Improving discharge planning using the re‐engineered discharge programme

Roberts, Sterling; Moore, Lee R.; Jack, Brian

doi:10.1111/jonm.12719

Cited by 12 publications

(6 citation statements)

References 7 publications

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“…There are now established hospital in the home and transitional programmes that allow early hospital discharge and prevent hospital admission are beneficial. [23][24][25][26] A systematic review of interventions to reduce early hospital readmissions concluded that interventions were complex with more recent ones less effective in their review from 2009 to 2013. 11 Singaporean-based RCT showed some positive results but again highlighted the issues facing clinicians with patients with multiple comorbidity and complex care needs.…”

Section: Discussionmentioning

confidence: 99%

A prospective cohort study of two predictor models for 30‐day emergency readmission in older patients

et al. 2021

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Section: Discussionmentioning

confidence: 99%

A prospective cohort study of two predictor models for 30‐day emergency readmission in older patients

et al. 2021

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“…Given this, we perhaps need to examine the issue in a different manner and focus on transitional care following discharge from hospital for this cohort of patients as a way to prevent/reduce hospital readmission. There are now established hospital in the home and transitional programmes that allow early hospital discharge and prevent hospital admission are beneficial [17,18,19,20]. A systematic review of interventions to reduce early hospital readmissions concluded that interventions were complex with more recent ones less effective in their review from 2009 to 2013 [8].…”

Section: Discussionmentioning

confidence: 99%

A prospective cohort study comparing two predictor models for 30-day emergency readmission in the elderly.

Armitage

Allison

et al. 2021

Preprint

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Aim: To undertake a prospective study of the efficacy of two models (LACE and BOOST) in predicting unplanned hospital readmission. Methods: Data were collected from a single centre prospectively over a continuous 30-day period on all patients over 75 years old admitted to the acute medical unit. The primary outcome was the area under the curve for both models. Results: Area under the curve were calculated for both tools with BOOST score 0.667 (95% CI: 0.559-0.775, p=0.005) and C-statistic for LACE index 0.685 (95% CI: 0.579-0.792, p=0.002). Conclusion: In this prospective study, both the BOOST and LACE scores were found to be significant predictive models of hospital readmission. Recent hospitalisation was found to be the most significant contributing factor. Key Words: Elderly, prediction, readmission

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“…Adams et al (2014) validated the RED toolkit as effective in reducing readmissions. The National Quality Forum and the Institute for Healthcare Improvement evaluated the RED toolkit as adequate for safe discharge planning practice (Roberts et al, 2018).…”

Section: Instrumentmentioning

confidence: 99%

A Targeted Discharge Planning for High-Risk Readmissions

Park-Clinton

Renda

Wang

2023

Professional Case Management

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Purpose of Study: Racial and ethnic minorities with socioeconomic disadvantages are vulnerable to 30-day hospital readmissions. A 16-week quality improvement (QI) project aimed to decrease readmissions of the vulnerable patient populations through tailored discharge planning. The project evaluated the effectiveness of using a 25-item checklist to increase patients' and caregivers' health knowledge, skills, and willingness for self-care and decrease readmissions. Primary Practice Setting: The project took place in an inner-city teaching hospital in the Mid-Atlantic region. Methodology and Participants: A casual comparative design compared readmissions of the before-intervention group (May 1–July 31, 2021) and the after-intervention group (August 1–October 31, 2021). A pre- and postintervention design evaluated the effectiveness of a 25-item checklist by analyzing the differences of Patient Activation Measure (PAM) pre- and postintervention survey scores and levels in the after-intervention group. Participants were General Medicine Unit patients 18 years or older who had Medicare Fee-for-Service, resided in 10 zip codes near the hospital, and were discharged home. Results: Of 30 patients who received the intervention, one patient was readmitted compared with 11 readmissions from 58 patients who did not receive the intervention. The readmission rate was decreased from 19% to 4% during the 16-week project: 11 (19%) versus 1 (4%), p = .038. After receiving the intervention, patients' PAM scores were increased by 8.55, t(22) = 2.67, p < .014. Three patients had a lower postintervention survey level, whereas 12 patients obtained a higher postintervention survey level (p = .01). The increase in scores and levels supported that the intervention effectively improved patients' self-management knowledge, skill, and willingness for self-care. Implications for Case Management Practice: The QI project showed that the hospital could partner with patients at high risk for readmission and their caregivers. Accurate evaluation of patients' health knowledge, skills, and willingness for self-care was essential for sufficient discharge planning. Tailored use of the checklist improved patients' self-activation and functionally facilitated patients' and caregivers' care needs and capabilities. The checklist was statistically and clinically effective in decreasing 30-day hospital readmissions of vulnerable patient populations.

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Improving discharge planning using the re‐engineered discharge programme

Abstract: Those responsible for education initiatives must make understanding nurses' learning preferences a priority to improve the quality of bedside practice.

Cited by 12 publications

References 7 publications

A prospective cohort study of two predictor models for 30‐day emergency readmission in older patients

A prospective cohort study of two predictor models for 30‐day emergency readmission in older patients

A prospective cohort study comparing two predictor models for 30-day emergency readmission in the elderly.

A Targeted Discharge Planning for High-Risk Readmissions

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