The Impact of a Standardized Discharge Process on 30-Day Readmissions for Patients on Outpatient Parenteral Antibiotic Treatment

2020 ◽  
pp. 001857872098543
Author(s):  
Charnicia E. Huggins ◽  
Tae Eun Park ◽  
Eric Boateng ◽  
Cosmina Zeana
Keyword(s):  
Antibiotic Treatment ◽  
Multidisciplinary Approach ◽  
Hospital Readmissions ◽  
Care Process ◽  
Innovative Technology ◽  
Post Discharge ◽  
Parenteral Antibiotic ◽  
Telephone Calls ◽  
Voice Calls ◽  
The Impact

Introduction: Outpatient parenteral antibiotic treatment (OPAT) is associated with shorter length of hospital stay and reduced cost. Yet, patients discharged home on OPAT are at risk of hospital readmissions due to adverse events and complications. Although the impact of a multidisciplinary approach to readmission has been assessed by previous studies, addition of an innovative technology has not been evaluated for OPAT. This study examines the impact of a multidisciplinary approach including automated voice calls on 30-day readmissions of OPAT patients. Methods: A post-discharge transitional care process (PDTCP) targeting OPAT patients was implemented in fall 2016. This process included an automated telephone patient engagement service and coordination among pharmacy, nursing, medicine, and social work personnel. The patients on OPAT received automated telephone calls at 2, 9, 16, 28, and 40 days post-discharge to ensure medication availability and adherence and to circumvent issues that would otherwise result in an emergency room visit or readmission to the hospital. Results: A total 429 voice calls were made to 148 patients from November 8, 2016 to February 28, 2019. Overall, 61% (n = 90/148) of the patients were successfully reached by the automated voice system. The patients who were reached by the automated voice system were less likely to be readmitted than those not reached (18.9% vs 41.4%; relative risk (RR) 0.46, 95% CI 0.27-0.77, P = .003). Conclusion: Our study demonstrated that a multidisciplinary approach involving the use of automated telephone calls was associated with decreased hospital readmissions.

Abstract TP278: Positive Impact of a Stroke Bundle Program

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Deborah Murphy ◽  
Colleen Boyle ◽  
Elissa Della Monica ◽  
Heather Peiritsch ◽  
Laura Schmidt ◽  
...  
Keyword(s):  
Care Coordination ◽  
Positive Impact ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Hospital Length Of Stay ◽  
Care Process ◽  
Full Time ◽  
Stroke Patients ◽  
Nurse Navigator ◽  
The Impact

Introduction: There are limited comparative data on the impact of a stroke bundle program on patient outcomes. We aimed to assess the magnitude of change that could occur during transitions of care process by implementation of a stroke bundle program. Methods: Six skilled nursing facilities (SNF) participated with a Joint Commission certified Comprehensive Stroke Center to implement a Bundled Payment Care Initiative (BPCI) program. The stroke leadership developed a charter and additional support teams (care coordination and SNF). Three smart goals were identified and reflected organizational strategic goals: reduction of the number of stroke patients that are admitted to a SNF by 5% (baseline 27.9%); reduction of preferred provider SNF days for stroke patients by 10% (baseline 35.5%) and reduction of hospital readmissions for stroke by 5% (baseline 31.5%). A strong infrastructure supported the care coordination teams including the hiring of a full time stroke nurse navigator. The kick off for the program was October 1, 2015. Several strategic and operational initiatives were developed and successfully implemented at SNFs: utilization of stroke clinical practice guidelines: stroke education programs; stroke summit for all SNF administrators, physicians and staff; bi-monthly, face to face/conference call meetings with SNF administrators and bundle team leadership; case reviews between caregivers at acute setting and SNF; SharePoint site to enhance communication; stroke nurse navigator interaction with patients, families, SNF staff, 90 day follow up and readmission case reviews. Results: Smart goal achievement over a 6 month period demonstrated: reduction of the number of stroke patients that were admitted to SNF by .4% (21.9%); reduction of preferred provider SNF days for stroke patients by 16% (16%) and reduction of hospital readmissions for stroke by 7% (23.3%). Comparison of hospital length of stay variance between bundle (3.78) and non-bundle patients (5.08) patients was 1.3%. Conclusions: A stroke bundle program impacts positively on transitions of care at preferred provider SNF facilities. Standardization of care and a unified care team attributes to stroke patients returning to their life at home in a much more efficient and timely manner.

