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Canadian Respiratory Journal 2015To provide the first description of intensive care unit (ICU) discharge practices from the perspective of Canadian ICU administrators, and ICU providers from Canada, the...
OBJECTIVE
To provide the first description of intensive care unit (ICU) discharge practices from the perspective of Canadian ICU administrators, and ICU providers from Canada, the United States and the United Kingdom.
METHODS
The authors identified 140 Canadian ICUs and administered a survey to ICU administrators (unit manager, director) to obtain an institutional perspective. Also surveyed were members of professional critical care associations in Canada, the United States and the United Kingdom, using membership distribution lists, to obtain a provider perspective.
RESULTS
A total of 118 ICU administrators (114 ICUs [81%]) and 737 ICU providers (denominator unknown) responded to the survey. Administrator and provider respondents reported that ICU physicians are primarily responsible for determining the timing (70% and 77%, respectively) and safety (94% and 96%) for patients discharged from ICU. The majority of respondents indicated that patient summaries (87% and 85%) and medication reconciliation (78% and 79%) were part of their institutions' discharge process. One-half of respondents reported the use of discharge protocols, while a minority indicated that checklists (46% and 44%), electronic tools (19% and 28%) or outreach follow-up (44% and 33%) were used. The majority of respondents rated current ICU discharge practices to be of medium quality (57% and 58% scored 3 on a five-point scale). Suggested opportunities for improvement included the information provided to patients and families (71% and 59%) and collaboration among hospital units (65% and 66%).
CONCLUSION
Findings from the present study revealed the complexity of the ICU discharge process, considerable practice variation, perception of only medium quality and several proposed opportunities for improvement.
Topics: Humans; Intensive Care Units; Patient Discharge; Quality of Health Care
PubMed: 25522304
DOI: 10.1155/2015/457431 -
Intensive Care Medicine Aug 2019
Topics: Conflict of Interest; Ethics, Medical; Health Policy; Hospitalization; Humans; Patient Discharge; Politics
PubMed: 31267194
DOI: 10.1007/s00134-019-05673-3 -
British Journal of Hospital Medicine... Jan 2009
Topics: Bed Occupancy; Humans; Length of Stay; Patient Discharge
PubMed: 19357568
DOI: 10.12968/hmed.2009.70.1.37685 -
Pediatrics Jul 2011To evaluate trends in adherence to American Academy of Pediatrics recommendations for early discharge of late-preterm newborns and to test the association between...
OBJECTIVE
To evaluate trends in adherence to American Academy of Pediatrics recommendations for early discharge of late-preterm newborns and to test the association between hospital characteristics and early discharge.
PATIENTS AND METHODS
This study was a population-based cohort study using statewide birth-certificate and hospital-discharge data for newborns in California, Missouri, and Pennsylvania from 1993 to 2005. A total of 282 601 late-preterm newborns at 611 hospitals were included. Using logistic regression, we studied the association of early discharge with regional and hospital factors, including teaching affiliation, volume, and urban versus rural location, adjusting for patient factors.
RESULTS
From 1995 to 2000, early discharge decreased from 71% of the sample to 40%. However, by 2005, 39% were still discharged early. Compared with Pennsylvania, California (adjusted odds ratio [aOR]: 5.95 [95% confidence interval (CI): 5.03-7.04]), and Missouri (aOR: 1.56 [95% CI: 1.26-1.93]) were associated with increased early discharge. Nonteaching hospitals were more likely than teaching hospitals to discharge patients early if they were uninsured (aOR: 1.91 [95% CI: 1.35-2.69]) or in a health maintenance organization plan (aOR: 1.40 [95% CI: 1.06-1.84]) but not patients with fee-for-service insurance (aOR: 1.04 [95% CI: 0.80-1.34]). A similar trend for newborns on Medicaid was not statistically significant (aOR: 1.77 [95% CI: 0.95-3.30]).
CONCLUSIONS
Despite a decline in the late 1990s, early discharge of late-preterm newborns remains common. We observe differences according to state, hospital teaching affiliation, and patient insurance. Additional research on the safety and appropriateness of early discharge for this population is necessary.
