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The Journal of Arthroplasty Apr 2016Up to 55% of total joint arthroplasty costs come from post-acute care, with large variability dependent on a patient's discharge location. At our institution, we...
BACKGROUND
Up to 55% of total joint arthroplasty costs come from post-acute care, with large variability dependent on a patient's discharge location. At our institution, we identified a group of surgeons using a preoperative discharge planning protocol emphasizing the merits of home discharge. We hypothesized that using the protocol would increase patients' odds for discharge home.
METHODS
Administrative data from 14,315 total hip and knee arthroplasties performed over a 3-year period were retrospectively analyzed to determine predictors of patient discharge location. Bayesian hierarchical logistic regression modeling was used to account for the complex multilevel structure within the data as we considered patient-, surgeon-, and hospital-level predictors. A simplified case-control data structure with logistic regression analysis was also used to better understand the impact of the preoperative discharge planning protocol.
RESULTS
A variety of patient- and surgeon-level variables are predictive of patients being discharged home after total joint arthroplasty including a patient's length of stay, age, illness severity, and insurance, as well as surgeon's affiliation. In the case-control data, patients exposed to the rapid recovery protocol had 45% increased odds of being discharged home compared to patients not exposed to the protocol.
CONCLUSIONS
Although patient factors are known to play a role in predicting postdischarge destination, this analysis describes additional surgeon- and hospital-level factors that predict discharge location. Exogenous factors based on how surgeons and hospital staff practice and interact with patients may impact the postdischarge decision-making process and provide a cost savings opportunity.
Topics: Adult; Aged; Arthroplasty, Replacement, Knee; Bayes Theorem; Cost Savings; Female; Hospitals; Humans; Logistic Models; Male; Middle Aged; Patient Discharge; Retrospective Studies; Surgeons
PubMed: 26725136
DOI: 10.1016/j.arth.2015.10.014 -
Lancet (London, England) Jun 2012
Topics: Delivery of Health Care; Ill-Housed Persons; Humans; Patient Care Team; Patient Discharge; State Medicine; United Kingdom
PubMed: 22682445
DOI: 10.1016/S0140-6736(12)60925-8 -
The Journal of Neuroscience Nursing :... Dec 2020Postcraniotomy individuals should be monitored because of the direct influence on brain function as well as constraints caused by underlying illness. The relationship...
BACKGROUND
Postcraniotomy individuals should be monitored because of the direct influence on brain function as well as constraints caused by underlying illness. The relationship between demographic and clinical characteristics of postcraniotomy individuals and their readiness for discharge was examined.
METHODS
A descriptive correlational study included 150 individuals. The Readiness for Hospital Discharge Scale and demographic variables were examined using descriptive statistics, correlation, and stepwise multiple linear regression.
RESULTS
The mean postcraniotomy score for the subdimension of knowledge related to readiness for discharge was 5.13 ± 3.04, and mean score for the whole scale was 7.76 ± 1.48. The individuals' age, employment status, presence of a person to provide care at home, poor financial status, and first hospitalization during the lifetime of the patient were statistically significant predictors of their readiness for discharge. This model was statistically significant (F = 25.572, P < .001) and accounted for 57% of the variance in discharge readiness.
CONCLUSION
Patients had moderate levels of readiness for discharge and low levels of discharge-related knowledge. The findings point to the importance of individual approach to the discharge planning.
Topics: Adaptation, Psychological; Adult; Aged; Correlation of Data; Craniotomy; Female; Health Literacy; Humans; Male; Middle Aged; Patient Discharge; Patients; Social Support; Turkey
PubMed: 32956132
DOI: 10.1097/JNN.0000000000000554 -
Nursing Times
Review
Topics: Continuity of Patient Care; Humans; Nurse's Role; Patient Discharge
PubMed: 23431715
DOI: No ID Found -
BMC Geriatrics Jul 2013Older age and higher acuity are associated with prolonged hospital stays and hospital readmissions. Early discharge planning may reduce lengths of hospital stay and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Older age and higher acuity are associated with prolonged hospital stays and hospital readmissions. Early discharge planning may reduce lengths of hospital stay and hospital readmissions; however, its effectiveness with acutely admitted older adults is unclear.
METHODS
In this systematic review, we compared the effectiveness of early discharge planning to usual care in reducing index length of hospital stay, hospital readmissions, readmission length of hospital stay, and mortality; and increasing satisfaction with discharge planning and quality of life for older adults admitted to hospital with an acute illness or injury.We searched the Cochrane Library, DARE, HTA, NHSEED, ACP, MEDLINE, EMBASE, CINAHL, Proquest Dissertations and Theses, PubMed, Web of Science, SciSearch, PEDro, Sigma Theta Tau International's registry of nursing research, Joanna Briggs Institute, CRISP, OT Seeker, and several internet search engines. Hand-searching was conducted in four gerontological journals and references of all included studies and previous systematic reviews. Two reviewers independently extracted data and assessed risk of bias. Data were pooled using a random-effects meta-analysis. Where meta-analysis was not possible, narrative analysis was performed.
RESULTS
Nine trials with a total of 1736 participants were included. Compared to usual care, early discharge planning was associated with fewer hospital readmissions within one to twelve months of index hospital discharge [risk ratio (RR) = 0.78, 95% CI = 0.69 - 0.90]; and lower readmission lengths of hospital stay within three to twelve months of index hospital discharge [weighted mean difference (WMD) = -2.47, 95% confidence intervals (CI) = -4.13 - -0.81)]. No differences were found in index length of hospital stay, mortality or satisfaction with discharge planning. Narrative analysis of four studies indicated that early discharge planning was associated with greater overall quality of life and the general health domain of quality of life two weeks after index hospital discharge.
