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Orthopedic NursingTotal joint arthroplasties are one of the most common procedures performed in the United States. As changes have occurred in the surgical techniques of these procedures,... (Review)
Review
Total joint arthroplasties are one of the most common procedures performed in the United States. As changes have occurred in the surgical techniques of these procedures, postoperative recovery time has decreased and patients have been able to safely transition to home rather than a post-acute care facility. The demand for total joint arthroplasty (TJA) is expected to grow 44% as the prevalence of lower extremity osteoarthritis continues to rise (Sher et al., 2017) because of an aging baby boomer population. In the next 20 years, it is expected that the demand for total hip arthroplasty will grow by 174% and demand for total knee arthroplasty will grow by as much as 670% (Napier et al., 2013). An area with high variability in the postoperative period is in postdischarge rehabilitation. Post-acute inpatient care can account for up to 36% of the bundled costs of a TJA. There is a lack of evidence that patients recover better or have decreased complications by transitioning to an inpatient rehabilitation setting compared with transitioning to home. The aims of this literature search were to (a) identify the safest discharge disposition for patients following TJA; (b) determine the rate of complications and readmissions among those discharged to skilled nursing facility, inpatient rehabilitation unit, and home; and (c) explore how specified care pathways affect patient expectations and outcomes. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, ProQuest, and Cochrane were searched using the following key terms: discharge disposition, total joint arthroplasty, joint replacement, hip arthroplasty, knee arthroplasty, care pathway, discharge outcomes and readmissions, discharge protocols, and discharge algorithms. Five key themes emerged. Patients with significant comorbidities may require longer length of stay in the hospital or potentially discharge to a facility, discharge to facility associated with high rate of complications, setting patient expectations increases likelihood of discharge home, discharge to inpatient facilities does not improve outcomes, and discharge to any post-acute care facility is more expensive than discharge to home. This review identified themes in postoperative care of TJA patients that can be utilized to create a discharge disposition algorithm using best practices to stratify patients into the appropriate discharge disposition while setting appropriate expectations for patients undergoing these procedures to ensure high levels of patient satisfaction following these procedures.
Topics: Algorithms; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Home Care Services; Humans; Patient Discharge; Patient Outcome Assessment; Patient Satisfaction; Postoperative Period; Skilled Nursing Facilities
PubMed: 34004610
DOI: 10.1097/NOR.0000000000000753 -
JAMA Network Open Aug 2021Shortcomings in the education of patients at hospital discharge are associated with higher risks for treatment failure and hospital readmission. Whether improving... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Shortcomings in the education of patients at hospital discharge are associated with higher risks for treatment failure and hospital readmission. Whether improving communication at discharge through specific interventions has an association with patient-relevant outcomes remains unclear.
OBJECTIVE
To conduct a systematic review and meta-analysis on the association of communication interventions at hospital discharge with readmission rates and other patient-relevant outcomes.
DATA SOURCES
PubMed, EMBASE, PsycINFO, and CINAHL were systematically searched from the inception of each database to February 28, 2021.
STUDY SELECTION
Randomized clinical trials that randomized patients to receiving a discharge communication intervention or a control group were included.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted data on outcomes and trial and patient characteristics. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Data were pooled using a random-effects model, and risk ratios (RRs) with corresponding 95% CIs are reported. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
MAIN OUTCOMES AND MEASURES
The primary outcome was hospital readmission, and secondary outcomes included adherence to treatment regimen, patient satisfaction, mortality, and emergency department reattendance 30 days after hospital discharge.
RESULTS
We included 60 randomized clinical trials with a total of 16 070 patients for the qualitative synthesis and 19 trials with a total of 3953 patients for the quantitative synthesis of the primary outcome. Of these, 11 trials had low risk of bias, 6 trials had high risk of bias, and 2 trials had unclear risk of bias. Communication interventions at discharge were significantly associated with lower readmission rates (179 of 1959 patients [9.1%] in intervention groups vs 270 of 1994 patients [13.5%] in control groups; RR, 0.69; 95% CI, 0.56-0.84), higher adherence to treatment regimen (1729 of 2009 patients [86.1%] in intervention groups vs 1599 of 2024 patients [79.0%] in control groups; RR, 1.24; 95% CI, 1.13-1.37), and higher patient satisfaction (1187 of 1949 patients [60.9%] in intervention groups vs 991 of 2002 patients [49.5%] in control groups; RR, 1.41; 95% CI, 1.20-1.66).