Topics: Female; Gestational Age; Guideline Adherence; Humans; Infant, Newborn; Infant, Premature; Length of Stay; Male; Patient Discharge
PubMed: 21690121
DOI: 10.1542/peds.2011-0258 -
Emergency Medicine Journal : EMJ Feb 2019A short-cut review was carried out to establish whether follow-up phone calls improved compliance with follow-up and discharge instructions given to the elderly on... (Review)
Review
A short-cut review was carried out to establish whether follow-up phone calls improved compliance with follow-up and discharge instructions given to the elderly on discharge from the emergency department. 211 papers were found using the reported searches, of which 5 presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that telephone follow-up can identify non-compliance with discharge instructions in the elderly, but there is currently no evidence to show that it actually improves it.
Topics: Aftercare; Aged; Emergency Service, Hospital; Female; Humans; Patient Discharge; Telephone
PubMed: 30696779
DOI: 10.1136/emermed-2019-208441.1 -
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 -
Progress in Transplantation (Aliso... Sep 2020Lung transplant recipients have high hospital readmission rates. Readmissions are costly to institutions and associated with higher mortality among patients within the...
BACKGROUND
Lung transplant recipients have high hospital readmission rates. Readmissions are costly to institutions and associated with higher mortality among patients within the first year of transplant. Strong evidence indicates that in hospitalized patients, the use of discharge bundles results in lower 30-day hospital readmission rates.
LOCAL PROBLEM
A lung transplant team at a Midwest academic medical center performs 40 to 50 lung transplants annually and provides comprehensive, ongoing care for approximately 300 lung transplant recipients. The objective of this quality improvement project was development and implementation of an evidence-based discharge bundle (standardized patient discharge process) to reduce 30-day hospital readmission rates for this patient population.
METHODS
A gap analysis was performed using focus groups to identify strategies to reduce readmissions. Using that data, a standardized discharge bundle was developed in collaboration with the transplant team.
INTERVENTIONS
The discharge bundle included improvements in discharge planning, scripted communication methods between team members, a standardized medication template for patient education, standardized follow-up appointment process, and increased telephone calls to the patient after discharge.
RESULTS
The primary outcome measured was the monthly 30-day hospital readmission rate of facility lung transplant recipients from June through August of 2019 as compared to the same time period in 2018. The readmission rate did not change during the evaluation period. Team members reported improved communication, efficiency, and improved standardization of follow-up care using the discharge bundle.
CONCLUSIONS
Implementing a discharge bundle for lung transplant recipients resulted in improved staff satisfaction with the discharge process.
Topics: Adult; Aged; Aged, 80 and over; Evidence-Based Practice; Female; Humans; Lung Transplantation; Male; Middle Aged; Midwestern United States; Patient Discharge; Patient Readmission; Practice Guidelines as Topic; Quality Improvement; Transplant Recipients
PubMed: 32552376
DOI: 10.1177/1526924820933832 -
Emergency Medicine Journal : EMJ Dec 2017ED crowding is associated with increased mortality, poor staff and patient experience, an increased inpatient length of stay and poor compliance with the four-hour...
INTRODUCTION
ED crowding is associated with increased mortality, poor staff and patient experience, an increased inpatient length of stay and poor compliance with the four-hour emergency access standard. Where crowding is caused by exit block, the focus needs to be on whole system patient management, reducing the temporal mismatch between admissions and discharges since at times of peak demand hospitals may become gridlocked until patients are discharged.In an attempt to tackle exit block, the Scottish Government Unscheduled Care Team have implemented the Daily Dynamic Discharge (DDD) approach, which aims to increase the number of inpatient discharges by 12 pm, thus enabling more timeous flow through the ED.
METHODS
A series of meetings were held between the Unscheduled Care Team and the clinical and managerial staff of Dumfries and Galloway Royal Infirmary over a two-week period to train staff on implementing the elements of the Daily Dynamic Discharge approach. These included holding a daily whiteboard meeting with input from the multidisciplinary team, early determination of an Estimated Date of Discharge (EDD) for each patient, and conducting 'golden hour' ward rounds whereby the highest acuity patients were seen first followed by those who were expected to be discharged that day, thus increasing the number of discharges by 12 pm.
