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Pediatric Emergency Care Oct 2018Although most young people under the age of 25 years with mental health presentations to the emergency department (ED) are discharged home, several studies suggest... (Review)
Review
BACKGROUND
Although most young people under the age of 25 years with mental health presentations to the emergency department (ED) are discharged home, several studies suggest discharge instructions are inadequate. We conducted a scoping review to characterize and map the literature, identify research gaps, and prioritize targeted areas for future reviews for ED discharge instructions for young people with mental disorders.
METHODS
Our review was conducted in an iterative approach with 6 stages including identifying the research question, identifying relevant studies, study selection, data extraction, collaring and summarizing, and stakeholder engagement. We characterized the available information on discharge instruction interventions using the Behavior Change Wheel.
RESULTS
Of the 805 potential publications screened, 25 were included for extraction. Nine of the 25 articles focused on suicide or self-harm, 6 were on mental health in general or mixed groups, and 9 focused on alcohol, tobacco, or substance use in general. Five studies included younger children (ie, less than 12 years) but ages ranged significantly among studies. Education and persuasion were intervention functions most commonly reported in publications (n = 13 and n = 12, respectively). From the policy categories, recommendations regarding service provision were most frequently made from four publications. Descriptions of theory were limited in publications.
CONCLUSIONS
The available literature regarding discharge instructions in the ED for youth with mental disorders is focused on certain content areas (eg, self injurious behaviors, substance use) with more work required in chronic mental disorders that make up a significant proportion of ED visits. Research that extends beyond education and with theoretical underpinnings to explain how and why various interventions work would be useful for clinicians, policy-makers, and other researchers.
Topics: Adolescent; Child; Emergency Service, Hospital; Humans; Mental Disorders; Mental Health; Patient Discharge; Patient Education as Topic; Young Adult
PubMed: 29112107
DOI: 10.1097/PEC.0000000000001037 -
Internal Medicine Journal Jan 2016A potential barrier to patient discharge from hospital is communication problems between the treating team and the patient or family regarding discharge planning.
BACKGROUND
A potential barrier to patient discharge from hospital is communication problems between the treating team and the patient or family regarding discharge planning.
AIM
To determine if a bedside 'Leaving Hospital Information Sheet' increases patient and family's knowledge of discharge date and destination and the name of the key clinician primarily responsible for team-patient communication.
METHODS
This article is a 'before-after' study of patients, their families and the interdisciplinary ward-based clinical team. Outcomes assessed pre-implementation and post-implementation of a bedside 'Leaving Hospital Information Sheet' containing discharge information for patients and families. Patients and families were asked if they knew the key clinician for team-patient communication and the proposed discharge date and discharge destination. Responses were compared with those set by the team. Staff were surveyed regarding their perceptions of patient awareness of discharge plans and the benefit of the 'Leaving Hospital Information Sheet'.
RESULTS
Significant improvement occurred regarding patients' knowledge of their key clinician for team-patient communication (31% vs 75%; P = 0.0001), correctly identifying who they were (47% vs 79%; P = 0.02), and correctly reporting their anticipated discharge date (54% vs 86%; P = 0.004). There was significant improvement in the family's knowledge of the anticipated discharge date (78% vs 96%; P = 0.04). Staff reported the 'Leaving Hospital Information Sheet' assisted with communication regarding anticipated discharge date and destination (very helpful n = 11, 39%; a little bit helpful n = 11, 39%).
CONCLUSIONS
A bedside 'Leaving Hospital Information Sheet' can potentially improve communication between patients, families and their treating team.
Topics: Communication; Hospitals; Humans; Length of Stay; Patient Care Team; Patient Discharge; Patient Satisfaction; Professional-Patient Relations; Surveys and Questionnaires
PubMed: 26439193
DOI: 10.1111/imj.12919 -
Journal of Neurosurgery Nov 2016OBJECTIVE Outpatient craniotomy has many advantages to the psychological and physical well-being of patients, as well as benefits to the health care system. Its efficacy...
