Predictors for Telephone Outreach Post-hospital Discharge

Purpose of Study: The project aimed to determine the impact of a standardized bowel regimen protocol for patients receiving opioids on the rate of stool softener prescription, occurrence of bowel movements of oncology patients, and improving the length of stay (LOS). Primary Practice of Setting: Oncology unit in a community hospital. Methodology and Sample: A posttest design was utilized, and a prospective medical record review of patients was completed after 8 weeks of the pilot study. The study sample (N = 164) included oncology patients admitted to a community hospital in the Southeast. The χ2 test was used to determine the impact of implementing a bowel panel order on the rate of stool softener prescriptions, the occurrence of bowel movements, and the LOS. Results: Only 43% (n = 40) of the patients from the comparison group were ordered laxatives, and more patients from the intervention group (68%; n = 49) received the bowel regimen protocol, whereas 26% (n = 19) of the patients used a laxative or stool softener using providers' preference and demonstrated statistical significance (p = .001). In the intervention group, 93% of the patients (n = 67) reported having bowel movements compared with the comparison group, whereas only 32% (n = 32) demonstrated statistical significance (p = .001). The average LOS in the intervention group is less than 9 days compared with the comparison group, which was at 9 days (p = .001). Implications to Case Management Practice: Case managers play a critical role in coordinating care, improving transitions of care, and reducing LOS. Case managers can have a significant impact by monitoring and reminding nurses to report the gastrointestinal movements of oncology patients and then escalate opioid-induced constipation with the providers immediately. Case managers can facilitate the implementation of bowel regimen protocols, which may reduce hospitalizations and enhance patient outcomes, by taking this action.

Section: Discussionmentioning

confidence: 99%

Bowel Management Protocol

Shanholtz,

Vergara,

Amba

et al. 2024

“…Multidisciplinary rounds were the standard work process in the CCU. The CCU has a designated case manager, and this structure is standard to many health care organizations because the case manager serves as a conduit among the multidisciplinary team (Vergara et al., 2021). Although not a direct utilizer of the CAM-ICU tool, the case manager was also familiar with the CAM-ICU tool and its impact on care coordination, acuity downgrades, unit transfers, and discharge planning.…”

Section: Designmentioning

confidence: 99%

Bringing Delirium to Light

Savino,

Vergara,

Ramos

et al. 2024

Self Cite

Background: Delirium is a serious complication in patients in the critical care unit (CCU) that may lead to prolonged hospitalization if left undetected. The CCU at our hospital does not have a framework for determining delirium that could affect patient outcomes and discharge planning. Primary Practice Setting: CCU in a community hospital. Method: A posttest-only design was used for this study. We established a framework for the early assessment of delirium, educated and trained nurses to detect delirium, collaborated with the informatics department, intensivist, nursing, respiratory therapy and worked with case management to deploy the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We used a one-tailed independent t test to determine the impact of CAM-ICU on length of stay (LOS). Cross-tabulation and chi-square tests were used to examine the impact of CAM-ICU tool on home care utilization between the intervention and comparison groups. Results: There was a 3.12% reduction in LOS after implementing the CAM-ICU tool. Also, a reduction in home care service utilization demonstrated statistical significance (p= .001) between the intervention group (62.5%; n= 177) and the comparison group (37.5%; n= 106). Implications for Case Management Practice: Case managers are essential in improving care transitions. Case managers need to become competent in understanding the implications of the CAM-ICU tool because of their relevant role in the multidisciplinary rounds as advocates to improve care transitions across the continuum of care. Case managers need to have an understanding on how to escalate when changes in the Richmond Agitation-Sedation Scale scores occur during the multidisciplinary rounds because it can affect care coordination throughout the hospital. Conclusions: Implementing the CAM-ICU decreased LOS, and reduced health care utilization. The early identification of patients with delirium can affect the outcomes of critically ill patients and entails multidisciplinary collaboration.

“…Care transition models have been implemented across the United States to reduce hospital readmissions and other adverse events in high-risk populations, such as adults older than 65 years with multiple comorbidities (Baldwin et al, 2018; Schletzbaum et al, 2023). Several care transition models focus on nurse-led care transition interventions with varying success (Ballard et al, 2018; Berkowitz et al, 2018; Finlayson et al, 2018; Gilbert et al, 2021; Hall et al, 2020; Jack et al, 2009; Joo & Liu, 2021; Kripalani et al, 2019; Morkisch et al, 2020; Schnipper et al, 2021; Vergara et al, 2021; Yiadom et al, 2020). Care transition models, such as Better Outcomes for Older Adults Through Safe Transitions (BOOST), Care Transitions Intervention Model (CTI), the Transitional Care Model (TCM), Project Red, and the Johns Hopkins Community Health Partnership (J-CHiP), have positive outcomes of reduced hospital readmissions, improved communication among care team members, reduced health care costs, and improved patient experiences (Ballard et al, 2018; Berkowitz et al, 2018; Hall et al, 2020; Jack et al, 2009; Joo & Liu, 2021; Kripalani et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Effective Care Transitions

Kinard,

Brennan-Cook,

Johnson

et al. 2023

Purpose/Objectives: Care transitions from one setting to another are vulnerable spaces where patients are susceptible to complications. Health systems, accountable care organizations, and payers recognize that care transition interventions are necessary to reduce unnecessary cost and utilization and improve patient outcomes following a hospitalization. Multiple care transition models exist, with varying degrees of intensity and success. This article describes a quality improvement project for a care transition model that incorporates key elements from the American Case Management Association's Transitions of Care Standards and the Transitional Care Management services as outlined by the Centers for Medicare & Medicaid Services. Primary Practice Setting: A collaboratively developed care transition model was implemented between a health system population health management office and a primary care organization. Findings/Conclusions: An effective care transitions model is stronger with collaboration among core members of a patient's care team, including a nurse care manager and a primary care provider. Ongoing quality improvement is necessary to gain efficiencies and effectiveness of such a model. Implications for Case Management Practice: Care managers are integral in coordinating effective transitions. Care management practice includes transition of care standards that are associated with improved outcomes for patients at high risk for readmission. Interventions inclusive of medication reconciliation, identification and addressing of health-related social needs, review of discharge instructions, and coordinated follow-up are important factors that impact patient outcomes. Patients and their health system care teams benefit from the role of a care manager when there is a collaborative, coordinated, and timely approach to hospital follow-up.