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Journal of Surgical Education 2019There is a paucity of data regarding the efficiency of care provided by teaching hospitals. Yet, instruction on transitions in care and an understanding of systems-based...
OBJECTIVE
There is a paucity of data regarding the efficiency of care provided by teaching hospitals. Yet, instruction on transitions in care and an understanding of systems-based practice are key components of modern graduate medical education. We aimed to determine the relationship between hospital teaching status and the discharge efficiency from a surgical service.
SETTING
Patients who were cared for at teaching and nonteaching hospitals captured in the Healthcare Cost and Utilization Project National Inpatient Sample from 2012.
PARTICIPANTS
A total of 272,090 patients who underwent one of 44 predefined general surgery procedure types.
DESIGN
Patients were stratified based on treating hospital teaching status (TH vs. NTH). Procedure-specific early discharge (PSED) was defined for each operation type as a discharge that occurred within the lowest 25th percentile for overall length of stay. PSED was used as the discharge efficiency metric. To adjust for cofounders and hospital level clustering, multivariable mixed-effects logistic regression was used to examine the association between teaching status and PSED. Subgroup analysis was performed by operation type. Models were constructed with and without adjustment for inpatient complications.
RESULTS
There were 140,878 (51.8%) patients who received care at a TH. TH status was significantly associated with lower PSED (TH: 10.7% vs. NTH: 11.4%; p < 0.001) and longer length of stay (TH: 5.5 days vs. NTH: 4.5 days; p < 0.001). In the adjusted model of the overall cohort, patients treated at a TH were 8% less likely to receive a PSED compared to those treated at NTH (odds ratio 0.92, 95% confidence interval (0.88, 0.97); p < 0.002). Differences in the rates and odds of PSED were noted across the subgroups.
CONCLUSIONS
Teaching hospital status is associated with a reduced likelihood of PSED. The effect of TH on PSED varied by procedure subgroup. Examining the recovery pathways and discharge practices at NTH may allow for the identification of more efficient methods of care that can be applied to the broader healthcare system.
Topics: Efficiency, Organizational; Hospitals, Teaching; Humans; Patient Discharge; Surgical Procedures, Operative
PubMed: 30987921
DOI: 10.1016/j.jsurg.2019.03.022 -
International Emergency Nursing Sep 2019Discharging patients with a self-reported low readiness for hospital discharge (RHD) may be challenging, as these patients may be vulnerable to risks and adaptation...
BACKGROUND
Discharging patients with a self-reported low readiness for hospital discharge (RHD) may be challenging, as these patients may be vulnerable to risks and adaptation issues that can delay recovery. However, little is known about whether emergency medicine ward (EMW) patients are sufficiently prepared for discharge to home. Therefore, the aim of this study is to examine the factors and outcomes associated with patients' RHD in an EMW setting.
METHODS
One hundred and eighty-four patients were recruited from the EMW of a tertiary hospital in Hong Kong. Cross-sectional data were collected from self-administered questionnaires and patients' medical records at the time of discharge and 1 month later. Descriptive statistics were obtained, and the variables were subjected to multivariable regression analyses.
RESULTS
Seventy-three patients (40%) reported a low RHD at the time of discharge. Living with someone was a factor contributing to a patient's perceived RHD. A greater RHD was associated with a lower risk of 30-day emergency department readmission (odds ratio [OR] = 0.75; 95% confidence interval [CI] = 0.57-0.99) and hospital readmission (OR = 0.59; 95% CI = 0.38-0.91). However, patients who reported higher scores on the knowledge RHD subscale had a higher risk of hospital readmission (OR = 2.34; 95% CI = 1.38-3.98).
CONCLUSION
These findings demonstrate the importance of paying careful attention to social support network of patients and the provision of patient education, as these may improve patients' RHD prior to discharge from the EMW. (242 words).
Topics: Aged; Aged, 80 and over; Cross-Sectional Studies; Emergency Service, Hospital; Female; Hong Kong; Humans; Length of Stay; Male; Middle Aged; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission; Patients; Prospective Studies; Surveys and Questionnaires
PubMed: 31130398
DOI: 10.1016/j.ienj.2019.04.002 -
Nicotine & Tobacco Research : Official... Mar 2020Hospitalization and post-discharge provide an opportune time for tobacco cessation. This study tested the feasibility, uptake, and cessation outcomes of a hospital-based...
INTRODUCTION
Hospitalization and post-discharge provide an opportune time for tobacco cessation. This study tested the feasibility, uptake, and cessation outcomes of a hospital-based tobacco cessation program, delivered by volunteers to the bedside with post-discharge referral to Quitline services. Patient characteristics associated with Quitline uptake and cessation were assessed.
METHODS
Between February and November 2016, trained hospital volunteers approached inpatient tobacco users on six pilot units. Volunteers shared a cessation brochure and used the ASK-ADVISE-CONNECT model to connect ready to quit patients to the Delaware Quitline via fax-referral. Volunteers administered a follow-up survey to all admitted tobacco users via telephone or email at 3-months post-discharge.
