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Cardiovascular Revascularization... Aug 2021
Topics: Comprehension; Humans; Patient Discharge
PubMed: 34172401
DOI: 10.1016/j.carrev.2021.06.015 -
Nursing Research 2020Promoting continuity of nurse assignment during discharge care has the potential to increase patient readiness for discharge-which has been associated with fewer... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Promoting continuity of nurse assignment during discharge care has the potential to increase patient readiness for discharge-which has been associated with fewer readmissions and emergency department visits. The few studies that examined nurse continuity during acute care hospitalizations did not focus on discharge or postdischarge outcomes.
OBJECTIVES
The aim of this research was to examine the association of continuity in nurse assignment to patients prior to hospital discharge with return to hospital (readmission and emergency department or observation visits), including exploration of the mediating pathway through patient readiness for discharge and moderating effects of unit environment and unit nurse characteristics.
METHODS
In a sample of 18,203 adult, medical-surgical patients from 31 Magnet hospitals, a correlational path analysis design was used in a secondary analysis to evaluate the effect of nurse continuity on readmissions and emergency department or observation visits within 30 days after hospital discharge. The mediating pathway through discharge readiness measured by patient self-report and nurse assessments was also assessed. Moderating effects of unit environment and nursing characteristics were examined across quartiles of unit environment (nurse staffing hours per patient day) and unit nurse characteristics (education and experience). Analyses were adjusted for patient characteristics, unit fixed effects, and clustering at the unit level.
RESULTS
Continuous nurse assignment on the last 2 days of hospitalization was observed in 6,441 (35.4%) patient discharges and was associated with a 0.85 absolute percentage point reduction (7.8% relative reduction) in readmissions. There was no significant association with emergency department or observation visits. Sensitivity analysis revealed a stronger effect in patients with higher Elixhauser Comorbidity Indexes. Readiness for discharge was not a mediator of the effect of continuity on return to hospital. Unit characteristics were not associated with nurse continuity. No moderation effect was evident for unit environment and nurse characteristics.
DISCUSSION
Continuity of nurse assignment on the last 2 days of hospitalization can reduce readmissions. Staffing for continuity may benefit patients and healthcare systems, with greater benefits for high-comorbidity patients. Nurse continuity prior to hospital discharge should be a priority consideration in assigning acute care nurses to augment readmission reduction efforts.
Topics: Adult; Aged; Continuity of Patient Care; Female; Humans; Male; Middle Aged; Nursing Evaluation Research; Nursing Staff, Hospital; Patient Discharge; Patient Readmission
PubMed: 31934945
DOI: 10.1097/NNR.0000000000000417 -
MMW Fortschritte Der Medizin Mar 2020
Review
Topics: Amputation, Surgical; Foot; Humans; Lower Extremity; Patient Discharge
PubMed: 32189266
DOI: 10.1007/s15006-020-0257-6 -
Journal of Intensive Care Medicine Jan 2020In the new era of decreasing hospital bed availability, there is an increasing rate of direct discharge to home (DDH) from intensive care units (ICUs), despite sparse...
BACKGROUND
In the new era of decreasing hospital bed availability, there is an increasing rate of direct discharge to home (DDH) from intensive care units (ICUs), despite sparse literature informing this practice.
OBJECTIVES
To evaluate patient, family, and ICU attending physician satisfaction with planning for DDH from the ICU and intensivists' current DDH practices and perceptions.
METHODS
Prospective cohort study, using convenience sampling, of adult patients undergoing DDH from an ICU between February 2016 and February 2017 using a modified FS-ICU 24 satisfaction survey completed by patients, family members, and attending physicians at the time of patient discharge to home from the ICU.
RESULTS
Seventy-two percent of patients, 37% of family members, and 100% of ICU physicians recruited completed the survey. A majority of patients (89%) and families (78%) were satisfied or very satisfied with DDH. Only 6% of patients and 8% of families were dissatisfied to very dissatisfied with DDH. Conversely, ICU physician satisfaction varied, with only 5% being very comfortable with DDH and the majority (50%) only somewhat comfortable. Twenty percent of staff consultants were uncomfortable to very uncomfortable with the practice of DDH. Thirty-one percent of staff physician respondents felt that patient and family discomfort would be barriers to DDH. Compared to physicians and other allied health professionals, nurses were identified as the most helpful members of the health-care team in preparation for DDH by 98% of patients and 92% of family members. The DDH rates have increased for the past 12 years in our ICUs but declined during the study period (February 2016 to February 2017).
CONCLUSIONS
Patients and family members are satisfied with the practice of DDH from ICU, although ICU physician satisfaction is more variable. Physician comfort may be improved by data informing which patients may be safely DDH from the ICU.
Topics: Adult; Aged; Attitude of Health Personnel; Canada; Family; Female; Humans; Intensive Care Units; Male; Middle Aged; Patient Discharge; Patient Satisfaction; Prospective Studies; Urban Health Services
PubMed: 28931361
DOI: 10.1177/0885066617731263 -
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 Nursing Care Quality 2020Patient flow, from emergency department admission through to discharge, influences hospital overcrowding. We aimed to improve patient flow by increasing discharge lounge...
BACKGROUND
Patient flow, from emergency department admission through to discharge, influences hospital overcrowding. We aimed to improve patient flow by increasing discharge lounge (DL) usage.
