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Journal of Perinatology : Official... 1998Although significant advances in the medical management of acutely ill preterm infants has resulted in unprecedented rates of survival, issues surrounding the... (Review)
Review
Although significant advances in the medical management of acutely ill preterm infants has resulted in unprecedented rates of survival, issues surrounding the convalescent care, discharge preparation, and readiness of parents or other caregivers has been less well studied and represents the art of medicine. We have summarized various guidelines for early discharge of the premature infant and provide our own recommendations for physiologic stability, social requirements, teaching needs of caregivers, and the coordination of community resources. Technology-dependent infants pose even greater complexities. Some infants and families adapt to extensive use of technology in the home. In other situations, basic infant care is difficult to achieve. What are the essential components for successful early discharge, and how can the studies involving selecting families be made universal? How can NICUs better prepare fathers and mothers for premature parenthood? To what extent are we overwhelming families with additional responsibilities and expectations that may compromise their competency in basic parenting? Furthermore, the degree of provider variation in evaluating and providing for discharge planning is now being more carefully studied. In some circumstances, integrated teams in the NICU have facilitated the discharge process, saving days of hospitalization, whereas in other circumstances, adherence to discharge planning guidelines have lengthened the stay in the NICU and resulted in higher costs. Failure to back transport infants to community NICUs has contributed to deregionalization efforts in some regions and increased cost of care. Efforts to establish regional referral networks with common guidelines and developmentally focused care should lead to a reduction in NICU costs and charges.
Topics: Cost-Benefit Analysis; Female; Hospital Costs; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Male; Patient Discharge; Practice Guidelines as Topic; United States
PubMed: 10023377
DOI: No ID Found -
Hospital Pediatrics Jul 2019The purpose of hospital discharge instructions (HDIs) is to facilitate safe patient transitions home, but electronic health records can generate lengthy documents filled...
OBJECTIVES
The purpose of hospital discharge instructions (HDIs) is to facilitate safe patient transitions home, but electronic health records can generate lengthy documents filled with irrelevant information. When our institution changed electronic health records, a cumbersome electronic discharge workflow produced low-value HDI and contributed to a spike in discharge delays. Our aim was to decrease these delays while improving family and provider satisfaction with HDI.
METHODS
We used quality improvement methodology to redesign the electronic discharge navigator and HDI to address the following issues: (1) difficulty preparing discharge instructions before time of discharge, (2) suboptimal formatting of HDI, (3) lack of standard templates and language within HDI, and (4) difficulties translating HDI into non-English languages. Discharge delays due to HDI were tracked before and after the launch of our new discharge workflow. Parents and providers evaluated HDI and the electronic discharge workflow, respectively, before and after our intervention. Providers audited HDI for content.
RESULTS
Discharge delays due to HDI errors decreased from a mean of 3.4 to 0.5 per month after our intervention. Parents' ratings of how understandable our HDIs were improved from 2.35 to 2.74 postintervention ( = .05). Pediatric resident agreement that the electronic discharge process was easy to use increased from 9% to 67% after the intervention ( < .001).
CONCLUSIONS
Through multidisciplinary collaboration we facilitated advance preparation of more standardized HDI and decreased related discharge delays from the acute care units at a large tertiary care hospital.
Topics: Child; Continuity of Patient Care; Efficiency, Organizational; Electronic Health Records; Health Literacy; Hospitals, Pediatric; Humans; Patient Discharge; Quality Improvement; Workflow
PubMed: 31243058
DOI: 10.1542/hpeds.2018-0251 -
Annals of Internal Medicine Mar 2013
Review
Topics: Continuity of Patient Care; Family; Humans; Medication Reconciliation; Patient Care Team; Patient Discharge; Patient Education as Topic; Patient Readmission; Quality of Health Care; Risk Assessment
PubMed: 23460071
DOI: 10.7326/0003-4819-158-5-201303050-01003 -
The Medical Clinics of North America Nov 2001The rationale for achieving an early discharge for patients with CAP is that reduced length of stay can result in lower costs. When hospital discharge is premature,... (Review)
Review
The rationale for achieving an early discharge for patients with CAP is that reduced length of stay can result in lower costs. When hospital discharge is premature, however, use of resources after discharge from the hospital may increase. This situation could increase overall cost and worsen quality of care. The objective should be to achieve a safe and early discharge. Several studies have evaluated methods for achieving this goal. Key findings from these studies are as follows: When a patient achieves clinical stability (e.g., systolic blood pressure, > or = 90 mm Hg; heart rate, < or = 100 beats/min; respiratory rate, < or = 24 breaths/min; temperature, < or = 38.3 degrees C [101 degrees F]; oxygen saturation, > or = 90%; able to eat; and stable mental status) or fulfills appropriate criteria (see Table 2), the patient may be eligible for switch from parenteral to oral antibiotics and early discharge. For many patients, this switch or discharge may occur on day 3 of hospitalization. When a patient is switched from parenteral to oral antibiotics, in many cases there does not appear to be a demonstrable clinical benefit to in-hospital observation. Elimination of in-hospital observation for patients who do not have an obvious reason for continued hospitalization potentially could reduce length of stay by 1 day. Improving efficiency of care reduces length of stay. This reduction may be accomplished by implementing clinical pathways, identifying and correcting causes of medically unnecessary hospital days, initiating early discharge planning, enlisting the services of a discharge coordinator, and organizing outpatient parenteral antibiotic treatment programs. These strategies are effective in many but not all patients, and their application should be tempered with careful clinical judgment.
