Getting Unstuck: Challenges and Opportunities in Caring for Patients Experiencing Prolonged Hospitalization While Stable for Discharge

Meo, Nicholas; Bann, Maralyssa; Sanchez, Mala M.; Reddy, Ashok; Cornia, Paul B.

doi:10.1016/j.amjmed.2020.05.024

Cited by 12 publications

(18 citation statements)

References 42 publications

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“…Consistent with prior research, 7,12 our study also showed that a small subset of patients (ie, the prolonged hospitalization cohort, ∼2% of overall discharges) is responsible for a disproportionate number of our overall bed days of care (∼23%). Thus, efforts targeted at reducing LOS for these patients are necessary and appropriate.…”

Section: Discussionsupporting

confidence: 90%

Focusing on the Medically Ready for Discharge Patient Using a Reliable Design Strategy: A Quality Improvement Project to Improve Length of Stay on a Medicine Service

Meo

Cornia

2021

Quality Management in Health Care

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Background and Objectives: Length of stay is a common measure of efficiency of care. We aimed to reduce length of stay on a general medicine service through a structured quality improvement project. Methods: A reliable design strategy was implemented in successive stages at a 238-bed academically-affiliated VA hospital. Over a 2-year period, continuous improvement efforts were directed at discrete cohorts of patients deemed medically appropriate for discharge but who remained hospitalized because of discharge barriers. We compared the mean length of stay and medically-ready bed days of care for a hospital in statistical control charts. Pre-and post-intervention comparisons were made using t-tests. Results: In total, 5321 discharges were included in this improvement project, accounting for 35 852 bed days of care. Overall, average length of stay was reduced by 15.7%, from 7.62 to 6.40 days (P < .05). There was a significant reduction in the mean number of medically-ready bed days of care from 2.3 to 1.72. Statistical process control charts demonstrated special cause variation across patient cohorts. Conclusion: A quality improvement project using reliable design principles was associated with shorter length of stay.

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Section: Discussionsupporting

confidence: 90%

Focusing on the Medically Ready for Discharge Patient Using a Reliable Design Strategy: A Quality Improvement Project to Improve Length of Stay on a Medicine Service

Meo

Cornia

2021

Quality Management in Health Care

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“…Consistent with other studies, our results confirm the importance of system-level and multi-pronged approaches to overcome discharge delays. 2,14 Our findings have several implications. First, although UAE hospitals routinely track length of stay, recognition of delayed discharges due to non-medical barriers can help identify inefficient processes and encourage interventions that improve discharge planning.…”

Section: Implications and Conclusionmentioning

confidence: 81%

“…13 Previous research has shown improvements in discharge planning through system-level approaches that integrate health care and social work. 14 For example, Meo et al implemented daily multidisciplinary discharge rounds with physicians, nurses and social workers, using an electronic tracking tool to standardize information. 15 They noted a 21% reduction in length of stay without increased readmission rates.…”

mentioning

confidence: 99%

Multi-Disciplinary Discharge Coordination Team to Overcome Discharge Barriers and Address the Risk of Delayed Discharges

Ibrahim¹,

Harhara²,

Athar³

et al. 2022

RMHP

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Background: Delays in hospital discharge occur when patients are medically cleared but continue to remain hospitalized. Discharge delays can result in reduced levels of treatment, placing patients at risk of functional decline, falls and hospital-related adverse events. The Institute of Medicine has highlighted timely, efficient, and safe hospital discharge as a marker for quality care. Hospitals, however, are often unable to meet discharge targets. Research has shown improvements in discharge planning through system-level approaches that integrate health care and social work. The purpose of this study is to describe the development and implementation of a multidisciplinary team intervention to overcome discharge barriers for patients with prolonged hospitalization. We also evaluated the impact of the intervention on length of stay, readmission rates and care team satisfaction and morale. Methods: A multidisciplinary discharge coordination team met weekly to proactively raise and resolve patient-related discharge issues for all patients admitted to the general medicine wards. Members included hospitalists, case managers, social workers, hospital finance representatives, and patient representatives. One of the hospital physicians facilitated the meetings. Results: Barriers to discharge included patient and family reluctance to discharge, medical delays in performing diagnostic tests or procedures, long-term care facility acceptance delays, and prolonged wait times for insurance approvals. Our multipronged approach decreased length of stay in our delayed discharge patient population from 15.45 days to 9.04 days, a 41.5% reduction, without an increase in readmissions. The healthcare team perceived the weekly multidisciplinary team meetings quite positively; 90% of respondents agreed that the meetings improved communication and increased their sense of support. Conclusion: Our intervention was successful in improving hospital processes to overcome barriers to patient discharge. We believe that similar multidisciplinary meetings can be implemented in hospitals throughout the region to decrease risks of prolonged hospitalization and, ultimately, improve hospital efficiency and care delivery.

