Increasing scrutiny of hospital readmission rates has spurred a wide variety of quality improvement initiatives. The Preventing Avoidable Readmissions Together (PART) initiative is a statewide quality improvement learning collaborative organized by stakeholder organizations in South Carolina. This descriptive report focused on initial interventions with hospitals. Eligible participants included all acute care hospitals plus home health organizations, nursing facilities, hospices, and other health care organizations. Measures were degree of statewide participation, curricular engagement, adoption of evidence-based improvement strategies, and readmission rate changes. Fifty-nine of 64 (92%) acute care hospitals and 9 of 10 (90%) hospital systems participated in collaborative events. Curricular engagement included: webinars and coaching calls (49/59, 83%), statewide in-person meetings (35/59, 59%), regional in-person meetings (44/59, 75%), and individualized consultations (46/59, 78%). Among 34 (58%) participating hospitals completing a survey at the completion of Year 1, respondents indicated complete implementation of multidisciplinary rounding (58%), post-discharge telephone calls (58%), and teach-back (32%), and implementation in process of high-quality transition records (52%), improved discharge summaries (45%), and timely follow-up appointments (39%). A higher proportion of hospitals had significant decreases (≥10% relative change) in all-cause readmission rates for acute myocardial infarction (55.6% vs. 30.4%, P=0.01), heart failure (54.2% vs. 31.7%, P=0.09), and chronic obstructive pulmonary disease (41.7% vs. 33.3%, P=0.83) between 2011-2013 compared to earlier (2009-2011) trends. Focus on reducing readmissions is driving numerous, sometimes competing, quality improvement initiatives. PART successfully engaged the majority of acute care facilities in one state to harmonize and accelerate adoption of evidence-based care transitions strategies.
BACKGROUND:Great emphasis is placed on optimizing treatment of hospitalized patients with diabetes and hyperglycemia.OBJECTIVE:This study was conducted to determine if the application of hospital‐wide insulin order sets improved inpatient safety by reducing the number of actual hypoglycemic and hyperglycemic events and increasing at‐target blood glucose.DESIGN:A retrospective chart review was conducted of hypoglycemic and hyperglycemic events and at‐target blood glucose occurring before and after institution of the insulin order sets and blood glucose protocols.SETTING:The Medical University of South Carolina (MUSC) Medical Center is a 709‐bed hospital and tertiary referral center for partnering hospitals in the southeastern United States.PATIENTS:All patients were evaluated who had a documented history of diabetes or who had at least 1 finger‐stick blood glucose above 180 mg/dL who were admitted for care to the MUSC adult main hospital (minimum of 18 years‐of‐age; maximum 100 years‐of‐age) during June 2004, June 2005, June 2006, and June 2007.INTERVENTION:The intervention involved institution of hospital‐wide hypoglycemia, hyperglycemia, subcutaneous insulin, and intravenous insulin treatment protocols.MEASUREMENTS:Retrospective data on hypoglycemia, hyperglycemia, and at‐target blood glucose incidence and frequency were collected via a computerized repository for all inpatients.RESULTS:The percent time in range improved by 10% with no increase in the amount of severe hypoglycemic episodes for the blood glucose results.CONCLUSIONS:Implementing standardized insulin order sets including hypoglycemia and hyperglycemia treatment protocols at MUSC produced expected benefits for patient safety for this patient population. Journal of Hospital Medicine 2009;4:331–339. © 2009 Society of Hospital Medicine.
Hospitalists have shorter LOS, lower charges per patient, and admit a larger proportion of high acuity patients at a state level.
Psychiatric comorbidity is common among chronically medically ill populations and the presence of psychiatric conditions tends to be associated with increased costs and excess utilization of general medical services. The purpose of this pilot investigation was to determine whether differences in nonpsychiatric inpatient hospitalization frequency, duration, and costs existed between patients receiving outpatient psychiatric treatment and patients without identified psychiatric problems. Length of stay and cost information for patients that had at least 1 inpatient medical/surgical hospitalization during a 6-month period was extracted from the hospital's inpatient billing database (n = 10,865). The medical record numbers of these patients were then cross-referenced against the outpatient psychiatry-billing database for the same 6-month period, thereby identifying all patients that had both a nonpsychiatric inpatient hospitalization and an outpatient psychiatry visit (n = 149). Patients identified as having outpatient psychiatry involvement had significantly more nonpsychiatric hospitalizations on average (mean = 1.60) than nonpsychiatric patients (mean = 1.34) during the study period (t4381 = 2.94, P = .003). There was no difference in the total costs associated with these hospitalizations between the 2 groups. Those that had a psychiatry consult during the nonpsychiatric hospitalization had a significantly higher length of stay and costs than those without. Thus, the criteria used to determine whether or not a psychiatry consultation is triggered, and the timing of the consultation request need further study.
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