Development of a discharge readiness report within the electronic health record—A discharge planning tool

Tyler, Amy; Boyer, Ann; Martin, Sara; Neiman, Jenae; Bakel, Leigh Anne; Brittan, Mark

doi:10.1002/jhm.2212

Cited by 25 publications

(29 citation statements)

References 10 publications

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“…Although many transitions of care programs have supported implementation of specific care interventions at a hospital or health system level, there have been surprisingly few studies describing efforts to standardize the assessment of discharge barriers and prospectively engage individual patients . One emblematic study used stakeholder interviews and process mapping to develop a “readiness report” within their electronic medical record (EMR) . Aggregate data from the EMR including orders and discharge plans were coded, extracted, and summarized into a report.…”

Section: Discussionmentioning

confidence: 99%

Not ready, not set…discharge: Patient‐reported barriers to discharge readiness at an academic medical center

Harrison

Greysen

Jacolbia

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Planning for discharge from the hospital should begin early in each patient's stay and focus on the patient's needs. OBJECTIVE To determine how often patient‐reported barriers to discharge on admission were resolved by discharge and to explore associations between barriers and readmission. DESIGN, SETTING, AND PARTICIPANTS A prospective observational study of patients admitted to an academic medical center. INTERVENTION AND MEASUREMENTS Patients completed a barriers to discharge survey from the start of hospitalization to discharge. Primary outcomes were the prevalence of discharge barriers, rates of resolution of barriers during hospitalization, and comparisons between barriers identified in admission and discharge surveys. RESULTS One hundred sixty‐three patients were enrolled, and 68 patients (42%) completed an admission survey and discharge survey ≤48 hours before discharge. Patients completed on average 1.82 surveys (standard deviation, 1.10; range, 1–8). Total and mean numbers of barriers were highest on the admission survey and decreased until the fourth survey. On average, the total number of barriers to discharge decreased by 0.15 (95% confidence interval: 0.01‐0.30) per day (P = 0.047). Ninety percent of patients were discharged with at least 1 issue. The 3 most common barriers on the admission and discharge survey remained the same: pain, lack of understanding of recovery plan, and daily‐living activities. CONCLUSIONS Patient‐reported barriers to discharge are prevalent and incompletely addressed. This suggests an opportunity for improved discharge planning and a framework for communication between providers and patients. Journal of Hospital Medicine 2016;11:610–614. © 2016 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Not ready, not set…discharge: Patient‐reported barriers to discharge readiness at an academic medical center

Harrison

Greysen

Jacolbia

et al. 2016

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…[10][11][12][13] Far less attention has been paid to conceptually important constructs such as overall primary care experience, caregiver activation, and broad social determinants of health. These limitations in readmissions research might explain some of the counterintuitive findings observed thus far 7,14,15 and why tools that predict readmissions with high sensitivity and specificity are not yet available.…”

Section: What This Study Addsmentioning

confidence: 99%

The Medical Home and Hospital Readmissions

et al. 2015

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BACKGROUND AND OBJECTIVE: Despite considerable attention, little is known about the degree to which primary care medical homes influence early postdischarge utilization. We sought to test the hypothesis that patients with medical homes are less likely to have early postdischarge hospital or emergency department (ED) encounters.METHODS: This prospective cohort study enrolled randomly selected patients during an acute hospitalization at a children's hospital during 2012 to 2014. Demographic and clinical data were abstracted from administrative sources and caregiver questionnaires on admission through 30 days postdischarge. Medical home experience was assessed by using Maternal and Child Health Bureau definitions. Primary outcomes were 30-day unplanned readmission and 7-day ED visits to any hospital. Logistic regression explored relationships between outcomes and medical home experiences. RESULTS:We followed 701 patients, 97% with complete data. Thirty-day unplanned readmission and 7-day ED revisit rates were 12.4% and 5.6%, respectively. More than 65% did not have a medical home. In adjusted models, those with medical home component "having a usual source of sick and well care" had fewer readmissions than those without (adjusted odds ratio 0.54, 95% confidence interval 0.30-0.96). Readmissions were higher among those with less parent confidence in avoiding a readmission, subspecialist primary care providers, longer length of index stay, and more hospitalizations in the past year. ED visits were associated with lack of parent confidence but not medical home components.CONCLUSIONS: Lacking a usual source for care was associated with readmissions. Lack of parent confidence was associated with readmissions and ED visits. This information may be used to target interventions or identify high-risk patients before discharge. WHAT'S KNOWN ON THIS SUBJECT:Receiving primary care in a high-quality medical home may lead to reductions in hospital or emergency department (ED) utilization; however, the relationship between the medical home and postdischarge hospitalizations and ED visits is poorly understood.WHAT THIS STUDY ADDS: Readmission rates vary markedly based on data source and definition. Unplanned readmissions were associated with absence of a usual source of well and sick care but not other medical home components. Lack of parent confidence at discharge identified patients at high risk for readmissions and ED visits shortly after discharge.

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“…Current EHR products do not support this functionality. 41,42 However, a recent report highlights new solutions and has served as a model to avoid redundant documentation. 33 With respect to hospitalist-to-PCP handoff at discharge, previously identified essential discharge content (7 elements) aligned well with the content of continuous care documentation as well as meaningful use requirements, a universal incentive for hospitals.…”

Section: Figurementioning

confidence: 99%

Project IMPACT Pilot Report: Feasibility of Implementing a Hospital-to-Home Transition Bundle

et al. 2017

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A pediatric care transition bundle was successfully tested and implemented, as demonstrated by improvement in all process measures, as well as caregiver home management skills. Important considerations for successful implementation and evaluation of the discharge bundle include the role of local context, electronic health record integration, and subgroup analysis for technology-supported patients.

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Development of a discharge readiness report within the electronic health record—A discharge planning tool

Cited by 25 publications

References 10 publications

Not ready, not set…discharge: Patient‐reported barriers to discharge readiness at an academic medical center

Not ready, not set…discharge: Patient‐reported barriers to discharge readiness at an academic medical center

The Medical Home and Hospital Readmissions

Project IMPACT Pilot Report: Feasibility of Implementing a Hospital-to-Home Transition Bundle

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