Reducing 30-Day All-Cause Rehospitalizations: A Pharmacist-Led Telehealth Service

2020 ◽  
Vol 35 (7) ◽  
pp. 324-330
Author(s):  
Casondra Kleven ◽  
Joshua Postolski ◽  
Brad Hein ◽  
Bethanne Brown
Keyword(s):  
Patient Satisfaction ◽  
Hospital Readmission ◽  
Discharge Planning ◽  
Discharge Process ◽  
Nursing Facilities ◽  
Consultation Service ◽  
Skilled Nursing ◽  
Telehealth Service ◽  
Institutional Review ◽  
The Impact

BACKGROUND: Use of skilled nursing facilities (SNFs) has grown as an intermediary step for patients unready to discharge to lower acuity care settings. Discharge planning from SNFs has become a critical component of the care continuum and may impact patient outcomes and facility payment status. Currently, the discharge process does not include a pharmacist-led comprehensive medication review.<br/> OBJECTIVES: To determine the impact of a pharmacistdriven discharge consultation service on 30-day allcause rehospitalization. Secondary outcomes included hospital readmission diagnosis, discharge consultation times, number of pharmacist interventions, and patient satisfaction.<br/> METHODS: The institutional review board approved this prospective cohort with a historical control pilot study to evaluate patients discharging from SNFs. Patients who provided informed consent were enrolled to participate in a video consultation service at the time of discharge. The primary outcome measured was 30-day hospital readmission rate postdischarge compared with one year prior.<br/> RESULTS: One hundred ninety-six counseling sessions were performed at three facilities. The average time per discharge was 15.4 ± 3.3 minutes, average number of medications was 15.5 ± 6.2, and average Charlson Comorbidity Index was 5.6 ± 2.2. Patient readmission data were tracked by diagnosis and reported by facility.<br/> CONCLUSION: A positive correlation between reduced readmission rates and participation in consultation service were observed. Second, positive patient satisfaction surveys indicated patients value medication education. The use of a pharmacist-led telehealth service like the one described in this study may lead to a reduction in facility readmission penalties and improve patient access to pharmacist services in remote locations.

Reducing 30-Day All-Cause Rehospitalizations: A Pharmacist-Led Telehealth Service

2020 ◽  
Vol 35 (7) ◽  
pp. 324-330
Author(s):  
Casondra Kleven ◽  
Joshua Postolski ◽  
Brad Hein ◽  
Bethanne Brown
Keyword(s):  
Patient Satisfaction ◽  
Hospital Readmission ◽  
Discharge Planning ◽  
Discharge Process ◽  
Nursing Facilities ◽  
Consultation Service ◽  
Skilled Nursing ◽  
Telehealth Service ◽  
Institutional Review ◽  
The Impact

BACKGROUND: Use of skilled nursing facilities (SNFs) has grown as an intermediary step for patients unready to discharge to lower acuity care settings. Discharge planning from SNFs has become a critical component of the care continuum and may impact patient outcomes and facility payment status. Currently, the discharge process does not include a pharmacist-led comprehensive medication review.<br/> OBJECTIVES: To determine the impact of a pharmacistdriven discharge consultation service on 30-day allcause rehospitalization. Secondary outcomes included hospital readmission diagnosis, discharge consultation times, number of pharmacist interventions, and patient satisfaction.<br/> METHODS: The institutional review board approved this prospective cohort with a historical control pilot study to evaluate patients discharging from SNFs. Patients who provided informed consent were enrolled to participate in a video consultation service at the time of discharge. The primary outcome measured was 30-day hospital readmission rate postdischarge compared with one year prior.<br/> RESULTS: One hundred ninety-six counseling sessions were performed at three facilities. The average time per discharge was 15.4 ± 3.3 minutes, average number of medications was 15.5 ± 6.2, and average Charlson Comorbidity Index was 5.6 ± 2.2. Patient readmission data were tracked by diagnosis and reported by facility.<br/> CONCLUSION: A positive correlation between reduced readmission rates and participation in consultation service were observed. Second, positive patient satisfaction surveys indicated patients value medication education. The use of a pharmacist-led telehealth service like the one described in this study may lead to a reduction in facility readmission penalties and improve patient access to pharmacist services in remote locations.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

Hospital Readmission From Skilled Nursing Facilities (SNFs): Perspectives of Hospital and SNF Providers

2019 ◽  
Vol 20 (8) ◽  
pp. 1050-1051
Author(s):  
Karl E. Minges ◽  
Meredith Campbell Britton ◽  
Bennett W. Clark ◽  
Gregory M. Ouellet ◽  
Beth Hodshon ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing

Does Investor-Ownership of Nursing Homes Compromise the Quality of Care?

