Dataset Information

Outcomes of a Resident-Led Early Hospital Discharge Intervention.

ABSTRACT:

Background

Early morning patient discharge from the hospital is increasingly being recognized as a key dimension of quality of care. At our institution, there is a significantly lower early discharge rate on the teaching hospitalist teams in comparison with the non-teaching teams.

Objective

To implement a resident-driven intervention in the teaching medical services to increase overall discharge order rate before 11 am (DOB-11) and assess the effect of this intervention on hospital length of stay (LOS), 30-day readmission rates (RR), and resident perception.

Design

Interrupted time series as well as controlled before-after designs.

Participants

All inpatients discharged from general medicine units.

Interventions

We implemented an educational didactic in conjunction with resident-attending daily walk rounds followed by resident-led multidisciplinary discharge huddles to identify next-day discharges.

Main measures

The primary outcome was DOB-11 rates 18 months pre- and 12 months post-intervention.

Secondary outcomes

LOS and RR. Additionally, we assessed residents' perception of the early discharge protocol.

Key results

The DOB-11 rate increased from 12 to 29% (p?ConclusionOur study demonstrates that DOB-11 is an achievable goal, not only for non-teaching teams but also for resident-run teaching teams.

SUBMITTER: Goolsarran N

PROVIDER: S-EPMC7018867 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

Outcomes of a Resident-Led Early Hospital Discharge Intervention.

Goolsarran Nirvani N Olowo Grace G Ling Yun Y Abbasi Sadia S Taub Erin E Teressa Getu G

Journal of general internal medicine 20191210 2

<h4>Background</h4>Early morning patient discharge from the hospital is increasingly being recognized as a key dimension of quality of care. At our institution, there is a significantly lower early discharge rate on the teaching hospitalist teams in comparison with the non-teaching teams.<h4>Objective</h4>To implement a resident-driven intervention in the teaching medical services to increase overall discharge order rate before 11 am (DOB-11) and assess the effect of this intervention on hospita ...[more]

PMID: 31823311

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Project description:BackgroundThere is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge.MethodsThe Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance.ResultsIneffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change.ConclusionsThis study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.

Project description:BACKGROUND:Nowadays 57% of the cardiologists based in the United Kingdom and 32% of the cardiologists based in Canada utilize same day discharge (SDD) following elective percutaneous coronary intervention (PCI) as a routine practice. In this analysis, we aimed to systematically assess early versus late clinical outcomes following SDD after elective PCI. METHODS:The Medical Literature Analysis and Retrieval System Online, the Cochrane Central, the Resources from the United States National Library of Medicine (www.ClinicalTrials.gov: http://www.clinicaltrials.gov) and EMBASE were carefully searched for relevant English publications which reported early versus late clinical outcomes in patients who were discharged on the same day following revascularization by PCI. Relevant clinical outcomes which were reported in the original studies were considered as the endpoints in this analysis. Odd ratios (OR) and 95% confidence intervals (CI) were used to represent the data, and RevMan 5.3 was used as the statistical software. RESULTS:A total number of 21, 687 participants (enrollment time period from the year 1998 to the year 2015) were assigned to this analysis. When early versus late clinical outcomes were compared in patients who were discharged on the same day following elective PCI, major adverse cardiac events (OR: 0.75, 95% CI: 0.31-1.79; P?=?.51), mortality (OR: 0.26, 95% CI: 0.06-1.06; P?=?.06), stroke (OR: 1.46, 95% CI: 0.72-2.94; P?=?.29), arrhythmia (OR: 1.30, 95% CI: 0.64-2.63; P?=?.47), hematoma (OR: 1.00, 95% CI: 0.60-1.66; P?=?1.00) and major bleeding from access site (OR: 1.68, 95% CI: 0.22-12.85; P?=?.62) were not significantly different. Post-procedural myocardial infarction (OR: 2.01, 95% CI: 0.71-5.70; P?=?.19) and minor bleeding from access site (OR: 6.61, 95% CI: 0.86-50.66; P?=?.07) were also similarly manifested. However, re-hospitalization was significantly higher in those patients with late clinical outcomes (OR: 0.18, 95% CI: 0.07-0.44; P?=?.0002). CONCLUSIONS:In those patients who were discharged from the hospital on the same day following elective PCI, no significant difference was observed in the assessed early versus late clinical outcomes. However, late clinical outcomes resulted in a significantly higher rate of re-hospitalization. Larger studies should confirm this hypothesis.

Dataset Information

Outcomes of a Resident-Led Early Hospital Discharge Intervention.

Background

Objective

Design

Participants

Interventions

Main measures

Secondary outcomes

Key results

Publications

Outcomes of a Resident-Led Early Hospital Discharge Intervention.

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