LOCAL PROBLEM
Patients need to receive a continuum of nursing care to encourage compliance with follow-up care after discharge from the acute care setting.
METHODS
Baseline data revealed inefficient use of the DL. We targeted the medical-surgical unit with the lowest DL use and trialed interventions over sequential Plan-Do-Study-Act cycles.
INTERVENTIONS
After surveying the nursing staff, we assessed the influence of 3 interventions on DL usage: educating staff on patient eligibility, engaging a recruitment scout, and displaying a visual cue notifying staff when a patient's discharge order was written.
RESULTS
The unit's average DL use increased from 18% to 36%, while hospital overcrowding and discharge turnaround time decreased.
CONCLUSION
The DL is an effective tool to improve patient flow and decrease hospital overcrowding.
Topics: Beds; Crowding; Hospitalization; Humans; Medical-Surgical Nursing; Patient Discharge; Quality Improvement; Time Factors
PubMed: 32433147
DOI: 10.1097/NCQ.0000000000000469 -
European Heart Journal. Acute... Oct 2020In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information... (Review)
Review
In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information imparted to subsequent healthcare providers (HCPs) may be sub-optimal. A French group of cardiologists, lipidologists and diabetologists decided to establish a consensus to optimize the discharge letter after hospitalization for acute myocardial infarction. The aim is to improve both the timeframe and the quality of the content transmitted to subsequent HCPs, including information regarding baseline assessment, procedures during hospitalization, residual risk, discharge treatments, therapeutic targets and follow-up recommendations in compliance with European Society of Cardiology guidelines. A consensus was obtained regarding a template discharge letter, to be released within two days after patient's discharge, and containing the description of the patient's history, risk factors, acute management, risk assessment, discharge treatments and follow-up pathway. Specifically for post acute MI patients, tailored details are necessary regarding the antithrombotic regimen, lipid-lowering and anti-diabetic treatments, including therapeutic targets. Lastly, the follow-up pathway needs to be precisely mentioned in the discharge letter. Additional information such as technical descriptions, imaging, and quality indicators may be provided separately. A template for a standardized discharge letter based on 8 major headings could be useful for implementation in routine practice and help to improve the quality and timing of information transmission between HCPs after acute MI.
Topics: Communication; Consensus; Humans; Myocardial Infarction; Patient Discharge
PubMed: 30990337
DOI: 10.1177/2048872619844444 -
Nursing & Health Sciences Mar 2020A pilot study was conducted to determine the feasibility of a longitudinal investigation of patients' coping during the early postdischarge period. Recruitment was...
A pilot study was conducted to determine the feasibility of a longitudinal investigation of patients' coping during the early postdischarge period. Recruitment was conducted on a general medical unit and a surgical orthopedic unit. Forty-four participants were recruited with 95% retention. Demographic characteristics plus measures of discharge risk and perceived readiness (expected coping) were collected before discharge. Measures of coping (experienced) and the use of supports and services were collected on the first day postdischarge, the end of the first week, and during weeks 3 and 5. Considerable variability was evident in coping scores, and not all participants exhibited improvement over time. Four patterns of coping were identified: ongoing recovery, initial shock, bumpy road, and progressive decline. Further investigation is required to validate the observed coping patterns. A better understanding of conditions affecting patient coping during the transition from hospital to home will support efforts to reduce unplanned use of acute care services.
Topics: Adaptation, Psychological; Aged; Female; Humans; Longitudinal Studies; Male; Middle Aged; Patient Discharge; Patient Readmission; Patient Satisfaction; Patients' Rooms; Pilot Projects
PubMed: 31692227
DOI: 10.1111/nhs.12658 -
Urologie (Heidelberg, Germany) Aug 2022
Topics: Humans; Length of Stay; Patient Discharge
PubMed: 35925291
DOI: 10.1007/s00120-022-01885-6 -
Professional Case ManagementDischarge delays are frustrating to patients, staff, and families. Case managers need a better understanding of what type of patient may experience a discharge delay so...
PURPOSE/OBJECTIVES
Discharge delays are frustrating to patients, staff, and families. Case managers need a better understanding of what type of patient may experience a discharge delay so they can better prepare patients and families or avoid the discharge delay before it happens.
PRIMARY PRACTICE SETTINGS
Hospital.
FINDINGS/CONCLUSIONS
Discharge delays are exasperating to all involved, as they take up precious time and resources of case managers and make patients and families feel like there is an unclear plan. There are actions a case manager can take to lessen the burden of a discharge delay. Actions such as having a rapid discharge plan once the home environment is deemed inappropriate and making sure families and patients are communicated with frequently about their plan of care can decrease or avoid a discharge delay.
IMPLICATIONS FOR CASE MANAGEMENT PRACTICE
Case managers need to know how to identify a patient who might experience a delay in their discharge early, so they can assist the patient and family to ease their stress by explaining limitations and realistic timelines. By identifying a patient who will be experiencing a delay in their discharge due to postacute lack of staffing, care managers can alert families that finding other options for discharge might be more satisfactory. By screening a patient and identifying their needs early, a discharge delay can be shortened or avoided.
Topics: Humans; Patient Discharge; Patients
PubMed: 36662662
DOI: 10.1097/NCM.0000000000000588