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PloS One 2013Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this... (Review)
Review
OBJECTIVES
Mortality following hospital discharge is an important and under-recognized contributor to overall child mortality in developing countries. The primary objective of this systematic review was to identify all studies reporting post-discharge mortality in children, estimate likelihood of death, and determine the most important risk factors for death.
SEARCH STRATEGY
MEDLINE and EMBASE were systematically searched using MeSH terms and keywords from the inception date to October, 2012. Key word searches using Google Scholar™ and hand searching of references of retrieved articles was also performed. Studies from developing countries reporting mortality following hospital discharge among a pediatric population were considered for inclusion.
RESULTS
Thirteen studies that reported mortality rates following discharge were identified. Studies varied significantly according to design, underlying characteristics of study population and duration of follow-up. Mortality rates following discharge varied significantly between studies (1%-18%). When reported, post-discharge mortality rates often exceeded in-hospital mortality rates. The most important baseline variables associated with post-discharge mortality were young age, malnutrition, multiple previous hospitalizations, HIV infection and pneumonia. Most post-discharge deaths occurred early during the post-discharge period. Follow-up care was examined in only one study examining malaria prophylaxis in children discharged following an admission secondary to malaria, which showed no significant benefit on post-discharge mortality.
CONCLUSIONS
The months following hospital discharge carry significant risk for morbidity and mortality. While several characteristics are strongly associated with post-discharge mortality, no validated tools are available to aid health workers or policy makers in the systematic identification of children at high risk of post-discharge mortality. Future research must focus on both the creation of tools to aid in defining groups of children most likely to benefit from post-discharge interventions, and formal assessment of the effectiveness of such interventions in reducing morbidity and mortality in the first few months following hospital discharge.
Topics: Child; Developing Countries; Health Resources; Humans; Mortality; Patient Admission; Patient Discharge
PubMed: 23825556
DOI: 10.1371/journal.pone.0066698 -
The British Journal of General Practice... Jan 2020Transitions between healthcare settings are vulnerable points for patients. (Review)
Review
BACKGROUND
Transitions between healthcare settings are vulnerable points for patients.
AIM
To identify key threats to safe patient transitions from hospital to primary care settings.
DESIGN AND SETTING
Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England.
METHOD
Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3: , 4-6: , 7-9: ). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%.
RESULTS
A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. 'Poor quality of handover instructions from secondary to primary care teams' achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients.
CONCLUSION
This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise.
Topics: Aged; Aged, 80 and over; Attitude of Health Personnel; Child; Child Health Services; Consensus; Delphi Technique; Female; Frail Elderly; Health Personnel; Health Services for the Aged; Humans; London; Male; Patient Discharge; Patient Handoff; Patient Safety; Primary Health Care
PubMed: 31848201
DOI: 10.3399/bjgp19X707105 -
Healthcare (Amsterdam, Netherlands) Mar 2021Little is known about the follow-up healthcare needs of patients hospitalized with coronavirus disease 2019 (COVID-19) after hospital discharge. Due to the unique...
Little is known about the follow-up healthcare needs of patients hospitalized with coronavirus disease 2019 (COVID-19) after hospital discharge. Due to the unique circumstances of providing transitional care in a pandemic, post-discharge providers must adapt to specific needs and limitations identified for the care of COVID-19 patients. In this study, we conducted a retrospective chart review of all hospitalized COVID-19 patients discharged from an Emory Healthcare Hospital in Atlanta, GA from March 26 to April 21, 2020 to characterize their post-discharge care plans. A total of 310 patients were included in the study (median age 58, range: 23-99; 51.0% female; 69.0% African American). The most common presenting comorbidities were hypertension (200, 64.5%), obesity (BMI≥30) (138, 44.5%), and diabetes mellitus (112, 36.1%). The median length of hospitalization was 5 days (range: 0-33). Sixty-seven patients (21.6%) were admitted to the intensive care unit and 42 patients (13.5%) received invasive mechanical ventilation. The most common complications recorded at discharge were electrolyte abnormalities (124, 40.0%), acute kidney injury (86, 27.7%) and sepsis (55, 17.7%). The majority of patients were discharged directly home (281, 90.6%). Seventy-five patients (24.2%) required any home service including home health and home oxygen therapy. The most common follow-up need was an appointment with a primary care provider (258, 83.2%). Twenty-four patients (7.7%) had one or more visit to an ED after discharge and 16 patients (5.2%) were readmitted. To our knowledge, this is the first large study to report on post-discharge medical care for COVID-19 patients.