RESULTS
Over a twelve-week period the average number of weekly discharges increased from 26.5 to 30.2, i.e., an average increase of 3.7 discharges per week. Average length of stay dropped from 6.8 days to 6.2 days, a saving of 0.6 days.The median discharge time was 32 min earlier once DDD had been implemented. Previously, a third (33%) of patients were discharged before 4 pm; after implementation, this rose to 44%.
DISCUSSION
Emergency Department activity, and particularly crowding, is the barometer for the rest of the hospital, and the only way to guarantee that patients who require admission, get into the right bed, and in a timely way, is to ensure that the downstream wards discharge sufficient numbers early in the day to accommodate admissions from the ED.The DDD approach has been shown to be effective in increasing the number of discharges by 12 pm, smoothing the admission/discharge profile, and is now being adopted in other hospitals throughout Scotland.
REFERENCE
Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust2006;184(5):213-216.
Topics: Clinical Protocols; Crowding; Emergency Service, Hospital; Hospital Bed Capacity; Humans; Length of Stay; Patient Discharge; Program Development; Scotland; Time Factors
PubMed: 29170318
DOI: 10.1136/emermed-2017-207308.21 -
Journal of Nursing Care Quality 2020Criteria-led discharge (CLD) is an approach for maximizing bed capacity by expediting patient discharge. (Observational Study)
Observational Study
BACKGROUND
Criteria-led discharge (CLD) is an approach for maximizing bed capacity by expediting patient discharge.
PROBLEM
In acute medicine settings, patients commonly have multiple medical problems, which render single care pathway and clinical protocols of limited use. CLD offers potential, but little evidence exists about how to best implement it in these contexts.
APPROACH
Retrospective case note analysis generated characteristics from patients' discharge plans to design a criterion-based framework to aid patient selection for CLD. These criteria were hypothetically tested on patient case notes (n = 50).
OUTCOMES
CLD was identified as suitable (n = 27) and unsuitable (n = 23) from 50 case notes. Interrater agreement was 86% between 3 reviewers.
CONCLUSIONS
This review has provided greater understanding of the complexity of discharge in acute medicine settings. Implementing CLD to optimize timeliness of patient discharge might offer a solution for selected patients.
Topics: Clinical Protocols; Humans; Inpatients; Patient Discharge; Patient Selection; Retrospective Studies; Time Factors
PubMed: 31306239
DOI: 10.1097/NCQ.0000000000000423 -
The Journal of Emergency Medicine Dec 2017As the numbers of emergency department (ED) visits and inpatient admissions continue to increase, there is growing interest in alternatives to inpatient hospitalization.
BACKGROUND
As the numbers of emergency department (ED) visits and inpatient admissions continue to increase, there is growing interest in alternatives to inpatient hospitalization.
OBJECTIVE
Our aim was to investigate a novel approach to expediting discharges from the ED with multidisciplinary discharge services to prevent an avoidable admission into the hospital.
METHODS
This pilot study was conducted at a large urban tertiary-care ED in 2016. All patients presenting to the ED with planned inpatient or observation admission were considered for discharge with enhanced discharge planning services. The patients selected, discharge diagnoses, and outcomes were analyzed by descriptive statistics. This study was approved by the study site's Institutional Review Board, including waiver of patient consent.
RESULTS
During the pilot period, 57 out of 143 (40%) selected patients with planned admission were discharged with enhanced discharge planning services. Median ED length of stay was 17.2 h and mean patient age was 73 years old. Of these patients, 7 (12%) returned within 72 h and 4 (0.07%) were subsequently admitted to the hospital.
CONCLUSIONS
In this pilot study, a novel approach to expediting discharges from the ED with multidisciplinary discharge services was feasible and resulted in fewer admissions to the hospital.
Topics: Academic Medical Centers; Adult; Aged; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Patient Discharge; Pilot Projects; Program Development; Retrospective Studies; Time Factors
PubMed: 29079490
DOI: 10.1016/j.jemermed.2017.08.075