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Academic Emergency Medicine : Official... Dec 2011Emergency department (ED) crowding is an international phenomenon that continues to challenge operational efficiency. Many statistical modeling approaches have been... (Comparative Study)
Comparative Study Review
Emergency department (ED) crowding is an international phenomenon that continues to challenge operational efficiency. Many statistical modeling approaches have been offered to describe, and at times predict, ED patient load and crowding. A number of formula-based equations, regression models, time-series analyses, queuing theory-based models, and discrete-event (or process) simulation (DES) models have been proposed. In this review, we compare and contrast these modeling methodologies, describe the fundamental assumptions each makes, and outline the potential applications and limitations for each with regard to usability in ED operations and in ED operations and crowding research.
Topics: Crowding; Efficiency, Organizational; Emergency Medicine; Emergency Service, Hospital; Female; Humans; Male; Models, Theoretical; Patient Admission; Patient Discharge; Regression Analysis; Total Quality Management; Workflow
PubMed: 22168201
DOI: 10.1111/j.1553-2712.2011.01135.x -
The Annals of Thoracic Surgery Sep 2013
Topics: Algorithms; Cardiac Surgical Procedures; Continuity of Patient Care; Female; Humans; Male; Patient Discharge; Rehabilitation Centers; Skilled Nursing Facilities
PubMed: 23992688
DOI: 10.1016/j.athoracsur.2013.04.052 -
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 -
Journal of General Internal Medicine Feb 2014
Topics: Continuity of Patient Care; Female; Health Behavior; Humans; Insurance Coverage; Male; Medicaid; Medically Uninsured; Patient Discharge
PubMed: 24327310
DOI: 10.1007/s11606-013-2698-4 -
Progress in Cardiovascular Diseases 2016Heart failure (HF) is a growing healthcare burden and one of the leading causes of hospitalizations and readmission. Preventing readmissions for HF patients is an... (Review)
Review
Heart failure (HF) is a growing healthcare burden and one of the leading causes of hospitalizations and readmission. Preventing readmissions for HF patients is an increasing priority for clinicians, researchers, and various stakeholders. The following review will discuss the interventions found to reduce readmissions for patients and improve hospital performance on the 30-day readmission process measure. While evidence-based therapies for HF management have proliferated, the consistent implementation of these therapies and development of new strategies to more effectively prevent readmissions remain areas for continued improvement.
Topics: Evidence-Based Medicine; Heart Failure; Humans; Kaplan-Meier Estimate; Monitoring, Ambulatory; Patient Discharge; Patient Readmission; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; United States
PubMed: 26432556
DOI: 10.1016/j.pcad.2015.09.004 -
Acta Medica Portuguesa Feb 2019Polypharmacy is often observed in elderly patients and is associated with an increased risk of adverse drug reactions, side effects and interactions. Clinicians should... (Observational Study)
Observational Study
INTRODUCTION
Polypharmacy is often observed in elderly patients and is associated with an increased risk of adverse drug reactions, side effects and interactions. Clinicians should be alert to inappropriate drug prescribing and reduce polypharmacy.
MATERIAL AND METHODS
Observational, longitudinal, retrospective and descriptive study in an internal medicine ward in a Portuguese hospital. Polypharmacy was defined as the use of five or more different medicines. The purpose of this study was to describe the prevalence of polypharmacy and inappropriate prescribing at admission and discharge in an internal medicine ward, according to deprescribing.org guidelines/algorithms. A total of 838 consecutive patients were admitted between January and July 2017. All patients were aged under 65 years old, and those who died before discharge were excluded. Patients' medications were reviewed from a medical database at hospital admission and discharge. We examined whether patients were taking anticoagulants, proton pump inhibitors, benzodiazepines, antipsychotics and/or antihyperglycemic medication.
RESULTS
A total of 483 patients were included, mean age was 79.2 ± 8.0 years, and 42% of patients were male. Median number of medications at admission and discharge was six. Polypharmacy was present in more than 70% of admitted patients. Proton pump inhibitors were the most common inappropriate prescription at discharge (17.2%).
DISCUSSION
This study demonstrated a low use of inappropriate medicine (11.2% - 17.2%) in older people discharged from hospital, when compared to other studies.
CONCLUSION
Our study shows that polypharmacy is present in more than 70% of elderly admitted patients. Nevertheless, the drug inappropriateness rate was not significantly affected by polypharmacy at both admission and discharge, being overall lower than published data.