2002 ◽  
Vol 32 (2) ◽  
pp. 315-325 ◽  
Author(s):  
Charlene Harrington ◽  
Steffie Woolhandler ◽  
Joseph Mullan ◽  
Helen Carrillo ◽  
David U. Himmelstein
Keyword(s):  
Quality Of Care ◽  
Nursing Homes ◽  
Skilled Nursing Facility ◽  
Nurse Staffing ◽  
Care Quality ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Staffing Ratios ◽  
The Impact

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories (“quality of care,” “quality of life,” and “other”) and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

scholarly journals Decisions to Enter and Leave Skilled Nursing Facilities for Post-Acute Rehabilitation: A Qualitative Study

2020 ◽  
Vol 3 ◽  
Author(s):  
Daniel Chimitt ◽  
Jennifer Carnahan
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Comparative Method ◽  
Skilled Nursing Facilities ◽  
Phone Call ◽  
Healthcare Team ◽  
Discharge Process ◽  
Nursing Facilities ◽  
Skilled Nursing

Background and Hypothesis:   Approximately 40% of patients aged 80+ enter a Skilled Nursing Facility (SNF) following a hospitalization. SNFs can be used as “safety nets” to expedite the discharge process of older adults and it can be difficult to pinpoint how and who made the decision for a hospitalized older adult to discharge to a SNF.   This project examines the factors that drive older adults to enter and leave a SNF for their rehabilitation care.    Project Methods:   Interview transcripts from a qualitative study with patients and their caregivers were used to examine factors influencing admission to and discharge from SNFs. Baseline interviews were conducted within two to seven days after returning home from a SNF stay followed by a follow up phone call one to two weeks after the initial interview. Transcripts and audio files were coded (using NVivo version 12+) for major themes. Interviews were analyzed using a constant comparative method to elicit themes of interest to interviewees.    Results:   There were 24 baseline interviews and X follow up interviews performed with a total of 24 patients and 15 caregivers. The primary theme identified was that patients perceived a loss of autonomy when considering the decision-making process. 75% (18/24) patients or their caregivers felt the healthcare team told them they must go to a SNF for their rehabilitation. 38% (9/24) patients or caregivers felt they had no choice but to leave due to insurance coverage and 50% (12/24) stated that they needed more time.    Potential Impact:   To achieve better patient outcomes, one must understand both the purpose of skilled nursing facilities and also how patients and their families are feeling as they transition through this uncertain period of their lives. Restoring a patient’s sense of autonomy will foster better patient-healthcare relationships and improve trust in the system. 

Impact of Delirium on Outcomes After Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Michael E. Reznik ◽  
Seth A. Margolis ◽  
Ali Mahta ◽  
Linda C. Wendell ◽  
Bradford B. Thompson ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hospital Discharge ◽  
Inpatient Rehabilitation ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Logistic Regression Models ◽  
Mediating Role ◽  
Discharge Site ◽  
Postacute Care ◽  
The Impact

Background and Purpose: Delirium portends worse outcomes after intracerebral hemorrhage (ICH), but it is unclear if symptom resolution or postacute care intensity may mitigate its impact. We aimed to explore differences in outcome associated with delirium resolution before hospital discharge, as well as the potential mediating role of postacute discharge site. Methods: We performed a single-center cohort study on consecutive ICH patients over 2 years. Delirium was diagnosed according to DSM-5 criteria and further classified as persistent or resolved based on delirium status at hospital discharge. We determined the impact of delirium on unfavorable 3-month outcome (modified Rankin Scale score, 4–6) using logistic regression models adjusted for established ICH predictors, then used mediation analysis to examine the indirect effect of delirium via postacute discharge site. Results: Of 590 patients (mean age 70.5±15.5 years, 52% male, 83% White), 59% (n=348) developed delirium during hospitalization. Older age and higher ICH severity were delirium risk factors, but only younger age predicted delirium resolution, which occurred in 75% (161/215) of ICH survivors who had delirium. Delirium was strongly associated with unfavorable outcome, but patients with persistent delirium fared worse (adjusted odds ratio [OR], 7.3 [95% CI, 3.3–16.3]) than those whose delirium resolved (adjusted OR, 3.1 [95% CI, 1.8–5.5]). Patients with delirium were less likely to be discharged to inpatient rehabilitation than skilled nursing facilities (adjusted OR, 0.31 [95% CI, 0.17–0.59]), and postacute care site partially mediated the relationship between delirium and functional outcome in ICH survivors, leading to a 25% reduction in the effect of delirium (without mediator: adjusted OR, 3.0 [95% CI, 1.7–5.6]; with mediator: adjusted OR, 2.3 [95% CI, 1.2–4.3]). Conclusions: Acute delirium resolves in most patients with ICH by hospital discharge, which was associated with better outcomes than in patients with persistent delirium. The impact of delirium on outcomes may be further mitigated by postacute rehabilitation.

