Implementation of discharge management for geriatric patients at risk of readmission or institutionalization

Steeman, Els; Moons, Philip; Milisen, Koen; Bal, Nele De; Geest, Sabina De; Froidmont, C de; Tellier, V.; Gosset, Christiane; Abraham, Ivo

doi:10.1093/intqhc/mzl026

Cited by 42 publications

(35 citation statements)

References 19 publications

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“…33 In a review of 12 trials involving general medical patients, no effects were seen on readmissions; 34 similar results were seen in two other trials that recruited a total of 3557 patients. 35,36 Collaboration with primary care and general practitioners in discharge processes…”

Section: Discharge Coordinatorsmentioning

confidence: 99%

Preventing the rebound: improving care transition in hospital discharge processes

Scott

2010

Aust. Health Review

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Background. Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions.Objective. To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre-and postdischarge elements.Design. Systematic metareview of controlled trials. Data collection. Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions.Data synthesis. Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure.Conclusion. Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre-and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospitalcommunity interface.What is known about this topic? Unplanned readmissions within 30 days of hospital discharge are common and may reflect deficiencies in discharge processes. Various peridischarge interventions have been evaluated, mostly single-component interventions that occur either before or after discharge, but failing to yield consistent evidence of benefit in reducing readmissions. More recent trials have assessed multicomponent interventions which involve pre-and postdischarge periods, but no formal review of such studies has been undertaken. What does this paper add? With the exception of intense self-management and transition coaching of high-risk patients, and nurse home visits and telephonic support for patients with heart failure, single-component interventions were ineffective in reducing readmissions. Multicomponent interventions demonstrated evidence of benefit in reducing readmissions by as much as 28%, with best results achieved in populations of older patients and those with heart failure. What are the implications for practitioners and managers? Hospital clinicians and managers should critically review and, where appropriate, modify their current discharge processes in accordance with these findings and negotiate the extra funding and personnel required to allow succ...

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Section: Discharge Coordinatorsmentioning

confidence: 99%

Preventing the rebound: improving care transition in hospital discharge processes

Scott

2010

Aust. Health Review

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“…The researchers reported that the patients assigned to the usual care group had nearly double the readmission rate by 15 days post-discharge, but the number of readmissions between 15 and 90 days was not significantly different among the groups (Steeman et al, 2006).…”

Section: Telemedicine and Ehealthmentioning

confidence: 99%

“…The researchers found reduced readmission rates within 30 days of the patients who received the TCM program 12.66%, as compared to 35.85% for the group that received no intervention (Ahmed &Rak, 2010). Discharge management by trained social workers or nurses may result in fewer elderly patients being institutionalized in a nursing home in the first days after hospital discharge (Steeman, Moons, Milisen, de Bal, de Geest, de Froidmont, Tellier, Gossett & Abraham, 2006). A quasi-experimental study was done to evaluate whether the application of "discharge management" reduced hospital readmissions and institutionalization of geriatric patients.…”

Section: Telemedicine and Ehealthmentioning

confidence: 99%

“…By training case managers to be sensitive to the elderly patients and caregivers discharge needs, appropriate services and programs can be initiated prior to the patient's discharge. In the "discharge management" model by Steeman, Moons, Milisen, de Bal, de Geest, de Froidmont, Tellier, Gossett & Abraham (2006), patients who received the enhanced management services, in addition to the usual case management services, showed a decline in hospital readmissions (Steeman, et al, 2006).…”

Section: Recommendations and Implications For Advanced Nursing Practicementioning

confidence: 99%

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Contributing Factors to Hospital Readmissions

Amalfitano¹

2013

Preprint

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“…tudios que muestran cómo la gestión de casos influye en la reducción de institucionalizaciones en pacientes geriá-tricos (30), o sobre su influencia en las disminuciones significativas en la hospitalización (31), o su capacidad preventiva para evitar la re-hospitalización (29,32). También tenemos evidencias sobre la influencia de la misma sobre la disminución de costes (33)(34)(35), aunque eso será analizado posteriormente.…”

Section: Influencia De Las Enfermeras Gestoras De Casos Hospitalariasunclassified

Influencia de las Enfermeras Gestoras de Casos hospitalarias sobre la preparación de las cuidadoras para asumir el cuidado domiciliario

et al. 2009

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Influencia de las EnfermerasGestoras de Casos hospitalarias sobre la preparación de las cuidadoras para asumir el cuidado domiciliario Nursing Case Management of caregiver emotional heatlh at hospital setting and it´s influence on caregivers decission to take care at homePresentación preeliminar de resultados: Un resumen de este trabajo fue galardonado con el premio a la mejor comunicación en las I Jornadas Regionales de Enfermeras Gestoras de Casos celebradas en Aracena (Huelva) en octubre de 2008. RESUMENObjetivos: a) Determinar la influencia de las intervenciones de las Enfermas Gestoras de Casos (EGC) sobre el cansancio en el rol de cuidador y en la decisión de éstos de asumir la atención del paciente en su domicilio. b) Cuantificar el ahorro de estancias y de costes. Metodología: Estudio observacional restrospectivo sobre pacientes con cansancio en el rol del cuidador gestionados por las EGC entre abril y septiembre de 2008. Se analiza la efectividad de las intervenciones midiendo la puntuación al ingreso y al alta del CRE Salud Emocional del Cuidador Principal. El ahorro de estancias y costes se ha calculado mediante la fórmula: total de pacientes con ingreso/alta precoz conseguida x estancia media x coste diario. Resultados: Sesenta y cuatro pacientes presentaban el diagnóstico. En todos los casos se activó el criterio de salud emocional. Las intervenciones fueron efectivas mejorando el CRE de 2,41 al ingreso a 3,81 al alta (p < 0,0001). Treinta y uno de estos pacientes que tenían previsto el traslado al hospital media estancia han sido dados de alta a domicilio tras su intervención. Existen diferencias en la puntuación al alta del CRE (> ó < 4) en este grupo comparado con el que continúa curso normal (p > 0,006). La intervención de las EGC ha ahorrado un total de 798 días de estancia tasados en 360.270 euros en 6 meses. Conclusiones: Las intervenciones de las EGC mejoran la salud emocional de las cuidadoras, sitúa a la cuidadora en disposición de SUMMARY Aims: a) To determine the influence of the interventions of

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Implementation of discharge management for geriatric patients at risk of readmission or institutionalization

Abstract: This implementation project showed that a discharge planning intervention can reduce institutionalization rates of elderly patients in real-life settings.

Cited by 42 publications

References 19 publications

Preventing the rebound: improving care transition in hospital discharge processes

Preventing the rebound: improving care transition in hospital discharge processes

Contributing Factors to Hospital Readmissions

Influencia de las Enfermeras Gestoras de Casos hospitalarias sobre la preparación de las cuidadoras para asumir el cuidado domiciliario

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