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Harvard Review of Psychiatry 2019After participating in this activity, learners should be better able to:• Evaluate risk of suicide and suicide attempts following psychiatric hospitalization• Assess... (Review)
Review
LEARNING OBJECTIVES
After participating in this activity, learners should be better able to:• Evaluate risk of suicide and suicide attempts following psychiatric hospitalization• Assess the relationship between suicide attempts and completed suicides BACKGROUND: Suicidal risks among psychiatric patients appear to be especially high soon after hospitalization. Given the importance of such outcomes, and the lack of recent reviews of post-discharge suicide attempt risks, we evaluated reported findings on the risk of suicide and attempts following psychiatric hospitalization.
METHODS
With systematic, computerized searching, we identified 48 studies (1964-2017) involving 1,700,785 subjects. Follow-up was limited to ≥12 months after discharge from psychiatric hospitalization to avoid inflation of annualized rates due to shorter exposure times.
RESULTS
The overall observed pooled, annualized rate of completed suicide was 241 (confidence interval, 238-243) per 100,000 person-exposure years in 41 studies, and for attempts, 722 (698-746) in 13 studies. In six studies (64,848 subjects) reporting on both suicides and attempts, the ratio of annualized rates for attempts/completed suicides was 8.79 (6.63-12.0). Among all 48 studies, cumulative distribution of suicidal events included 26.4% (25.9-26.9) within the initial month, 40.8% (40.2-41.4) within 3 months, and 73.2% (72.7-73.7) within 12 months of discharge.
CONCLUSIONS
Among patients recently discharged from psychiatric hospitalization, rates of suicide deaths and attempts were far higher than in the general population or even in unselected clinical samples of comparable patients, with a strong inverse association with time post-discharge. Improved monitoring and care of patients discharged from psychiatric hospitalization are needed, ideally with detailed planning and implementation of aftercare prior to discharge.
Topics: Hospitals, Psychiatric; Humans; Patient Discharge; Risk Factors; Suicide
PubMed: 31274577
DOI: 10.1097/HRP.0000000000000222 -
ANZ Journal of Surgery Sep 2023
Topics: Humans; Patient Discharge; Patient Care; Hospitals
PubMed: 37710411
DOI: 10.1111/ans.18612 -
Archives of Disease in Childhood. Fetal... Jul 2021Neonatal intensive care unit (NICU) discharge readiness is the primary caregivers' masterful attainment of technical care skills and knowledge, emotional comfort and... (Review)
Review
Neonatal intensive care unit (NICU) discharge readiness is the primary caregivers' masterful attainment of technical care skills and knowledge, emotional comfort and confidence with infant care by the time of discharge. NICU discharge preparation is the process of facilitating discharge readiness. Discharge preparation is the process with discharge readiness as the goal. Our previous work described the importance of NICU discharge readiness and strategies for discharge preparation from an American medical system perspective. NICU discharge planning is, however, of international relevance as challenges in relation to hospital discharge are a recurring global theme. In this manuscript, we conceptualise NICU discharge preparation with international perspective.
Topics: Child Restraint Systems; Environment; Health Education; Humans; Infant Behavior; Infant Care; Infant, Newborn; Intensive Care Units, Neonatal; Patient Discharge
PubMed: 33046524
DOI: 10.1136/archdischild-2019-318021 -
Journal of Medical Virology Nov 2020Coronavirus disease 2019 (COVID-19) represents a significant global medical issue, with a growing number of cumulative confirmed cases. However, a large number of... (Review)
Review
Coronavirus disease 2019 (COVID-19) represents a significant global medical issue, with a growing number of cumulative confirmed cases. However, a large number of patients with COVID-19 have overcome the disease, meeting hospital discharge criteria, and are gradually returning to work and social life. Nonetheless, COVID-19 may cause further downstream issues in these patients, such as due to possible reactivation of the virus, long-term pulmonary defects, and posttraumatic stress disorder. In this study, we, therefore, queried relevant literature concerning severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19 for reference to come to a consensus on follow-up strategies. We found that strategies, such as the implementation of polymerase chain reaction testing, imaging surveillance, and psychological assessments, starting at the time of discharge, were necessary for long-term follow-up. If close care is given to every aspect of coronavirus management, we expect that the pandemic outbreak will soon be overcome.
