Impact of Discharge Planning Decision Support on Time to Readmission Among Older Adult Medical Patients

Abstract

Purpose of the Study Hospital clinicians are overwhelmed with the volume of patients churning through the health care systems. The study purpose was to determine whether alerting case managers about high-risk patients by supplying decision support results in better discharge plans as evidenced by time to first hospital readmission. Primary Practice Setting Four medical units at one urban, university medical center. Methodology and Sample A quasi-experimental study including a usual care and experimental phase with hospitalized English-speaking patients aged 55 years and older. The intervention included using an evidence-based screening tool, the Discharge Decision Support System (D2S2), that supports Clinicians′ discharge referral decision making by identifying high-risk patients upon admission who need a referral for post-acute care. The usual care phase included collection of the D2S2 information, but not sharing the Information with case managers. The experimental phase Included data collection and then sharing the results with the case managers. The study compared time to readmission between index discharge date and 30 and 60 days in patients in both groups (usual care vs. experimental). Results After sharing the D2S2 results, the percentage of referral or high-risk patients readmitted by 30 and 60 days decreased by 6% and 9%, respectively, representing a 26% relative reduction in readmissions for both periods. Implications for Case Management Practice Supplying decision support to identify high-risk patients recommended for postacute referral is associated with better discharge plans as evidenced by an increase in time to first hospital readmission. The tool supplies standardized information upon admission allowing more . time to work with high-risk admissions.

Post–Acute Care Use and Hospital Readmission after Sepsis

“…For sepsis survivors discharged with home services, the issue of whether early and intensive home health nursing services and physician followup improve outcomes after sepsis, strategies that appear to improve outcomes in other patient populations (48,49), should be studied. For survivors discharged to home without services, the question of whether referral practices, which frequently fail to identify those at risk for poor outcomes postdischarge (50), could be optimized with decision support strategies to improve access and outcomes remains unanswered (51). Related to this question is whether timely access to palliative care services could be optimized for targeted subgroups, given the frequency of hospice use among …”

Identifying Hospitalized Pediatric Patients for Early Discharge Planning: A Feasibility Study

“…Patients in this study setting who screened positive not only have longer lengths of stay, but also may be at greater risk of readmission within 30 days. Although the ESDP-C was not specifically designed with risk of readmissions in mind, readmissions are linked to the quality of the discharge planning process (Bowles et al, 2014;Bowles et al, 2012;Coleman, 2003;Coleman & Boult, 2003;Coller et al, 2013;Weiss et al, 2010). Certain components in the ESDP-C may also represent factors indicative of readmission risk (e.g., technology dependence, neurologic disorders) (Cohen et al, 2012;Feudtner et al, 2009;Gay, Hain, Grantham, & Saville, 2011;Hudson, 2013).…”

“…Comprehensiveness of the discharge plan begun early during the hospital stay has been shown to reduce the overall LOS and positively impact continuity of care and patient outcomes after discharge . Maximizing continuity of care in the transition process ultimately influences readmission rates for individuals with complex, post-acute care needs (Bowles, Hanlon, Holland, Potashnik, & Topaz, 2014;Bowles et al, 2012;Coleman, 2003;Coleman & Boult, 2003;Coller, Klitzner, Lerner, & Chung, 2013;Weiss, Yakusheva, & Bobay, 2010). Patients whose complex discharge plans are developed quickly near the end of the hospital stay are at risk of being discharged later than necessary.…”

“…timely organization, patient and family engagement, and coordination of services) has implications for length of stay (LOS) and readmissions in hospitalized adults. This is illustrated in the studies supporting the Early Screen for Discharge Planning, which was developed as a decision support tool to enhance the deployment of discharge planning resources to the right patients in a timely manner (Bowles, Holland, Potashnik, Topaz, & Hanlon, 2012;Holland, Harris, Leibson, Pankratz, & Krichbaum, 2006;Holland & Hemann, 2011). The Early Screen for Discharge Planning identifies adults on admission who may have complex discharge plans.…”

Developing evidence-based tools from EHR data

“…In two recent studies, when this tool was used to support referral decision making, 30-day readmissions declined by 26% and 35%. 4,5 …”