Impact of pharmacist discharge counseling on hospital readmission and emergency department visit

Objective: The enactment of the Affordable Care Act (ACA) in 2010 imposes payment penalty on hospitals with high hospital readmission rates. In an effort to reduce readmissions, a pharmacist discharge counseling program was implemented to facilitate transition of care to the outpatient setting. Our study objective was to evaluate the impact of the program on hospital readmissions and visits to the emergency department (ED).Methods: This was a single-center, retrospective cohort study conducted at a not-for-profit, teaching community hospital with 462 total beds. Pharmacists provided counseling to patients discharged from the medicine floor between November 2013 and January 2014, and included those considered to be high-risk (e.g., taking 5 scheduled medications and had diseases such as congestive heart failure and diabetes mellitus). Descriptive analysis was performed and outcomes were compared between patients who did and did not receive pharmacist counseling.Results: Of a total of 889 discharged patients, 488 (55%) received counseling from a pharmacist. For the entire cohort, mean age was 55 ± 20 years; Charlson Comorbidity Index (CCI) score was 2.74 ± 2.95; and length of hospitalization was 4 ± 4 days. These parameters were not statistically different between the two groups. Within 30-days after hospital discharge, significantly fewer subjects who received counseling, compared with those who did not, were readmitted to the hospital (11.3% vs. 15%, p = .009) or visited the ED (10.6% vs. 15%, p = .005).Conclusions: Discharge counseling provided by pharmacists during transitions of care at a community hospital significantly reduced 30-day readmission and ED visit rates.

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Diabetes Discharge Planning and Transitions of Care: A Focused Review

Current Diabetes Reviews ◽

10.2174/1573399814666180711120830 ◽

2019 ◽

Vol 15 (2) ◽

pp. 111-117 ◽

Cited By ~ 9

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.

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A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

10.21203/rs.3.rs-149642/v2 ◽

2021 ◽

Author(s):

Mei Qiu Lim ◽

Fahad Javaid Siddiqui ◽

Seyed Ehsan Saffari ◽

Andrew Fu Wah Ho ◽

Johannes Nathaniel Min Hui Liew ◽

...

Keyword(s):

Emergency Department ◽

Severe Disease ◽

Descriptive Analysis ◽

Circuit Breaker ◽

Historical Period ◽

Management Planning ◽

Crowd Management ◽

Patient Demographics ◽

Icd 10 ◽

The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) has impacted the utilisation of Emergency Department (ED) services worldwide. This study aims to describe the changes in attendance of a single ED and corresponding patient visit characteristics before and during the COVID-19 period. Methods: In a single-centre retrospective cohort study, we used descriptive statistics to compare ED attendance, patient demographics and visit characteristics during the COVID-19 period (1 January – 28 June 2020) and its corresponding historical period in 2019 (2 January – 30 June 2019). Results: Mean ED attendance decreased from 342 visits/day in the pre-COVID-19 period, to 297 visits/day in the COVID-19 period. This was accompanied by a decline in presentations in nearly every ICD-10-CM diagnosis category except for respiratory-related diseases. Notably, we observed reductions in visits by critically ill patients and severe disease presentations during the COVID-19 period. We also noted a shift in ED patient case-mix from ‘Non-fever’ cases to ‘Fever’ cases, likely giving rise to two distinct trough-to-peak visit patterns during the pre-Circuit Breaker and Circuit Breaker period. Conclusions: This descriptive study revealed distinct ED visit trends across different time periods. The COVID-19 pandemic caused a reduction in ED attendances amongst patients with low-acuity conditions and those with highest priority for emergency care. This raises concern about treatment-seeking delays and possible impact on health outcomes. The downward trend in low-acuity presentations also presents learning opportunities for ED crowd management planning in a post-COVID-19 era.

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Strategies to upgrade safety for at-home autologous stem cell transplantation in multiple myeloma patients.

10.21203/rs.3.rs-30978/v1 ◽

2020 ◽

Author(s):

Luis Gerardo Rodríguez-Lobato ◽

Alexandra Martínez-Roca ◽

Sandra Castaño-Díez ◽

Alicia Palomino-Mosquera ◽

Gonzalo Gutiérrez-García ◽

...