Topics: Adult; Aged; COVID-19; Female; Hospitalization; Humans; Male; Middle Aged; Patient Discharge; Patient Transfer
PubMed: 33383393
DOI: 10.1016/j.hjdsi.2020.100512 -
BMJ Open Aug 2017Many studies have assessed the predictors of morbidity/mortality of patients with traumatic brain injury (TBI) in acute care. However, with the increasing rate of... (Review)
Review
INTRODUCTION
Many studies have assessed the predictors of morbidity/mortality of patients with traumatic brain injury (TBI) in acute care. However, with the increasing rate of survival after TBI, more attention has been given to discharge destinations from acute care as an important measure of clinical priorities. This study describes the design of a systematic review compiling and synthesising studies on the prognostic factors of discharge settings from acute care in patients with TBI.
METHODS AND ANALYSIS
This systematic review will be conducted on peer-reviewed studies using seven databases including Medline/Medline in-Process, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PsycINFO, CINAHL and Supplemental PubMed. The reference list of selected articles and Google Scholar will also be reviewed to determine other relevant articles. This study will include all English language observational studies that focus on adult patients with TBI in acute care settings. The quality of articles will be assessed by the Quality in Prognostic Studies tool.
ETHICS AND DISSEMINATION
The results of this review will provide evidence that may guide healthcare providers in making more informed and timely discharge decisions to the next level of care for patient with TBI. Also, this study will provide valuable information to address the gaps in knowledge for future research.
TRIAL REGISTRATION NUMBER
Trial registration number (PROSPERO) is CRD42016033046.
Topics: Brain Injuries, Traumatic; Humans; Patient Discharge; Prognosis; Treatment Outcome
PubMed: 28860230
DOI: 10.1136/bmjopen-2017-016694 -
The Journal of Thoracic and... Mar 2018
Topics: Anticoagulants; Humans; Patient Discharge
PubMed: 29305033
DOI: 10.1016/j.jtcvs.2017.11.023 -
MedEdPORTAL : the Journal of Teaching... Dec 2018Safe transitions of care are an essential component of safety and quality for the patient community. It is imperative that providers choose appropriate discharge...
INTRODUCTION
Safe transitions of care are an essential component of safety and quality for the patient community. It is imperative that providers choose appropriate discharge settings to reduce avoidable hospital readmissions. Additionally, providers must also ensure that the multifaceted needs of each patient are met with every discharge recommendation. There is often a lack of formal instruction in medical school on the various discharge dispositions, indications for rehab, and clinical indications for each setting. This is problematic for new interns who are tasked with entering discharge orders and relaying critical information between lead physicians and the interprofessional team.
METHODS
A 60-minute workshop with both didactic and experiential components provided medical students with opportunities to gain an overview of discharge dispositions while also exercising critical thinking using case examples. The workshop was part of a 2-week Transition to Residency course at a single institution.
RESULTS
Twenty-two fourth-year medical students participated in the workshop. Following the workshop, 100% of the participants stated that they had learned something new and that they intended to use the content in practice as interns. Subjective responses indicated that workshop content ought to be incorporated earlier in medical training.
DISCUSSION
These results suggest that a 60-minute workshop including didactic instruction as well as experiential and inquiry-based learning can impact medical student knowledge and intent for practice change in regard to providing safe transitions of care for the patient community.
