Discharge by Noon: A Checklist Initiative by the Otolaryngology Service

Tamaki, Akina; Cabrera, Claudia I.; Hoppe, Kathryn; Maronian, Nicole

doi:10.1002/lary.28729

Cited by 4 publications

(6 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Currently, the only published otolaryngology-specific discharge checklist aims to improve the number of discharges by noon by refining structural hospital characteristics. 23 This checklist has many benefits but did not show an improvement in 30-day readmissions. In another study, Revell et al 24 generated a physiological scoring system to help determine readiness for discharge in otolaryngology patients.…”

Section: Discussionmentioning

confidence: 96%

Qualitative Study Assessing Factors for 30-day Readmissions: A Head and Neck Oncology Cohort

Beatty

Penn

O'Donnell

et al. 2023

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objectives: There is a paucity of literature on what contributes to 30-day readmission rates from the patient’s perspective in head and neck cancer patients. Post-operatively, these patients are often discharged with multiple surgical sites and home equipment requiring education and a large responsibility upon arriving home. Patients have a unique understanding of the discharge process and rationale behind presenting for care following initial discharge. Understanding the experience of the readmitted patient may be critical in finding effective methods to prevent unnecessary readmissions. Methods: Through key-informant interviews, we assessed factors that impact readmission rates from the patient perspective. Patients were eligible if they were discharged within the last 30 days and subsequently readmitted following an admission for a head and neck cancer surgery. Inductive coding was used to analyze interview transcripts and develop themes. Results: Thirteen respondents were interviewed. 46% (n = 6) did not feel ready for discharge after the index admission. Out of these 6 patients, 83% (n = 5) felt their readmission could have been avoided. Patients often encountered unexpected events after returning home from the index admission and felt their readmissions were potentially avoidable with more information regarding what to expect at home, prior to discharge. Although medically stable upon discharge, these findings indicate some patients might be discharged sooner than they should be due to factors outside of medical indications. Conclusions: To address the various biopsychosocial components of patient care in addition to medical aspects, an otolaryngology-specific, prior-to-discharge checklist could aid in lowering 30-day readmissions. Since the amount of education each patient requires to feel competent managing their health at home varies, more work is needed to craft post-education assessments of patient/caregiver competencies for home equipment, prior to discharge to reduce avoidable readmissions.

show abstract

Section: Discussionmentioning

confidence: 96%

Qualitative Study Assessing Factors for 30-day Readmissions: A Head and Neck Oncology Cohort

Beatty

Penn

O'Donnell

et al. 2023

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

show abstract

“…The primary outcome of this analysis is an aggregate of unplanned hospital readmission or presentation to the ED within 30 days of discharge. Early TOD, which was defined as discharge before noon in concordance with other analyses in the medical and surgical literature, 6,7,[10][11][12] was a secondary outcome.…”

Section: Outcome Measurementioning

confidence: 99%

“…2,3,[15][16][17][18] Data on these effects in patients undergoing elective surgery are less clear. 4,6,19,20 Our analysis of TOD after inpatient admission after elective anterior cervical surgery is the only known assessment of early TOD in spine surgery. In that analysis, we demonstrated that, when controlling for numerous covariates, TOD was not associated with increased risk of readmission to the hospital or re-presentation to the emergency department (ED) within 30 days of surgery.…”

mentioning

confidence: 99%

“…[1][2][3] Efforts to optimize patient length of stay (LOS) and to facilitate early time of discharge (TOD) for hospitalized medical and surgical inpatients are a common focus of hospital operations. [4][5][6][7][8] Although the evidence is far from definitive, such initiatives promise increased bed availability and utilization, decreased emergency department wait times, and, potentially, improved patient outcomes and satisfaction. 4,[9][10][11][12] Elective surgical admissions can be a significant contributor to overall impairments of hospital bed flow and efficiency.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Time of Discharge and 30-Day Re-Presentation to an Acute Care Setting After Elective Lumbar Decompression Surgery