Topics: COVID-19; COVID-19 Nucleic Acid Testing; Communicable Disease Control; Disease Management; Follow-Up Studies; Humans; Patient Discharge
PubMed: 32383776
DOI: 10.1002/jmv.25994 -
Otolaryngology--head and Neck Surgery :... Aug 2020We conducted a quality improvement project to increase the rate of discharges before noon (DBN) in the otolaryngology department at a tertiary care center.
OBJECTIVE
We conducted a quality improvement project to increase the rate of discharges before noon (DBN) in the otolaryngology department at a tertiary care center.
METHODS
Based on a Plan-Do-Study-Act framework, monthly discharge data and observed-to-expected (O:E) length of stay were collected and shared with the department members monthly. A target of 43% DBN was predetermined by the center (Plan). The following interventions were implemented (Do): discharge planning starting at the time of admission, focus on early attending-to-resident team communication, placement of discharge order prior to rounding, and weekly reminders to the entire department.
RESULTS
Discharges were monitored for 3 years. For the year prior to this study, a minority of patients were discharged before noon (12 months: 75 of 190, 36%). During the first 6 months of monitoring (Study), no significant improvement was identified (34 of 95, 36%). After interventions, performance significantly improved (31 months: 250 of 548, 68%). The performance was consistently above the predetermined target of 43%. During the study time, O:E length of stay remained below the predetermined target (O:E ratio, 0.90; hospital target, 0.93).
DISCUSSION
Comprehensive discharge planning beginning at the time of admission, weekly reminders, and improved communication (Act) can help to prioritize DBN and increase the percentage of discharges before noon.
IMPLICATIONS FOR PRACTICE
By utilizing a quality improvement framework, significant improvements in timely discharge can be achieved and sustained with changes in workflow and departmental culture. These changes can be achieved without increases in resources or prolonging the length of stay.
Topics: Hospital Departments; Humans; Length of Stay; Otolaryngology; Patient Discharge; Quality Improvement; Tertiary Care Centers; Time Factors
PubMed: 31906819
DOI: 10.1177/0194599819898910 -
Hospital Pediatrics Apr 2020To determine the effect of discharge criteria on discharge readiness and length of stay (LOS). Discharge inefficiency is a common barrier to hospital flow, affecting...
BACKGROUND AND OBJECTIVES
To determine the effect of discharge criteria on discharge readiness and length of stay (LOS). Discharge inefficiency is a common barrier to hospital flow, affecting admissions, discharges, cost, patient satisfaction, and quality of care. Our center identified increasing discharge efficiency as a method to improve flow and better meet the needs of our patients.
METHODS
A multidisciplinary team was assembled to examine discharge efficiency and flow. Discharge criteria were created for the 3 most common diagnoses on the hospital medicine service then expanded to 10 diagnoses 4 months into the project. Discharge workflow was evaluated through swim lane mapping, and barriers were evaluated through fishbone diagrams and a key driver diagram. Progress was assessed every 2 weeks through statistical process control charts. Additional interventions included provider education, daily review of criteria, and autotext added to daily notes. Our primary aim was to increase the percentage of patients discharged within 3 hours of meeting discharge criteria from 44% to 75% within 12 months of project implementation.
RESULTS
Discharge within 3 hours as well as 2 hours of meeting criteria improved significantly, from 44% to 87% and from 33% to 78%, respectively. LOS for the 10 diagnoses decreased from 2.89 to 1.47 days, with greatest gains seen for patients with asthma, pneumonia, and bronchiolitis without a change in the 30-day readmission rate.
CONCLUSIONS
Discharge criteria for common diagnoses may be an effective way to decrease variability and improve LOS for hospitalized children.
