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The American Journal of Nursing Jul 2015
Topics: Humans; Nursing Care; Patient Discharge; Patient Safety
PubMed: 26110934
DOI: 10.1097/01.NAJ.0000467255.17018.69 -
JAMA Pediatrics Oct 2014
Topics: Child Care; Hospitals, Pediatric; Humans; Patient Discharge
PubMed: 25154591
DOI: 10.1001/jamapediatrics.2014.1028 -
Nursing Administration Quarterly 2020Hospitals are under increased pressure to address both financial and capacity constraints to improve their clinical operations. Effective capacity management programs...
Hospitals are under increased pressure to address both financial and capacity constraints to improve their clinical operations. Effective capacity management programs have become a key driver of clinical operations for managing the flow of patients into and out of the hospital. Many high-functioning medical centers have developed capacity management programs to strategically address patient throughput. Discharging patients from the hospital is one fundamental, but complex, patient flow initiative for efficient patient throughput. Despite advances in optimizing patient flow, there is a lack of understanding associated with the structure and processes to efficiently discharge patients. This article outlines a discharge timeliness project where advanced practice providers are principal leaders of designing a safe and efficient patient discharge prototype. Design thinking was used to develop a patient discharge prototype that included 6 key areas that led to improved discharge times on a cardiac surgery step-down unit. High tech solutions were incorporated into the electronic medical record system to enhance communication across phases of care and inform the interdisciplinary team of patient progress.
Topics: Advanced Practice Nursing; Efficiency, Organizational; Humans; Patient Discharge; Program Evaluation
PubMed: 32881806
DOI: 10.1097/NAQ.0000000000000435 -
Internal Medicine Journal Apr 2015Shorthand is commonplace in clinical notation. While many abbreviations are standard and widely accepted, an increasing number are non-standard and/or unrecognisable.
BACKGROUND
Shorthand is commonplace in clinical notation. While many abbreviations are standard and widely accepted, an increasing number are non-standard and/or unrecognisable.
AIM
We sought to describe the frequency of inappropriate and ambiguous shorthand in discharge summaries.
METHODS
Eighty electronic discharge summaries from the four General Medical Units at the Royal Melbourne Hospital were randomly extracted from the hospital's electronic records. Extraction was stratified by the four units and by the four quarters between July 2012 and June 2013. All abbreviations were assigned into one of four categories according to appropriateness: 1. 'Universally accepted and understood even without context'; 2. 'Understood when in context'; 3. 'Understood but inappropriate and/or ambiguous'; and 4. 'Unknown'. These categories were determined by the authors, which included junior and senior medical staff.
RESULTS
The 80 discharge summaries contained 840 different abbreviations used on 6269 occasions. Of all words, 20.1% were abbreviations. Of the 6269 occasions of shorthand, 6.8% were categorised as 'Understood but inappropriate and/or ambiguous' or 'Unknown' (category 3 or 4), equating to 1.4% of all words, and an average of 5.4 words per discharge summary.
CONCLUSION
Abbreviations are common in electronic discharge summaries, occurring at a frequency of one in five words. While the majority of shorthand used seems to be appropriate, the use of inappropriate, ambiguous or unknown shorthand is still frequent. This has implications for safe and effective patient care and highlights the need for better awareness and education regarding use of shorthand in clinical notation.
Topics: Electronic Health Records; Humans; Patient Discharge; Shorthand
PubMed: 25827509
DOI: 10.1111/imj.12668 -
Orthopedic Nursing 2020Total knee arthroplasty is on the rise. Some patients choose to undergo simultaneous bilateral total knee arthroplasty (simultaneous BTKA). No studies were found that...
BACKGROUND
Total knee arthroplasty is on the rise. Some patients choose to undergo simultaneous bilateral total knee arthroplasty (simultaneous BTKA). No studies were found that examined which patients may be better candidates to successfully undergo this procedure.
PURPOSE
The purpose of this study was to determine personal and comorbid characteristics of patients undergoing simultaneous BTKA that are predictive of length of stay (LOS) and discharge to a skilled nursing facility (SNF).
METHODS
A retrospective database study of 125 patients post-simultaneous BTKA was conducted. Binary and multiple linear regression models identified personal and clinical predictors of LOS and SNF discharge.
RESULTS
Body mass index (BMI) (p < .001) and SNF discharge (p = .025) were significant predictors of increased LOS and explained 18% of the variance. Older age, female sex, and presence of cardiopulmonary disease predicted SNF admission; 21% of the variance for SNF discharge was explained by the model.
CONCLUSION
Patients with a high BMI should be carefully screened before undergoing simultaneous BTKA; older patients, women, and those with cardiopulmonary disease may benefit from early discharge planning for SNF transfer, thereby decreasing LOS and hospital utilization.
Topics: Aged; Arthroplasty, Replacement, Knee; Body Mass Index; Comorbidity; Female; Humans; Length of Stay; Linear Models; Male; Middle Aged; Outcome Assessment, Health Care; Patient Discharge; Postoperative Complications; Retrospective Studies; Risk Factors
PubMed: 32218002
DOI: 10.1097/NOR.0000000000000639 -
Medicine Dec 2020Whereas handover of pertinent information between hospital and primary care is necessary to ensure continuity of care and patient safety, both quality of content and...
