing Jun 2020The purpose of this study was to validate patient's primary caregiver and their nurse's perception of patient discharge readiness assessment and their association with...
AIMS
The purpose of this study was to validate patient's primary caregiver and their nurse's perception of patient discharge readiness assessment and their association with postdischarge medical consumption.
DESIGN
The study employed a descriptive research, prospective longitudinal study design.
METHOD
The study was performed in a ward of a medical centre in Taipei, Taiwan, from June 2017-May 2018. Obtained data were analysed using an independent t test, one-way ANOVA and logistic regression approach.
RESULTS/FINDINGS
The number of comorbidities and the number of days of hospital stay were positively associated with post discharge emergency room visits. Caregiver readiness for hospital discharge had significant negative correlation with patient's 30-day readmission. Both caregiver and nurse readiness for the hospital discharge scale score were not factors associated with the patients' 30-day emergency room visit.
CONCLUSION
Based on the research findings, to assess the discharge readiness as perceived by caregivers at patients' discharge is recommended.
IMPACT
Caregiver and nurse scores on readiness for hospital discharge showed a significant positive correlation. The higher the score of a caregiver's readiness for a patient's hospital discharge, the lower the 30-day readmission rate. Family-centred care enables patients to safely pass though the transition phase from hospital to community and reduces the postrelease consumption of medical resources. The discharge readiness perceived by caregivers should be included in any decision-making.
Topics: Adult; Aftercare; Aged; Aged, 80 and over; Caregivers; Female; Guidelines as Topic; Humans; Male; Middle Aged; Nursing Staff, Hospital; Patient Acceptance of Health Care; Patient Discharge; Patient Readmission; Taiwan
PubMed: 32056269
DOI: 10.1111/jan.14329 -
MedEdPORTAL : the Journal of Teaching... Dec 2018Safe transitions of care are an essential component of safety and quality for the patient community. It is imperative that providers choose appropriate discharge...
INTRODUCTION
Safe transitions of care are an essential component of safety and quality for the patient community. It is imperative that providers choose appropriate discharge settings to reduce avoidable hospital readmissions. Additionally, providers must also ensure that the multifaceted needs of each patient are met with every discharge recommendation. There is often a lack of formal instruction in medical school on the various discharge dispositions, indications for rehab, and clinical indications for each setting. This is problematic for new interns who are tasked with entering discharge orders and relaying critical information between lead physicians and the interprofessional team.
METHODS
A 60-minute workshop with both didactic and experiential components provided medical students with opportunities to gain an overview of discharge dispositions while also exercising critical thinking using case examples. The workshop was part of a 2-week Transition to Residency course at a single institution.
RESULTS
Twenty-two fourth-year medical students participated in the workshop. Following the workshop, 100% of the participants stated that they had learned something new and that they intended to use the content in practice as interns. Subjective responses indicated that workshop content ought to be incorporated earlier in medical training.
DISCUSSION
These results suggest that a 60-minute workshop including didactic instruction as well as experiential and inquiry-based learning can impact medical student knowledge and intent for practice change in regard to providing safe transitions of care for the patient community.
Topics: Clinical Competence; Education; Feedback; Humans; Patient Discharge; Rehabilitation; Students, Medical
PubMed: 30800985
DOI: 10.15766/mep_2374-8265.10785 -
BMJ Open Mar 2019To assess the magnitude of suicide rates in the first week and first month postdischarge following psychiatric hospitalisation. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the magnitude of suicide rates in the first week and first month postdischarge following psychiatric hospitalisation.
DESIGN
Meta-analysis of relevant English-language, peer-reviewed papers published in MEDLINE, PsycINFO or Embase between 01 January 1945 and 31 March 2017 and supplemented by hand searching and personal communication. A generalised linear effects model was fitted to the number of suicides, with a Poisson distribution, log link and log of person years as an offset. A random effects model was used to calculate the overall pooled rates and within subgroups in sensitivity analyses.
OUTCOME MEASURES
Suicides per 100 000 person years in the first week and the first month after discharge from psychiatric hospitalisation.
RESULTS
Thirty-four included papers comprised 29 studies that reported suicides in the first month postdischarge (3551 suicides during 222 546 patient years) and 24 studies that reported suicides in the first week postdischarge (1928 suicides during 60 880 patient years). The pooled estimate of the suicide rate in the first month postdischarge suicide was 2060 per 100 000 person years (95% CI=1300 to 3280, I=90). The pooled estimate of the suicide rate in the first week postdischarge suicide was 2950 suicides per 100 000 person years (95% CI=1740 to 5000, I=88). Eight studies that were included after personal communication had lower pooled rates of suicide than studies included after data extraction and there was evidence of publication bias towards papers reporting a higher rate of postdischarge suicide.
