scholarly journals The Effect of Follow-up Contact in Reoccurrence of Psychiatric Readmission

2019 ◽  
Author(s):  
David Mallo ◽  
Ian E. Wickramasekera
Keyword(s):  
Case Management ◽  
Intervention Strategies ◽  
Psychiatric Facility ◽  
Readmission Rates ◽  
Psychiatric Readmission ◽  
Inpatient Facility ◽  
The Impact ◽  
Number Of Individuals ◽  
Inpatient Psychiatric Facility

This study examined if clinical contact with clients within one week of discharge from an inpatient psychiatric facility had an influence on their readmission. One of the factors explored in this study was whether the impact of clinical contact could reduce readmission rates after discharge used to develop intervention strategies to reduce readmission. The study found that those individuals who had a case management appointment set within the first seven days of discharge from an inpatient psychiatric facility was approximately eight times more likely than non-clinical referrals, 32 % vs. 4 %, to be not readmitted to an inpatient psychiatric facility. When this was examined even more closely, it was determined that case management appointments attended within the first day following discharge from an inpatient psychiatric facility was significantly associated with attendance following discharge. The number of individuals who attended case management appointments dropped approximately 50% within 24 hours of discharge, as compared with the number of individuals who attended appointments following two days after discharge (18 % to 8 %). This trend continued as time progressed for the first two to seven days following discharge from an inpatient psychiatric facility, where the attendance of a clinical appointment dropped to 4% within seven days following discharge. These findings have implications on what type of clinical contact should be pursued following discharge from an inpatient facility, and how soon that appointment should be accomplished in order to decrease readmissions.

scholarly journals Impact of pharmacist-conducted anticoagulation patient education and telephone follow-up on transitions of care: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lamis R. Karaoui ◽  
Elsy Ramia ◽  
Hanine Mansour ◽  
Nisrine Haddad ◽  
Nibal Chamoun
Keyword(s):  
Tertiary Care ◽  
Intervention Group ◽  
Bleeding Event ◽  
Transitions Of Care ◽  
Control Group ◽  
Published Data ◽  
Post Discharge ◽  
Readmission Rates ◽  
The Impact

Abstract Background There is limited published data in Lebanon evaluating the impact of supplemental education for anticoagulants use, especially DOACs, on clinical outcomes such as bleeding. The study aims to assess the impact of pharmacist-conducted anticoagulation education and follow-up on bleeding and readmission rates. Methods This study was a randomized, non-blinded interventional study conducted between August 2017 and July 2019 in a tertiary care teaching Lebanese hospital. Participants were inpatients ≥18 years discharged on an oral anticoagulant for treatment. Block randomization was used. The control group received the standard nursing counseling while the intervention group additionally received pharmacy counseling. Phone call follow-ups were done on day 3 and 30 post-discharge. Primary outcomes included readmission rates and any bleeding event at day 3 and 30 post-discharge. Secondary outcomes included documented elements of education in the medical records and reported mortality upon day 30 post-discharge. Results Two hundred patients were recruited in the study (100 patients in each study arm) with a mean age of 73.9 years. In the pharmacist-counseled group, more patients contacted their physician within 3 days (14% versus 4%; p = 0.010), received explicit elements of education (p < 0.001) and documentation in the chart was better (p < 0.05). In the standard of care group, patients were more aware of their next physician appointment date (52% versus 31%, p < 0.001). No difference in bleeding rates at day 3 and 30 post-discharge was observed between the groups. Conclusions Although pharmacist-conducted anticoagulation education did not appear to reduce bleeding or readmission rates at day 30, pharmacist education significantly increased patient communication with their providers in the early days post-discharge. Trial registration Lebanon Clinical Trial Registry LBCTR2020033424. Retrospectively registered. Date of registration: 06/03/2020.

scholarly journals Alcohol withdrawal-related outcomes associated with gabapentin use in an inpatient psychiatric facility

2019 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Taylor A. Nichols ◽  
Sophie Robert ◽  
David J. Taber ◽  
Jeffrey Cluver
Keyword(s):  
Alcohol Withdrawal ◽  
Length Of Hospital Stay ◽  
Control Cohort ◽  
Psychiatric Facility ◽  
Therapeutic Uses ◽  
Significant Difference ◽  
Benzodiazepine Use ◽  
The Impact ◽  
Hospital Stay Duration ◽  
Inpatient Psychiatric Facility

