Implementing Inter-professional Discharge Planning to Reduce Time for Patient Discharge
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Other TitlesDischarge Planning to Reduce Time for Patient Discharge
AbstractProblem: Discharging patients from the hospital can be a complicated process that comes with challenges. Hospital data from the telemetry/ medical-surgical unit in August 2021 identified an average time of 419 minutes from the time of written discharge to the actual time the patient leaves the unit, and the goal time is 120 minutes. This delay has also affected emergency department length of stay as the average number in the hospital is approaching 4 hours. Purpose: To implement and evaluate the n-by-T strategy and interprofessional discharge planning in a telemetry/ medical-surgical unit to reduce the time between eligibility for discharge and time of discharge. Methods: The quality improvement project involves utilizing a discharge checklist with the n-by-T strategy during interprofessional rounds to safely schedule a number of patients (n) for the same or next day discharge by a goal time (T) for the patients on a 51-bed telemetry/ medical-surgical unit. The evaluation includes the use of the discharge checklist during discharge rounds, the average speed of the discharge process (difference in time of eligibility for discharge and time of discharge), the average time of discharges (this is the time the patient leaves the unit), the length of stay, the unit’s 7-day and 30-day readmission rates. Results: In August 2021 pre-implementation, the speed of discharge process was 419 minutes, and the length of stay was 4.33 days. Post implementation, the average speed of discharge was 628 minutes in October, 302 minutes in November, and 261 minutes in December. The average length of stay post-implementation was 4.04 days, 3.69 days, and 3.98 days, for October, November, and December, respectively. Conclusions: Implementation of interprofessional discharge planning and the n-by-T strategy was associated with decreased length of stay, and improved discharge speed.
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/18880
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Risk of drug overdose death following discharge from a trauma center for an injuryGreene, Christina Reagan; Smith, Gordon S., M.B., Ch.B., M.P.H.; Albrecht, Jennifer S. (2019)Background: Trauma patients have a higher rate of long-term mortality due to natural and external causes, yet drug overdose (OD) death within this population has not been explored previously. Pre-existing behavioral risk factors, such as drug and alcohol use disorders (DUD/AUD), and chronic pain resulting from traumatic injury may increase trauma patient’s risk of subsequent drug overdose death. Objectives: To determine whether trauma patients are at greater risk of drug OD death than the general population and detect whether smoking status or fracture is associated with future drug OD death among surviving trauma patients. Methods: Trauma patients between 18 and 64 years of age who were discharged alive from a Level I Trauma Center between January 1999 and October 2008 were linked to the National Death Index (N=36,288). Patients who were alive at least 30 days after discharge without cancer were included in this study. Trauma patient risk of drug OD death was compared with the age, gender and race adjusted state population using a standardized mortality ratio (SMR) and 95% confidence intervals (CI). Cox proportional hazard regression was used to determine whether current smoking status or lower limb fracture injury were risk factors for drug overdose death factors. Results: Trauma patients had a significantly higher drug overdose mortality rate than the state population [SMR=6.10 (95% CI 5.35-6.93)]. Cox proportional hazard modeling revealed a significant increased risk of drug overdose for current smokers [HR = 1.66 (95% CI 1.25-2.21)]. The effect of smoking was stronger in patients with no DUD/AUD and BAC< 80mg/dL [HR=2.45, 95% CI 1.67-3.57], while smoking was not associated with drug OD death in those with DUD/AUD or BAC≥ 80mg/dL on admission. Patients with lower limb fracture were not at increased risk of drug overdose death compared to those without fracture injuries. Conclusion: Trauma patients have a higher risk of drug OD death than the general population. Smoking is a significant risk factor for drug OD following traumatic injury. Future drug overdose prevention programs should focus efforts on reducing drug overdose mortality in trauma patients, particularly those who smoke.
Depressive Symptoms, Non-Adherence to Discharge Instructions, and 30-Day Unplanned Hospital Readmission among Community-Dwelling EldersAlbrecht, Jennifer S.; Furuno, Jon P.; Gruber-Baldini, Ann L. (2012)Background: Hospital readmissions are costly to the healthcare system. Understanding patient factors associated with hospital readmission will facilitate targeting of interventions designed to reduce readmissions. Depressive symptoms are associated with poor patient outcomes and may impact hospital readmission. Objective: To investigate the association between depressive symptoms and 30-day unplanned hospital readmission. Non-adherence to discharge instructions was examined as a potential mediator of this association. Methods: We conducted a prospective cohort study of hospitalized patients ages 65 and older. Depressive symptoms were measured within 72 hours of admission to the University of Maryland Medical Center and defined as a score of greater than or equal to 6 on the Geriatric Depression Scale-15. Patients were then contacted three times post-hospital discharge to ascertain incident deaths, unplanned hospital readmissions, and adherence to discharge instructions. Results: 750 patients were enrolled in the study. Depressive symptoms were not associated with 30-day unplanned hospital readmission (RR 1.20; 95% CI 0.83, 1.72). Depressive symptoms were associated with non-adherence to the medication domain of the discharge instructions (OR 1.75; 95% CI 1.02, 2.99), but not with follow-up appointments (OR 1.25; 95% CI 0.62, 2.52), lifestyle recommendations (RR 0.94; 95% CI 0.75, 1.17), or overall non-adherence to the discharge instructions (COR 1.17; 95% CI 0.78, 1.75). Non-adherence to one or more domains of the discharge instructions at 5 days (OR 1.58; 95% CI 0.94, 2.65) or 15 days (OR 1.37; 95% CI 0.68, 2.74) post-hospital discharge was not significantly associated with 30-day unplanned hospital readmission. Because a significant association between depressive symptoms and 30-day unplanned hospital readmission was not observed, mediation was not assessed. Conclusions: In this sample of hospitalized adults aged 65 and older, neither depressive symptoms nor non-adherence to discharge instructions was significantly associated with 30-day unplanned hospital readmission. Hence, targeting interventions toward patients with depressive symptoms may not result in decreased hospital readmission. While depressive symptoms were associated with non-adherence to medication, other factors may play a greater role in predicting non-adherence to the discharge instructions. Further research is needed to identify predictors of non-adherence to the discharge instructions as well as to understand perceived barriers to non- adherence.