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Tidsskrift For Den Norske Laegeforening... Dec 2018
Topics: Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Length of Stay; Mothers; Patient Discharge; Puerperal Disorders; Vulnerable Populations
PubMed: 30539601
DOI: 10.4045/tidsskr.18.0878 -
The American Journal of Cardiology May 2018Given high rates of heart failure (HF) hospitalizations and widespread adoption of the hospitalist model, patients with HF are often cared for on General Medicine (GM)... (Comparative Study)
Comparative Study
Given high rates of heart failure (HF) hospitalizations and widespread adoption of the hospitalist model, patients with HF are often cared for on General Medicine (GM) services. Differences in discharge processes and 30-day readmission rates between patients on GM and those on Cardiology during the contemporary hospitalist era are unknown. The present study compared discharge processes and 30-day readmission rates of patients with HF admitted on GM services and those on Cardiology services. We retrospectively studied 926 patients discharged home after HF hospitalization. The primary outcome was 30-day all-cause readmission after discharge from index hospitalization. Although 60% of patients with HF were admitted to Cardiology services, 40% were admitted to GM services. Prevalence of cardiovascular and noncardiovascular co-morbidities were similar between patients admitted to GM services and Cardiology services. Discharge summaries for patients on GM services were less likely to have reassessments of ejection fraction, new study results, weights, discharge vital signs, discharge physical examinations, and scheduled follow-up cardiologist appointments. In a multivariable regression analysis, patients on GM services were more likely to experience 30-day readmissions compared with those on Cardiology services (odds ratio 1.43 95% confidence interval [1.05 to 1.96], p = 0.02). In conclusion, outcomes are better among those admitted to Cardiology services, signaling the need for studies and interventions focusing on noncardiology hospital providers that care for patients with HF.
Topics: Aged; Cardiology Service, Hospital; Female; Heart Failure; Hospitalization; Humans; Internal Medicine; Logistic Models; Male; Middle Aged; Multivariate Analysis; Outcome Assessment, Health Care; Patient Discharge; Patient Readmission; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Treatment Outcome; United States
PubMed: 29548676
DOI: 10.1016/j.amjcard.2018.01.027 -
Anaesthesia Feb 2022Patient-centred outcomes are increasingly recognised as crucial measures of healthcare quality. Days alive and at home up to 30 days after surgery (DAH ) is a...
Patient-centred outcomes are increasingly recognised as crucial measures of healthcare quality. Days alive and at home up to 30 days after surgery (DAH ) is a validated and readily obtainable patient-centred outcome measure that integrates much of the peri-operative patient journey. However, the minimal difference in DAH that is clinically important to patients is unknown. We designed and administered a 28-item survey to evaluate the minimal clinically important difference in DAH among adult patients undergoing inpatient surgery. Patients were approached pre-operatively or within 2 days postoperatively. We did not study patients undergoing day surgery or nursing home residents. Patients ranked their opinions on the importance of discharge home using a Likert scale (from 1, not important at all to 6, extremely important) and the minimum number of extra days at home that would be meaningful using this scale. We recruited 104 patients; the survey was administered pre-operatively to 45 patients and postoperatively to 59 patients. The mean (SD) age was 53.5 (16.5) years, and 51 (49%) patients were male. Patients underwent a broad range of surgery of mainly intermediate (55%) to major (33%) severity. The median minimal clinically important difference for DAH was 3 days; this was consistent across a broad range of scenarios, including earlier discharge home, complications delaying hospital discharge and the requirement for admission to a rehabilitation unit. Discharge home earlier than anticipated and discharge home rather than to a rehabilitation facility were both rated as important (median score = 5). Empirical data on the minimal clinically important difference for DAH may be useful to determine sample size and to guide the non-inferiority margin for future clinical trials.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Minimal Clinically Important Difference; Patient Discharge; Postoperative Care; Postoperative Period; Surveys and Questionnaires; Treatment Outcome
PubMed: 34797923
DOI: 10.1111/anae.15623 -
International Journal of Environmental... Dec 2020Discharge planning is important to prevent surgical site infections, reduce costs, and improve the hospitalization experience. The identification of early variables that...
Discharge planning is important to prevent surgical site infections, reduce costs, and improve the hospitalization experience. The identification of early variables that can predict a longer-than-expected length of stay or the need for a discharge with additional needs can improve this process. A cohort study was conducted in the largest hospital of Northern Italy, collecting discharge records from January 2017 to January 2020 and pre-admission visits in the last three months. Socio-demographic and clinical data were collected. Linear and logistic regression models were fitted. The main outcomes were the length of stay (LOS) and discharge destination. The main predictors of a longer LOS were the need for additional care at discharge (+10.76 days), hospitalization from the emergency department (ED) (+5.21 days), and age (+0.04 days per year), accounting for clinical variables ( < 0.001 for all variables). Each year of age and hospitalization from the ED were associated with a higher probability of needing additional care at discharge (OR 1.02 and 1.77, respectively, < 0.001). No additional findings came from pre-admission forms. Discharge difficulties seem to be related mainly to age and hospitalization procedures: those factors are probably masking underlying social risk factors that do not show up in patients with planned admissions.
Topics: Cohort Studies; Emergency Service, Hospital; Female; Hospitalization; Humans; Italy; Length of Stay; Male; Patient Discharge; Retrospective Studies
PubMed: 33352913
DOI: 10.3390/ijerph17249490 -
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 -
PloS One 2021The Centers for Medicare and Medicaid Services identified unplanned hospital readmissions as a critical healthcare quality and cost problem. Improvements in hospital...
