scholarly journals Improving mental health care transitions through information capture during admission to inpatient mental health services: a quality improvement study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Natasha Tyler ◽  
Nicola Wright ◽  
Kyriakos Gregoriou ◽  
Justin Waring
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Discharge Planning ◽  
Care Pathway ◽  
Care Transitions ◽  
Distributed Teams ◽  
The Novel ◽  
Essential Information ◽  
Junior Staff ◽  
Health Care Transitions

Abstract Background Many interventions aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. We aimed to develop a novel information capture tool during admission that facilitates and accelerates discharge. Methods A quality improvement study to develop, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. We developed the tool by synthesising existing evidence and working with multi-agency and multi-disciplinary professionals in two co-design workshops. During implementation the tool was piloted on three wards. Ethnographic observations (145 h) and interviews (45) were used to evaluate the implementation of the tool across the three wards. Thematic synthesis was used to consolidate the findings. Results The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to hospital to facilitate discharge planning to community settings. Reported advantages of the tool were: (1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward (2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and (3) collecting information from the services/agencies to which patients will eventually be discharged. Conclusions Improving the quality of information at admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems. However, the introduction of the tool exacerbated complex, fragile distributed team dynamics, highlighting the importance of sociocultural context in information flow transitional interventions within distributed teams.

scholarly journals A Formative Quality Improvement Implementation Study To Improve Care Transitions Through Information Capture Upon Admission To An Acute Mental Health Ward

2021 ◽  
Author(s):  
Natasha Tyler ◽  
Nicola Wright ◽  
Kyriakos Gregoriou ◽  
Justin Waring
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Discharge Planning ◽  
Care Pathway ◽  
Care Transitions ◽  
Relevant Information ◽  
Implementation Study ◽  
Framework Analysis ◽  
Essential Information ◽  
Junior Staff

Abstract Background: Many interventions have been developed that aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. This quality improvement aims to develop a novel intervention that improves mental health care transitions by providing a framework for capturing relevant information at admission that facilitates and accelerates discharge. Methods: A formative implementation study to co-design, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. Two cycles of PDSA were completed which included two workshops based on the principles of co-design. During implementation the tool was piloted on three wards. Ethnographic observations (145 hours) and interviews (45) were used to evaluate the implementation of the tool across the three wards. The consolidated framework for implementation research was used to analyse and categorise the qualitative data generated. Results: The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to facilitate discharge planning. The most reported advantages of the tool were: 1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward 2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and 3) collecting information from the services/agencies that patients will eventually be discharged to. The consolidated framework analysis highlighted multiple barriers to implementation from both an outer and inner setting perspective. Conclusions: The results suggest that improving the quality of information captured upon admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems.

scholarly journals A formative quality improvement implementation study to improve care transitions through information capture upon admission to an acute mental health ward

2020 ◽  
Author(s):  
Natasha Tyler ◽  
Nicola Wright ◽  
Kyriakos Gregoriou ◽  
Justin Waring
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Discharge Planning ◽  
Care Pathway ◽  
Care Transitions ◽  
Relevant Information ◽  
Implementation Study ◽  
Framework Analysis ◽  
Essential Information ◽  
Junior Staff

Abstract Background: Many interventions have been developed that aim to improve the transition from ward to community at the time of discharge, with varying success. Guidelines suggest that discharge planning should begin at admission, but in reality this is ideal rather than standard practice. This quality improvement aims to develop a novel intervention that improves mental health care transitions by providing a framework for capturing relevant information at admission that facilitates and accelerates discharge. Methods: A formative implementation study to co-design, implement and evaluate a novel tool that improves information capture upon admission to acute mental health wards within a single English National Health Service (NHS) trust. Two cycles of PDSA were completed which included two workshops based on the principles of co-design. During implementation the tool was piloted on three wards. Ethnographic observations (145 hours) and interviews (45) were used to evaluate the implementation of the tool across the three wards. The consolidated framework for implementation research was used to analyse and categorise the qualitative data generated. Results: The tool developed considerably as the process evolved. The finished product is a list of 10 information categories that should be captured from external agencies upon admission to facilitate discharge planning. The most reported advantages of the tool were: 1) facilitating confidence in junior staff to legitimately question the suitability of a patient for an acute ward 2) collecting and storing essential information in a single accessible place that can be used throughout the care pathway and 3) collecting information from the services/agencies that patients will eventually be discharged to. The consolidated framework analysis highlighted multiple barriers to implementation from both an outer and inner setting perspective. Conclusions: The results suggest that improving the quality of information captured upon admission has the potential to facilitate and accelerate discharge. The novel tool provides a framework for capturing this information that can be incorporated into existing information systems.