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Hospital Readmissions ◽

Primary Prophylaxis ◽

Outpatient Setting ◽

The Impact ◽

At Home

Abstract Background. Autologous stem cell transplantation (ASCT) remains the standard of care for young multiple myeloma (MM) patients; indeed, at-home ASCT has been positioned as an appropriate therapeutic strategy. However, despite the use of prophylactic antibiotics, neutropenic fever (NF) and hospital readmissions continue to pose as the most important limitations in the outpatient setting. It is possible that the febrile episodes may have a non-infectious etiology, and engraftment syndrome could play a more significant role. The aim of this study was to analyze the impact of both G-CSF withdrawal and the addition of primary prophylaxis with corticosteroids after ASCT.Methods. Between January 2002 and August 2018, 111 MM patients conditioned with melphalan were managed at-home beginning + 1 day after ASCT. Three groups were established: Group A (n = 33) received standard G-CSF post-ASCT; group B (n = 32) avoided G-CSF post-ASCT; group C (n = 46) avoided G-CSF yet added corticosteroid prophylaxis post-ASCT.Results. The incidence of NF among the groups was reduced (64%, 44%, and 24%; P < 0.001), with a non-significant decrease in hospital readmissions as well (12%, 6%, and 2%; P = 0.07). The most important variables identified for NF were: HCT-CI > 2 (OR 6.1; P = 0.002) and G-CSF avoidance plus corticosteroids (OR 0.1; P < 0.001); and for hospital readmission: age ≥ 60 years (OR 14.6; P = 0.04) and G-CSF avoidance plus corticosteroids (OR 0.07; P = 0.05).Conclusions. G-CSF avoidance and corticosteroid prophylaxis post ASCT minimize the incidence of NF in MM patients undergoing at-home ASCT.

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Abstract TP278: Positive Impact of a Stroke Bundle Program

Stroke ◽

10.1161/str.48.suppl_1.tp278 ◽

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.

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P3343Association of minority status with mortality and hospital readmission in patients with ischemic cardiomyopathy in the STICH trial

European Heart Journal ◽

10.1093/eurheartj/ehz745.0219 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J M Pires ◽

D L Brown

Keyword(s):

Coronary Artery ◽

Medical Therapy ◽

Hospital Readmission ◽

Hospital Readmissions ◽

Bypass Graft ◽

Antiplatelet Drug ◽

Minority Status ◽

Comorbidity Burden ◽

Stich Trial ◽

The Impact

Abstract Background Racial and ethnic minorities with coronary artery disease (CAD) suffer worse outcomes than their non-minority counterparts, including increased mortality and hospital readmissions. Proposed explanations include impaired access to care, reduced quality of care, comorbidity burden and medication access. Study of the outcomes of minorities in randomized controlled trials (RCT) allows controlling for some of these factors. Purpose The purpose of the current study was to evaluate the impact of minority status on mortality and hospital readmission in patients enrolled in the Surgical Treatment for Ischaemic Heart Failure (STICH) trial. Methods STICH was a multicenter, international RCT of patients with an ejection fraction (EF) of 35% or less and CAD amenable to coronary artery bypass graft surgery (CABG) who were randomized to undergo CABG plus medical therapy or medical therapy alone. Median follow-up was 9.8 years. Minority status was defined by self-reported black race or Hispanic ethnicity. Optimal medical therapy (OMT) was the combination of at least 1 antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The primary outcomes of interest were mortality and hospital readmission. Separate Cox proportional hazards models were constructed to examine the independent associations between minority status and mortality and readmission. Results Of 1212 patients randomized, 421 (35%) were members of a minority. CABG was the treatment assignment in 52.5% of minority participants whereas 47.5% were randomized to medical therapy (P=0.27). Minority patients were significantly younger than non-minority patients (57.8 vs 61.6 years, P=0.003). Sex, smoking status, and the prevalence of diabetes, hypertension, stroke and chronic kidney disease did not differ between minority and non-minority patients. Fewer minority patients had hyperlipidemia (49% vs. 66%, P<0.001), prior MI (72% vs 80%, P=0.003), atrial fibrillation (8.1% vs. 15%, P=0.001) or prior percutaneous coronary intervention (9% vs. 15%, P=0.004). Minority patients were less often on OMT at 30 days (56% vs. 66%, P=0.001), 1 year (70% vs. 76%, P=0.048) and 5 years (66% vs. 75%, P=0.002). Crude mortality rates were lower in minority patients (57% vs. 65%, P=0.004). However, minority status was independently associated with an increased hazard of mortality (HR 2.3, 95% CI: 1.5–2.5, P<0.001) but had no effect on rehospitalization (HR 1.01, 95% CI: 0.78–1.31, P=0.97). Conclusion Despite being a low risk population, minority status in the STICH trial was associated with a 2.3-fold increased hazard of mortality in patients with ischaemic cardiomyopathy. Additional research is urgently needed to delineate and address the causes of disparate outcomes among minority patients.

