A team approach to effectively discharge trauma patients

Bardes, James M.; Khan, Uzer; Cornell, Nicole; Wilson, Alison

doi:10.1016/j.jss.2017.02.018

Cited by 8 publications

(10 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…29.6% on control teams). Bardes et al 9 tested a discharge team for trauma patients and found an increase in discharges before noon from 25.5% to 51.2%. Both use a similar approach to ours.…”

Section: Discussionmentioning

confidence: 99%

Length of stay in the clinical wards in a hospital after introducing a multiprofessional discharge team: An effectiveness improvement report

Falcetta,

Rados,

Molina

et al. 2024

Journal of Hospital Medicine

View full text Add to dashboard Cite

IntroductionEmergency overcrowding is a problem in hospitals worldwide. The expansion of wards has limitations. Hospital administrative leaders are constantly looking for opportunities to improve the efficiency of resource use.MethodsThis is a care improvement study with a quasi‐experimental design. We created a hospital discharge team (HDT) to solve the issues of prolonged hospital stays. The main interventions were active search and resolution of prolongation of stay and multi‐disciplinary huddles. We developed strategies with different hospital units to expedite the processing of patients near discharge. Length of stay (LOS), morning hospital discharges, readmission rates, and bed usage were compared before (2018) and after (2019) HDT implementation.ResultsThere was a reduction in the mean LOS of 1.8 days (95% confidence interval [CI] −0.9 to −2.6; p < .001). The rate of hospital discharges before noon increased by 7.0% (95% CI 4%–11%; p < .001). The readmission rate was similar between 2018 and 2019 (+0.7%; 95% CI −0.1% to 1.9%; p = .358). We observed higher bed turnover, with 0.5 more hospitalizations per bed per month (95% CI 0.1–0.7; p = .01; mean of 3.7 ± 0.3 in 2018 and 4.1 ± 0.3 in 2019).ConclusionHDT brought benefits to our hospital, reducing the length of stay and increasing bed turnover. However, there is a need for a team focused on the project and support from managers to overcome resistance and integrate units until they are fully operational.

show abstract

Section: Discussionmentioning

confidence: 99%

Length of stay in the clinical wards in a hospital after introducing a multiprofessional discharge team: An effectiveness improvement report

Falcetta,

Rados,

Molina

et al. 2024

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…Although there is a growing body of research about discharge practices for general medicine and elective surgery patients, there is a relative paucity of evidence concerning optimal practices for this transition of care for TACS patients. [10][11][12] Additionally, there are currently few interventions known to improve the discharge transition of care from the patient's perspective. We sought to better understand the challenges in the transition from inpatient to subsequent recovery by conducting semi-structured interviews of experienced clinicians and patients as a necessary first step to develop interventions applicable to this complex, poorly optimized process.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study

McFadden

Gosdin

Jurkovich

et al. 2022

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

ObjectivesTrauma and acute care surgery (TACS) patients face complex barriers associated with hospitalization discharge that hinder successful recovery. We sought to better understand the challenges in the discharge transition of care, which might suggest interventions that would optimize it.MethodsWe conducted a qualitative study of patient and clinician perceptions about the hospital discharge process at an urban level 1 trauma center. We performed semi-structured interviews that we recorded, transcribed, coded both deductively and inductively, and analyzed thematically. We enrolled patients and clinicians until we achieved data saturation.ResultsWe interviewed 10 patients and 10 clinicians. Most patients (70%) were male, and the mean age was 57±16 years. Clinicians included attending surgeons, residents, nurse practitioners, nurses, and case managers. Three themes emerged. (1) Communication (patient-clinician and clinician-clinician): clinicians understood that the discharge process malfunctions when communication with patients is not clear. Many patients discussed confusion about their discharge plan. Clinicians lamented that poorly written discharge summaries are an inadequate means of communication between inpatient and outpatient clinicians. (2) Discharge teaching and written instructions: patients appreciated discharge teaching but found written discharge instructions to be overwhelming and unhelpful. Clinicians preferred spending more time teaching patients and understood that written instructions contain too much jargon. (3) Outpatient care coordination: patients and clinicians identified difficulties with coordinating ongoing outpatient care. Both identified the patient’s primary care physician and insurance coverage as important determinants of the outpatient experience.ConclusionTACS patients face numerous challenges at hospitalization discharge. Clinicians struggle to effectively help their patients with this stressful transition. Future interventions should focus on improving communication with patients, active communication with a patient’s primary care physician, repurposing, and standardizing the discharge summary to serve primarily as a means of care coordination, and assisting the patient with navigating the transition.Level of evidenceIII—descriptive, exploratory study.

show abstract

“…Hospitals employ various strategies to reduce inpatient length of stay (LOS) and improve patient throughput [1,2]. Reducing LOS has been a focus as it is a major driver of the costs of an admission, and to facilitate transfers of patients to appropriate levels of care, including reducing Emergency Department (ED) boarding time, and transfer times into and from the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

Late-afternoon communication and patient planning (CAPP) rounds: an intervention to allow early patient discharges

et al. 2020

View full text Add to dashboard Cite

Objective: Measure effect of late-afternoon communication and patient planning (CAPP) rounds to increase early electronic discharge orders (EDO). Methods: We enrolled 4485 patients discharged from six subspecialty medical services. We implemented late-afternoon CAPP rounds to identify patients who could have morning discharge the subsequent day. After an initial successful implementation of the intervention, we identified lack of sustainability. We made changes with sustained implementation of the intervention. This is a beforeafter study of a quality improvement intervention. Program evaluation: Primary measures of intervention effectiveness were percentage of patients who received EDO by 11 am and patients discharged by noon. Additional measure of effectiveness were percent of patients admitted to the correct ward, emergency department (ED)-toward transfer time compared between intervention and nonintervention periods. We compared the overall expected LOS and the average weekly discharges to assess for comparability across the control and intervention time periods. We used the readmission rate as balancing measure to ensure that the intervention was not have unintended negative patients consequences. Results: Expected length of stay based upon discharge diagnosis/comorbidities and readmission rates were similar across the intervention and control time periods. The average weekly discharges were not statistically significant. Percentage of EDO by 11 am was higher in the first intervention period, second intervention period and combined intervention periods (28.9% vs. 21.8%, P < 0.001) compared with the respective control periods. Percent discharged before noon increased in the first intervention period, second intervention period and for the combined intervention periods (17 vs. 11.8%, P < 0.001). There was no difference in the percent admitted to the correct ward and ED-toward transfer time. Conclusion: Afternoon CAPP rounds to identify early patient discharges the following day led to increase in EDO entered by 11 am and discharges by noon without an adverse change in readmission rates and LOS.

show abstract

A team approach to effectively discharge trauma patients

Cited by 8 publications

References 16 publications

Length of stay in the clinical wards in a hospital after introducing a multiprofessional discharge team: An effectiveness improvement report

Length of stay in the clinical wards in a hospital after introducing a multiprofessional discharge team: An effectiveness improvement report

Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study

Late-afternoon communication and patient planning (CAPP) rounds: an intervention to allow early patient discharges

Contact Info

Product

Resources

About