scholarly journals Geographically Localized Medicine House-Staff Teams and Patient Satisfaction

2018 ◽  
Vol 6 (1) ◽  
pp. 46-52
Author(s):  
Zishan Siddiqui ◽  
Amanda Bertram ◽  
Stephen Berry ◽  
Timothy Niessen ◽  
Lisa Allen ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Patient Experience ◽  
Discharge Planning ◽  
Chief Resident ◽  
House Staff ◽  
Direct Care ◽  
Physician Communication ◽  
Inpatient Service ◽  
Team Members ◽  
The Impact

Background: Geographically localized care teams may demonstrate improved communication between team members and patients, potentially enhancing coordination of care. However, the impact of geographically localized team on patient experience scores is not well understood. Objective: To compare experience scores of patients on resident teams home clinical units with patients assigned to them off of their home units over a 10-year period. Participants: Patients admitted to any of the 4 chief resident staffed internal medicine inpatient service were included. Patients admitted to the house-staff teams’ home clinical unit comprised the exposure group and their patients off of their home units comprised the control patients. Measurement: Top-box experience scores calculated from the physician Hospital Consumer Assessment of Healthcare and Provider Systems (HCAHPS) and Press Ganey patient satisfaction surveys. Results: There were 3012 patients included in the study. There were no significant differences in experience scores with physician communication, nursing communication, pain, or discharge planning between the 2 groups. Patients did not report satisfaction more often with the time physicians spent with them on localized teams (48.6% vs 47.5%; P = .54) or that staff were better at working together (63.2% vs 61.3%; P = .29). This did not change during a 45-month period when the proportion of patients on home units exceeded 75% and multidisciplinary rounds were started. Conclusion: Patients cared for by geographically localized teams did not have better patient experience. Other factors such as physician communication skills or limited time spent in direct care may overshadow the impact of having localized teams. Further research is needed to better understand organizational, team, and individual factors impacting patient experience.

Impacting Readmission Rates and Patient Satisfaction: Results of a Discharge Pharmacist Pilot Program

2011 ◽  
Vol 46 (11) ◽  
pp. 876-883 ◽  
Author(s):  
Samaneh Tavalali Wilkinson ◽  
Pal Aroop ◽  
J. Couldry Richard
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Readmission Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Control Group ◽  
Unplanned Readmission ◽  
Discharge Process ◽  
Readmission Rates ◽  
The Impact

Background Readmission to a hospital within 30 days of discharge has become a key quality outcome measure. With an observed 30-day readmission rate as high as 20% and attributed costs of almost $17.4 billion a year for Medicare patients, the potential implications for patients and the entire health care system are significant. Medication-related complications have been shown to increase the risk for unplanned readmission. Pharmacists have an opportunity to impact quality and cost by risk stratifying and identify patients at high risk for hospital readmission. Objective To study the impact of a pharmacist-driven discharge counseling program for high-risk patients identified by BOOST (Better Outcomes for Older adults through Safe Transitions) criteria on 30-day readmission rates. Method This was a prospective, cohort, nonrandomized trial at a single medical-surgical unit with telemetry capability at a single academic medical center including 669 patients who were older than 18 years. Primary outcome was 30-day readmission rate. Secondary outcomes were the number and type of pharmacist interventions, cost avoidance, and patient satisfaction results. Results The readmission rate for patients counseled by a pharmacist during the discharge process was 15.7% compared to 21.6% for patients not counseled by a pharmacist on discharge (relative risk [RR] 0.728; 95% confidence interval [CI], 0.514–1.032; P = .04). The readmission rate for adult medicine patients not counseled at discharge by a pharmacist in the study was comparable to the readmission rates of a similar patient control group at 3 months and 1 year prior to the initiation of the study (18.7% and 19.1% vs 19.6%). Conclusions Pharmacists' support in the discharge process facilitated increased communication on the multidisciplinary team and resulted in a lower unplanned readmission rate for patients.