et al. 2022

View full text Add to dashboard Cite

BACKGROUND:Evidence regarding the consequence of efforts to increase patient throughput and decrease length of stay in the context of elective spine surgery is limited.OBJECTIVE:To evaluate whether early time of discharge results in increased rates of hospital readmission or return to emergency department for patients admitted after elective, posterior, lumbar decompression surgery.METHODS:We conducted a retrospective cohort study of 779 patients admitted to hospital after undergoing elective, posterior, lumbar decompression surgery. Multiple logistic regression evaluated the relationship between time of discharge and the primary outcome of return to acute care within 30 days, while controlling for sociodemographic, procedural, and discharge characteristics.RESULTS:In multiple logistic regression, time of discharge earlier in the day was not associated with increased odds of return to acute care within 30 days (odds ratio [OR] 1.18, 95% CI 0.92-1.52, P = .19). Weekend discharge (OR 1.99, 95% CI 1.04-3.79, P = .04) increased the likelihood of return to acute care. Surgeon experience (<1 year of attending practice, OR 0.43, 95% CI 0.19-1.00, P = .05 and 2-5 years of attending practice, OR 0.50, 95% CI 0.25-1.01, P = .054), weekend discharge (OR 0.49, 95% CI 0.27-0.89, P = .02), and physical therapy evaluation (OR 0.20, 95% CI 0.12-0.33, P < .001) decreased the likelihood of discharge before noon.CONCLUSION:Time of discharge is not associated with risk of readmission or presentation to the emergency department after elective lumbar decompression. Weekend discharge is independently associated with increased risk of readmission and decreased likelihood of prenoon discharge.

show abstract

“…1,2,[13][14][15][16] Similar trends have not necessarily been observed in the context of surgical admissions, although effects are mixed. 4,9,17,18 Specific data regarding the efficacy of such approaches in the context of spine surgery are lacking. As such, in this analysis, we sought to assess the impact of time of discharge (TOD) on readmission after elective spine surgery in a contemporary patient cohort at a large academic medical center.…”

mentioning

confidence: 99%

Influence of Time of Discharge and Length of Stay on 30-Day Outcomes After Elective Anterior Cervical Spine Surgery

et al. 2022

View full text Add to dashboard Cite

BACKGROUND:Encouraging early time of discharge (TOD) for medical inpatients is commonplace and may potentially improve patient throughput. It is unclear, however, whether early TOD after elective spine surgery achieves this goal without a consequent increase in re-presentations to the hospital.OBJECTIVE:To evaluate whether early TOD results in increased rates of hospital readmission or return to the emergency department after elective anterior cervical spine surgery.METHODS:We analyzed 686 patients who underwent elective uncomplicated anterior cervical spine surgery at a single institution. Logistic regression was used to evaluate the relationship between sociodemographic, procedural, and discharge characteristics, and the outcomes of readmission or return to the emergency department and TOD.RESULTS:In multiple logistic regression, TOD was not associated with increased risk of readmission or return to the emergency department within 30 days of surgery. Weekend discharge (odds ratio [OR] 0.33, 95% CI 0.21-0.53), physical therapy evaluation (OR 0.44, 95% CI 0.28-0.71), and occupational therapy evaluation (OR 0.32, 95% CI 0.17-0.63) were all significantly associated with decreased odds of discharge before noon. Disadvantaged status, as measured by area of deprivation index, was associated with increased odds of readmission or re-presentation (OR 1.86, 95% CI 0.95-3.66), although this result did not achieve statistical significance.CONCLUSION:There does not appear to be an association between readmission or return to the emergency department and early TOD after elective spine surgery. Overuse of inpatient physical and occupational therapy consultations may contribute to decreased patient throughput in surgical admissions.

show abstract

Discharge by Noon: A Checklist Initiative by the Otolaryngology Service

Cited by 4 publications

References 10 publications

Qualitative Study Assessing Factors for 30-day Readmissions: A Head and Neck Oncology Cohort

Qualitative Study Assessing Factors for 30-day Readmissions: A Head and Neck Oncology Cohort

Time of Discharge and 30-Day Re-Presentation to an Acute Care Setting After Elective Lumbar Decompression Surgery

Influence of Time of Discharge and Length of Stay on 30-Day Outcomes After Elective Anterior Cervical Spine Surgery

Contact Info

Product

Resources

About