CONCLUSIONS AND RELEVANCE
These findings suggest that communication interventions at discharge are significantly associated with fewer hospital readmissions, higher treatment adherence, and higher patient satisfaction and thus are important to facilitate the transition of care.
Topics: Adult; Aged; Aged, 80 and over; Communication; Female; Humans; Male; Middle Aged; Patient Discharge; Patient Education as Topic; Patient Readmission; Practice Guidelines as Topic
PubMed: 34448868
DOI: 10.1001/jamanetworkopen.2021.19346 -
Professional Case Management 2019Miscommunications during the complex process of discharging patients from acute care facilities can lead to adverse events, patient dissatisfaction, and delays in...
PURPOSE OF STUDY
Miscommunications during the complex process of discharging patients from acute care facilities can lead to adverse events, patient dissatisfaction, and delays in discharge. Brief multidisciplinary discharge rounds (MDRs) can increase communication between stakeholders and shorten a patient's length of stay (LOS). At our tertiary academic medical center, case managers (CMs) have historically been assigned patients by physical unit location rather than by provider teams caring for patients. As a result, medicine teams often interact with several unit-based CMs due to lack of geographically cohorted patients, leading to inefficiency and fragmentation in discharge planning communication. Our aim was to implement and evaluate the impact of multidisciplinary, team-based discharge planning rounds (MDR) for general medicine patients.
PRIMARY PRACTICE SETTING
A tertiary academic medical center.
METHODOLOGY AND SAMPLE
Using the model for continuous improvement, we implemented and optimized MDR on 2 of 4 internal medicine resident ward teams that care for general internal medicine patients, including creation of a multidisciplinary team, improving physician continuity.
RESULTS
During the pilot, 1,584 patients were discharged from all medicine teams-825 from pilot teams and 759 from control teams. The proportion of patients with discharge before noon (DBN) orders was 41.2% on pilot versus 29.6% on control teams. Length of stay was 92.2 hr versus 97.2 hr, and 30-day readmission rate was 16.0% versus 18.3% for the pilot versus control teams, respectively. After the pilot concluded, we continued to have resident continuity on pilot teams but returned to the unit-based CM model. During this time, the proportion of DBN orders and LOS were similar between the pilot and control teams (29.0% vs. 24.3% and 95.8 hr vs. 96.6 hr, respectively). The 30-day readmission rate was 12.6% compared with 18.9% for the pilot versus control teams.
IMPLICATIONS FOR CASE MANAGEMENT PRACTICE
Our team-based MDR pilot improved interdisciplinary relationships and communication and resulted in shorter LOS, earlier discharge times, and lower 30-day readmissions.
Topics: Academic Medical Centers; Adult; Aged; Aged, 80 and over; Colorado; Female; Humans; Interdisciplinary Communication; Intersectoral Collaboration; Length of Stay; Male; Middle Aged; Patient Care Team; Patient Discharge; Patient Readmission; Practice Guidelines as Topic; Tertiary Care Centers
PubMed: 30688821
DOI: 10.1097/NCM.0000000000000318 -
British Journal of Nursing (Mark Allen... Feb 2017
Topics: Humans; Length of Stay; Patient Discharge; Practice Guidelines as Topic; State Medicine; United Kingdom
PubMed: 28185498
DOI: 10.12968/bjon.2017.26.3.129 -
Journal of Nursing Care Quality 2019This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge.
BACKGROUND
This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge.
PURPOSE
Improving patient flow and timely bed capacity is a global issue. Criteria-led discharge enables accelerated patient discharge in accordance with patient selection.