CONCLUSION
Acknowledging the presence of marked heterogeneity between studies and the likelihood of bias towards publication of studies reporting a higher postdischarge suicide rate, the first week and first month postdischarge following psychiatric hospitalisation are periods of extraordinary suicide risk. Short-term follow-up of discharged patients should be augmented with greater focus on safe transition from hospital to community care.
PROSPERO REGISTRATION NUMBER
PROSPERO registration CRD42016038169.
Topics: Hospitals, Psychiatric; Humans; Patient Discharge; Suicide
PubMed: 30904843
DOI: 10.1136/bmjopen-2018-023883 -
The Journal of Surgical Research Jun 2017Trauma patients represent a high-volume and high-acuity population. This makes discharge planning difficult. Discharged by noon is a metric shown to correlate with...
BACKGROUND
Trauma patients represent a high-volume and high-acuity population. This makes discharge planning difficult. Discharged by noon is a metric shown to correlate with hospital throughput. Improvements in efficiency will be needed to improve resource utilization and increase discharge by noon rate. This study aimed to evaluate the impact of a standardized discharge team on length of stay and discharge by noon.
MATERIALS AND METHODS
A university level I trauma center implemented a discharge team composed of a trauma attending and an advanced practice provider. This team is tasked with evaluating patients on the discharge list daily. This allowed patients ready for discharge to be evaluated and discharged before noon. A retrospective review was performed to analyze discharge by noon rates before and after implementation of the discharge team.
RESULTS
A total of 3053 patients were discharged before the implementation of the discharge team and 3801 after. Discharges by noon increased from 25.5% to 51.2% in the post. For patients with an injury severity score >15, this same improvement was seen, 22.5% to 51.9%. Similar improvements were seen when controlling for final discharge disposition and primary payer status.
CONCLUSIONS
By establishing a separate discharge team, large improvements can be seen in the discharge by noon rate. These improvements were maintained when controlling for injury severity score, final discharge disposition, and insurance status. Significant savings are possible in both charges to the patient and direct costs to the facility. The utilization of a discharge team should be considered at similar facilities.
Topics: Adult; Aged; Aged, 80 and over; Cost Savings; Efficiency, Organizational; Female; Hospital Costs; Humans; Length of Stay; Male; Middle Aged; Outcome and Process Assessment, Health Care; Patient Discharge; Retrospective Studies; Trauma Centers; West Virginia; Wounds and Injuries
PubMed: 28601301
DOI: 10.1016/j.jss.2017.02.018 -
Journal of Surgical Education 2019There is a paucity of data regarding the efficiency of care provided by teaching hospitals. Yet, instruction on transitions in care and an understanding of systems-based...
OBJECTIVE
There is a paucity of data regarding the efficiency of care provided by teaching hospitals. Yet, instruction on transitions in care and an understanding of systems-based practice are key components of modern graduate medical education. We aimed to determine the relationship between hospital teaching status and the discharge efficiency from a surgical service.
SETTING
Patients who were cared for at teaching and nonteaching hospitals captured in the Healthcare Cost and Utilization Project National Inpatient Sample from 2012.
PARTICIPANTS
A total of 272,090 patients who underwent one of 44 predefined general surgery procedure types.
DESIGN
Patients were stratified based on treating hospital teaching status (TH vs. NTH). Procedure-specific early discharge (PSED) was defined for each operation type as a discharge that occurred within the lowest 25th percentile for overall length of stay. PSED was used as the discharge efficiency metric. To adjust for cofounders and hospital level clustering, multivariable mixed-effects logistic regression was used to examine the association between teaching status and PSED. Subgroup analysis was performed by operation type. Models were constructed with and without adjustment for inpatient complications.
RESULTS
There were 140,878 (51.8%) patients who received care at a TH. TH status was significantly associated with lower PSED (TH: 10.7% vs. NTH: 11.4%; p < 0.001) and longer length of stay (TH: 5.5 days vs. NTH: 4.5 days; p < 0.001). In the adjusted model of the overall cohort, patients treated at a TH were 8% less likely to receive a PSED compared to those treated at NTH (odds ratio 0.92, 95% confidence interval (0.88, 0.97); p < 0.002). Differences in the rates and odds of PSED were noted across the subgroups.
CONCLUSIONS
Teaching hospital status is associated with a reduced likelihood of PSED. The effect of TH on PSED varied by procedure subgroup. Examining the recovery pathways and discharge practices at NTH may allow for the identification of more efficient methods of care that can be applied to the broader healthcare system.
Topics: Efficiency, Organizational; Hospitals, Teaching; Humans; Patient Discharge; Surgical Procedures, Operative
PubMed: 30987921
DOI: 10.1016/j.jsurg.2019.03.022