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The New England Journal of Medicine Dec 2009A reduction in hospital readmissions may improve quality and reduce costs. The Centers for Medicare and Medicaid Services has initiated a national effort to measure and...
BACKGROUND
A reduction in hospital readmissions may improve quality and reduce costs. The Centers for Medicare and Medicaid Services has initiated a national effort to measure and publicly report on the conduct of discharge planning. We know little about how U.S. hospitals perform on the current discharge metrics, the factors that underlie better performance, and whether better performance is related to lower readmission rates.
METHODS
We examined hospital performance on the basis of two measures of discharge planning: the adequacy of documentation in the chart that discharge instructions were provided to patients with congestive heart failure, and patient-reported experiences with discharge planning. We examined the association between performance on these measures and rates of readmission for congestive heart failure and pneumonia.
RESULTS
We found a weak correlation in performance between the two discharge measures (r=0.05, P<0.001). Although larger hospitals performed better on the chart-based measure, smaller hospitals and those with higher nurse-staffing levels performed better on the patient-reported measure. We found no association between performance on the chart-based measure and readmission rates among patients with congestive heart failure (readmission rates among hospitals performing in the highest quartile vs. the lowest quartile, 23.7% vs. 23.5%; P=0.54) and only a very modest association between performance on the patient-reported measure and readmission rates for congestive heart failure (readmission rates among hospitals performing in the highest quartile vs. the lowest quartile, 22.4% vs. 24.7%; P<0.001) and pneumonia (17.5% vs. 19.5%, P<0.001).
CONCLUSIONS
Our findings suggest that current efforts to collect and publicly report data on discharge planning are unlikely to yield large reductions in unnecessary readmissions.
Topics: Benchmarking; Hospital Administration; Humans; Patient Discharge; Patient Readmission; Quality Indicators, Health Care; United States
PubMed: 20042755
DOI: 10.1056/NEJMsa0904859 -
Narrative Inquiry in Bioethics 2020This series of personal stories about hospital discharge experiences expose how fraught this transition can be. Not only do the authors reveal personal angst, feelings...
This series of personal stories about hospital discharge experiences expose how fraught this transition can be. Not only do the authors reveal personal angst, feelings of endangerment, frank safety problems, lack of structural supports, but even more concerning are their perceptions of callous disregard, lack of adequate preparation and education, and unilateral decision-making by the health care teams. The "invisible hand" of our corporate health care system percolates, with some authors questioning whether the health professionals are advocating for their (i.e., the patient's) best interest or the best interest of their institution. There are also some shining examples though-moments when a health care team member takes the time, listens, problem-solves, advocates and expresses concern. In this commentary I will explore common themes in the narratives, and conclude with some suggestions-some simple, others aspirational, for how to make the discharge process more patient-centered and less traumatic for all moving forward.
Topics: Humans; Morals; Narration; Patient Discharge; Patient Transfer; Patients; Psychological Distress
PubMed: 33583854
DOI: 10.1353/nib.2020.0067 -
Clinical Medicine (London, England) Aug 2009Elderly patients represent a large number of admissions to hospital, accounting for a disproportionate number of hospital bed days. Discharge planning can improve the... (Review)
Review
Elderly patients represent a large number of admissions to hospital, accounting for a disproportionate number of hospital bed days. Discharge planning can improve the safety and appropriateness of discharge from hospital, and can have a positive impact on length of stay and efficiency. Despite this, discharge planning is often neglected. This review, both evidence and experience based, is provided to aid with the safe discharge of elderly patients back into the community.
Topics: Age Factors; Aged; Geriatric Assessment; Humans; Length of Stay; Patient Discharge; Time Factors
PubMed: 19728500
DOI: 10.7861/clinmedicine.9-4-311 -
Southern Medical Journal Jan 2022
Topics: COVID-19; Hospitalization; Humans; Patient Discharge
PubMed: 34964054
DOI: 10.14423/SMJ.0000000000001346 -
The Patient 2012Patients are vulnerable to issues that emerge after discharge from the hospital, and this susceptibility is compounded as patients attempt to navigate complex healthcare...
BACKGROUND
Patients are vulnerable to issues that emerge after discharge from the hospital, and this susceptibility is compounded as patients attempt to navigate complex healthcare organizations. Post-discharge clinic appointments may provide the opportunity to mitigate risks posed to patients during this vulnerable time.
OBJECTIVE
Our aim was to determine whether actively engaging patients in scheduling post-discharge appointments before leaving the hospital affects the rate of patients seeing an ambulatory care physician.
METHODS
This was a prospective cohort pilot study from May to July 2007 with a historical convenience control from 2003. The setting was an inpatient academic tertiary care referral center in the US. Study participants had been discharged from a general medicine hospitalist service during the study time period. Patients, or their designated caregivers, were contacted in hospital rooms to schedule a post-discharge appointment before discharge. The primary outcome was rate of attendance at post-discharge appointments, determined a priori.