METHODS
A systematic review was conducted to identify literature on criteria-led discharge from 2007 to 2017. The quality of articles was appraised using a tool for disparate studies. Two reviewers extracted relevant data independently.
RESULTS
Fifteen studies were identified that showed no increase in patient readmission or complication rates with criteria-led discharge, demonstrating patient safety. The quality of the patient discharge was unremarkable. None of the studies showed an increase in length of stay.
CONCLUSIONS
The safety, quality, and length of stay for patients discharged through criteria-led discharge are inextricably linked to the process adopted for its implementation.
Topics: Humans; Length of Stay; Patient Discharge; Patient Readmission; Patient Selection; Time Factors
PubMed: 30198948
DOI: 10.1097/NCQ.0000000000000356 -
Quality Management in Health Care 2019The uncertainty and ambiguity of not knowing how many patients will be discharged impact patient throughput in hospitals, causing concerns for responding to demand for...
BACKGROUND
The uncertainty and ambiguity of not knowing how many patients will be discharged impact patient throughput in hospitals, causing concerns for responding to demand for admissions. Understanding the potential number of patients to be discharged can support caregivers, ability to concentrate on the range of interactions that patients require to ensure early discharge. Accurate forecasting of patients expected to be discharged by noon is beneficial in accommodating patients who need services and in achieving sustainable patient satisfaction.
METHOD
Models to predict patient discharge before noon (DBN) were formulated using Holt's double exponential smoothing and Box-Jenkins' methods with the aim of achieving minimal errors in each model. The models are applied to 24 months of weekly patient discharge historic data in a medical observation unit and a short-stay clinical unit of a health care hospital system located on the East Coast of United States.
RESULTS
DBN prediction outcomes were more accurate when applying Box-Jenkins' method than Holt's method. Analysis revealed that the model of ARIMA(3,1,2) is most suitable for forecasting. Upon the outcomes of forecast error metrics, the study identifies the mean absolute percent error for the ARIMA model is 14%.
CONCLUSION
Box-Jenkins forecasting performance is superior in predicting DBN with the least forecast error. Predicted values are significant to decision-making interventions aimed at taking new patients, improving quality patient care, and meeting patient throughput performance goals.
Topics: Hospital Administration; Humans; Models, Statistical; Patient Discharge; Time Factors; United States
PubMed: 31567847
DOI: 10.1097/QMH.0000000000000224 -
The American Journal of Nursing Dec 2014
Topics: Humans; Nursing Care; Patient Discharge; Planning Techniques; Practice Guidelines as Topic
PubMed: 25423376
DOI: 10.1097/01.NAJ.0000457394.98317.92 -
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 -
Revista Medica de Chile Feb 2014Discharge is one of the most important processes that hospitalized patients must endure. This process is complex, requires coordination among several professionals and... (Review)
Review
Discharge is one of the most important processes that hospitalized patients must endure. This process is complex, requires coordination among several professionals and transfers an overwhelming amount of information to patients. Often, it is limited to the writing of the discharge summary, with a primary emphasis on the drug list. Since the rise of hospitalism in 1996, a greater emphasis has been placed on understanding this process and in developing interventions to make it more effective and safe. In our country, little is known about how this process is taking place. Probably the absence of financial penalties for readmissions has influenced in the lack of study and development of this process. In the USA the knowledge of the discharge process is well advanced, and several strategies have been developed for reducing adverse events, medication errors, and 30-days readmissions. Other interventions have increased patient satisfaction and the degree of knowledge about their conditions. The aim of this paper is to do a comprehensive review of the literature, to provide healthcare teams with various tools that could improve both the discharge process as well as the discharge summary. The final objective is to optimize the safety and satisfaction of our patients and the hospital metrics of quality.
Topics: Humans; Medication Errors; Patient Discharge; Patient Readmission
PubMed: 24953112
DOI: 10.4067/S0034-98872014000200012 -
Nursing Standard (Royal College of... Jan 2016
Topics: Continuity of Patient Care; Humans; Patient Discharge; Patient Readmission; Time Factors; United Kingdom
PubMed: 26758142
DOI: 10.7748/ns.30.20.17.s21