Timely discharge of older patients from hospital: improving the process

Dainty, Philip; Elizabeth, Jimmy

doi:10.7861/clinmedicine.9-4-311

Cited by 15 publications

(11 citation statements)

References 16 publications

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“…MDTs were used in all the included studies in an attempt to improve medication management on discharge of patients to RACFs . This is by no means a revolutionary concept, because MDTs have been shown in the past to be a vital factor in effective and safe discharge planning . All the interventions were focused on providing medication information on discharge, but only two studies also attempted to provide RACF nursing staff with a medication administration chart .…”

Section: Discussionmentioning

confidence: 99%

Interventions to improve the continuity of medication management upon discharge of patients from hospital to residential aged care facilities

Fredrickson

Burkett

2019

Pharmacy Practice and Res

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Aim: The aim of this study was to undertake a systematic review of the literature and evaluate interventions used to improve continuity of medication management upon transition of care from an acute hospital setting to a residential aged care facility (RACF). Data sources: Embase, PubMed, The Cochrane Database of Systematic Reviews, Google Scholar, Informit Health Collection, grey literature and reference mining of included studies (from inception to March 2018). Study selection: Interventions aimed at improving the continuity of medication management upon discharge of patients from hospital to an RACF or similar facility were included. Interventions were defined as a communication tool or a service initiated by any healthcare professional. Studies were excluded if they were not available in English, had certain study designs (i.e. qualitative, observational and systematic review) and if no abstract and full-text article could be obtained. Results: Seven studies met the inclusion criteria. All interventions involved a multidisciplinary approach to discharge facilitation including the provision of discharge medication information. Six studies included pharmacist-led medication reconciliation. Two studies used an RACF-specific medication chart. Although positive findings were shown for most interventions, critical analysis of the studies included identified many limitations. Conclusion: Interventions involving a multidisciplinary team, pharmacist-led medication reconciliation and the provision of accurate discharge information have been identified as improving continuity of medication management during transitions of care from hospital to RACF. Importantly, this systematic review has identified an ongoing need for development of a comprehensive intervention that addresses all barriers to optimal continuity of medications encountered during this high-risk transition.

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Section: Discussionmentioning

confidence: 99%

Interventions to improve the continuity of medication management upon discharge of patients from hospital to residential aged care facilities

Fredrickson

Burkett

2019

Pharmacy Practice and Res

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“…The need for families and patients to be involved in discharge planning and agree to the plan is critical. 16 The majority of families and patients in this study reported that they did not know or were unsure of the length of hospital stay. In fact, many patients reported that they were returning home.…”

Section: Discussionmentioning

confidence: 80%

Analysis of the Influencing Factors Associated With Being Designated Alternate Level of Care

Barnable¹,

Welsh²,

Lundrigan³

et al. 2014

Home Health Care Management & Practice

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A health care organization within the Western region of Newfoundland and Labrador has been experiencing high levels of alternate level of care (ALC) cases and days within their acute care units. The majority of these individuals are older adults. The overall goal of this mixed-methods study was to identify factors for becoming designated ALC and to present recommendations for early intervention. This research found that older female adults with co-morbid conditions who access emergency medical services often are admitted to a hospital. The authors also found that once these patients are admitted to an acute care unit, they tend to experience functional decline that may also result in being designated ALC. This study outlines recommendations that may prevent patients from being designated ALC.

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“…Also, dispositions against medical advice cannot be uniformly described as they occur for a variety of reasons, usually with inadequate characterization. LOS categories that would be difficult to optimize are those of shorter length: drug prescription and compliance is of such short nature that it cannot be predictable or manageable; furthermore, this is the period of time when a lot of expensive drugs have to be used to treat acute medical or surgical situations [15,16] …”

Section: Discussionmentioning

confidence: 99%

In-hospital drug-use optimization using the Marginal Utility Theory

Zgheib

Cecchetti

et al. 2011

Journal of Pharmaceutical Health Services Research

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Objective To use cost‐utility analysis as an application of the Marginal Utility Theory whereby optimal drug use in terms of optimal drug cost and volume is estimated based on the diminishing marginal utility conditions. Methods Data were collected between 2003 and 2005 from the billing system of two large hospitals that belong to the University of Pittsburgh Medical Center. Domains of interest were stored and correlated in a multidimensional, highly structured Drug Use and Management System (DRUMS) developed by the Center for Clinical Pharmacology at the University of Pittsburgh. Optimal in‐hospital drug use is achieved when there are equal marginal rates of substitution between in‐hospital drug use and therapeutic outcome subject to diminishing marginal utility conditions. Key findings Patient disposition after hospitalization and length of stay appeared to be reliable indicators of patient therapeutic outcome. Drug cost and volume were over‐extended in patients with a length of stay exceeding 20 days and disposition into long‐term care, implying over‐utilization and/or over‐prescribing of drugs. All categories of length of stay and disposition were investigated; they each present a different potential for cost‐utility optimization. Conclusion We recommend that entrepreneurial hospital strategists adopt knowledge systems such as DRUMS to analyse aggregate data, and use cost utility as a tool for aggregate in‐hospital drug use analyses.

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Timely discharge of older patients from hospital: improving the process

Cited by 15 publications

References 16 publications

Interventions to improve the continuity of medication management upon discharge of patients from hospital to residential aged care facilities

Interventions to improve the continuity of medication management upon discharge of patients from hospital to residential aged care facilities

Analysis of the Influencing Factors Associated With Being Designated Alternate Level of Care

In-hospital drug-use optimization using the Marginal Utility Theory

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