Successful Electronic Implementation of Discharge Referral Decision Support Has a Positive Impact on 30‐ and 60‐day Readmissions

Abstract

In a quasi-experimental study decision support software was installed in three hospitals to study the ability to scale (spread) its use from one hospital on paper to three hospitals as software, and to examine the effect on 30 and 60-day readmissions. The Discharge Decision Support System (D2S2) software analyzes data collected by nurses on admission with a proprietary risk assessment tool, identifies patients in need of post-acute care, and alerts discharge planners. On six intervention units, with a concurrent comparison group of 76 units, we examined the implementation experience and compared readmission outcomes before and after implementation. The software implementation finished one month ahead of schedule, the software performed reliably. High-risk patients admitted in the experimental phase after implementation of D2S2 decision support had significantly fewer 30-day readmissions (a decrease 22.2% to 9.4%) When high and low risk patients were analyzed together, D2S2 achi8eved a 33% relative reduction in 30 day readmissions (13.1% to 8.8%) and sustained a 37% relative reduction at 60 days. The software, available commercially through RightCare Solutions, was adopted by the health system and remains in use after 22 months. The D2S2 risk assessment tool can be installed easily in existing EHR systems. Future research will focus on how the tool influences discharge decision-making and how its accuracy can be improved in specific settings.

Identifying distinct risk profiles to predict adverse events among community-dwelling older adults

“…Additionally, the risk profiles, if further refined, could be integrated into clinical decision support systems to assist clinicians identify specific community-based referrals needed by older adults according to their level of risk. 45 Classifying community dwelling older adults into three risk profiles may also be helpful to determine the intensity and type of services to render according to their level of risk. These results also provide support for nurse-led community-based interventions and a road-map of critical information to increase efficiency and improve the care and services provided to chronically-ill, community-dwelling older adults and reduce potentially avoidable and costly events such as hospitalization, ED visits and death among this already vulnerable population.…”

Patient Preferences for Information on Post-Acute Care Services

“…Hospital systems could utilize their volunteer workforce by pairing volunteers who had experienced a PAC service to patients with questions. Moreover, decision support interventions such as the D2S2 may help to identify and alert case managers upon admission as to which patients are likely to need PAC to start discharge planning processes and discussions early (Bowles, et al, 2014a; Bowles, et al, 2014b). …”

“…Inclusion criteria were as follows: age 55 or older, and in need of PAC as determined by the Discharge Decision Support System (D2S2). The D2S2 is an evidenced based screening tool that identifies patients upon hospital admission who are likely to need PAC services (Bowles, et al, 2014a; Bowles, et al, 2014b). Exclusion criteria included the following: cognitively impaired (determined by documentation in the medical record or nurse report), unable to respond to interview questions, non-English speaking, and on do-not-resuscitate comfort care status (DNR-C).…”

Why older adults may decline offers of post-acute care services: A qualitative descriptive study

“…The electronic health record was used by hospital staff to prescreen participants to establish eligibility. Eligibility inclusion criteria were study participants must have been (1) age 55 or older and (2) determined to have been in need of PAC as indicated by the Discharge Decision Support System (D2S2), an evidenced-based screening tool used by the hospital that identifies patients upon hospital admission who are likely to need PAC services (8, 9). Study participant exclusion criteria were: cognitive impairment, inability to respond to interview questions, inability to speak English, and those documented as do-not-resuscitate (DNR) comfort care.…”