scholarly journals 113. Improving Transitions-of-Care for Patients Discharged on High-Risk Antimicrobial Therapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S171-S171
Author(s):  
Ryan Zabrosky ◽  
Ellen C Rubin ◽  
Erica Liu ◽  
Karrine Brade ◽  
Hope Serafin ◽  
...  
Keyword(s):  
Infectious Disease ◽  
High Risk ◽  
Antimicrobial Therapy ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Post Discharge ◽  
Healthcare Improvement ◽  
Medication Counseling ◽  
Risk Patients

Abstract Background Providing effective transitions-of-care (TOC) services improves outcomes for patients discharged on high-risk medications. Literature has shown that successful TOC for certain antimicrobials reduces hospital readmissions, medication errors, and improves post-discharge follow-up and laboratory monitoring. Prior to this quality improvement (QI) initiative, there was no formal TOC process for patients discharged on high-risk antimicrobial therapy (HAT) at our institution. Without standardization, only 55.1% of patients discharged on HAT had successful TOC. The aim of this initiative was to develop and implement a TOC protocol in at least 90% of patients discharged on HAT. Methods This QI initiative utilized the Institute of Healthcare Improvement model for improvement. A workgroup of key stakeholders developed a protocol to identify and standardize TOC services provided to patients discharged on HAT. Successful protocol completion was achieved if the following process metrics were evaluated, obtained, and documented prior to discharge: baseline laboratory values, pharmacokinetic monitoring, appropriate intravenous access, drug-drug interactions, medication availability, discharge medication counseling, and formal pharmacist documentation in a discharge note. Outcome metrics included referral to outpatient infectious disease (ID) follow-up, 90-day readmissions, and successful TOC. Balancing metrics included pharmacist time and protocol initiation for patients not discharged on HAT. Results Between October 2020 and May 2021, 218 patients met protocol inclusion criteria. Of these, 203/218 (93.1%) were appropriately identified with the new TOC process. The protocol was successfully followed in 78.9% of patients identified. Readmission rates were 42.8%, which was unchanged from baseline. Inpatient ID involvement increased from 80.9% to 95.7% and referral to outpatient ID follow-up from 59% to 94.8%. Conclusion This newly developed TOC protocol successfully identifies patients discharged on HAT, improves provision of TOC services to these high-risk patients, and significantly improves the rate of infectious disease involvement while inpatient and after discharge. Disclosures All Authors: No reported disclosures

scholarly journals Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity

2020 ◽  
Vol 49 (4) ◽  
pp. 558-569 ◽  
Author(s):  
Justine Tomlinson ◽  
V-Lin Cheong ◽  
Beth Fylan ◽  
Jonathan Silcock ◽  
Heather Smith ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Older Patients ◽  
Medication Reconciliation ◽  
Meta Analysis ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Self Management ◽  
Multiple Time ◽  
Post Discharge

Abstract Background medication-related problems occur frequently when older patients are discharged from hospital. Interventions to support medication use have been developed; however, their effectiveness in older populations are unknown. This review evaluates interventions that support successful transitions of care through enhanced medication continuity. Methods a database search for randomised controlled trials was conducted. Selection criteria included mean participant age of 65 years and older, intervention delivered during hospital stay or following recent discharge and including activities that support medication continuity. Primary outcome of interest was hospital readmission. Secondary outcomes related to the safe use of medication and quality of life. Outcomes were pooled by random-effects meta-analysis where possible. Results twenty-four studies (total participants = 17,664) describing activities delivered at multiple time points were included. Interventions that bridged the transition for up to 90 days were more likely to support successful transitions. The meta-analysis, stratified by intervention component, demonstrated that self-management activities (RR 0.81 [0.74, 0.89]), telephone follow-up (RR 0.84 [0.73, 0.97]) and medication reconciliation (RR 0.88 [0.81, 0.96]) were statistically associated with reduced hospital readmissions. Conclusion our results suggest that interventions that best support older patients’ medication continuity are those that bridge transitions; these also have the greatest impact on reducing hospital readmission. Interventions that included self-management, telephone follow-up and medication reconciliation activities were most likely to be effective; however, further research needs to identify how to meaningfully engage with patients and caregivers to best support post-discharge medication continuity. Limitations included high subjectivity of intervention coding, study heterogeneity and resource restrictions.

