Reducing Pediatric Readmissions

Shermont, Herminia; Pignataro, Shelly; Humphrey, Kate; Bukoye, Bolanle

doi:10.1097/ncq.0000000000000176

Cited by 33 publications

(28 citation statements)

References 21 publications

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“…By gradually implementing this over 16 inpatient units, they were able to decrease readmissions by 8% at 7 days and 10% at 30 days. Similar to our study, in the study by Shermont et al, 9 multiple small tests of change were used to gradually implement their improvement strategy and obtain a significant decrease in their outcomes measure.…”

Section: Discussionmentioning

confidence: 58%

“…8 Although these were the first studies to look at unplanned readmission to the hospital system following pediatric surgery, none of them focused on measures to reduce these rates. Shermont et al 9 focused on standardization of discharge bundles combined with teach back methodologies to improve the rate of 7-day and 30-day readmissions following discharge from a pediatric hospital. They used PDSA cycles to implement a standardized discharge plan including medication reconciliation, scheduled follow-up appointments, and verifying that the patient/family understood the discharge plan and a number to call for any questions or concerns.…”

Section: Discussionmentioning

confidence: 99%

“…We were able to standardize the education given to patients for many common disease states by utilizing templates in the patients’ discharge summaries to highlight what the patient should expect over the course of their treatment, provide appropriate teaching regarding when to notify the office should problems arise, and have a physical document that the patient can take home and read at their leisure to gain more insight into their disease and treatment. We additionally implemented standardized discharge summaries and teaching for patients in clinic, similar to the QI methodologies used by Shermont et al 9…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Decreasing Unexpected Returns to Orthopedic Hand Clinic: Improving Efficiency of Health Care Delivery

Little

Trehan

Cornwall

et al. 2018

Pediatric Quality &Amp; Safety

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Purpose:An unexpected return to clinic (URTC) visit can place a substantial financial burden on patients and families while stressing the health care system. Our SMART aim was to decrease the rate of URTC visits from 1.8 per 100 patient follow-up visits by 50% using quality improvement methodology.Methods:The rate of URTC visits was tracked at our tertiary care pediatric hospital from February 1, 2014, to May 31, 2015, using a weekly P-chart. Interventions were studied from January 1 to May 31, 2015. Pareto charts determined the common causes of URTC visits. Interventions were studied using Plan-Do-Study-Act cycles. Medical charges for URTC patient visits were collected and patients/families were given a cost survey to determine nonmedical costs associated with the clinic visits.Results:Cast issues (50.5%) were most common, followed by new symptom/complaints (29.5%), and persistent or worse symptoms (15.2%). Following interventions, URTC rates decreased from 1.8 to 0.7 (⇓62%) per 100 follow-up visits during the study period. Interventions were targeted toward cast use and improved patient education via standardized materials. The average URTC resulted in $350.38 of charges. Additionally, the average URTC cost families $70 for a half day of lost wages and travel expenses.Discussion:Applying quality improvement methodology to URTC visits by standardizing patient education and minimizing cast usage resulted in a substantial decrease in the number of patients returning to clinic, both for scheduled follow-ups and unexpectedly. This improvement resulted in a savings of more than $420 per visit saved, including medical and nonmedical costs.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Decreasing Unexpected Returns to Orthopedic Hand Clinic: Improving Efficiency of Health Care Delivery

Little

Trehan

Cornwall

et al. 2018

Pediatric Quality &Amp; Safety

View full text Add to dashboard Cite

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“…Use of ePED in hospitals with different acuity levels of pediatric care or without Magnet status may result in wider variability of discharge teaching scores. Optimizing the patient/family experience (Shermont, Pignataro, Humphrey, & Bukoye, 2016;Wood et al, 2017) is a priority for healthcare systems in the current era of performance measurement and value-based care, yet nurses often feel unprepared to teach (Lahl, Modic, & Siedlecki, 2013). Having the ePED app available to facilitate discharge teaching provides a structure to assist the nurse in applying evidence-based teaching strategies that promotes the nurse's confidence as an effective teacher.…”

