The Alice Springs Hospital Readmission Prevention Project (ASHRAPP): a randomised control trial

Abstract

BackgroundHospitals are frequently faced with high levels of emergency department presentations and demand for inpatient care. An important contributing factor is the subset of patients with complex chronic diseases who have frequent and preventable exacerbations of their chronic diseases. Evidence suggests that some of these hospital readmissions can be prevented with appropriate transitional care. Whilst there is a growing body of evidence for transitional care processes in urban, non-indigenous settings, there is a paucity of information regarding rural and remote settings and, specifically, the indigenous context.MethodsThis randomised control trial compares a tailored, multidimensional transitional care package to usual care. The objective is to evaluate the efficacy of the transitional care package for Indigenous and non-Indigenous Australian patients with chronic diseases at risk of recurrent readmission with the aim of reducing readmission rates and improving transition to primary care in a remote setting. Patients will be recruited from medical and surgical admissions to Alice Springs Hospital and will be followed for 12 months. The primary outcome measure will be number of admissions to hospital with secondary outcomes including number of emergency department presentations, number of ICU admissions, days alive and out of hospital, time to primary care review post discharge and cost-effectiveness.DiscussionSuccessful transition from hospital to home is important for patients with complex chronic diseases. Evidence suggests that a coordinated transitional care plan can result in a reduction in length of hospital stay and readmission rates for adults with complex medical needs. This will be the first study to evaluate a tailored multidimensional transitional care intervention to prevent readmission in Indigenous and non-Indigenous Australian residents of remote Australia who are frequently admitted to hospital. If demonstrated to be effective it will have implications for the care and management of Indigenous Australians throughout regional and remote Australia and in other remote, culturally and linguistically diverse populations and settings.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12615000808549- Retrospectively registered on 4/8/15.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2077-7) contains supplementary material, which is available to authorized users.

Frequency and Risk of Occupational Health and Safety Hazards for Home Healthcare Workers

“…Rising health care costs stemming from increased prevalence of chronic diseases, lengthy hospitalizations, and hospital readmissions have shifted the paradigm from in-hospital care to caring for clients in the home. 1,2 Cost containment strategies shifting care to the home have highlighted a vital role for home health care in reducing readmission rates and improving outcomes. [3][4][5] This important shift to care for clients in the home has increased demand for home health services and subsequently has led to an overwhelming need for home health care workers (HHCWs).…”

The Evaluation of Reasons for Re-admission to Family Physicians and Emergency Services and the Factors Affecting Satisfaction

“…This is usually because the patient does not receive adequate support from family, social environment and primary health care. Readmissions of these patients can be reduced by good care at home or with good protection (22).…”

“…Initiatives aimed at reducing admission to hospital can reduce the crowd in the emergency room, improve patient outcomes, and contribute positively to existing hospital facilities without requiring an additional cost and additional hospital beds. It was found that a comprehensive good discharge planning and temporary care were effective in reducing readmission to the hospital and facilitated follow-up with primary health care after discharge from the hospital (22).…”

Factors associated with emergency room visits within 30 days of outpatient foot and ankle surgeries

“…It has been shown that good transitional care is an important factor in preventing ED visits and readmission to the hospital. 12 Many of our patients are operated on in an ambulatory surgical center setting, where they receive a written postoperative instruction sheet prior to discharge. The instruction sheet includes a phone number to call for any questions or concerns.…”