scholarly journals 608. Impact of Implementing Pharmacist Review and Monitoring of Outpatient Parenteral Antimicrobial Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S365-S365
Author(s):  
Emily R Kirkpatrick ◽  
Elizabeth O Hand ◽  
Darrel W Hughes ◽  
Jasmin K Badwal ◽  
Kristi A Traugott
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Therapy ◽  
Intervention Group ◽  
Care Program ◽  
Standard Of Care ◽  
Transitions Of Care ◽  
Control Group ◽  
Laboratory Monitoring ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Background Given current efforts to increase the safety of outpatient parenteral antimicrobial therapy (OPAT) programs nationwide, this project sought to determine whether pharmacist managed OPAT review and monitoring improves adherence to standard of care laboratory monitoring recommendations. Methods A single-center, retrospective review of patients > 18 years of age who received OPAT from University Health System was conducted. Patients who received OPAT between October 2018 and December 2018 served as the historical control group. After a pharmacist transitions of care program was implemented, patients who received OPAT between October 2019 and December 2019 were included in the intervention group. Patients were excluded if they received less than 7 days of OPAT, completed therapy prior to discharge, or died while inpatient. The primary endpoint was adherence to laboratory monitoring recommendations > 75% of the duration of planned OPAT. Only patients followed by the OPAT clinic were included in this analysis. Recommendations provided in the 2018 Infectious Diseases Society of America OPAT guidelines were used to define appropriate lab monitoring. Secondary endpoints included 30-day readmissions. Results A total of 409 patients were included in this study: 198 patients in the pre-implementation group and 211 patients in the post-implementation group. In patients with OPAT clinic follow-up, the post-implementation group was significantly more likely to receive monitoring adherent to standard of care laboratory monitoring recommendations > 75% of the duration of planned OPAT: 42/161 (26.1%) vs. 98/176 (55.7%), OR 3.6 (95% CI 2.2-5.6, p = 0.0001). There was no difference in 30-day readmission rates between groups in the overall population. Patients in the post-implementation group with OPAT clinic follow up had lower 30-day infectious disease-attributed readmissions: 18/161 (11.2%) vs. 14/176 (8.0%), p = 0.31. Conclusion Implementation of a transitions of care pharmacist significantly improved adherence to laboratory monitoring recommendations for patients receiving OPAT and numerically reduced 30-day infectious disease-attributed readmissions. Disclosures All Authors: No reported disclosures

Is there a role for referral of high-risk patients seen in preoperative medical consultation for postoperative inpatient follow-up?

2021 ◽  
pp. 175045892110310
Author(s):  
Jessica Evans ◽  
James Chan ◽  
Delvina H Saraqini ◽  
Ranjeeta Mallick
Keyword(s):  
High Risk ◽  
Chart Review ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Medical Consultation ◽  
Medical Assessment ◽  
Risk Patients ◽  
Lost To Follow Up

The potential benefit of referring select high-risk surgical patients who are seen during a preoperative medical consultation for postoperative inpatient medical follow-up is uncertain. Over a seven-year period, our internal medicine perioperative clinic referred 5% of 4642 preoperative consults for postoperative follow-up. A retrospective chart review found that although reasons for referral were heterogeneous, those assessed by the medical consult team postoperatively were more comorbid, had more adverse medical complications and had longer hospital admissions compared to those not referred. Physicians were best able to predict adverse cardiac and diabetes-related complications. Half of the patients who were referred for postoperative assessment were lost to follow-up, and there was a trend towards increased hospital readmissions in this group. Further research is required to identify the subset of patients who might benefit from postoperative inpatient medical assessment.

scholarly journals 606. Implementation of a Telehealth-based OPAT Early Post-Discharge Clinic May Reduce Hospital Readmission

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S405-S405
Author(s):  
Nicolas W Cortes-Penfield ◽  
Nicolas W Cortes-Penfield ◽  
Melissa LeMaster ◽  
Bryan Alexander
Keyword(s):  
High Risk ◽  
Panel Member ◽  
High Rate ◽  
Categorical Variables ◽  
Related Complication ◽  
Post Discharge ◽  
Readmission Rates ◽  
Cardiac Device ◽  
Risk Patients