RESULTS
Of the 743 admitted tobacco users, 531 (72%) were visited by a volunteer, and 97% (531/547) of those approached, accepted the visit. Over one-third (201/531; 38%) were ready to quit and fax-referred to the Quitline, and 36% of those referred accepted Quitline services. At 3 months post-discharge, 37% (135/368) reported not using tobacco in the last 30 days; intent-to-treat cessation rate was 18% (135/743). In a multivariable regression model of Quitline fax-referral completion, receiving nicotine replacement therapy (NRT) during hospitalization was the strongest predictor (odds ratios [OR] = 1.97; 95% confidence interval [CI] = 1.34 to 2.90). In a model of 3-month cessation, receiving Quitline services (OR = 3.21, 95% CI = 1.35 to 7.68) and having coronary artery disease (OR = 2.28; 95% CI = 1.11 to 4.68) were associated with tobacco cessation, but a volunteer visit was not.
CONCLUSIONS
An "opt-out" tobacco cessation service using trained volunteers is feasible for connecting patients to Quitline services.
IMPLICATIONS
This study demonstrates the feasibility of a systems-based approach to link inpatients to evidence-based treatment for tobacco use. This model used trained bedside volunteers to connect inpatients to a state-funded Quitline after discharge that offers free cessation treatment of telephone coaching and cessation medications. Receiving NRT during hospitalization positively impacted Quitline referral, and engagement with Quitline resources was critical to tobacco abstinence post-discharge. Future work is needed to evaluate the cost-effectiveness and sustainability of this volunteer model.
Topics: Female; Hospitalization; Humans; Male; Middle Aged; Patient Discharge; Referral and Consultation; Telephone; Tobacco Use Cessation; Volunteers
PubMed: 30462274
DOI: 10.1093/ntr/nty252 -
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 -
Health Information Management : Journal... 2021
Topics: COVID-19; Data Accuracy; Humans; Pandemics; Patient Discharge; SARS-CoV-2
PubMed: 32930004
DOI: 10.1177/1833358320948655 -
Journal of the American Geriatrics... Apr 2020Discharge decision making for hospitalized older adults can be a complicated process involving functional assessments, capacity evaluation, and coordination of...
Discharge decision making for hospitalized older adults can be a complicated process involving functional assessments, capacity evaluation, and coordination of resources. Providers may feel pressured to recommend that an older adult with complex care needs be discharged to a skilled nursing facility rather than home, potentially contradicting the patient's wishes. This can lead to a professional and ethical dilemma for providers, who value patient autonomy and shared decision making. We describe a discharge decision-making framework focused on interprofessional evaluation and management, longitudinal follow-up, and education and support for patients and families. By gathering and synthesizing information, eliciting goals and preferences, and identifying community resources, the healthcare team can help maximize independence for vulnerable older adults. J Am Geriatr Soc 68:859-866, 2020.
Topics: Aged; Aged, 80 and over; Decision Making; Female; Geriatric Assessment; Humans; Male; Patient Discharge; Patient Preference; Patient-Centered Care
PubMed: 31905244
DOI: 10.1111/jgs.16315 -
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 -
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 -
Journal of Clinical Nursing Feb 2020To evaluate aspects of patient safety before and after a person-centred (PC) inpatient care intervention.
AIMS AND OBJECTIVES
To evaluate aspects of patient safety before and after a person-centred (PC) inpatient care intervention.
BACKGROUND
Transitioning from disease-centred to person-centred care requires great effort but can improve patient safety.
DESIGN
A quasi-experimental study with data collection preceding and 12 months after a PC inpatient care intervention.
METHODS
The study consecutively recruited adult patients (2014, n = 263; 2015/2016, n = 221) admitted to an inpatient care unit. The patients reported experiences of care at discharge and their perceived pain at admission and discharge. Medical records were reviewed to gather data on medications, planned care and clinical observations. The study is reported according to TREND guidelines.
RESULTS
At discharge, patients receiving PC inpatient care reported competent medical-technical care. Patients receiving PC inpatient care reported more effective pain relief. Updated prescribed medications at the ward were maintained, and patients were made aware of planned medical care to higher extent during PC inpatient care. The assessment of pulse and body temperature was maintained, but fewer elective care patients had their blood pressure taken during PC inpatient care. Weight assessment was not prioritised during usual or PC inpatient care.
CONCLUSIONS
Patients receiving PC inpatient care reported that they were given the best possible care and had less pain at discharge. The PC inpatient care included improved documentation and communication of planned medical care to the patients. Vital signs were more frequently recorded for patients admitted for acute care than patients admitted for elective care. PC inpatient care had no effect on frequency of weight measurements.
RELEVANCE TO CLINICAL PRACTICE
PC inpatient care seems beneficial for the patients. Aspects of patient safety such as prescribed medications were maintained, and PC inpatient care seems to enhance the continuity of care. Inpatient clinical observations need further evaluation as healthcare transitions from disease-centred to person-centred care.
Topics: Adult; Communication; Female; Hospitalization; Humans; Inpatients; Male; Outcome Assessment, Health Care; Patient Discharge; Patient Safety; Patient Satisfaction; Patient-Centered Care
PubMed: 31769572
DOI: 10.1111/jocn.15120