CONCLUSIONS
Early discharge planning with acutely admitted older adults improves system level outcomes after index hospital discharge. Service providers can use these findings to design and implement early discharge planning for older adults admitted to hospital with an acute illness or injury.
Topics: Acute Disease; Aged; Aged, 80 and over; Hospitalization; Humans; Patient Discharge; Time Factors; Treatment Outcome; Wounds and Injuries
PubMed: 23829698
DOI: 10.1186/1471-2318-13-70 -
Seminars in Neonatology : SN Apr 2003Early neonatal intensive care unit (NICU) discharge has been advocated for selected preterm infants to reduce both the adverse environment of prolonged hospital stay and... (Review)
Review
Early neonatal intensive care unit (NICU) discharge has been advocated for selected preterm infants to reduce both the adverse environment of prolonged hospital stay and to encourage earlier parental involvement by empowering parents to contribute to the ongoing care of their infant, and thereby reducing costs of care. Randomized trials and descriptive experiences of early discharge programs are critically reviewed over the last 30 years, and the key elements necessary for successful early discharge are reviewed and defined. Early discharge is clearly achievable for a large number of infants. Variations in neonatal care practices are reviewed since these variations have been documented to influence NICU stay. Management of apnea of prematurity and feeding practices is documented to significantly influence NICU length of stay, as is timing of discharge based on institutional factors. Developmentally centered care, use of nutritional supplements pre- and postdischarge, hearing screening programs, evaluation for retinopathy of prematurity, evaluation for apnea and bradycardia events, and cardiopulmonary stability while in a car seat all influence timing of discharge. Programs of early hospital discharge with home nursing and neonatologist support have been successful in lowering the length of NICU stay. However, trends in length of stay in NICUs indicate that for infants >750 g at birth over the last decade there have been insignificant reductions in length of hospital stay. Thus, because of the increase in the percentage of low birth weight infants in the US, there remain opportunities to improve on variations in care that will be translated to fewer NICU days in hospitals for selected infants. Several professional guidelines are summarized, and standards of care as related to discharge of premature infants are reviewed.
Topics: Female; Hospital Costs; Humans; Infant Welfare; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Length of Stay; Male; Outcome and Process Assessment, Health Care; Patient Discharge; Practice Guidelines as Topic; Prognosis; United States
PubMed: 15001147
DOI: 10.1016/S1084-2756(02)00219-1 -
Emergency Nurse : the Journal of the... Dec 2008
Topics: Aged; Aged, 80 and over; Cost-Benefit Analysis; Health Services Research; Humans; Length of Stay; Outcome and Process Assessment, Health Care; Patient Discharge; Patient Readmission; United Kingdom
PubMed: 19119563
DOI: 10.7748/en2008.12.16.8.16.c6786 -
Journal of Hospital Medicine Sep 2009One of the causes of postdischarge adverse events is poor discharge communication between hospital-based physicians, patients, and outpatient physicians. The value of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
One of the causes of postdischarge adverse events is poor discharge communication between hospital-based physicians, patients, and outpatient physicians. The value of hospital discharge software to improve communication and clinically relevant outcomes is unknown.
OBJECTIVE
To measure effects of a discharge software application of computerized physician order entry (CPOE).
DESIGN
Cluster randomized controlled trial.
SETTING
Tertiary care, teaching hospital in central Illinois.
PATIENTS
A total of 631 inpatients discharged to home with high risk for readmission.
INTERVENTION
Seventy internal medicine hospital physicians were randomly assigned (allocation concealed) to discharge software versus usual care, handwritten discharge.
MEASUREMENTS
Blinded assessment of patient readmission, emergency department visit, and postdischarge adverse event.
RESULTS
A total of 590 (94%) patients provided 6-month follow-up data. Generalized estimating equations gave intervention variable coefficients with 95% confidence interval (CI). When comparing patients assigned to discharge software versus usual care, there was no difference in hospital readmission within 6 months (37.0% versus 37.8%; coefficient -0.005 [95% CI, -0.074 to 0.065]; P = 0.894), emergency department visit within 6 months (35.4% versus 40.6%; coefficient -0.052 [95% CI, -0.115 to 0.011]; P = 0.108), or adverse event within 1 month (7.3% versus 7.3%; coefficient 0.003 [95% CI; -0.037 to 0.043]; P = 0.884).
CONCLUSIONS
Discharge software with CPOE did not affect readmissions, emergency department visits, or adverse events after discharge. Future studies should assess other endpoints such as patient perceptions or physician perceptions to see if discharge software has value.
Topics: Cluster Analysis; Continuity of Patient Care; Emergency Service, Hospital; Female; Humans; Male; Medical Records Systems, Computerized; Patient Discharge; Patient Readmission; Patient Satisfaction; Sample Size; Software
PubMed: 19479782
DOI: 10.1002/jhm.469 -
Clinical Medicine (London, England) 2001
Topics: Aged; Aged, 80 and over; Communication; Humans; Length of Stay; Middle Aged; Patient Discharge; United Kingdom
PubMed: 11792104
DOI: 10.7861/clinmedicine.1-6-518 -
BioMed Research International 2015The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher... (Review)
Review
The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22-67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review.
Topics: Critical Care; Humans; Length of Stay; Patient Admission; Patient Discharge; Time Factors
PubMed: 26558286
DOI: 10.1155/2015/868653