Abstract Introduction Limited evidence exists evaluating the impact of gabapentin in conjunction with benzodiazepines for the management of alcohol withdrawal. A review of outcomes associated with combination gabapentin and benzodiazepine therapy may illuminate new therapeutic uses in clinical practice. Methods This retrospective study evaluated the impact of gabapentin on as-needed use of benzodiazepines in inpatients being treated for acute alcohol withdrawal. The treatment cohort consisted of patients prescribed gabapentin while on a symptom-triggered alcohol withdrawal protocol. The control cohort consisted of patients on symptom-triggered alcohol withdrawal protocol without concurrent gabapentin use. Secondary objectives included length of hospital stay, duration on alcohol withdrawal protocol, frequency of complicated withdrawal, and use of additionally prescribed as-needed or scheduled benzodiazepines. Results The gabapentin cohort was on the alcohol withdrawal protocol for a similar duration, compared with the control cohort (median of 4 [interquartile range: 2,6] days vs 3 [2,4] days, P = .09, respectively). Similarly, the gabapentin cohort required a median of 1 [1,2] benzodiazepine dose for alcohol withdrawal symptoms compared with a median of 1 [1,2] dose in the control cohort, P = .89. No significant difference was found between cohorts for as-needed and scheduled benzodiazepine use. Length of stay in hospital was similar between groups. Discussion These results suggest that gabapentin use, in conjunction with benzodiazepines, impacts neither the time on alcohol withdrawal protocol or the number of benzodiazepine doses required for withdrawal. Larger, prospective studies are needed to detect if gabapentin alters benzodiazepine usage and to better elucidate gabapentin's role in acute alcohol withdrawal.

Effect of home-based follow-up intervention on readmissions and mortality in heart failure patients: a meta-analysis

2019 ◽  
Vol 15 (5) ◽  
pp. 377-386 ◽  
Author(s):  
Aaqib H Malik ◽  
Senada S Malik ◽  
Wilbert S Aronow ◽  
Keyword(s):  
Heart Failure ◽  
Discharge Planning ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Readmission Rates ◽  
Randomized Controlled ◽  
Home Based ◽  
Home Based Intervention ◽  
The Impact

Aim: We investigated whether the home-based intervention (HBI) for heart failure (HF), restricted to education and support, improves readmissions or mortality compared with usual care. Patients & methods: We searched PubMed and Embase for randomized controlled trials that examined the impact of HBI in HF. A random-effects meta-analysis was performed using R. Result: Total 17/409 articles (3214 patients) met our inclusion criteria. The pooled estimate showed HBI was associated with a reduction in readmission rates and mortality (22 and 16% respectively; p < 0.05). Subgroup analysis confirmed that the benefit of HBI increases significantly with a longer follow-up. Conclusion: HBI in the form of education and support significantly reduces readmission rates and improves survival of HF patients. HBI should be considered in the discharge planning of HF patients.

scholarly journals Standardized follow-up program may reduce emergency room and urgent care visits for patients undergoing radical prostatectomy

2014 ◽  
Vol 8 (7-8) ◽  
pp. 505 ◽  
Author(s):  
Ryan Kendrick Flannigan ◽  
Geoffrey T. Gotto ◽  
Bryan Donnelly ◽  
Kevin V. Carlson
Keyword(s):  
Radical Prostatectomy ◽  
Urgent Care ◽  
Additional Patient ◽  
Readmission Rates ◽  
Entire Cohort ◽  
Number Of Patients ◽  
Ed Visits ◽  
Hospital Visits ◽  
The Impact

Introduction: The objective of the current study was to determine the impact of a standardized follow-up program on the morbidity and rates of hospital visits following radical prostatectomy (RP) in a tertiary, non-teaching urologic centre.Methods: Patients who underwent a RP in 2008 were retrospectively evaluated in this study. Postoperative morbidity for the entire cohort was assessed using the Modified Clavien Scale (MCS). Those patients readmitted to hospital or who visited an urban or rural emergency department (ED) within 90 days of surgery were further evaluated to determine the reason for readmission.Results: At our centre, 321 patients underwent RP in 2008 by 11 surgeons. Of the 321 patients, 77 (24.0%) visited an ED within 90 days, and 14 were readmitted to hospital, with an additional patient readmitted directly (with a total 15 readmissions, 4.7% overall). No patients died within the study period. In 2009 we launched a pilot study wherein 115 RP patients received scheduled and on-demand follow-up care by a dedicated nurse between May and November. We found that 90-day readmission rates among this cohort dropped to 5% and 2.6% for ED visits and hospital readmission, respectively.Conclusions: At our tertiary non-teaching centre, a significant number of patients presented back to hospital within 90 days following RP. Most of these patients (80.8%) were managed entirely through an outpatient ED, and many visits were for routine postoperative care. Only 18.2% (4.7% of the 321 prostatectomy patients) were readmitted to hospital. These data point to a need for enhanced postoperative support of patients to reduce costly and often unnecessary visits to acute care EDs. This conclusion is supported by our early experience. Limitations include retrospective design, and variability in practice of surgeons in this study.