The Centers for Medicare and Medicaid Services identified unplanned hospital readmissions as a critical healthcare quality and cost problem. Improvements in hospital discharge decision-making and post-discharge care are needed to address the problem. Utilization of clinical decision support (CDS) can improve discharge decision-making but little is known about the empirical significance of two opposing problems that can occur: (1) negligible uptake of CDS by providers or (2) over-reliance on CDS and underuse of other information. This paper reports an experiment where, in addition to electronic medical records (EMR), clinical decision-makers are provided subjective reports by standardized patients, or CDS information, or both. Subjective information, reports of being eager or reluctant for discharge, was obtained during examinations of standardized patients, who are regularly employed in medical education, and in our experiment had been given scripts for the experimental treatments. The CDS tool presents discharge recommendations obtained from econometric analysis of data from de-identified EMR of hospital patients. 38 clinical decision-makers in the experiment, who were third and fourth year medical students, discharged eight simulated patient encounters with an average length of stay 8.1 in the CDS supported group and 8.8 days in the control group. When the recommendation was "Discharge," CDS uptake of "Discharge" recommendation was 20% higher for eager than reluctant patients. Compared to discharge decisions in the absence of patient reports: (i) odds of discharging reluctant standardized patients were 67% lower in the CDS-assisted group and 40% lower in the control (no-CDS) group; whereas (ii) odds of discharging eager standardized patients were 75% higher in the control group and similar in CDS-assisted group. These findings indicate that participants were neither ignoring nor over-relying on CDS.
Topics: Clinical Decision Rules; Decision Making; Decision Support Systems, Clinical; Education, Medical; Electronic Health Records; Patient Discharge; Patient Readmission; Patients; Students, Medical
PubMed: 33684144
DOI: 10.1371/journal.pone.0247270 -
BMC Surgery Mar 2021To investigate the readiness for hospital discharge of patients discharged with tubes from the department of hepatobiliary surgery and to explore the influencing factors.
BACKGROUND
To investigate the readiness for hospital discharge of patients discharged with tubes from the department of hepatobiliary surgery and to explore the influencing factors.
METHODS
A cross-sectional survey was conducted for the 161 patients with tubes who were discharged from the department of hepatobiliary surgery of Shaoxing Second Hospital by using the modified Chinese version of Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). General data of the patients, such as gender, age, BMI (body mass index), and educational level, were collected.
RESULTS
According to the statistical results, the total score of the RHDS was 142.40 ± 23.98, and that of the QDTS was 148.14 ± 17.74. Multiple linear step-wise regression analysis revealed that the total score of the QDTS, residence and educational level were the independent influencing factors of the readiness for hospital discharge (p < 0.05).
CONCLUSION
The level of the readiness for hospital discharge of the 161 discharged patients with tubes from the department of hepatobiliary surgery was in the middle and lower level. For the patients who are far away from the hospital and have a low education level, we should pay more attention to health education and discharge teaching, so as to improve the readiness for hospital discharge of relatively vulnerable patients, reduce the incidence of adverse events after discharge with tubes, and ensure the health and safety of patients.
Topics: China; Cross-Sectional Studies; Digestive System Diseases; Female; Humans; Male; Patient Discharge; Socioeconomic Factors; Surgery Department, Hospital
PubMed: 33685424
DOI: 10.1186/s12893-021-01119-0 -
Journal of Hospital Medicine Dec 2015
Topics: Humans; Patient Discharge; Patient Readmission; Predictive Value of Tests; Time Factors
PubMed: 26434568
DOI: 10.1002/jhm.2445 -
European Journal of Hospital Pharmacy :... Jan 2020To compare the transcribing error rates of discharge prescriptions between pharmacy technicians and doctors in an acute hospital setting. (Comparative Study)
Comparative Study
OBJECTIVES
To compare the transcribing error rates of discharge prescriptions between pharmacy technicians and doctors in an acute hospital setting.
METHODS
Pharmacy technicians were trained in the transcribing of discharge medications from inpatient to discharge medication charts. Prospective prescribing audits were undertaken over 5 days on eight hospital medical wards by ward pharmacists to compare pharmacy technician (on four wards) and doctor (on four wards) discharge transcribing error rates. Transcribed discharge medications were compared with the inpatient medication list by ward pharmacists to identify any transcription errors. Transcribing data for each technician and doctor, and number of items and errors, were input into SPSS and analysed using relevant statistical tests.
RESULTS
Doctors (n=12) transcribed 77 discharge prescriptions, and 678 items with 127 errors recorded (18.7% error rate). Pharmacy technicians (n=8) transcribed 63 discharge prescriptions, and 654 items with 25 errors recorded (3.8% error rate), a significant difference between groups in error frequency (χ(1)=58.6, p=<0.005) with a 14.9% difference between groups.
CONCLUSIONS
Pharmacy technicians have significantly lower discharge transcribing error rates compared with doctors. This service intervention has the potential to improve patient safety and minimise inefficiencies from correcting errors. Further work is needed to explore the views and opinions of service users of the intervention, and why technician-transcribing error rates are significantly lower than doctors.
Topics: Drug Prescriptions; Humans; Medication Errors; Patient Discharge; Pharmacy Technicians; Physicians; Prospective Studies; Quality of Health Care
PubMed: 32064082
DOI: 10.1136/ejhpharm-2018-001538 -
The Journal of Thoracic and... Mar 2018
Topics: Anticoagulants; Humans; Patient Discharge
PubMed: 29274912
DOI: 10.1016/j.jtcvs.2017.10.147