Abstract WP351: Using Standard Work to Improve the Discharge Process on a Neurology Division

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Rose M Donnelly ◽  
Tim Tranor ◽  
Julie Griffin ◽  
Kalcee Foreman ◽  
Adrienne Ford ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multidisciplinary Team ◽  
Skilled Nursing Facilities ◽  
Multidisciplinary Teams ◽  
Discharge Process ◽  
Nursing Facilities ◽  
Mobile Computer ◽  
Skilled Nursing ◽  
Standard Work ◽  
Inadequate Information

Background and Issues: Patient volume increased significantly over first half of 2011 on the Neurology Service. Bed occupancy increased by 14% over previous year and bed availability became a major constraint. Data showed, patients were discharged late in the day or sometimes stayed an extra night because discharge orders were released too late to place patients in rehab or skilled nursing facilities. Only 16% of patients were discharged by 2:00 pm due to communication barriers and inadequate information exchanged between multidisciplinary teams. There was also an issue with inconsistent acceptance criteria from primary placement facilities which resulted in a longer length of stay. Purpose: Primary goal of project was to free up capacity on the Nursing Division to accommodate the increase in patient volumes without increasing staffing or the number of available beds. Methods: In September 2011, a multidisciplinary team was assembled to understand causes of the problems and develop solutions to resolve. Solutions implemented include working with partner Rehab and Skilled Nursing Facilities to define standardized Acceptance Guidelines to ensure issues could be addressed before day of discharge. Also, processes for releasing discharge orders were redesigned so orders were more frequently written and placed “on hold” the day before expected discharge. A mobile computer was issued to physician rounding teams so orders could be released during rounds instead of batch-released in the afternoon. Additionally, team communication was significantly improved by standardizing a daily multidisciplinary team huddle and implementing a visual communication board to track key information about patients to proactively plan for discharge. Results: The overall length of stay of patients on the Neurology Service decreased from 4.26 days in 2011 to 3.69 days in 2012. Conclusions: Many variables contributed to the decrease in length of stay for patients in this study. No decisive conclusions can be made about the effectiveness of any particular variable. Other variables during this timeframe likely contributed, however the authors of this study presented the most likely factors. Although the findings are exciting, further analysis is needed to isolate the main drivers.

Abstract 15301: Skilled Nursing Facilities and 30-day Hospital Readmissions in Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sheila M Manemann ◽  
Alanna M Chamberlain ◽  
Jennifer St. Sauver ◽  
Susan A Weston ◽  
Ruoxiang Jiang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
International Classification Of Diseases ◽  
Revolving Door ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Classification Of Diseases ◽  
The Impact

Background: Referral to a skilled nursing facility (SNF) should contribute to reducing hospital readmissions; however, a “revolving door” phenomenon after admission to SNF has been hypothesized to drive readmissions. The urgent need to study the impact of SNF on readmissions in heart failure (HF) was recently emphasized, yet this has never been studied in the community. Objectives: To evaluate the association between discharge to SNF and 30-day readmissions in a community cohort of hospitalized incident HF patients. Methods: Olmsted County, MN residents hospitalized with first ever (incident) HF (International Classification of Diseases-9 th Revision code 428) from 1995 through 2010 were identified. HF was validated by Framingham criteria. Patients residing in a SNF prior to hospitalization were excluded from the analysis. Logistic regression was used to examine the association between discharge to SNF and 30-day readmissions. Results: Among 1360 HF patients (mean age 74±14, 47% male), 241(18%) were referred to a SNF. Overall, 296 (22%) patients were readmitted within 30-days after index hospitalization. The proportion of 30-day readmissions was greater among patients discharged to a SNF compared to patients discharged home (27% vs 21%, p=0.031). After adjustment for age and sex, patients discharged to a SNF had a 40% increase in the odds of having a hospital readmission within 30 days post HF compared to those discharged home (OR: 1.42, 95% CI 1.01-1.99). Further adjustment for year of HF diagnosis, ejection fraction, anemia, renal function, dementia and cancer did not alter the strength of the association (OR: 1.43, 95% CI: 0.99-2.09). Conclusion: Among community patients with HF, 30-day readmissions remain frequent and are more likely to occur among patients discharged to a SNF compared to those discharged home. These data provide new insight into the drivers of HF readmissions and suggest that interventions targeted to HF patients in SNFs may be warranted.

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