The Institute for Healthcare Improvement–NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols

2020 ◽  
Vol 33 (6) ◽  
pp. 812-821
Author(s):  
Scott L. Zuckerman ◽  
Clinton J. Devin ◽  
Vincent Rossi ◽  
Silky Chotai ◽  
E. Hunter Dyer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Discharge Planning ◽  
Lumbar Fusion ◽  
Nonparametric Tests ◽  
Learning System ◽  
Design Quality ◽  
Implementation Phase ◽  
Healthcare Improvement ◽  
The Impact

OBJECTIVENational databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module.METHODSThe NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention.RESULTSThe novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0–10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342).CONCLUSIONSThe NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.

scholarly journals Potential of community-based risk estimates for improving hospital performance measures and discharge planning

2021 ◽  
Vol 10 (2) ◽  
pp. e001230
Author(s):  
Michael Reid ◽  
George Kephart ◽  
Pantelis Andreou ◽  
Alysia Robinson
Keyword(s):  
Discharge Planning ◽  
Care Transitions ◽  
Hospital Setting ◽  
Hospital Performance ◽  
Case Mix ◽  
Readmission Rates ◽  
Mixed Effect ◽  
Adjusted Risk ◽  
Community Risk ◽  
Effect Regression

BackgroundRisk-adjusted rates of hospital readmission are a common indicator of hospital performance. There are concerns that current risk-adjustment methods do not account for the many factors outside the hospital setting that can affect readmission rates. Not accounting for these external factors could result in hospitals being unfairly penalized when they discharge patients to communities that are less able to support care transitions and disease management. While incorporating adjustments for the myriad of social and economic factors outside of the hospital setting could improve the accuracy of readmission rates as a performance measure, doing so has limited feasibility due to the number of potential variables and the paucity of data to measure them. This paper assesses a practical approach to addressing this problem: using mixed-effect regression models to estimate case-mix adjusted risk of readmission by community of patients’ residence (community risk of readmission) as a complementary performance indicator to hospital readmission rates.MethodsUsing hospital discharge data and mixed-effect regression models with a random intercept for community, we assess if case-mix adjusted community risk of readmission can be useful as a quality indicator for community-based care. Our outcome of interest was an unplanned repeat hospitalisation. Our primary exposure was community of residence.ResultsCommunity of residence is associated with case-mix adjusted risk of unplanned repeat hospitalisation. Community risk of readmission can be estimated and mapped as indicators of the ability of communities to support both care transitions and long-term disease management.ConclusionContextualising readmission rates through a community lens has the potential to help hospitals and policymakers improve discharge planning, reduce penalties to hospitals, and most importantly, provide higher quality care to the people that they serve.

scholarly journals The Role of Rehabilitation in Reducing Resource Use and Lowering Hospital Readmission Through Discharge Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 804-804
Author(s):  
Kenneth Miller
Keyword(s):  
Health Care Providers ◽  
Resource Use ◽  
Hospital Readmission ◽  
Discharge Planning ◽  
Care Transitions ◽  
Healthcare Team ◽  
Transition Management ◽  
Care Providers ◽  
Initial Examination ◽  
The Individual

Abstract The transitions between medical settings, the community and back again is a complex and intimidating process for patients, families and caregivers. These transitions are vulnerable points where planning is key and must begin at the initial examination with rehabilitation providers (PTs/OTs,SLPs). These providers are key members of the healthcare team to facilitate effective transition management. In this session, attendees will learn the critical factors rehabilitation providers use to evaluate patients in order to facilitate successful care transitions. An overview of the indications for rehabilitation referral will be presented, as well as evidence for effective rehabilitation strategies. The speaker will present tools from the American Physical Therapy Association Home Health Toolbox and outline a decision-making process for care transitions based on the individual, caregivers, and health care providers to achieve successful transitions that reduce resource use and hospital readmission rates. Attendees will learn strategies to facilitate inter-professional collaboration, communication, and advocacy.

scholarly journals How Has The Mental Health Of Junior Staff Been Negatively Affected By the Current COVID-19 Climate?

2021 ◽  
pp. 100143
Author(s):  
Rory Chambers ◽  
Rebecca Pigot ◽  
Mr Atul Kusanale ◽  
Mr Peter A. Brennan
Keyword(s):  
Mental Health ◽  
Junior Staff
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