Topics: Aged; Female; Humans; Inappropriate Prescribing; Internal Medicine; Male; Patient Admission; Patient Discharge; Polypharmacy; Portugal; Retrospective Studies
PubMed: 30896395
DOI: 10.20344/amp.10683 -
JAMA Pediatrics Oct 2014To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This... (Review)
Review
To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10 000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process. We then outline a framework within which to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. In the framework, we describe processes to (1) initiate pediatric discharge care, (2) develop discharge care plans, (3) monitor discharge progress, and (4) finalize discharge. We contextualize these processes with a clinical case of a child undergoing hospital discharge. Use of this narrative review will help pediatric health care professionals (eg, nurses, social workers, and physicians) move forward to better understand what works and what does not during hospital discharge for children, while steadily improving their quality of care and health outcomes.
Topics: Aftercare; Child; Child Care; Delivery of Health Care; Goals; Health Education; Hospitals, Pediatric; Humans; Medical Records; Needs Assessment; Patient Care Planning; Patient Care Team; Patient Discharge
PubMed: 25155156
DOI: 10.1001/jamapediatrics.2014.891 -
BMJ Open Quality 2019Discharge conversation is an essential part of preparing patients for the period after hospitalisation. Successful communication during such conversations is associated...
BACKGROUND
Discharge conversation is an essential part of preparing patients for the period after hospitalisation. Successful communication during such conversations is associated with improved health outcomes for patients.
OBJECTIVE
To investigate the association between discharge conversation and discharge quality assessed by measuring elderly patients' experiences.
METHODS
In this cross-sectional study, we surveyed all patients ≥65 years who had been discharged from two medical units in two hospitals in Western Norway 30 days prior. We measured patient experiences using two previously validated instruments: The Discharge Care Experiences Survey Modified (DICARES-M) and The Nordic Patient Experiences Questionnaire (NORPEQ). We examined differences in characteristics between patients who reported having a discharge conversation with those who did not, and used regression analyses to examine the associations of the DICARES-M and NORPEQ with the usefulness of discharge conversation.
RESULTS
Of the 1418 invited patients, 487 (34%) returned the survey. Their mean age was 78.5 years (SD=8.3) and 52% were women. The total sample mean scores for the DICARES-M and NORPEQ were 3.9 (SD=0.7, range: 1.5-5.0) and 4.0 (SD=0.7, range: 2.2-5.0), respectively. Higher DICARES-M and NORPEQ scores were found for patients who reported having a discharge conversation (74%) compared with those who did not (15%), or were unsure (11%) whether they had a conversation (p<0.001). Patients who considered the conversation more useful had significantly higher scores on both the DICARES-M and NORPEQ (p<0.001).
CONCLUSIONS
Reported discharge conversation at the hospital was correlated with positive patient experiences measurements indicating the increased quality of hospital discharge care. The reported usefulness of the conversation had a significant association with discharge care quality.
Topics: Aged; Aged, 80 and over; Communication; Cross-Sectional Studies; Female; Hospitals; Humans; Male; Norway; Patient Discharge; Patient Satisfaction; Patients; Quality of Health Care; Surveys and Questionnaires
PubMed: 31909210
DOI: 10.1136/bmjoq-2019-000728 -
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 -
Journal of General Internal Medicine Sep 2019Inpatient attending physicians may change during a patient's hospital stay. This study measured the association of attending physician continuity and discharge...
BACKGROUND
Inpatient attending physicians may change during a patient's hospital stay. This study measured the association of attending physician continuity and discharge probability.
METHODS
All patients admitted to general medicine service at a tertiary care teaching hospital in 2015 were included. Attending inpatient physician continuity was measured as the consecutive number of days each patient was treated by the same staff-person. Generalized estimating equation methods were used to model the adjusted association of attending inpatient physician continuity with daily discharge probability.
RESULTS
6301 admissions involving 41 internists, 5134 patients, and 38,242 patient-days were studied. The final model had moderate discrimination (c-statistic = 0.70) but excellent calibration (Hosmer-Lemeshow statistic 11.5, 18 df, p value 0.89). Daily discharge probability decreased significantly with greater severity of illness, higher patient death risk, and longer length of stay, on admission day, for elective admissions, and on the weekend. Discharge likelihood increased significantly with attending inpatient physician continuity; daily discharge probability increased for the average patient from 15.3 to 20.9% when the consecutive number of days the patient was treated by the same attending inpatient physician increased from 1 to 7 days.
CONCLUSIONS
Inpatient attending physician continuity is significantly associated with the likelihood of patient discharge. This finding could be considered if resource utilization is a factor when scheduling attending inpatient physician coverage.
Topics: Aged; Cohort Studies; Continuity of Patient Care; Female; Humans; Inpatients; Male; Medical Staff, Hospital; Middle Aged; Patient Discharge; Physician-Patient Relations
PubMed: 31197735
DOI: 10.1007/s11606-019-05031-5