Whereas handover of pertinent information between hospital and primary care is necessary to ensure continuity of care and patient safety, both quality of content and timeliness of discharge summary need to be improved. This study aims to assess the impact of a quality improvement program on the quality and timeliness of the discharge summary/letter (DS/DL) in a University hospital with approximatively 40 clinical units using an Electronic medical record (EMR).A discharge documents (DD) quality improvement program including revision of the EMR, educational program, audit (using scoring of DD) and feedback with a ranking of clinical units, was conducted in our hospital between October 2016 and November 2018. Main outcome measures were the proportion of the DD given to the patient at discharge and the mean of the national score assessing the quality of the discharge documents (QDD score) with 95% confidence interval.Intermediate evaluation (2017) showed a significant improvement as the proportion of DD given to patients increased from 63% to 85% (P < .001) and mean QDD score rose from 41 (95%CI [36-46]) to 74/100 (95%CI [71-77]). In the final evaluation (2018), the proportion of DD given to the patient has reached 95% and the mean QDD score was 82/100 (95% CI [80-85]). The areas of the data for admission and discharge treatments remained the lowest level of compliance (44%).The involvement of doctors in the program and the challenge of participating units have fostered the improvement in the quality of the DD. However, the level of appropriation varied widely among clinical units and completeness of important information, such as discharge medications, remains in need of improvement.
Topics: Controlled Before-After Studies; Documentation; Hospitalization; Humans; Paris; Patient Discharge; Program Evaluation; Quality Improvement; Time Factors
PubMed: 33371146
DOI: 10.1097/MD.0000000000023776 -
Nigerian Journal of Clinical Practice Jul 2018Discharge summaries are important components of hospital-care transitions in ensuring continuity of care.
BACKGROUND
Discharge summaries are important components of hospital-care transitions in ensuring continuity of care.
AIM
We assessed the adequacy and accuracy of discharge summaries written by junior doctors.
METHODS
An instrument, adapted largely from the current hospital discharge summary template and recommendations regarding content from the Joint Commission International, was used to study 420 discharge summaries written in 2012 from the ophthalmology service of a Rural Teaching Hospital in Nigeria. The simple descriptive analysis was done with Statistical Package for the Social Science version 17.
RESULTS
Completeness of entries was relatively high in many traditional areas (biodata of patient, admission/discharge dates, name of supervising consultant, principal diagnosis, surgical procedures done, follow-up instructions, and condition on discharge) of the summaries. The portion of the paper-based template titled "summary" of the admission was most problematic; with information on medication changes and result of tests missing in 368/420 (87.6%) and 334/420 (79.5%), respectively.
CONCLUSION
Educational intervention for doctors in training with the provision of oversight and feedback by their supervisors is required. Standardized discharge summary templates recognizing the peculiarities of specialized patient groups are recommended. Transition to electronic discharge summary system is imperative.
Topics: Documentation; Hospitals, Teaching; Humans; Medical Audit; Nigeria; Ophthalmology; Patient Discharge
PubMed: 29984723
DOI: 10.4103/njcp.njcp_363_17 -
BioMed Research International 2015The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher... (Review)
Review
The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22-67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review.
Topics: Critical Care; Humans; Length of Stay; Patient Admission; Patient Discharge; Time Factors
PubMed: 26558286
DOI: 10.1155/2015/868653 -
Journal of Hospital Medicine Dec 2015
Topics: Humans; Patient Discharge; Patient Readmission; Predictive Value of Tests; Time Factors
PubMed: 26434568
DOI: 10.1002/jhm.2445 -
The American Journal of Cardiology May 2018Given high rates of heart failure (HF) hospitalizations and widespread adoption of the hospitalist model, patients with HF are often cared for on General Medicine (GM)... (Comparative Study)
Comparative Study
Given high rates of heart failure (HF) hospitalizations and widespread adoption of the hospitalist model, patients with HF are often cared for on General Medicine (GM) services. Differences in discharge processes and 30-day readmission rates between patients on GM and those on Cardiology during the contemporary hospitalist era are unknown. The present study compared discharge processes and 30-day readmission rates of patients with HF admitted on GM services and those on Cardiology services. We retrospectively studied 926 patients discharged home after HF hospitalization. The primary outcome was 30-day all-cause readmission after discharge from index hospitalization. Although 60% of patients with HF were admitted to Cardiology services, 40% were admitted to GM services. Prevalence of cardiovascular and noncardiovascular co-morbidities were similar between patients admitted to GM services and Cardiology services. Discharge summaries for patients on GM services were less likely to have reassessments of ejection fraction, new study results, weights, discharge vital signs, discharge physical examinations, and scheduled follow-up cardiologist appointments. In a multivariable regression analysis, patients on GM services were more likely to experience 30-day readmissions compared with those on Cardiology services (odds ratio 1.43 95% confidence interval [1.05 to 1.96], p = 0.02). In conclusion, outcomes are better among those admitted to Cardiology services, signaling the need for studies and interventions focusing on noncardiology hospital providers that care for patients with HF.
Topics: Aged; Cardiology Service, Hospital; Female; Heart Failure; Hospitalization; Humans; Internal Medicine; Logistic Models; Male; Middle Aged; Multivariate Analysis; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Treatment Outcome; United States
PubMed: 29548676
DOI: 10.1016/j.amjcard.2018.01.027