Section: Discussionmentioning

confidence: 99%

Using the Engaging Parents in Education for Discharge (ePED) iPad Application to Improve Parent Discharge Experience

Lerret

Johnson

Polfuss

et al. 2020

Journal of Pediatric Nursing

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The purpose of this study was to evaluate the use of the Engaging Parents in Education for Discharge (ePED) iPad application on parent experiences of hospital discharge teaching and care coordination. Hypotheses were: parents exposed to discharge teaching using ePED will have 1) higher quality of discharge teaching and 2) better care coordination than parents exposed to usual discharge teaching. The secondary purpose examined group differences in the discharge teaching, care coordination, and 30-day readmissions for parents of children with and without a chronic condition. Design/Methods Using a quasi-experimental design, ePED was implemented on one inpatient unit (n = 211) and comparison group (n = 184) from a separate unit at a pediatric academic medical center. Patient experience outcome measures collected on day of discharge included Quality of Discharge Teaching Scale-Delivery (QDTS-D) and care coordination measured by Care Transition Measure (CTM). Thirty-day readmission was abstracted from records. Results Parents taught using ePED reported higher QDTS-D scores than parents without ePED (p = .002). No differences in CTM were found between groups. Correlations between QDTS-D and CTM were small for ePED (r = 0.14, p 0.03) and non-ePED (r = 0.29, p < .001) parent groups. CTM was weakly associated with 30-day readmissions in the ePED group. Conclusion The use of ePED by the discharging nurse enhances parent-reported quality of discharge teaching. Practice implications The ePED app is a theory-based structured conversation guide to engage parents in discharge preparation. Nursing implementation of ePED contributes to optimizing the patient/family healthcare experience.

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“…1 Researchers reported families identified that feeling unprepared for discharge contributed to a return to the emergency department (ED). 1,2 When a discharged patient returns to the ED, these visits can be complicated by a readmission to the hospital. Patients and their families can experience effects of hospital resource reutilization due to inpatient readmission, including financial and/or psychosocial suffering from lost work revenue, high health care costs, and disruption in family relationships.…”

mentioning

confidence: 99%

A Multidisciplinary Approach to Improving the Pediatric Discharge Process

Jubic

Dick

Moelber

2021

Journal of Nursing Care Quality

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Background: A collaborative and multidisciplinary shared responsibility with providing discharge information to pediatric patients/families can support successful reassimilation to life posthospitalization. Problem: An analysis of the current discharge process at an urban pediatric hospital identified variations in discharge practices and instructions. Approach: A multidisciplinary taskforce used the Plan-Do-Study-Act methodology to standardize the discharge process including creating a discharge template, adopting a new education platform, enhancing the electronic health record, and implementing strategies to improve discharge. Outcomes: There was a reduction in 7-day readmission rate from preintervention 4.58 to postintervention for 4 consecutive quarters of 3. 92, 4.20, 3.44, and 3.41, respectively. Percentile ranking and top box scores of the patient satisfaction measure of discharge preparation increased from 12th-62nd to 65th-95th percentile postimplementation and 81% to 88%, respectively. Conclusions: A local improvement initiative related to standardization of the discharge process resulted in a reduction in 7-day readmission rate and improved patient satisfaction scores.

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Reducing Pediatric Readmissions

Cited by 33 publications

References 21 publications

Decreasing Unexpected Returns to Orthopedic Hand Clinic: Improving Efficiency of Health Care Delivery

Decreasing Unexpected Returns to Orthopedic Hand Clinic: Improving Efficiency of Health Care Delivery

Using the Engaging Parents in Education for Discharge (ePED) iPad Application to Improve Parent Discharge Experience

A Multidisciplinary Approach to Improving the Pediatric Discharge Process

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