ACUTE HOSPITAL DISCHARGE OF OLDER PATIENTS AND EXTERNAL CONTROL

1982 ◽  
Vol 3 (1) ◽  
pp. 39-57
Author(s):  
Betsy C. Robinson ◽  
Joseph C. Barbaccia
Keyword(s):  
Hospital Discharge ◽  
Older Patients ◽  
Acute Hospital ◽  
External Control

Persistence of Effect of Medication Review on Potentially Inappropriate Prescriptions in Older Patients Following Hospital Discharge

Drugs & Aging ◽  
2021 ◽  
Author(s):  
Camille Debacq ◽  
Julie Bourgueil ◽  
Amal Aidoud ◽  
Joëlle Bleuet ◽  
Marc Mennecart ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Medication Review ◽  
Older Patients ◽  
Inappropriate Prescriptions

Fall prevention education for older people being discharged from hospital: Educators’ perspectives

2021 ◽  
pp. 001789692110327
Author(s):  
Jacqueline Francis-Coad ◽  
Den-Ching A Lee ◽  
Terry P Haines ◽  
Meg E Morris ◽  
Steven M McPhail ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Fall Prevention ◽  
Older Patients ◽  
Education Programme ◽  
Prevention Strategies ◽  
Post Intervention ◽  
Prevention Education ◽  
Barriers And Enablers ◽  
Education Delivery ◽  
Fall Prevention Education

Objective: Falls are a significant problem for many older patients after hospital discharge. The purpose of this study was to evaluate the fidelity and impact of a tailored patient fall prevention education programme from the perspective of the educators who delivered the programme. Design: Qualitative sequential design. Setting: Three rehabilitation hospitals in Western Australia. Method: Three experienced physiotherapists trained as ‘educators’ to deliver a tailored fall prevention education programme to 195 older patients prior to hospital discharge, together with monthly telephone follow-up for 3 months after discharge. Educator–patient interactions were recorded in a standardised educator diary. Post-intervention, educators participated in a mini-focus group, providing their perspectives regarding education delivery and its impact on patient abilities to engage in fall prevention strategies. Data were analysed using deductive content analysis. Results: Educators followed up 184 (94%) patients, identifying multiple barriers and enablers affecting patient engagement in planned fall prevention strategies. Key barriers included unresolved medical conditions, reluctance to accept assistance on discharge, delays in assistive service provision, patient beliefs and perceptions about falls and, in some cases, patients’ absolving responsibility for recovery. Enablers were related to programme design, the completion of hospital discharge processes and support networks following discharge. Conclusion: Educators identified several barriers and enablers to programme delivery, receipt and enactment by older patients that contributed to the fidelity of the education programme. The consistent need for more patient support to enable improved enactment of plans and assist with safe recovery long after discharge warrants further attention at policy and health system levels.

scholarly journals 289 Detection of Falls in Older Patients by Medical Professionals on Admission to Hospital: An Audit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Emily Buckley ◽  
Mazen Alalawi
Keyword(s):  
Practice Guidelines ◽  
Older Patients ◽  
Best Practice ◽  
Acute Hospital ◽  
Medical Professionals ◽  
Medical Patients ◽  
Screening Questionnaire ◽  
Best Practice Guidelines ◽  
Audit Data ◽  
History Of

Abstract Background A history of a previous fall is one of the best predictors of future falls, increasing its risk 3-fold. The Health Service Executive (HSE) best practice guidelines recommend that all patients aged over 65 years in contact with healthcare professionals should be asked routinely whether they have fallen in the past year and asked about the fall-frequency, context and characteristics. The aim of this audit was to increase falls recognition by medical professionals following the implementation of a falls screening questionnaire into the admission proforma of an acute hospital. Methods This was a clinical audit. Data was collected on 29 consecutive patients aged > 65 who were admitted via the emergency department of an acute hospital over a 6 day period. Data on falls was collected using the medical admissions hospital proforma during the first 72 hours. Following the initial audit, a new proforma containing a falls screening questionnaire (as per best practice guidelines) was introduced and an information session provided on its use. A re-audit of 17 admitted medical patients was then completed over the next 72 hours. Results The initial audit highlighted poor assessment of falls with only 3 (25%) patients being screened at admission. 1 (33%) had a fall; described as mechanical. Following introduction of a falls screening questionnaire into the admission proforma, a re-audit showed a significant increase, with 58% of admissions now being screened. Of these, 40% had fallen in the last year: 75% of falls were mechanical and 25% due to other causes. Conclusion This audit shows that falls in this patient population was largely unrecognised by medical professionals. Following implementation of a screening questionnaire, significant improvements were made. This audit concludes that implementation of a falls screening questionnaire into the medical admissions proforma is an effective method in identifying falls in older patients admitted to hospital.

Predictors of Nasogastric Tube Removal Before Acute Hospital Discharge in First-Ever Ischemic Stroke Patients

2016 ◽  
Vol 97 (10) ◽  
pp. e49
Author(s):  
Yun-Shan Yen ◽  
Willy Chou ◽  
Ya-Fang Hsu ◽  
Mei-Ju Ko ◽  
Daniel Chiung Jui Su ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Discharge ◽  
Nasogastric Tube ◽  
Acute Hospital ◽  
Stroke Patients ◽  
Tube Removal

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Elderly People with Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland.

