-
Studies in Health Technology and... Oct 2023Discharge letters could be sent to the patients. This poster explores pros and cons of such a procedure.
Discharge letters could be sent to the patients. This poster explores pros and cons of such a procedure.
Topics: Humans; Patient Discharge
PubMed: 37869825
DOI: 10.3233/SHTI230759 -
Narrative Inquiry in Bioethics 2020Hospitalization is a distressing time for patients and their care partners. While in the hospital, they are often thinking about how they will manage their healthcare...
Hospitalization is a distressing time for patients and their care partners. While in the hospital, they are often thinking about how they will manage their healthcare once they leave the hospital. The hospital providers are tasked with conducting discharge planning with the patient and their care partners to ensure a smooth transition from the hospital. However, as the narratives in this symposium illustrate, the patients and their care partners often feel too little attention paid to ensuring their unique needs are met, including their preferences for where they go when they leave the hospital. Patients and their care partners desire increased and improved communication with healthcare providers, including those in the hospital as well as insurers, as they attempt to take control of their discharge through self-advocacy. While these are three common themes across the stories, the authors share a variety of views, circumstances, and opinions that speak to the variability in patients' discharge experiences and preferences.
Topics: Communication; Hospitalization; Humans; Narration; Patient Advocacy; Patient Discharge; Patient Preference; Patient Transfer
PubMed: 33583855
DOI: 10.1353/nib.2020.0071 -
Annals of Emergency Medicine Mar 2020We conduct a systematic review with meta-analysis to provide an overview of the different manners of providing discharge instructions in the emergency department (ED)... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
We conduct a systematic review with meta-analysis to provide an overview of the different manners of providing discharge instructions in the emergency department (ED) and to assess their effects on comprehension and recall of the 4 domains of discharge instructions: diagnosis, treatment, follow-up, and return instructions.
METHODS
We performed a systematic search in the PubMed, EMBASE, Web of Science Google Scholar, and Cochrane databases for studies published before March 15, 2018. A quality assessment of included articles was performed. Pooled proportions of correct recall by manner of providing discharge instructions were calculated.
RESULTS
A total of 1,842 articles were screened, and after selection, 51 articles were included. Of the 51 included studies, 12 used verbal discharge instructions only, 30 used written discharge instructions, and 7 used video. Correct recall of verbal, written, and video discharge instructions ranged from 8% to 94%, 23% to 92%, and 54% to 89%, respectively. Meta-analysis was performed on data of 1,460 patients who received verbal information only, 3,395 patients who received written information, and 459 patients who received video information. Pooled data showed differences in correct recall, with, on average, 47% for patients who received verbal information (95% confidence interval 32.2% to 61.7%), 58% for patients who received written information (95% confidence interval 44.2% to 71.2%), and 67% for patients who received video information (95% confidence interval 57.9% to 75.7%).
CONCLUSION
Communicating discharge instructions verbally to patients in the ED may not be sufficient. Although overall correct recall was not significantly higher, adding video or written information to discharge instructions showed promising results for ED patients.
Topics: Comprehension; Emergency Service, Hospital; Humans; Mental Recall; Patient Discharge; Patients
PubMed: 31439363
DOI: 10.1016/j.annemergmed.2019.06.008 -
PloS One 2021The Centers for Medicare and Medicaid Services identified unplanned hospital readmissions as a critical healthcare quality and cost problem. Improvements in hospital...
The Centers for Medicare and Medicaid Services identified unplanned hospital readmissions as a critical healthcare quality and cost problem. Improvements in hospital discharge decision-making and post-discharge care are needed to address the problem. Utilization of clinical decision support (CDS) can improve discharge decision-making but little is known about the empirical significance of two opposing problems that can occur: (1) negligible uptake of CDS by providers or (2) over-reliance on CDS and underuse of other information. This paper reports an experiment where, in addition to electronic medical records (EMR), clinical decision-makers are provided subjective reports by standardized patients, or CDS information, or both. Subjective information, reports of being eager or reluctant for discharge, was obtained during examinations of standardized patients, who are regularly employed in medical education, and in our experiment had been given scripts for the experimental treatments. The CDS tool presents discharge recommendations obtained from econometric analysis of data from de-identified EMR of hospital patients. 38 clinical decision-makers in the experiment, who were third and fourth year medical students, discharged eight simulated patient encounters with an average length of stay 8.1 in the CDS supported group and 8.8 days in the control group. When the recommendation was "Discharge," CDS uptake of "Discharge" recommendation was 20% higher for eager than reluctant patients. Compared to discharge decisions in the absence of patient reports: (i) odds of discharging reluctant standardized patients were 67% lower in the CDS-assisted group and 40% lower in the control (no-CDS) group; whereas (ii) odds of discharging eager standardized patients were 75% higher in the control group and similar in CDS-assisted group. These findings indicate that participants were neither ignoring nor over-relying on CDS.