scholarly journals A Study of Short Term Outcomes among Covid-19 Patients Discharged without Follow up In the New York Metropolitan Area

2021 ◽  
pp. 85-92
Author(s):  
Louise Molmenti Christine ◽  
Mitra Neil ◽  
Shah Abhinit ◽  
Flynn Anne ◽  
Brown Zenobia ◽  
...  
Keyword(s):  
New York ◽  
Functional Status ◽  
Metropolitan Area ◽  
Phone Call ◽  
Post Discharge ◽  
Readmission Rates ◽  
York Metropolitan Area ◽  
New York Metropolitan Area ◽  
The Impact

Background: A shortage of beds, high case volume, decreased availability of outpatient medical doctors, and limited disease knowledge resulted in the premature discharge and poor follow up of COVID-19 patients in the New York Metropolitan Area. Objective: The primary objective of this retrospective study and phone survey was to characterize the demographics and clinical outcomes (e.g., readmission rates, comorbidities, mortality, and functional status) of COVID-19 patients discharged without follow-up. The secondary objective was to assess the impact of race and comorbidities on readmission rates and the extent to which patients were escalated to another care provider. Methods: Electronic medical records were reviewed for COVID-19 patients discharged from 3 NYMA hospitals in March 2020. Follow up data regarding medical status, ability to perform activities of daily living and functional status was also obtained from patients via phone call. The Chi-square, Fishers exact test and t-tests were used to analyze the data. Results: 349 patients were included in the analysis. The hospital readmission rate was 10.6% (58.8% for pulmonary reasons) and did not differ by race. 74.3% of readmissions were <14 days after release. The post-discharge mortality rate was 2.6%. Hypertension was the most common comorbidity (43%). There was a statistically significant association between mortality and number of comorbidities (p=<0.0001). 82% of patients were contacted by phone. 66.6% of patients returned to pre-COVID baseline function in ≥1 month. As a result of information obtained on the follow up phone call, 4.2% of patients required “escalation” to another provider. Conclusion: Discharging COVID-19 patients without prearranged follow up was associated with high readmission and mortality rates. While the majority of patients recovered, prolonged weakness, lengthy recovery, and the need for additional medical intervention was noted. Further work to assess the effectiveness COVID-19 post-discharge programs is warranted.

scholarly journals Impact of Physician Follow-Up Care on Psychiatric Readmission Rates in a Population-Based Sample of Patients With Schizophrenia

2018 ◽  
Vol 69 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Paul Kurdyak ◽  
Simone Natalie Vigod ◽  
Alice Newman ◽  
Vasily Giannakeas ◽  
Benoit H. Mulsant ◽  
...  
Keyword(s):  
Population Based ◽  
Readmission Rates ◽  
Psychiatric Readmission ◽  
Follow Up Care

Aiming Beyond: A Pharmacist Impact on 90-Day Readmissions and Clinical Outcomes Within a Family Medicine Service

2019 ◽  
Vol 33 (6) ◽  
pp. 738-744
Author(s):  
Lindsey E. Wiegmann ◽  
Matthew S. Belisle ◽  
Kristin S. Alvarez ◽  
Neelima J. Kale
Keyword(s):  
Family Medicine ◽  
Intervention Group ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Care Group ◽  
Readmission Rates ◽  
Medicine Service ◽  
The Impact ◽  
Disease Specific

Previous studies have shown pharmacists positively impact 30-day readmission rates. However, there is limited data regarding the effect of clinical pharmacist (CP) follow-up on 90-day readmission or evaluation of disease-specific goals after hospitalization. Investigators analyzed the impact of postdischarge extended CP follow-up within a family medicine service (FMS). The primary end point was all-cause 90-day readmission rates. Secondary end points included all-cause 30- and 60-day readmission rates and the achievement of disease-specific goals postdischarge. Retrospective chart review was performed for patients admitted from August 2016 to November 2017 who were seen by a physician within the FMS 14 days postdischarge. Fourteen percent of patients within the CP intervention group were readmitted within 90 days in comparison to 22% in the standard of care group ( P = .244). Readmission rates at 30 and 60 days were as follows: intervention group 2%, 10%, and standard of care group 16%, 22% ( P = .015, P = .089, respectively). In addition, multiple patients with uncontrolled diabetes who completed CP visits upon hospital discharge met glycemic goals at the end of the study time period. Despite inclusion of the CP in postdischarge care, 90-day readmission rate remained unchanged.