2021 ◽  
Author(s):  
Nicole Bachmann ◽  
Andrea Zumbrunn ◽  
Lucy Bayer-Oglesby
Keyword(s):  
Health Care ◽  
Nursing Home ◽  
Hospital Discharge ◽  
Census Data ◽  
Acute Hospital ◽  
Living Alone ◽  
Nursing Home Admission ◽  
Chronic Health ◽  
Regional Factors ◽  
The Impact

Abstract Background: If hospitalisation becomes inevitable in the course of a chronic disease, discharge from acute hospital care in elderly individuals is often associated with temporary or persistent frailty, functional limitations and the need for help with daily activities. Thus, acute hospitalisation represents a particularly vulnerable phase of transient dependency on social support and health care. This study examines how social and regional inequality affect the decision for an institutionalisation after acute hospital discharge in Switzerland. Methods: The current analysis uses routinely collected inpatient data from all Swiss acute hospitals that was linked on the individual level with Swiss census data. The study sample included N=60,209 patients 75 years old and older living still at a private home and being hospitalised due to a chronic health condition in N=199 hospitals between 2010 and 2016. Random intercept multilevel logistic regression was used to assess the impact of social and regional factors on the odds of a nursing home admission after hospital discharge. Results: Results show that 7.8% of all patients were admitted directly to a nursing home after hospital discharge. We found significant effects of education level, insurance class, living alone and language regions on the odds of nursing home admission in a model adjusted for age, gender, nationality, health status, year of hospitalisation and hospital-level variance. The language regions moderated the effect of education and insurance class but not of living alone.Conclusion: Acute hospital discharge in elderly is a critical moment of transient dependency. Social and health care should work closely and coordinated together for a well-supported hospital discharge to avoid unnecessary institutionalisations of socially disadvantaged patients.

scholarly journals Real-life implementation of guidelines on the hospital-to-home transition for older patients: a cohort study in general practice

2019 ◽  
Vol 49 (1) ◽  
pp. 46-51
Author(s):  
Aline Hurtaud ◽  
François Lallier ◽  
Matthieu Heidet ◽  
Charline Arnoult ◽  
Moustapha Dramé ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cohort Study ◽  
Hospital Discharge ◽  
Older Patients ◽  
Real Life ◽  
Discharge Summary ◽  
Life Assessment ◽  
Hospital To Home ◽  
Discharge Summaries

Abstract Background hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7 days. The relevance and feasibility of these guidelines have not previously been assessed. Objective to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors’ association with 30-day readmissions. Design a prospective multicentre cohort study. Setting primary care (general practice) in France. Subjects a sample of GPs and the same number of patients aged 75 or over having consulted within 30 days of hospital discharge. Methods the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7 days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses. Results seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53–76) consulted their GP within 7 days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27–50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07–0.91]). Conclusions compliance with the French guidelines on hospital-to-home transitions is insufficient.

Physical Function in the Hospital Is Associated With Patient-Centered Outcomes in an Inpatient Rehabilitation Facility

2020 ◽  
Vol 100 (8) ◽  
pp. 1237-1248 ◽  
Author(s):  
Joshua K Johnson ◽  
Julie M Fritz ◽  
Benjamin S Brooke ◽  
Paul C LaStayo ◽  
Anne Thackeray ◽  
...  
Keyword(s):  
Physical Function ◽  
Hospital Discharge ◽  
Short Form ◽  
Academic Medical Center ◽  
Inpatient Rehabilitation ◽  
Acute Hospital ◽  
Adjusted Relative Risk ◽  
Day Hospital ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility

Abstract Objective Poor knowledge of the relationships between physical function (PF) in the hospital and patient outcomes in an inpatient rehabilitation facility (IRF) limits the identification of patients most appropriate for discharge to an IRF. This study aimed to test for independent associations between PF measured via the AM-PAC “6-clicks” basic mobility short form in the hospital and outcomes in an IRF. Methods This was a retrospective cohort study. Primary data were collected from an acute hospital and IRF at 1 academic medical center. Associations were tested between PF at hospital admission or discharge and PF improvement in the IRF, discharge from the IRF to the community, and 30-day hospital events by estimating adjusted relative risk (aRR) using modified Poisson regression and the relative difference in IRF length of stay (LOS) using Gamma regression. Results A total of 1323 patients were included. Patients with moderately low, (aRR = 1.50; 95% CI = 1.15–1.93), moderately high (aRR = 1.52; 95% CI = 1.16–2.01), or high (aRR = 1.37; 95% CI = 1.02–1.85) PF at hospital discharge were more likely than those with very low PF to improve their PF while in the IRF. These same patients were more likely to discharge from IRF to the community and had significantly shorter IRF LOS. Hospital-measured PF did not differentiate risk for 30-day hospital events. Conclusion Patients with moderate—but not very low or very high—PF measured near the time of acute hospital discharge were likely to achieve meaningful PF improvement in an IRF. They also had a shorter IRF LOS so may be ideal candidates for discharge to IRF. Prospective studies with larger samples are necessary to test this assertion. Impact Providers in the hospital should identify patients with moderate PF near the time of hospital discharge as those who may benefit most from post-acute rehabilitation in an IRF.

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