Topics: Clinical Decision Rules; Decision Making; Decision Support Systems, Clinical; Education, Medical; Electronic Health Records; Patient Discharge; Patient Readmission; Patients; Students, Medical
PubMed: 33684144
DOI: 10.1371/journal.pone.0247270 -
Journal of Patient Safety Mar 2020Prompt, complete, and accurate information transfer at the time of discharge between hospital-based and primary care providers (PCPs) is needed for the provision of safe...
BACKGROUND
Prompt, complete, and accurate information transfer at the time of discharge between hospital-based and primary care providers (PCPs) is needed for the provision of safe and effective care.
PURPOSE OF THE STUDY
To evaluate timeliness, quality, and interventions to improve timeliness and quality of hospital discharge summaries.
DATA SOURCES
PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus database published in English between January 2007 and February 2014 were searched. We also hand-searched bibliographies of relevant articles.
STUDY SELECTION
Observational studies investigating transfer of information at hospital discharge (n = 7) and controlled studies evaluating interventions to improve timeliness and quality of discharge information (n = 12) were included.
DATA EXTRACTION
We extracted data on availability, timeliness, and content of hospital discharge summaries and on the effectiveness of interventions targeting discharge summaries. Results of studies are presented narratively and using descriptive statistics.
DATA SYNTHESIS
Across the studies, discharge summaries were completed within 48 hours in a median of 67% and were available to PCPs within 48 hours only 55% of the time. Most of the time, discharge summaries included demographics, primary diagnosis, hospital course, and discharge instructions. However, information was limited to pending test results (25%), diagnostic tests performed (60%), and postdischarge medications (78%). In 6 interventional studies, implementation of electronic discharge summaries was associated with improvement in timeliness but not quality.
CONCLUSIONS
Delayed or insufficient transfer of discharge information between hospital-based providers and PCPs remains common. Creation of electronic discharge summaries seems to improve timeliness and availability but does not consistently improve quality.
Topics: Hospitals; Humans; Patient Discharge
PubMed: 26741789
DOI: 10.1097/PTS.0000000000000248 -
Anaesthesia Feb 2022Patient-centred outcomes are increasingly recognised as crucial measures of healthcare quality. Days alive and at home up to 30 days after surgery (DAH ) is a...
Patient-centred outcomes are increasingly recognised as crucial measures of healthcare quality. Days alive and at home up to 30 days after surgery (DAH ) is a validated and readily obtainable patient-centred outcome measure that integrates much of the peri-operative patient journey. However, the minimal difference in DAH that is clinically important to patients is unknown. We designed and administered a 28-item survey to evaluate the minimal clinically important difference in DAH among adult patients undergoing inpatient surgery. Patients were approached pre-operatively or within 2 days postoperatively. We did not study patients undergoing day surgery or nursing home residents. Patients ranked their opinions on the importance of discharge home using a Likert scale (from 1, not important at all to 6, extremely important) and the minimum number of extra days at home that would be meaningful using this scale. We recruited 104 patients; the survey was administered pre-operatively to 45 patients and postoperatively to 59 patients. The mean (SD) age was 53.5 (16.5) years, and 51 (49%) patients were male. Patients underwent a broad range of surgery of mainly intermediate (55%) to major (33%) severity. The median minimal clinically important difference for DAH was 3 days; this was consistent across a broad range of scenarios, including earlier discharge home, complications delaying hospital discharge and the requirement for admission to a rehabilitation unit. Discharge home earlier than anticipated and discharge home rather than to a rehabilitation facility were both rated as important (median score = 5). Empirical data on the minimal clinically important difference for DAH may be useful to determine sample size and to guide the non-inferiority margin for future clinical trials.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Minimal Clinically Important Difference; Patient Discharge; Postoperative Care; Postoperative Period; Surveys and Questionnaires; Treatment Outcome
PubMed: 34797923
DOI: 10.1111/anae.15623 -
Disability and Rehabilitation Nov 2021Research to date has focused on clinicians' views on patients' discharge readiness from acute hospital settings.This study aims to synthesise the literature on discharge...
PURPOSE
Research to date has focused on clinicians' views on patients' discharge readiness from acute hospital settings.This study aims to synthesise the literature on discharge readiness from sub-acute (rehabilitation) hospital settings from all stakeholders' perspectives.
METHODS
Electronic databases (MEDLINE, CINAHL, Ageline, AMED and Global Health) were systematically searched for post-2000 publications on discharge readiness of adult inpatients in sub-acute settings. After screening, quantitative and qualitative studies were assessed for bias using the Downs and Black checklist and McMaster critical assessment tool respectively, and narrative analysis conducted.
