Discharge planning from hospital to home

Shepperd, Sasha; Parkes, Julie; McClaran, Jacqueline; Phillips, Christopher

doi:10.1002/14651858.cd000313.pub2

Cited by 297 publications

(369 citation statements)

References 46 publications

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“…Data regarding the effectiveness of pre-and postdischarge interventions have been mixed, but targeting these lower acuity admissions may be more cost-effective than interventions addressing long-term outpatient disease management. [38][39][40][41][42][43][44][45] Primary care access and ED utilization patterns have been examined in multiple studies looking at risk for admission, with varying results. 4,6,12,13,[46][47][48] In our study, self-reported ambulatory care did not differ between the patients with strongly acuity-driven and moderately/weakly acuity-driven admissions.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

et al. 2015

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BACKGROUND:Little is known about the factors that influence physicians' admission decisions, especially among lower acuity patients. For the purpose of our study, non-medical refers to all of the factors-other than the patient's clinical condition-that could potentially influence admission decisions. OBJECTIVE: To describe the influence of non-medical factors on physicians' decisions to admit non-critically ill patients presenting to the ED. DESIGN: Cross-sectional study of hospital admissions at a single academic medical center. PARTICIPANTS: Non-critically ill adult patients admitted to the hospital (n=297) and the admitting emergency medicine physicians (n=34). MAIN MEASURES: A patient survey assessed nonmedical factors, including primary care access and utilization. A physician survey assessed clinical and nonmedical factors influencing the decision to admit. Based on physician responses, admissions were characterized as Bstrongly acuity-driven,^Bmoderately acuity-driven,ô r Bweakly acuity-driven.^Among these admission types, we compared length of stay, cost, and readmission within 30 days to the hospital or ED. KEY RESULTS: Based on the admitting physician's assessment, we categorized the motivation for admission as strongly acuity-driven in 185 (62 %) admissions, moderately acuity-driven in 92 (31 %), and weakly acuity-driven in 20 (7 %). Per the physician surveys, 51 % of hospitalizations were strongly or moderately influenced by one or more non-medical factors, including lack of information about baseline conditions (23 %); inadequate access to outpatient specialty care (14 %); need for a diagnostic testing or procedure (12 %); a recent ED visit (11 %); and inadequate access to primary care (10 %). Compared with strongly-acuity driven admissions, admissions that were moderately or weakly acuity-driven were shorter and less costly but were associated with similar rates of ED (35 %) and hospital (27 %) readmission. CONCLUSIONS: Non-medical factors are influential in the admission decisions for many patients presenting to the emergency department. Moderately and weakly acuity-driven admissions may represent a feasible target for alternative care pathways.KEY WORDS: non-medical factors; hospital admission decision; access to care; care transitions; decision making; emergency medicine; health care delivery; medical decision making; severity of illness; socioeconomic factors; utilization.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

et al. 2015

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“…However, unintended consequences of early discharges include poor patient outcomes and increased readmission rates while coordinated discharge planning has been shown to decrease these effects. 69,70 "We see a lot of bounce-backs and I think particularly with bed pressure. But it's pushing patients out perhaps before they're a 100 per cent…" (Cathy)…”

Section: System Pressures To Free Up Bedsmentioning

confidence: 99%

Hospital pharmacists' perceptions of medication counseling: A focus group study

Chevalier

Watson

Barras

et al. 2016

Research in Social and Administrative Pharmacy

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BackgroundMedication counselling sessions are key times for a pharmacist to speak to patients about their medications and the changes made to their therapies during their hospital stay. ObjectivesTo explore hospital pharmacists' perceptions of their roles and goals in patient medication counselling, and perceived barriers and facilitators to achieving their goals. MethodsHospital pharmacist focus groups were held in two tertiary referral hospitals. Eligible pharmacists had provided medication counselling within the previous six months in inpatient and/or outpatient settings. Interested pharmacists attended a focus group designed to elicit their opinions and perceptions of patient medication counselling. Focus groups were audio recorded and transcribed verbatim. Inductive thematic analysis was applied to the data to identify initial patterns (codes) which were then organized into common overarching themes using NVivo ® software. The codes were reviewed for reliability by pharmacists independent of the focus groups. ResultsSix, one-hour focus groups were conducted with a total of 24 pharmacists participating. Saturation of information was determined after four focus groups. Greater than 80% consensus was achieved for reliability of the identified codes. A number of themes emerged from these codes around the goals, roles, and the barriers and facilitators to meeting these goals. Pharmacists' patient-centred goals in medication counselling were to build rapport, to empower patients and to improve patients' experience, health and safety. These goals would be accomplished through specific roles such as being an assessor, educator and problem-solver. Pharmacists frequently cited time pressures caused by systemic (hospital), and pharmacy specific processes as key challenges to achieving their goals. Factors that enabled pharmacists to meet their goals were those related to effective interprofessional collaboration and the quality of professional practice (such as training, expanded roles and advanced planning for discharge). ConclusionsHospital pharmacists emphasised patient-centred goals in medication counselling and outlined the challenges to meet those goals. The findings from this study will be used to develop strategies for effective communication and inform pharmacy practice changes to improve patient care. Key Words Hospital pharmacist Focus group Goal Role Communication M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTPage 2 of 27 IntroductionDischarge from hospital to community or to other healthcare facilities marks an important transition in care for patients. Discharge and other transitions such as admission to hospital or transfers within a hospital have been identified as particular times when patients may be at risk of experiencing medication errors and adverse events. 1-3 Medication counselling opportunities are key times for pharmacists to speak to patients about their medications and the changes made to their therapies during their hospital stay. 2,[4][5][6][7] Failure by a hospital phar...

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“…None of the studies reviewed for the Cochrane Library (Shepperd et al, 2013) included DP for pediatric patients. Recognition is emerging of the need to develop a DP model to address the transitional care needs of families of children with medical complexities (Berry, Agrawal, Cohen, & Kuo, 2013).…”

Section: Applied Nursingmentioning

confidence: 99%

“…Although DP is a required activity in the United States by hospitals participating in the Centers for Medicare & Medicaid Services payment programs, there is no universal or widely accepted operational model for the DP process. A wide variation in models of DP care delivery was noted in a recent Cochrane Review ( Shepperd et al, 2013), with differing configurations of roles and activities assigned to steps in the process.…”

mentioning

confidence: 99%