OBJECTIVE Outpatient craniotomy has many advantages to the psychological and physical well-being of patients, as well as benefits to the health care system. Its efficacy and safety have been well demonstrated, but barriers to its widespread adoption remain. Among the challenges is a perception that its application is limited to cases performed under conscious sedation, which is not always feasible given certain patient or surgeon factors. The object of this study was to characterize the rate of patient discharge from the day surgery unit (DSU) following craniotomy for tumor resection in a patient under general anesthesia. The authors identify postoperative complications and discuss appropriate patient selection for day surgery craniotomy. METHODS Patients undergoing elective craniotomy for supratentorial tumors between January 2010 and June 2014 were prospectively considered for outpatient management. Authors of the present study performed a retrospective chart review of these patients, analyzing cases by intention to treat. RESULTS Of 318 craniotomies undertaken in the study period, 141 were performed with the patient under general anesthesia. The day surgery protocol was initiated in 44 cases and completed in 38 (86%). Five patients required admission from the DSU, and 1 was discharged but admitted within the 1st postoperative day. In-hospital medical complications were fewer in the outpatient group, and no patients experienced an adverse outcome due to early discharge. CONCLUSIONS Close clinical and imaging surveillance in the early postoperative period allows for safe discharge of patients following craniotomy for tumor resection performed under general anesthesia. Therefore, general anesthesia does not preclude the application of outpatient craniotomy.
Topics: Ambulatory Surgical Procedures; Anesthesia, General; Brain Neoplasms; Craniotomy; Female; Humans; Male; Middle Aged; Patient Discharge; Retrospective Studies
PubMed: 26943840
DOI: 10.3171/2015.11.JNS152151 -
The British Journal of General Practice... Jan 2020Transitions between healthcare settings are vulnerable points for patients. (Review)
Review
BACKGROUND
Transitions between healthcare settings are vulnerable points for patients.
AIM
To identify key threats to safe patient transitions from hospital to primary care settings.
DESIGN AND SETTING
Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England.
METHOD
Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3: , 4-6: , 7-9: ). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%.
RESULTS
A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. 'Poor quality of handover instructions from secondary to primary care teams' achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients.
CONCLUSION
This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise.
Topics: Aged; Aged, 80 and over; Attitude of Health Personnel; Child; Child Health Services; Consensus; Delphi Technique; Female; Frail Elderly; Health Personnel; Health Services for the Aged; Humans; London; Male; Patient Discharge; Patient Handoff; Patient Safety; Primary Health Care
PubMed: 31848201
DOI: 10.3399/bjgp19X707105 -
Journal of Hospital Medicine Jan 2019Discharge delays adversely affect hospital bed availability and thus patient flow.
BACKGROUND
Discharge delays adversely affect hospital bed availability and thus patient flow.
OBJECTIVE
We aimed to increase the percentage of early discharges (EDCs; before 11 am). We hypothesized that obtaining at least 25% EDCs would decrease emergency department (ED) and postanesthesia care unit (PACU) hospital bed wait times.
DESIGN
This study used a pre/postintervention retrospective analysis.
SETTING
All acute care units in a quaternary care academic children's hospital were included in this study.
PATIENTS
The patient sample included all discharges from the acute care units and all hospital admissions from the ED and PACU from January 1, 2014, to December 31, 2016.
INTERVENTION
A multidisciplinary team identified EDC barriers, including poor identification of EDC candidates, accountability issues, and lack of team incentives. A total of three successive interventions were implemented using Plan-Do-Check-Act (PDCA) cycles over 10 months between 2015 and 2016 addressing these barriers. Interventions included EDC identification and communication, early rounding on EDCs, and modest incentives.
MEASUREMENTS
Calendar month EDC percentage, ED (from time bed requested to the time patient left ED) and PACU (from time patient ready to leave to time patient left PACU) wait times were measured.
RESULTS
EDCs increased from an average 8.8% before the start of interventions (May 2015) to 15.8% after interventions (February 2016). Using an interrupted time series, both the jump and the slope increase were significant (3.9%, P = .02 and 0.48%, P < .01, respectively). Wait times decreased from a median of 221 to 133 minutes (P < .001) for ED and from 56 to 36 minutes per patient (P = .002) for PACU.
CONCLUSION
A multimodal intervention was associated with more EDCs and decreased PACU and ED bed wait times.
Topics: Efficiency, Organizational; Emergency Service, Hospital; Humans; Length of Stay; Patient Discharge; Retrospective Studies; Time Factors; Waiting Lists
PubMed: 30667407
DOI: 10.12788/jhm.3133 -
International Journal For Quality in... Jul 2020Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have... (Meta-Analysis)
Meta-Analysis
PURPOSE
Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the 'weekend effect.' However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges.
DATA SOURCES
PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019.
STUDY SELECTION
Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies.
DATA EXTRACTION
Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate.