The Effectiveness of Transition Interventions to Support Older Patients From Hospital to Home: A Systematic Scoping Review

2020 ◽  
pp. 073346482096871
Author(s):  
Renee O’Donnell ◽  
Melissa Savaglio ◽  
Helen Skouteris ◽  
Jane Banaszak-Holl ◽  
Chris Moran ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Readmissions ◽  
Well Being ◽  
Evidence Base ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Hospital To Home ◽  
The Impact ◽  
Health And Well Being

Background: Interventions supporting older adults’ transition from hospital to home can address geriatric needs. Yet this evidence base is fragmented. This review describes transitional interventions that provide pre- and post-discharge support for older adults and evaluates their implementation and effectiveness in improving health and well-being. Method: Articles were included if they examined the extent to which transitional interventions were effective in improving health and well-being outcomes and reducing hospital readmission rates among older adults. Results: Twenty studies met the inclusion criteria. Four types of interventions were identified: education-based (10/20); goal-oriented (4/20); exercise (4/20); and social support interventions (2/20). Education and goal-oriented interventions were effective in improving health and well-being outcomes. The impact of interventions on mitigating hospital readmissions was inconclusive. Only five studies examined implementation. Discussion: Older adults transitioning from hospital to home would benefit from tailored education and goal-oriented interventions that promote their capacity for self-care.

scholarly journals “Brown Bag Clinic”: A Pharmacist-led Approach to Reduce Heart Failure Hospital Readmission

2021 ◽  
Vol 12 (4) ◽  
pp. 11
Author(s):  
Maggie N. Faraj ◽  
Ileana L. Piña ◽  
Candice Garwood
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Post Discharge ◽  
Academic Medical ◽  
The Impact

Objectives: Heart failure (HF) affects approximately 6 million in the United States and despite guideline-directed medical therapy (GDMT), still more than 20% of patients are readmitted within 30 days.1,2 This study evaluated the impact of a “pharmacist-led HF Brown Bag Clinic” (BBC) on HF patient outcomes including readmissions and mortality. Methods: This retrospective study, conducted at an academic medical center, included adult patients 18 to 89 years old with HF presenting to the BBC 7-14 days post HF hospitalization. Those failing to attend the BBC within 30 days of hospital discharge were in the control group. Our electronic medical records were used to capture patients’ baseline characteristics and describe pharmacists’ interventions. Thirty- and ninety-day post-discharge HF readmission and all-cause mortality were evaluated. Results: A total of 32 patients met the inclusion criteria; 15 receiving intervention and 17 controls. A total of 18 HF hospital readmissions occurred, 4 (22%) readmissions in the intervention group and 14 (78%) in the control group (p= 0.06). Hospital readmissions within 30 days and 90 days were greater in the control group compared with the intervention group (18% vs. 7% and 41% vs. 21% respectively). Conclusion: A pharmacist-led post-discharge clinic demonstrated numerically fewer HF hospital readmissions compared with a scheduled but “no show” control group.

scholarly journals Discharge Medication Counseling and its Correlation with Reducing Readmissions for Patients with Chronic Obstructive Pulmonary Disease Exacerbations

2015 ◽  
Vol 6 (3) ◽  
Author(s):  
Emily M. Laswell ◽  
Elizabeth A. Svelund ◽  
Melody L. Harzler ◽  
Kasandra D. Chambers ◽  
Aleda M.H. Chen
Keyword(s):  
Hospital Readmissions ◽  
Phone Call ◽  
Control Group ◽  
Chronic Obstructive ◽  
Original Research ◽  
Post Discharge ◽  
Readmission Rates ◽  
Discharge Medication ◽  
Medication Counseling ◽  
The Impact

Objective: To determine the impact of pharmacist-provided discharge medication counseling on 30 and 90 day hospital readmissions and ED visits in patients admitted with COPD exacerbation. Methods: A hospital-wide improvement was initiated, where COPD patients received discharge medication counseling and follow up phone call by a pharmacist. A pilot study was implemented, and data on readmission rates at 30- and 90-days were collected and compared to a hand-matched, retrospective control group that had not received discharge counseling by a pharmacist. Differences in readmission rates were analyzed using Chi-squared tests. Results: A total of 28 patients received discharge counseling by the pharmacist and were compared to 28 retrospective patients. Differences in 30-day and 90-day readmission rates were not significant (p=1.000 and p=0.589, respectively). After thirty days, 7 (25%) intervention and 7 (25%) retrospective group patients had been readmitted. After ninety days, 11 (39.3%) intervention and 13 (46.4%) non-intervention patients had been readmitted. Since a small cohort of patients received discharge counseling, the study did not meet power. Conclusions: Although not statistically significant, patients who received discharge medication counseling provided by a pharmacist had lower 90-day readmission rates post discharge. As regulations are implemented that penalize hospitals for readmissions that occur within 30 days of discharge, it is imperative that health care systems develop new strategies aimed at reducing readmission rates. Further studies that are adequately powered are needed to assess the impact pharmacists can have on readmission rates.   Type: Original Research

scholarly journals Parenteral Antibiotics Reduce Bifidobacteria Colonization and Diversity in Neonates

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Séamus Hussey ◽  
Rebecca Wall ◽  
Emma Gruffman ◽  
Lisa O'Sullivan ◽  
C. Anthony Ryan ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Patient Group ◽  
Gel Electrophoresis ◽  
Denaturing Gradient Gel Electrophoresis ◽  
Neonatal Period ◽  
Short Term ◽  
Parenteral Antibiotic ◽  
Gradient Gel Electrophoresis ◽  
Stool Samples ◽  
The Impact