Topics: Child; Hospitalization; Humans; Length of Stay; Patient Discharge; Patient Readmission; Quality Improvement
PubMed: 32179570
DOI: 10.1542/hpeds.2019-0244 -
Nature Reviews. Urology Aug 2022
Topics: Decision Making; Humans; Patient Discharge
PubMed: 35831544
DOI: 10.1038/s41585-022-00630-0 -
Current Opinion in Anaesthesiology Dec 2019Day surgery coming and leaving hospital day of surgery is growing. From minor and intermediate procedure performed on health patient, day surgery is today performed on... (Review)
Review
PURPOSE OF REVIEW
Day surgery coming and leaving hospital day of surgery is growing. From minor and intermediate procedure performed on health patient, day surgery is today performed on complex procedures and elderly patient and on patients with comorbidities. Thus, appropriate discharge assessment is of huge importance to secure safety and quality of care.
RECENT FINDINGS
Discharge has since decades been assessed on a combination of stable vital signs, control of pain and postoperative nausea and vomiting and securing that patients can stand walk unaided. There is controversy around whether patients must drink and void before discharge. The absolute need for escort when leaving hospital and someone at home first night after surgery is argued but it does support safety. Discharge is not being 'street fit,' it merely allows patients to go back home for further recovery in the home environment. A structured discharge timeout checklist securing that patients are informed of further plans, signs, and symptoms to watch out for and what to do in case recovery don't follow plans facilitate safety.
SUMMARY
Discharge following day surgery must be based on appropriate assessment of stable vital signs and reasonable resumption of activity of daily living performance. Rapid discharge must not jeopardize safety. Classic discharge criteria are still basis for safe discharge, adding a structured discharge checklist facilitates safe discharge.
Topics: Ambulatory Surgical Procedures; Anesthesia Recovery Period; Humans; Patient Discharge
PubMed: 31425193
DOI: 10.1097/ACO.0000000000000784 -
The Nursing Clinics of North America Sep 2021Major risks associated with inadequate discharge preparation and execution include medication errors, adverse drug events, and hospital readmissions. Nurses must develop... (Review)
Review
Major risks associated with inadequate discharge preparation and execution include medication errors, adverse drug events, and hospital readmissions. Nurses must develop pertinent skills to assess how the social environment impacts patients' likelihood of a safe and healthy transition back into the community as they prepare patients for discharge. Recognition and consideration of social determinants of health are critical to minimizing health disparities, enhancing health equity and supporting positive patient outcomes. Examples of strategies for enhanced discharge practices include implicit bias assessment and training, screening for food insecurity, and assessment for quality referral sources.
Topics: Humans; Inpatients; Medication Errors; Patient Discharge; Patient Readmission; Practice Patterns, Physicians'; Quality Improvement; Social Determinants of Health
PubMed: 34366157
DOI: 10.1016/j.cnur.2021.04.004 -
International Journal of Mental Health... Aug 2019To ensure a safe transition of mental health patients from hospital to community settings, greater attention is being given to discharge planning. However, assessing the... (Review)
Review
To ensure a safe transition of mental health patients from hospital to community settings, greater attention is being given to discharge planning. However, assessing the quality of discharge planning has been challenging due to wide variations in its definition. To facilitate evaluation of discharge planning, its meaning in the mental health literature was systematically explored. This concept analysis is part of a larger study to develop an instrument to measure the quality of discharge planning processes in mental health care. Walker and Avant's (2011) concept analysis approach was adopted to provide a comprehensive definition of discharge planning. Electronic databases and grey literature were searched and analysed according to Grant and Booth's (2009) systematic search and review process. Literature published between 1900 and 2018 was reviewed. Forty-nine articles meeting the inclusion criteria were included in the analysis. Discharge planning is a complex, multifaceted concept with six defining attributes: comprehensive needs assessment; collaborative, patient-centered care; resource availability management; care and service coordination; discharge planner role; and a discharge plan. Discharge planning begins with the initial rapid assessment and symptom stabilization of a patient on admission, coincides with treatment planning, and is associated with hospital readmissions and continuity of care. The mental health literature was reviewed to analyse different interpretations of discharge planning. The conceptual definition provided can assist healthcare providers, organizational leaders, and policymakers to design and implement effective discharge planning policies and guidelines. Providing clarity regarding discharge planning also provides a critical foundation for developing an instrument.
Topics: Hospitals, Psychiatric; Humans; Mental Disorders; Patient Discharge
PubMed: 31039293
DOI: 10.1111/inm.12599