RESULTS
Eighty-three patients with 115 scheduled appointments in the intervention group were compared with 306 patients with 398 appointments in the historical control group. The attendance rate was 59.5% in the control group versus 78.3% in the study group (pā<ā0.0001). Patients received 1.3 discharge appointments per discharge in both the historical and study group. In a limited evaluation, the study group had a trend towards a lower return rate to the emergency department within 3 days of discharge (1.2% vs 3.8%, nonsignificant), and a lower readmission rate within 14 days of discharge (10.8% vs 11.8%, nonsignificant).
CONCLUSION
Our patient-centered process for helping patients arrange their post-discharge appointments before discharge improved the attendance rate at those appointments.
Topics: Appointments and Schedules; Humans; Patient Discharge; Prospective Studies; United States
PubMed: 22217264
DOI: 10.2165/11594290-000000000-00000 -
Texas Hospitals Jun 1981
Topics: Patient Discharge
PubMed: 10251657
DOI: No ID Found -
Harefuah Nov 2000
Review
Topics: Ambulatory Surgical Procedures; Anesthesia; Humans; Patient Discharge; Safety
PubMed: 11341219
DOI: No ID Found -
Diseases of the Colon and Rectum Apr 2012Standardized discharge criteria are considered valuable to reduce the risk of premature discharge and avoid unnecessary hospital stays. The most appropriate criteria to...
BACKGROUND
Standardized discharge criteria are considered valuable to reduce the risk of premature discharge and avoid unnecessary hospital stays. The most appropriate criteria to indicate readiness for discharge after colorectal surgery are unknown.
OBJECTIVE
The aim of this study is to achieve an international consensus on hospital discharge criteria for patients undergoing colorectal surgery.
DESIGN
Fifteen experts from different countries participated in a 3-round Delphi process. In round 1, experts determined which criteria best indicate readiness for discharge and described specific end points for each criterion. In rounds 2 and 3, experts rated their agreement with the use of a 5-point Likert scale.
MAIN OUTCOME MEASURES
Consensus was defined when criteria and end points were rated as agree or strongly agree by at least 75% of the experts in round 3.
RESULTS
Experts reached consensus that patients should be considered ready for hospital discharge when there is tolerance of oral intake, recovery of lower gastrointestinal function, adequate pain control with oral analgesia, ability to mobilize and self-care, and no evidence of complications or untreated medical problems. Specific end points were defined for each of the criteria. Experts also agreed that after these criteria are achieved, discharge may take place as soon as the patient has adequate postdischarge support and is willing to leave the hospital. If a stoma was constructed, the patient or the patient's family should have received training on stoma care or had outpatient training arranged.
LIMITATIONS
The panel comprised mostly experts from developed countries. This may restrict the applicability of these discharge criteria in countries where there are dissimilar health care resources.
CONCLUSION
This Delphi study has provided substantial consensus on discharge criteria for patients undergoing colorectal surgery. We recommend that these criteria be used in clinical practice to guide decisions regarding patient discharge and applied in future research to increase the comparability of study results.
Topics: Colorectal Surgery; Delphi Technique; Humans; Patient Discharge; Surveys and Questionnaires
PubMed: 22426265
DOI: 10.1097/DCR.0b013e318244a8f2 -
Intensive Care Medicine Apr 2016
Topics: Humans; Intensive Care Units; Patient Discharge; Patient Safety
PubMed: 26602785
DOI: 10.1007/s00134-015-4148-8 -
BMJ Quality & Safety Oct 2012High-quality discharge summaries are a key component of a safe transition in care. The purpose of this study was to determine the effects of standardised feedback and a...
BACKGROUND
High-quality discharge summaries are a key component of a safe transition in care. The purpose of this study was to determine the effects of standardised feedback and a 'discharge time-out' (DTO) on the quality of discharge summaries.
METHODS
During 2006-2007, the authors trained hospitalists to provide two interventions at their discretion: (1) feedback on one discharge summary to each intern using a standardised form and (2) a DTO, modelled after the surgical time-out, in which key questions about the patient's hospital course and discharge plan are answered verbally by the intern during rounds on the day of discharge. To evaluate these interventions, trained clinicians, blinded to group assignment, performed an explicit review of two discharge summaries before and after intervention implementation. The authors used a mixed linear model to evaluate relative improvement over time.
RESULTS
The authors compared 14 interns who only received a 1-h lecture and a small-group resident-led training session with 13 interns who also received feedback and 12 interns who received feedback and a DTO. Save greater improvement in the documentation of tasks to be completed after discharge (39% vs 8% absolute improvement, p=0.05) by interns receiving an intervention, most domains were unaffected by having received a DTO and/or feedback.
CONCLUSION
These results suggest that standardised feedback and a DTO integrated into attending rounds have limited potential to improve discharge summaries as currently designed. This study stresses the need for developing and refining interventions that can improve the narrative flow of discharge summaries.
Topics: Hospitalists; Humans; Patient Discharge; Quality Assurance, Health Care
PubMed: 22562879
DOI: 10.1136/bmjqs-2011-000441