Topics: Age Factors; Aged; Ambulatory Care; Anti-Bacterial Agents; Community-Acquired Infections; Critical Pathways; Efficiency, Organizational; Humans; Length of Stay; Outcome and Process Assessment, Health Care; Patient Discharge; Patient Selection; Pneumonia; Quality of Health Care; Safety; Time Factors; Total Quality Management; Treatment Outcome
PubMed: 11686189
DOI: 10.1016/s0025-7125(05)70389-8 -
Joint Commission Journal on Quality and... Jun 2024
Topics: Humans; Suicide Prevention; Patient Discharge
PubMed: 38644154
DOI: 10.1016/j.jcjq.2024.04.007 -
International Journal of Environmental... Nov 2019The purpose of this study was to examine the factors affecting the discharge to home of medical patients treated in an intensive care unit, including elements of...
The purpose of this study was to examine the factors affecting the discharge to home of medical patients treated in an intensive care unit, including elements of in-hospital rehabilitation and prehospital movement ability. The participants of this retrospective cohort study were medical patients treated in an intensive care unit (ICU) and who began rehabilitation in ICU. We assessed the participants in the ICU and analyzed data on patient background, hospitalization, and rehabilitation status. There were 155 ICU patients available for analysis. A multivariable logistic regression model identified the four variables of age (OR 1.06, 95% CI 1.02-1.09), APACHE II score (OR 1.12, 95% CI 1.04-1.24), independence in home life before admission (OR 7.10, 95% CI 1.65-30.44), and standing within 5 days of admission (OR 6.58, 95% CI 2.60-16.61) as factors significantly related to discharge from hospital to home. Independence of home life before admission and early start of standing were identified as factors strongly related to discharge to home. The degree of independence in living before hospital admission and progress toward early mobilization are helpful when considering an ICU patient's discharge destination.
Topics: Aged; Aged, 80 and over; Cohort Studies; Critical Care; Female; Humans; Intensive Care Units; Japan; Logistic Models; Male; Middle Aged; Patient Discharge; Retrospective Studies
PubMed: 31698814
DOI: 10.3390/ijerph16224324 -
BMC Health Services Research Apr 2017Variation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU...
BACKGROUND
Variation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU discharge practices. Our objective was threefold: (1) describe variation in rates of ICU readmissions within 48 h and post-ICU in-hospital mortality, (2) describe ICU discharge practices in Dutch hospitals, and (3) study the association between rates of ICU readmissions within 48 h and post-ICU in-hospital mortality and ICU discharge practices.
METHODS
We analysed data on 42,040 admissions to 82 (91.1%) Dutch ICUs in 2011 from the Dutch National Intensive Care Evaluation (NICE) registry to describe variation in standardized ICU readmission and post-ICU mortality rates using funnel-plots. We send a questionnaire to all Dutch ICUs. 75 ICUs responded and their questionnaire data could be linked to 38,498 admissions in the NICE registry. Generalized estimation equations analyses were used to study the association between ICU readmissions and post-ICU mortality rates and the identified discharge practices, i.e. (1) ICU discharge criteria; (2) bed managers; (3) early discharge planning; (4) step-down facilities; (5) medication reconciliation; (6) verbal and written handover; (7) monitoring of post-ICU patients; and (8) consulting ICU nurses. In all analyses, the outcomes were corrected for patient-related confounding factors.
RESULTS
The standardized rate of ICU readmissions varied between 0.14 and 2.67 and 20.8% of the hospitals fell outside the 95% control limits and 3.6% outside the 99.8% control limits. The standardized rate of post-ICU mortality varied between 0.07 and 2.07 and 17.1% of the hospitals fell outside the 95% control limits and 4.9% outside the 99.8% control limits. We could not demonstrate an association between the eight ICU discharge practices and rates of ICU readmissions or post-ICU in-hospital mortality. Implementing a higher number of ICU discharge practices was also not associated with better patient outcomes.
CONCLUSIONS
We found both variation in patient outcomes and variation in ICU discharge practices between ICUs. However, we found no association between discharge practices and rates of ICU readmissions or post-ICU mortality. Further research is necessary to find factors, which may influence these patient outcomes, in order to improve quality of care.
Topics: Aged; Critical Care; Female; Hospital Mortality; Hospitalization; Humans; Intensive Care Units; Male; Middle Aged; Netherlands; Patient Discharge; Patient Readmission; Professional Practice; Registries; Retrospective Studies
PubMed: 28416016
DOI: 10.1186/s12913-017-2234-z -
Quality & Safety in Health Care Feb 2010
Topics: Automobile Driving; Hospitals, Teaching; Humans; Patient Compliance; Patient Discharge; Referral and Consultation; United Kingdom
PubMed: 20172891
DOI: 10.1136/qshc.2009.033399 -
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 -
The Annals of Thoracic Surgery Oct 2013
Topics: Coronary Artery Bypass; Female; Humans; Male; Patient Discharge
PubMed: 24088447
DOI: 10.1016/j.athoracsur.2013.06.032