An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review

Pryor

et al. 2019

PM&R

Readmission to acute care (RTAC) from inpatient rehabilitation can have negative consequences for individuals and associated financial costs are increasing. Consequently, preventing avoidable RTAC represents a target for improvement in quality of care. The aim of this integrative review was to identify predictors of RTAC from inpatient rehabilitation. A systematic search of MEDLINE, EMBASE, ProQuest, and CINAHL databases was used. Thematic analysis was used to examine extracted data. Strong evidence indicating that the principal predictors of RTAC are lower functional status on admission to rehabilitation, a more severe injury and a higher number of comorbidities was identified in this review. This is despite the heterogeneous nature of impairment groups and factors/measures examined. However, the relevance of some predictors of RTAC (such as patient demographics, invasive devices and primary diagnoses) may be dependent on rehabilitation setting, impairment group or time between rehabilitation admission and RTAC (eg, below 3 vs 30 days). Consequently, findings of this integrative review highlight that RTAC is a complex, multifactorial patient issue with a complex interplay between the predictors and reasons for RTAC.

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictors of Readmission to Acute Care from Inpatient Rehabilitation: An Integrative Review

Pryor

et al. 2019

PM&R

“…It should therefore handle not only the patient's transfer, but also the transfer of all relevant information, respecting the patient's privacy. This unit and its introduction into the discharge process proved to be effective in terms of patient, process and hospital outcomes (Mileski et al, 2017;Carr et al, 2007;Venkatasalu et al, 2015). The conceptual model developed herein focuses mainly on a clinical governance approach, in specific on clinical pathways that "describe the spatial and temporal sequences of activities to be performed, based on the scientific and technical knowledge and the organisational, professional and technological available resources" (De Blaser et al, 2006).…”

Section: Organisational Unitsmentioning

confidence: 99%

Conceptual modelling of the flow of frail elderly through acute-care hospitals

Bruzzi

Landa

Tànfani

et al. 2018

Purpose -The ageing of the world's population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, we propose a conceptual model to facilitate the pathway of frail elderly patients across acute-care hospitals, focused on avoiding improper wait times and treatment during the process. Design/methodology/approach -The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient's stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly's pathways, providing proper information that can validate the model when applied in current practice. Findings -The paper proposes a design of the clinical path of frail patients in acute-care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. We can therefore expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients.Research limitations/implications -The framework proposed is a conceptual model to manage frail elderly patients in acute-care wards. Our research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings. Practical implications -The paper includes suggestions for re-engineering the management of frail elderly patients in hospitals, when a reduction of lengths of stay and the improvement of clinical outcomes are required. Originality/value -This paper fulfills an identified need to study and provide solutions for the management of frail elderly patients in acute-care hospitals, and generally to produce value in a patient-centred model.

Health Soc Care Community

“…A large number of older people are required to transfer between hospitals and nursing homes (Lamantia, Scheunemann, Viera, Busby‐Whitehead, & Hanson, ). Older people with complex care needs are vulnerable to unsuccessful transitions due to errors in the communication of information between hospitals and nursing homes, which causes unnecessary medical expenses (Lamantia et al, ; Mileski et al, ). Improvements in the quality of transitional care necessitate the collaboration of members from multiple disciplines between these two types of settings to ensure the continuity of care for elder people.…”

Section: Introductionmentioning

confidence: 99%

Reliability and validity of the Mandarin version of the Continuity Assessment Record and Evaluation for older people who are transferred between hospitals and nursing homes in China

Jiang

Zha

Chen

et al. 2020

To date, assessment tools for older people are different between hospitals and nursing homes in China. The difference between assessment tools can lead to poor communication of information between hospitals and nursing homes, which causes discontinuity of care and adverse outcomes when older people are transferred between these different settings. Continuity Assessment Record and Evaluation (CARE) is a comprehensive geriatric assessment tool developed in the United States of America. This study aimed to evaluate the reliability and validity of the Mandarin Version of CARE for older people who are transferred between hospitals and nursing homes. Using a convenience sampling method, 120 older people in hospitals and 120 older people in nursing homes in Shanghai were selected to test the internal consistency, interrater reliability and criterion-related validity of CARE from May to November 2017. When used among hospital, 70.0% (7/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an intraclass correlation coefficient (ICC) of greater than 0.75. When used in nursing homes, 90.0% (9/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an ICC of greater than 0.75. For both settings, the correlation coefficients of the subscales with their corresponding instruments for criterion-related validity were all greater than 0.8 (p < .01). The Mandarin version of CARE exhibits good reliability and validity. It can be used as an assessment tool for transition between hospitals and nursing homes. K E Y W O R D Scomprehensive geriatric assessment, hospital, nursing home, older people, reliability, transition, validity