We investigated the impact of parenteral antibiotic treatment in the early neonatal period on the evolution of bifidobacteria in the newborn. Nine babies treated with intravenous ampicillin/gentamicin in the first week of life and nine controls (no antibiotic treatment) were studied. Denaturing gradient gel electrophoresis was used to investigate the composition ofBifidobacteriumin stool samples taken at four and eight weeks. Bifidobacteria were detected in all control infants at both four and eight weeks, while only six of nine antibiotic-treated infants had detectable bifidobacteria at four weeks and eight of nine at eight weeks. Moreover, stool samples of controls showed greater diversity ofBifidobacteriumspp. compared with antibiotic-treated infants. In conclusion, short-term parenteral antibiotic treatment of neonates causes a disturbance in the expected colonization pattern of bifidobacteria in the first months of life. Further studies are required to probiotic determine if supplementation is necessary in this patient group.

scholarly journals Assessing the Impact of Nurse Post-Discharge Telephone Calls on 30-Day Hospital Readmission Rates

2014 ◽  
Vol 29 (11) ◽  
pp. 1519-1525 ◽  
Author(s):  
James D. Harrison ◽  
Andrew D. Auerbach ◽  
Kathryn Quinn ◽  
Ellen Kynoch ◽  
Michelle Mourad
Keyword(s):  
Hospital Readmission ◽  
Day Hospital ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Telephone Calls ◽  
The Impact

scholarly journals Framed messages effects on readmissions

2016 ◽  
Vol 5 (4) ◽  
pp. 95
Author(s):  
Angela P. Halpin ◽  
Felicia S. Hodge
Keyword(s):  
Hospital Readmissions ◽  
Severity Index ◽  
The Elderly ◽  
Framing Effects ◽  
Control Group ◽  
Post Discharge ◽  
Readmission Rates ◽  
Double Blind ◽  
Negative Messages ◽  
The Impact

Objective: As the eighth leading cause of death in the US, pneumonia (PN) is relevant to the health of the elderly and young. Accountability for readmission is part of the Affordable Care Act’s Hospital Readmissions Reduction Program (RRP), which levies penalties for readmissions. We examined communication using framing effects which can motivate patients’ decisions collaboratively with providers for post discharge care and readmissions prevention. Communication strategies (CS) can facilitate decision-making (DM) about health care choices. The project’s aims were to (1) compare CS of framing effects (positive or negative messages) on the readmission outcome 30 days post discharge; (2) assess PN readmissions decrease 30 days post discharge when CS include the patient/family in decisions about transitions; (3) determine the impact of between patients and HCPs agreement for post hospital care, and (4) examine confounding effects between framing effects and readmission rates of age, PN severity index (PSI), and the number of diagnoses.Methods: A double-blind randomized control trial (RCT) used parallel assignment of 153 PN patients to one of three arms to test the communication framing effects using power analysis, odds ratio, Fischer’s exact and ANOVA. Arm A was the Intervention positive framing group (n = 44), arm B was the Intervention Negative framing group (n = 65), and arm C was the control group (n = 44).Conclusions: Findings suggest that framed messages aid in the reduction of PN readmission rates in hospitals. DM strategies incorporates education and understanding of risk by the patient, so the healthcare teams can encourage and improve readmission outcomes.

scholarly journals Decreasing Readmissions in Medically Complex Children

2020 ◽  
Author(s):  
◽  
Colleen Bartlett
Keyword(s):  
Medication Reconciliation ◽  
Hospital Readmissions ◽  
Outcome Evaluation ◽  
Evidence Based ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital System ◽  
Practice Problem ◽  
Telephone Calls

Practice Problem: There was a report of an existing practice problem of increased 30-day readmission rates in medically complex children at an outpatient clinic within an extensive hospital system. Hospital readmissions can cause clinical, social, and financial burdens to the patients and their families and thus reflected a need for interventions to reduce readmissions. PICOT: The PICOT question that guided this change project: In medically complex pediatric patients ages 0-17, what is the effect of a discharge intervention bundle in reducing all-cause 30-day hospital readmissions compared to current practice within an 8-week timeframe? Evidence: The literature revealed 18 pertinent studies that fit the inclusion and exclusion criteria that promoted a discharge intervention bundle. The themes within the evidence included post-discharge telephone calls, follow-up appointments, medication reconciliation, and education with teach-back to reduce overall readmission rates. Intervention: The evidence-based intervention utilized the bundle of post-discharge telephone calls within 72 hours, follow up appointments within 7 days, and medication reconciliation with education and teach-back through in-person and virtual care. The clinic nurses championed the intervention and tracked all the data using a check sheet. Outcome: Evaluation of the outcome measures confirmed a decrease in all-cause 30-day readmissions from 23% to 14.5% within the project timeframe. Implications of the findings support the existing evidence for implementing a multifaceted bundle to decrease readmissions. Conclusion: The evidence-based change project decreased all-cause 30-day readmissions rates. The results of the project proved that implementing consistent discharge standards in medically complex children helped guide medical staff, improved patient outcomes, saved costs to the organization, and reduced 30-day all-cause hospital readmissions.

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