Barriers to Early Hospital Discharge: A Cross‐Sectional Study at Five Academic Hospitals

Zoucha, Jeff; Hull, Madelyne; Keniston, Angela; Mastalerz, Katarzyna; Quinn, Roswell; Tsai, Albert; Berman, Jacob; Lyden, Jennifer; Stella, Sarah A; Echaniz, Marisa; Scaletta, Nicholas; Handoyo, Karina; Hernandez, Estebes; Saini, Inderpreet; Smith, Aneesah; Young, Anthony P.; M, Walsh; Zaros, Mark C.; Albert, Richard K.; Burden, Marisha

doi:10.12788/jhm.3074

Cited by 26 publications

(48 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The decision about the duration of stay is always made by the doctor and the therapeutic team. This corresponds to observations in the literature [1,2]. The share of neurological patients is increasing -sequelae of strokes 281, degenerative changes 79, scoliosis 83, coxarthrosis 82, gonartrosis 44, consequences of injuries 44.…”

Section: Resultssupporting

confidence: 89%

The Evolution of Treatment at the Orthopedics and Rehabilitation Clinic

et al. 2020

View full text Add to dashboard Cite

Introduction: The last 20 years have been a period of huge changes in Polish healthcare, both in terms of medical progress as well as organization and financing. These changes, and especially the newly introduced queuing systems significantly influenced the changes in the profile of hospital admission. The aim: To analyze changes in the patient profile, causes and time of hospitalization, as well as the waiting time for hospitalization, in 1996-2019 Lublin SPSK4 Orthopedics and Rehabilitation Clinic. Material and methods: Patients’ medical records were analyzed, including qualification cards. The waiting time for admission to the hospital, the time of hospitalization, the cause of hospitalization, gender and the patient’s place of residence were analyzed. Results and conclusions: 1. During the 13 years analyzed, the number of hospitalizations increased from 452 to 1387 patients a year. 2. The waiting time for hospitalization increased from an average of 2 months in 1996 to even 2 years (in the case of patients with chronic category) in 2020. 3. The average length of hospitalization changed compared to the level of 1996 (8 weeks) in the case of patients with the early neurological category increased slightly (9 weeks), in the case of other patients - it decreased to 4 weeks, respectively - chronically ill patients, 3 weeks - patients from the systemic and weekly rehabilitation category - orthopedic patients. 4. The scope of the reasons for hospitalization, but also methods of treatment has expanded significantly. 5. Patient demographic profile in the examined aspects (origin, gender) - remained similar.

show abstract

Section: Resultssupporting

confidence: 89%

The Evolution of Treatment at the Orthopedics and Rehabilitation Clinic

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Typical approaches for moving discharge to earlier in the day and improving the flow of hospitalized patients rely on one-way communication mechanisms, static documentation in the electronic health record (EHR), and in-person care team huddles or telephone calls, which often take place on the day a patient is expected to be discharged [ 2 , 15 - 22 ]. Multidisciplinary rounds are a common workflow in many hospitals during which discharging patients are discussed.…”

Section: Introductionmentioning

confidence: 99%

Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach

Keniston¹,

McBeth²,

Pell³

et al. 2021

JMIR Hum Factors

Self Cite

View full text Add to dashboard Cite

Background Typical solutions for improving discharge planning often rely on one-way communication mechanisms, static data entry into the electronic health record (EHR), or in-person meetings. Lack of timely and effective communication can adversely affect patients and their care teams. Objective Applying robust user-centered design strategies, we aimed to design an innovative EHR-based discharge readiness communication tool (the Discharge Today tool) to enable care teams to communicate any barriers to discharge, the status of patient discharge readiness, and patient discharge needs in real time across hospital settings. Methods We employed multiple user-centered design strategies, including exploration of the current state for documenting discharge readiness and directing discharge planning, iterative low-fidelity prototypes, multidisciplinary stakeholder meetings, a brainwriting premortem exercise, and preproduction user testing. We iteratively collected feedback from users via meetings and surveys. Results We conducted 28 meetings with 20 different stakeholder groups. From these stakeholder meetings, we developed 14 low-fidelity prototypes prior to deploying the Discharge Today tool for our pilot study. During the pilot study, stakeholders requested 46 modifications, of which 25 (54%) were successfully executed. We found that most providers who responded to the survey reported that the tool either saved time or did not change the amount of time required to complete their discharge workflow (21/24, 88%). Responses to open-ended questions offered both positive feedback and opportunities for improvement in the domains of efficiency, integration into workflow, avoidance of redundancies, expedited communication, and patient-centeredness. Conclusions Survey data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design were critical to the successful implementation of this tool.

show abstract

“…caring for other sicker patients) and competing priorities in the discharge process [11,12]. Other factors include timing and length of morning rounds, availability of rehabilitation or skilled nursing facility bed, completion of the discharge summary and medicine reconciliation process, awaiting outpatient appointments to be made, transport to home or facility, and suboptimal communication among the health care team [13][14][15]. Our institution faces similar challenges particularly around early discharges.…”

Section: Introductionmentioning

confidence: 99%

Late-afternoon communication and patient planning (CAPP) rounds: an intervention to allow early patient discharges

et al. 2020

View full text Add to dashboard Cite

Objective: Measure effect of late-afternoon communication and patient planning (CAPP) rounds to increase early electronic discharge orders (EDO). Methods: We enrolled 4485 patients discharged from six subspecialty medical services. We implemented late-afternoon CAPP rounds to identify patients who could have morning discharge the subsequent day. After an initial successful implementation of the intervention, we identified lack of sustainability. We made changes with sustained implementation of the intervention. This is a beforeafter study of a quality improvement intervention. Program evaluation: Primary measures of intervention effectiveness were percentage of patients who received EDO by 11 am and patients discharged by noon. Additional measure of effectiveness were percent of patients admitted to the correct ward, emergency department (ED)-toward transfer time compared between intervention and nonintervention periods. We compared the overall expected LOS and the average weekly discharges to assess for comparability across the control and intervention time periods. We used the readmission rate as balancing measure to ensure that the intervention was not have unintended negative patients consequences. Results: Expected length of stay based upon discharge diagnosis/comorbidities and readmission rates were similar across the intervention and control time periods. The average weekly discharges were not statistically significant. Percentage of EDO by 11 am was higher in the first intervention period, second intervention period and combined intervention periods (28.9% vs. 21.8%, P < 0.001) compared with the respective control periods. Percent discharged before noon increased in the first intervention period, second intervention period and for the combined intervention periods (17 vs. 11.8%, P < 0.001). There was no difference in the percent admitted to the correct ward and ED-toward transfer time. Conclusion: Afternoon CAPP rounds to identify early patient discharges the following day led to increase in EDO entered by 11 am and discharges by noon without an adverse change in readmission rates and LOS.

show abstract

Barriers to Early Hospital Discharge: A Cross‐Sectional Study at Five Academic Hospitals

Cited by 26 publications

References 38 publications

The Evolution of Treatment at the Orthopedics and Rehabilitation Clinic

The Evolution of Treatment at the Orthopedics and Rehabilitation Clinic

Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool: User-Centered Design Approach

Late-afternoon communication and patient planning (CAPP) rounds: an intervention to allow early patient discharges

Contact Info

Product

Resources

About