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“…5 When patients eligible for OPAT finish therapy elsewhere, more hospital beds are available, which also shortens emergency department waiting times and increases the capacity to accept patient transfers. 6 In Belgium, 152 OPAT treatments resulted in avoidance of 3,153 days of hospitalization. 7 The critical importance of hospital capacity, especially flexibility and adaptability, is particularly highlighted in the era of the SARS-CoV-2 pandemic.…”

mentioning

confidence: 99%

“…7 The critical importance of hospital capacity, especially flexibility and adaptability, is particularly highlighted in the era of the SARS-CoV-2 pandemic. 6 Because inpatient care accounts for one-third of all healthcare spending in the United States, 6 utilizing subacute healthcare programs such as OPAT can bring many financial benefits to healthcare systems.…”

mentioning

confidence: 99%

Experiences in outpatient parenteral antimicrobial therapy (OPAT): Barriers and challenges from the front lines

Bailey

Pryor

et al. 2021

ASHE

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Background: Outpatient parenteral antimicrobial therapy (OPAT) is now the standard of care for managing patients who no longer need inpatient care but require prolonged intravenous antimicrobial therapy. OPAT increases patient satisfaction, reduces the lengths of hospital stay, lowers emergency department readmission rates, and decreases total healthcare spending. Objective: To investigate Virginia Commonwealth University Health System’s experience with OPAT and to highlight the obstacles patients and clinicians face when navigating and utilizing this program. Design: We conducted this descriptive study at a large, academic, tertiary-care hospital in Central Virginia. Methods: We performed manual reviews of electronic medical records of 602 patient, and we evaluated the records of those receiving OPAT between 2017 and 2020. Reviews included antimicrobial agents, diagnoses requiring OPAT, adverse effects related to antimicrobials, adverse effects related to peripherally inserted central catheters (PICC), readmission rate, discharge destination, and death. We evaluated our program with descriptive statistics. Results: Among 602 patients who received OPAT, most were diagnosed with bacteremia or musculoskeletal infections. Patients were either discharged home or to another healthcare facility, with the former comprising most of the rehospitalizations. Ertapenem and vancomycin were associated with the most adverse drug events among our cohort. Elevated transaminase levels were noted in 23% of patients. The rate of PICC-line adverse events in this study population was 0.05%. Conclusions: Our findings highlight the barriers and challenges that patients and providers face when receiving OPAT, and they can inform efforts to improve patient clinical outcomes.

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Getting Unstuck: Challenges and Opportunities in Caring for Patients Experiencing Prolonged Hospitalization While Stable for Discharge

Cited by 12 publications

References 42 publications

Focusing on the Medically Ready for Discharge Patient Using a Reliable Design Strategy: A Quality Improvement Project to Improve Length of Stay on a Medicine Service

Focusing on the Medically Ready for Discharge Patient Using a Reliable Design Strategy: A Quality Improvement Project to Improve Length of Stay on a Medicine Service

Multi-Disciplinary Discharge Coordination Team to Overcome Discharge Barriers and Address the Risk of Delayed Discharges

Experiences in outpatient parenteral antimicrobial therapy (OPAT): Barriers and challenges from the front lines

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