Abstract Background Recent studies suggest that early post-discharge follow-up for patients receiving outpatient parenteral antimicrobial therapy (OPAT) reduces readmission rates. We report our experience implementing a telehealth-based clinic to facilitate early (1-2 week) follow-up for selected OPAT patients perceived to be at high risk for readmission. Methods We identified patients who met criteria for and completed a supplemental OPAT telehealth visit following the initial seven months after implementation of this clinic (11/1/20 – 5/31/21). Clinical criteria triggering intake of patients for these visits included: endovascular or cardiac device-related infection; treatment with vancomycin, oxacillin/nafcillin, or aminoglycosides; ≥2 prior hospitalizations within past 1 year; treating Infectious Disease or OPAT team’s subjective assessment of high readmission risk. Patients planned for < 14 days of OPAT therapy were excluded. Categorical variables were compared using a Chi-square test at the α=0.05 level of significance. Results A total of 49 patients completed a telehealth visit; mean time from discharge to telehealth visit was 12.1 days (SD +/- 3.9). An intervention was made in 27% of these visits (13 of 49 patients), most commonly involving attempted mitigation of an adverse event or line-related complication (7 cases). The all-cause, 30-day readmission rate for this cohort was 6.1% (3 of 49 patients), while the rate for OPAT patients who did not receive an early telehealth visit during the same period was 22.7% (52 of 229 patients) which was statistically significant (p=0.008). This association of benefit was also found when comparing infection-related, 30-day readmission rates (0% vs 7.4%, p=0.049). Conclusion Implementation of OPAT telehealth encounters for high-risk patients resulted in a high rate of intervention to mitigate adverse events of OPAT therapy. Readmission occurred less than one-third as frequently in the telehealth group compared to patients with no early follow-up visit. Telehealth-based encounters appear comparable in effectiveness to those previously reported utilizing in-person visits, introducing efficiencies that may allow for broader implementation of this intervention. Disclosures Nicolas W. Cortes-Penfield, MD, Nothing to disclose Bryan Alexander, PharmD, Astellas Pharma (Advisor or Review Panel member)

The impact of C1/D1 treatment follow-up calls on emergency room visits for chemotherapy patients.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 289-289
Author(s):  
Kimberly Davidson
Keyword(s):  
High Risk ◽  
Emergency Room ◽  
Hospital Readmissions ◽  
Care Coordinator ◽  
Risk Patients ◽  
Oncology Care ◽  
New Treatment ◽  
Chemotherapy Patients ◽  
The Impact

289 Background: One of the more challenging aspects of managing patients receiving chemotherapy is to reduce Emergency Room (ER) visits and ultimately hospital readmissions. Patients may not understand who or when to call with issues and may be concerned about reaching their physician or receiving a call back in a reasonable amount of time. Methods: C1/D1 calls were initiated with the Medical Oncology Care Coordinator (CC) staff in August 2017. All patients receiving a C1/D1 dose of a new treatment and change in regimen were called by the CC. During this call, the patient is asked several questions including how they are currently feeling, if they are having any issues as well as reviewing contact information and direction regarding if they have a fever. Re-education was provided to the staff in January 2018 regarding the importance of the calls. Also at this time, the CC were asked to do Nadir calls (repeat call 7-10 days after D1) for those patients who were determined to be high risk (percentage calculated using a toxicity formula). Results: Initially the % of ER visits were reduced after the C1/D1 calls were initiated but then began trending upward again. After re-education and the initiation of the Nadir calls, ER visits again trended down. Conclusions: Increased touch points with patients, including C1/D1 follow up calls, Nadir calls and toxicity checks for high risk patients contributed to a downward trend of treatment patients visiting the ER.[Table: see text]

scholarly journals Hospital readmissions after pulmonary resection: post-discharge nursing telephone assessment identifies high risk patients

2020 ◽  
Vol 12 (3) ◽  
pp. 184-190
Author(s):  
Robert M. Van Haren ◽  
Arlene M. Correa ◽  
Boris Sepesi ◽  
David C. Rice ◽  
Wayne L. Hofstetter ◽  
...  
Keyword(s):  
High Risk ◽  
Pulmonary Resection ◽  
Hospital Readmissions ◽  
Post Discharge ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Utilizing a Post-discharge Telephone Call in Outpatient Parenteral Antimicrobial Therapy (OPAT): Findings from a Quality Improvement Project

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S333 ◽  
Author(s):  
Kimberly Felder ◽  
Louise Vaz ◽  
Penelope Barnes ◽  
Cara Varley
Keyword(s):  
Quality Improvement ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Hospital Readmissions ◽  
Completion Rate ◽  
Transitions Of Care ◽  
Post Discharge ◽  
Improvement Project ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Arm Pain