RESULTS OF DATA SYNTHESIS
There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity.
CONCLUSION
In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.
Topics: Aftercare; Emergency Service, Hospital; Humans; Length of Stay; Mortality; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission; Quality Assurance, Health Care; Time Factors
PubMed: 32453404
DOI: 10.1093/intqhc/mzaa060 -
Clinical Nursing Research Oct 2016Patient characteristics and lack of preparedness are associated with poor outcomes after hospital discharge. Our purpose was to explore the association between patient...
Patient characteristics and lack of preparedness are associated with poor outcomes after hospital discharge. Our purpose was to explore the association between patient characteristics and patient- and nurse-completed Readiness for Hospital Discharge Scale (RHDS). We conducted a prospective study of 70 Veterans being discharged from medical and surgical units. Differences in RHDS knowledge subscale scores were found among literacy levels, with lower perceived knowledge reported for those with marginal or inadequate literacy (p = .03). Differences in RHDS expected support subscale scores were also found, with those who were unmarried and/or living alone (p < .001) anticipating less support upon discharge. No other differences were found. Similar differences were found for the RHDS completed by nurses. These findings suggest that the RHDS appears responsive to differences in health literacy and social environment, adding to evidence of its utility as a tool to identify, and plan interventions for, those at risk for readmission.
Topics: Adult; Aged; Aged, 80 and over; Female; Health Literacy; Humans; Male; Middle Aged; Nursing Staff; Patient Discharge; Patient Readmission; Prospective Studies; Social Support; Surveys and Questionnaires; Veterans
PubMed: 26787745
DOI: 10.1177/1054773815624380 -
Injury May 2018Falls can result in injuries that require rehabilitation and long-term care after hospital discharge. Identifying factors that contribute to prediction of discharge...
BACKGROUND
Falls can result in injuries that require rehabilitation and long-term care after hospital discharge. Identifying factors that contribute to prediction of discharge disposition is crucial for efficient resource utilization and reducing cost. Several factors may influence discharge location after hospitalization for a fall. The aim of this study was to examine clinical and non-clinical factors that may predict discharge disposition after a fall. We hypothesized that age, injury type, insurance type, and functional status would affect discharge location.
METHODS
This two-year retrospective study was performed at an urban, adult level-1 trauma center. Fall patients who were discharged home or to a facility after hospital admission were included in the study. Data was obtained from the trauma registry and electronic medical records. Logistic regression modeling was used to assess independent predictors.
RESULTS
A total of 1,121 fallers were included in the study. 621 (55.4%) were discharged home and 500 (44.6%) to inpatient rehabilitation (IRF)/skilled nursing facility (SNF). The median age was 64 years (IQR: 49-79) and 48.4% (543) were male. The median length of hospital stay was 5 days (IQR: 2.5-8). Increasing age (p < 0.001), length of stay in the ICU (p < 0.001), injury severity (p < 0.001), number of comorbidities (p = 0.038), having Medicare insurance (p = 0.025), having a fracture at any body region (p < 0.001), and ambulation status (p = 0.025) significantly increased the odds of being discharged to IRF/SNF compared to home. The removal of injury severity score and ICU length of stay from the "late/regular discharge" model, to create an "early discharge" model, decreased the accuracy of the prediction rate from 78.5% to 74.9% (p < 0.001).
CONCLUSION
A combination of demographic, clinical, social, economic, and functional factors can together predict discharge disposition after a fall. The majority of these factors can be assessed early in the hospital stay, which may facilitate a timely discharge plan and shorter stays in the hospital.
Topics: Accidental Falls; Adult; Aged; Aged, 80 and over; Female; Humans; Length of Stay; Logistic Models; Male; Medicare; Middle Aged; Patient Discharge; Rehabilitation Centers; Retrospective Studies; Severity of Illness Index; United States; Wounds and Injuries; Young Adult
PubMed: 29463382
DOI: 10.1016/j.injury.2018.02.014 -
Nursing Management (Harrow, London,... Feb 2015
Topics: Emergency Service, Hospital; Humans; Patient Admission; Patient Discharge; State Medicine; United Kingdom
PubMed: 25629324
DOI: 10.7748/nm.21.9.5.s1 -
Southern Medical Journal Oct 2020
Topics: Humans; Insurance, Health; Patient Discharge; Reimbursement Mechanisms; Treatment Refusal
PubMed: 33005967
DOI: 10.14423/SMJ.0000000000001150