scholarly journals 0578 Incident Hypertension Rates in OSA Identified Using American Academy Of Sleep Medicine (AASM) Hypopnea Criteria, but Misclassified by Medicare (CMS) Hypopnea Definition

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A221-A222
Author(s):  
R Budhiraja ◽  
S Javaheri ◽  
R B Berry ◽  
S Parthasarathy ◽  
S F Quan
Keyword(s):  
Sleep Medicine ◽  
Incidence Rates ◽  
Health Study ◽  
Apnea Hypopnea Index ◽  
Incident Hypertension ◽  
Stage 1 ◽  
Study Participants ◽  
The Impact ◽  
Number Of Individuals

Abstract Introduction The impact of not treating OSA identified using AASM standards (hypopneas scored using a minimum 3% O2 desaturation or arousal), but misclassified by CMS standards (hypopneas scored only if minimum 4% O2 desaturation) remains unclear. This analysis determined the ~5 year incident hypertension rates using the new 2018 ACC/AHA blood pressure (BP) guidelines in these individuals. Methods Data were analyzed from all Sleep Heart Health Study exam 2 study participants (N=1219) who were normotensive (BP≤120/80) at exam 1. The apnea hypopnea index (AHI) at exam 1 was classified into 4 categories of OSA severity: &lt;5, 5 ≤15, 15 ≤30 and ≥30/hour using both the AASM or CMS definitions. Three definitions of hypertension were used: Elevated BP (&gt;120/80), Stage 1 (&gt;130/80) and Stage 2 (&gt;140/90) to determine incidence rates at exam 2. Results Five year follow-up data were available for 476 participants classified as having OSA (AHI ≥5) by AASM criteria, but not by CMS standards at exam 1. Incident hypertension rates in these misclassified participants for ACC/AHA defined BP categories were 15% (Elevated BP), 15% (Stage 1) and 6% (Stage 2). 4% of normotensive participants used hypertensive medications. Overall incidence rate of at least an elevated BP was 40% (191/476) in those with OSA defined using AASM, but not by CMS criteria and 17% (191/1219) of the overall population at risk. In comparison to those with incident hypertension and OSA identified by CMS standards, BMI (27.7 vs 30.1 kg/m2, p&lt;.001) and % men were lower (45 vs 58%, p=.012), but age and race were not different. Conclusion Use of the CMS hypopnea definition as a component of the AHI resulted in the failure to identify a significant number of individuals with OSA who eventually developed hypertension and could have benefited from earlier diagnosis and treatment. Support HL53938

Intensive Case Management in Suicide Attempters Following Discharge from Psychiatric Care

2007 ◽  
Vol 13 (3) ◽  
pp. 49 ◽  
Author(s):  
Diego De Leo ◽  
Travis Heller
Keyword(s):  
High Risk ◽  
Case Management ◽  
Suicide Ideation ◽  
Psychiatric Inpatient ◽  
Dropout Rate ◽  
Inpatient Setting ◽  
Intensive Case Management ◽  
Post Discharge ◽  
The Impact

Suicide risk is high in the first week, month and year following discharge from psychiatric inpatient settings. The decrease in care following discharge has been considered as contributing to the excessive suicide rate in this population. The aim of this research was to evaluate the impact of an intensive case management follow-up of these high-risk people for one year. Sixty males with a history of suicide attempts and psychiatric illness were recruited at discharge from a psychiatric inpatient setting at the Gold Coast Hospital, Queensland. Participants were randomly assigned to one of two conditions: Intensive Case Management (ICM) or Treatment As Usual (TAU). ICM featured weekly face-to-face contact with a community case manager and outreach telephone calls from experienced telephone counsellors. TAU participants were discharged under existing hospital practices. All participants completed assessment interviews at baseline, six and twelve months post-discharge. At the end of the twelve-month treatment phase, there was a dropout rate of 53.3% in the ICM condition, and 73.3% in the TAU condition, leaving a final sample of 22 (ICM=14, TAU=8). People in the ICM condition had significant improvements in depression scores, suicide ideation, and quality of life. ICM participants reported more contacts with mental and allied health services, had better relationships with therapists, and were more satisfied with the services that they did receive. No suicides were recorded in the twelve-month follow-up period. A few participants engaged in self-harming behaviours, though there were no differences between treatment conditions with regard to this aspect. Despite the high attrition rate and subsequent low sample size, initial indications are that intensive case management may be beneficial in assisting the post-discharge phase of high-risk psychiatric patients.

Sign in / Sign up

Export Citation Format

Share Document