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Residents' Self-Perceived Errors in Transitions of Care in the Emergency Department

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00033.1 ◽

2011 ◽

Vol 3 (1) ◽

pp. 37-40 ◽

Cited By ~ 6

Author(s):

Dustin Smith ◽

J. Wayne Burris ◽

Guisou Mahmoud ◽

Gregory Guldner

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Resident Physician ◽

Transitions Of Care ◽

Transition Of Care ◽

Standardized Protocol ◽

The Mean ◽

System Errors ◽

The Impact ◽

Research Assistants

Abstract Background The Accreditation Council for Graduate Medical Education requirements for systems-based practice state residents are expected to participate in identifying system errors and implementing potential systems solutions. The objective of this study was to determine the numbers of perceived errors occurring from patient pass offs between resident physicians in our emergency department. Methods Using a prospective observational study, we queried emergency medicine residents about perceived errors in the transition of care using trained research assistants and a standardized protocol. Transition of care was defined as the transfer of responsibility to evaluate and treat and disposition of a patient in the emergency department from 1 resident physician to a second oncoming emergency department resident physician. Mean resident-perceived errors per shift and per patient transfer of care were calculated. Additionally, the mean number of perceived errors impacting patients was calculated. Results Emergency medicine residents on 107 shifts reported receiving 713 patients in pass off with a mean of 7 patients per physician per shift, with 40% of patients passed off needing some intervention (mean of 2.8 patients per provider per shift). Nineteen of the 107 shifts (17.8%) during which a resident took patients from a prior provider had a perceived error in at least 1 patient signed off. Of the 713 patients transitioned, the receiving physician perceived an error related to the transition of care for 23. Two of the 23 errors were determined by reviewing emergency medicine attendings to not be errors, and for 9 the receiving physician perceived an impact on the patient. All were delays in care or disposition. Conclusion Our data suggest emergency medicine residents were able to perceive errors related to transitions of care, describe the types of pass-off errors, and, to a lesser degree, describe the impact these errors have on patients.

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The Impact of Peer Support on the Risk of Future Hospital Readmissions among Older Adults with a Medical Illness and Co-Occurring Depression

Social Sciences ◽

10.3390/socsci7090156 ◽

2018 ◽

Vol 7 (9) ◽

pp. 156

Author(s):

Kyaien Conner ◽

Tamara Cadet ◽

Monique Brown ◽

Joshua Barnett

Keyword(s):

Older Adults ◽

Peer Support ◽

Hospital Readmission ◽

Protective Factor ◽

Medical Condition ◽

Hospital Readmissions ◽

Medical Illness ◽

Future Hospital ◽

Discharge From Hospital ◽

The Impact

Older adults account for 60% of all preventable hospital readmissions. Although not all readmissions are preventable, evidence indicates that up to 75% of hospital readmissions can be prevented with enhanced patient education, pre-discharge assessment, and effective care upon discharge. Social support, specifically peer support, after discharge from hospital may be a crucial factor in minimizing the risk of preventable hospital readmission. The pilot study reported here evaluated the relationship between peer support and hospital readmissions in a sample of depressed older adults (N = 41) who were recently discharged from hospital due to a medical condition and who simultaneously had an untreated mental health diagnosis of depression. As hypothesized, participants who received the 3-month long peer support intervention were significantly less likely to be readmitted compared to those who did not receive the intervention. Findings from this preliminary information suggest that peer support is a protective factor that can positively affect patient outcomes, reduce the risk of hospital readmission, and reduce depressive symptoms among older adults with health and behavioral health comorbidities.

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Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

Journal of Pharmacy Technology ◽

10.1177/8755122519883642 ◽

2019 ◽

Vol 36 (2) ◽

pp. 47-53

Author(s):

Julie B. Cooper ◽

Elizabeth Jeter ◽

Cory John Sessoms

Keyword(s):

Internal Medicine ◽

Hospital Readmission ◽

Adverse Drug Events ◽

Community Hospital ◽

Medical Center ◽

Hospital Readmissions ◽

Readmission Rates ◽

General Internal ◽

Hospital Readmission Rates ◽

Context Specific

Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described. Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists’ service at a nonacademic medical center. Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP. Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs. Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.