Abstract Background Transitions of care from hospitals to outpatient settings, especially for patients requiring outpatient parenteral antimicrobial therapy (OPAT) are complex. OPAT complications, such as adverse antimicrobial reactions, vascular access problems, and hospital readmissions are common. Data from transitions of care literature suggest that post-discharge telephone calls (TCs) may significantly decrease re-hospitalization but no studies have assessed the utility of post-discharge TCs as an OPAT program quality improvement process. Methods Adult OPAT patients discharged from our hospital between April 1, 2015 and May 31, 2016 were queried for post-discharge concerns. TCs to patients or their caregivers were administered by trained medical assistants within the Department of Infectious Diseases using a standardized script and documented in the electronic medical record (EMR). Feasibility was assessed using call completion rate. The type and frequency of reported issues were analyzed by retrospective chart review. Results 636 of 689 eligible adult OPAT patients or their caregivers received a TC with responses to scripted questions documented in the EMR (92% completion rate). 302 patients (47%) reported 319 issues, including 293 (92%) relevant to OPAT. Antimicrobial issues included diarrhea/stool changes (58; 9%); nausea/vomiting (27; 4%); and missed antimicrobial doses (22; 3%). Vascular access issues included line patency concerns (21; 3%); vascular access dressing problems (17; 2.6%) and arm pain/swelling (6; 1%). OPAT vendor issues included delays in lab or line care services (23; 4%) and OPAT orders reported as lost/not received (21; 3%). Other ID-related issues included fevers/chills/sweats (27; 4%), wound concerns (16; 2.5%), and pain (15; 2.5%). Conclusion Adding a post-discharge TC to an OPAT program was feasible and resulted in frequent and early identification of significant OPAT patient and caregiver concerns. Findings suggest potential high-yield topics for process improvement, as well as anticipatory guidance and patient education in OPAT. Further evaluation and analysis of optimal hospital discharge processes and care coordination in OPAT, as well as their impact on post-discharge adverse events, is needed. Disclosures All authors: No reported disclosures.

scholarly journals Accuracy of upper endoscopies with random biopsies to identify patients with gastric premalignant lesions who can safely be exempt from surveillance

2021 ◽  
Vol 24 (3) ◽  
pp. 680-690
Author(s):  
Michiel C. Mommersteeg ◽  
Stella A. V. Nieuwenburg ◽  
Wouter J. den Hollander ◽  
Lisanne Holster ◽  
Caroline M. den Hoed ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Low Risk ◽  
Premalignant Lesions ◽  
High Risk Patients ◽  
European Guidelines ◽  
Progression Of Disease ◽  
Risk Patients ◽  
Progression Risk

Abstract Introduction Guidelines recommend endoscopy with biopsies to stratify patients with gastric premalignant lesions (GPL) to high and low progression risk. High-risk patients are recommended to undergo surveillance. We aimed to assess the accuracy of guideline recommendations to identify low-risk patients, who can safely be discharged from surveillance. Methods This study includes patients with GPL. Patients underwent at least two endoscopies with an interval of 1–6 years. Patients were defined ‘low risk’ if they fulfilled requirements for discharge, and ‘high risk’ if they fulfilled requirements for surveillance, according to European guidelines (MAPS-2012, updated MAPS-2019, BSG). Patients defined ‘low risk’ with progression of disease during follow-up (FU) were considered ‘misclassified’ as low risk. Results 334 patients (median age 60 years IQR11; 48.7% male) were included and followed for a median of 48 months. At baseline, 181/334 (54%) patients were defined low risk. Of these, 32.6% were ‘misclassified’, showing progression of disease during FU. If MAPS-2019 were followed, 169/334 (51%) patients were defined low risk, of which 32.5% were ‘misclassified’. If BSG were followed, 174/334 (51%) patients were defined low risk, of which 32.2% were ‘misclassified’. Seven patients developed gastric cancer (GC) or dysplasia, four patients were ‘misclassified’ based on MAPS-2012 and three on MAPS-2019 and BSG. By performing one additional endoscopy 72.9% (95% CI 62.4–83.3) of high-risk patients and all patients who developed GC or dysplasia were identified. Conclusion One-third of patients that would have been discharged from GC surveillance, appeared to be ‘misclassified’ as low risk. One additional endoscopy will reduce this risk by 70%.

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