Topics: Clinical Competence; Education; Feedback; Humans; Patient Discharge; Rehabilitation; Students, Medical
PubMed: 30800985
DOI: 10.15766/mep_2374-8265.10785 -
Canadian Journal of Psychiatry. Revue... May 2014
Topics: Hospitals, Psychiatric; Humans; Mental Health Services; Patient Discharge; Patient Readmission; Registries
PubMed: 25004467
DOI: 10.1177/070674371405900509 -
AMIA ... Annual Symposium Proceedings.... Nov 2009The discharge planning process can be successful when information is shared among the patient, caregiver, and provider from admission through post discharge. The... (Review)
Review
The discharge planning process can be successful when information is shared among the patient, caregiver, and provider from admission through post discharge. The objective of this paper was to evaluate the association of information sharing among patients, caregivers, and health care providers and the impact on the discharge process. The authors identified reports of the discharge planning process through systematic electronic database searches. The eligibility criteria were 1) usual discharge planning process, and 2) patient, caregiver, or provider perception or feedback. Of the eligible articles, all voiced concern about a broken discharge planning process that affected the information exchanged among all involved in patient care. Outcomes related to satisfaction, knowledge transfer, and communication were identified. The initial evidence suggests information sharing through interdisciplinary patient care can play a significant role in the future.
Topics: Humans; Information Dissemination; Medical Informatics; Outcome Assessment, Health Care; Patient Discharge
PubMed: 20351814
DOI: No ID Found -
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 -
Nicotine & Tobacco Research : Official... Mar 2020Hospitalization and post-discharge provide an opportune time for tobacco cessation. This study tested the feasibility, uptake, and cessation outcomes of a hospital-based...
INTRODUCTION
Hospitalization and post-discharge provide an opportune time for tobacco cessation. This study tested the feasibility, uptake, and cessation outcomes of a hospital-based tobacco cessation program, delivered by volunteers to the bedside with post-discharge referral to Quitline services. Patient characteristics associated with Quitline uptake and cessation were assessed.
METHODS
Between February and November 2016, trained hospital volunteers approached inpatient tobacco users on six pilot units. Volunteers shared a cessation brochure and used the ASK-ADVISE-CONNECT model to connect ready to quit patients to the Delaware Quitline via fax-referral. Volunteers administered a follow-up survey to all admitted tobacco users via telephone or email at 3-months post-discharge.
RESULTS
Of the 743 admitted tobacco users, 531 (72%) were visited by a volunteer, and 97% (531/547) of those approached, accepted the visit. Over one-third (201/531; 38%) were ready to quit and fax-referred to the Quitline, and 36% of those referred accepted Quitline services. At 3 months post-discharge, 37% (135/368) reported not using tobacco in the last 30 days; intent-to-treat cessation rate was 18% (135/743). In a multivariable regression model of Quitline fax-referral completion, receiving nicotine replacement therapy (NRT) during hospitalization was the strongest predictor (odds ratios [OR] = 1.97; 95% confidence interval [CI] = 1.34 to 2.90). In a model of 3-month cessation, receiving Quitline services (OR = 3.21, 95% CI = 1.35 to 7.68) and having coronary artery disease (OR = 2.28; 95% CI = 1.11 to 4.68) were associated with tobacco cessation, but a volunteer visit was not.
CONCLUSIONS
An "opt-out" tobacco cessation service using trained volunteers is feasible for connecting patients to Quitline services.
IMPLICATIONS
This study demonstrates the feasibility of a systems-based approach to link inpatients to evidence-based treatment for tobacco use. This model used trained bedside volunteers to connect inpatients to a state-funded Quitline after discharge that offers free cessation treatment of telephone coaching and cessation medications. Receiving NRT during hospitalization positively impacted Quitline referral, and engagement with Quitline resources was critical to tobacco abstinence post-discharge. Future work is needed to evaluate the cost-effectiveness and sustainability of this volunteer model.
Topics: Female; Hospitalization; Humans; Male; Middle Aged; Patient Discharge; Referral and Consultation; Telephone; Tobacco Use Cessation; Volunteers
PubMed: 30462274
DOI: 10.1093/ntr/nty252