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Initial evaluation of patients diagnosed with pancreatic cancer within a community health system.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.269 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 269-269

Author(s):

Kathryn Tzung-Kai Chen

Keyword(s):

Pancreatic Cancer ◽

Emergency Department ◽

Health System ◽

Community Health ◽

Outpatient Clinic ◽

Care Center ◽

Tertiary Care ◽

Initial Evaluation ◽

Entire Cohort ◽

The Impact

269 Background: The management of pancreatic patients who are referred to a tertiary care center is well described. However, many patients receive their initial evaluation and care at community health systems. We sought to describe how patients present within the community, the patterns of initial evaluation, and the impact on management. Methods: In a period spanning 3 years (2010-2013), 82 patients were newly diagnosed with pancreatic cancer, as identified by a cancer registry at a community health system. Under IRB approval, data regarding patient characteristics, initial evaluation, and management were retrospectively collected from the electronic medical record (EMR) and analyzed. Results: Of the 82 patients, 68 patients had sufficient data available in the EMR for analysis. Thirty-two patients (47%) initially presented to outpatient clinic, and 36 patients (53%) presented to the emergency department. The presenting complaint was identified as abdominal pain in 33 patients (49%), jaundice in 20 patients (29%), and general malaise in 9 patients (13%). Patients who presented through outpatient clinic vs. emergency department received similar initial imaging studies upfront, including CT of the abdomen and pelvis (61% vs. 72%) and abdominal ultrasound (27% vs. 17%). Sixteen percent of those patients evaluated in outpatient clinic were subsequently admitted, compared to 94% of those patients evaluated in the emergency department. Finally, 31% of those presenting in outpatient clinic eventually underwent surgical resection, compared to 8% of those presenting through the ER, and the median time to surgery for the entire cohort was 1.1 months. Conclusions: Within the community, half of all patients present through the emergency department, and the majority of these are admitted for work up and management of symptoms. In contrast, those patients who present through outpatient clinic are less likely to be admitted, and are more likely to undergo definitive resection. This likely represents a disparity on several levels: the acuity of patients presenting to the emergency department vs. clinic, and how they are managed in each setting.

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Characterization of Drug-Related Problems Occurring in Patients Receiving Outpatient Antimicrobial Therapy

Journal of Pharmacy Practice ◽

10.1177/0897190016688771 ◽

2017 ◽

Vol 30 (6) ◽

pp. 600-605 ◽

Cited By ~ 9

Author(s):

Cory M. Hale ◽

Jeffrey M. Steele ◽

Robert W. Seabury ◽

Christopher D. Miller

Keyword(s):

Antimicrobial Therapy ◽

Hospital Readmission ◽

Care Management ◽

Hospital Readmissions ◽

Antimicrobial Treatment ◽

Transitions Of Care ◽

Drug Related Problems ◽

Patient Harm ◽

Outpatient Parenteral Antimicrobial Therapy

Background: Despite the numerous benefits of outpatient parenteral antimicrobial therapy (OPAT), appreciable risks of drug-related problems (DRPs) exist. No studies to date comprehensively assess DRPs in this population. Objectives: Objectives of this study were to (1) characterize the frequency and types of DRPs experienced by patients discharged on OPAT and (2) determine the fraction of adverse drug reactions (ADRs) resulting in hospital readmission or emergency department (ED) presentation and changes in therapy. Methods: This was a retrospective chart analysis evaluating consecutive adult patients discharged on OPAT between May 2015 and October 2015. Patients were assessed for the presence of DRPs until the cessation of antimicrobial treatment, including oral step-down therapy. The outcome of each ADR was recorded, including those resulting in hospital readmissions, presentation to the ED, or changes in antimicrobials. Results: Among 144 patients discharged on OPAT, 199 DRPs occurred in 91 (63.2%) patients. Harm and potential impaired efficacy occurred in 76.9% and 23.1%, respectively. The ADRs comprised 59% of DRPs, occurring in 44.4% of patients. The second most common DRP type was drug interactions (DIs), accounting for 22.6% of DRPs. Rifampin, fluoroquinolones, and daptomycin had the highest frequencies of preventable DRPs in the form of DIs, whereas cephalosporins had the fewest DRPs. Approximately 26% of ADRs caused changes in therapy and 9% resulted in hospital readmission or ED utilization. Conclusion: DRPs with the potential to cause patient harm or impair treatment efficacy often occur with OPAT, most commonly ADRs and DIs. Enhanced monitoring and transitions of care management may reduce the incidence of these DRPs.

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