RESULTS
From the 3516 papers identified, 23 were included in the review. Overall quality of articles was rated as adequate. Narrative synthesis identified three main themes: the importance of functional outcomes; confounding factors impact on discharge destination and length of stay and barriers and facilitators to discharge.
CONCLUSION
Despite limited literature defining sub-acute patients' discharge-readiness from all stakeholders' perspectives, synthesis of available findings identified major themes for consideration when determining when a patient is ready to leave hospital. Limitations include the heterogeneity of the studies located impacted on data extraction and quality appraisal.IMPLICATIONS FOR REHABILITATIONDischarging patients from hospital is complex, discharge too early may lead to poor medical outcomes or readmission, while discharge too late may increase the risk of hospital-based adverse events.Multiple factors need to be considered when considering the discharge readiness of an inpatient.Ensuring adequate social support is key to maximising transition from hospital to home.Combining the use of functional outcome measures with clinical decision-making allows for quantifying readiness for discharge.
Topics: Adult; Hospitals; Humans; Inpatients; Patient Discharge; Qualitative Research; Subacute Care
PubMed: 32126189
DOI: 10.1080/09638288.2020.1733107 -
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 -
Acta Psychiatrica Scandinavica Sep 2019People discharged from in-patient psychiatric facilities have highly elevated rates of suicide, and there is increasing concern about natural mortality among the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
People discharged from in-patient psychiatric facilities have highly elevated rates of suicide, and there is increasing concern about natural mortality among the seriously mentally ill.
METHOD
A meta-analysis of English-language, peer-reviewed longitudinal studies of mortality among patients discharged from in-patient psychiatric facilities was conducted using papers published in MEDLINE, PsycINFO or EMBASE (from 1 January 1960 to 1 April 2018) located using the terms ((suicid*).ti AND (hospital OR discharg* OR inpatient OR in-patient OR admit*)).ab and ((mortality OR outcome* OR death*) AND (psych* OR mental*)).ti AND (admit* OR admis* OR hospital* OR inpatient* OR in-patient* OR discharg*).ab. Pooled mortality rates for aggregated natural and unnatural causes, and the specific causes of suicide, accident, homicide, vascular, neoplastic, respiratory, gastrointestinal, infectious and metabolic death were calculated using a random-effects meta-analytic model. Between-study heterogeneity was investigated using subgroup analysis and metaregression.
RESULTS
The pooled natural death rate of 1128 per 100 000 person-years exceeded the pooled unnatural deaths of 479 per 100 000 person-year among studies with varying periods of follow-up. Natural deaths significantly exceeded unnatural deaths among studies with a mean follow-up of longer than 2 years, and vascular deaths exceeded suicide deaths among studies with mean period of follow-up of 5 years or longer.
CONCLUSION
Suicide may be the largest single cause of death in the short term after discharge from in-patient psychiatric facilities but vascular disease is the major cause of mortality in the medium- and long-term.
Topics: Cardiovascular Diseases; Cause of Death; Humans; Mental Disorders; Patient Discharge; Suicide
PubMed: 31325315
DOI: 10.1111/acps.13073 -
Medical Care Mar 2020Improving the collection and quality of race and ethnicity reported in hospital data is a key step in identifying disparities in health service utilization and outcomes...
BACKGROUND
Improving the collection and quality of race and ethnicity reported in hospital data is a key step in identifying disparities in health service utilization and outcomes and opportunities for quality improvement.
OBJECTIVE
The objective of this study was to assess the quality of race/ethnicity reported in hospital discharge data and examine the impact on the identification of disparities in select health outcomes in New York City.
RESEARCH DESIGN
Using the birth certificate as a gold standard, we examined the quality of hospital discharge race/ethnicity and estimated the impact of misclassification on racial/ethnic disparities in severe maternal morbidity and preventable hospitalizations.
SUBJECTS
Delivery hospitalizations from the New York State hospital discharge data (Statewide Planning and Research Cooperative System) linked with 2015 New York City birth certificates.
MEASURES
Sensitivity and positive predictive value (PPV).
RESULTS
The non-Hispanic white and black race had relatively high sensitivity and PPV. Hispanic ethnicity and Asian race had moderate sensitivity and high PPV, but were often misclassified as "Other." As a result, health disparities may be underestimated for those of Hispanic ethnicity and Asian race, particularly for indicators that use population denominators drawn from another source.
CONCLUSIONS
The quality of hospital discharge data varies by race/ethnicity and may underestimate disparities in some groups. Future research should validate findings with other data sources, identify driving factors, and evaluate progress over time.
Topics: Adult; Birth Certificates; Ethnicity; Female; Health Status Disparities; Humans; Male; New York City; Patient Discharge; Racial Groups
PubMed: 31851043
DOI: 10.1097/MLR.0000000000001259