scholarly journals Effective discharge policy: are we getting there?

2004 ◽  
Vol 28 (3) ◽  
pp. 255 ◽  
Author(s):  
Sandy Middleton ◽  
Michael Appleberg ◽  
Seham Girgis ◽  
Jeanette E Ward
Keyword(s):  
Primary Care ◽  
Health Policy ◽  
Length Of Stay ◽  
Carotid Endarterectomy ◽  
Telephone Survey ◽  
Univariate Analysis ◽  
Discharge Summary ◽  
Effective Discharge ◽  
Discharge Policy ◽  
Discharge Summaries

Purpose: To determine patients? knowledge before admission about how many days they were likely to be hospitalised and, after discharge, to determine patients? perceptions of their ?readiness? to leave hospital following carotid endarterectomy. Usefulness of discharge communications to patients? GPs also was ascertained. Methods: Pre- and post-operative self-administered questionnaires to 133 patients and a followup telephone survey of GPs providing primary care to 118 of these patients. Results: Pre-operatively, the majority (84.2%) of patients recalled being told how many days they were likely to be hospitalised. Univariate analysis did not demonstrate any factors predicting positive recall. The majority (87.0%) of patients perceived themselves ?ready to go home? at discharge. Twenty-eight GPs (23.7%) had received both a discharge summary from the hospital and a personalised letter from the patient?s surgeon. GP?s rated the surgeons? letters as significantly more useful than discharge summaries (P = 0.01). Conclusions: Although hospitals are required by NSW Health?s Effective Discharge Policy to inform patients about their likely length of stay in hospital, not all patients recalled whether they were so informed pre-operatively. Barriers impeding realisation of the NSW Health policy remain.

scholarly journals Real-life implementation of guidelines on the hospital-to-home transition for older patients: a cohort study in general practice

2019 ◽  
Vol 49 (1) ◽  
pp. 46-51
Author(s):  
Aline Hurtaud ◽  
François Lallier ◽  
Matthieu Heidet ◽  
Charline Arnoult ◽  
Moustapha Dramé ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cohort Study ◽  
Hospital Discharge ◽  
Older Patients ◽  
Real Life ◽  
Discharge Summary ◽  
Life Assessment ◽  
Hospital To Home ◽  
Discharge Summaries

Abstract Background hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7 days. The relevance and feasibility of these guidelines have not previously been assessed. Objective to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors’ association with 30-day readmissions. Design a prospective multicentre cohort study. Setting primary care (general practice) in France. Subjects a sample of GPs and the same number of patients aged 75 or over having consulted within 30 days of hospital discharge. Methods the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7 days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses. Results seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53–76) consulted their GP within 7 days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27–50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07–0.91]). Conclusions compliance with the French guidelines on hospital-to-home transitions is insufficient.

Abstract TMP77: Predictors of Readmission After Stroke in a Cohort of Privately Insured Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Haitham M Hussein ◽  
Ella Chrenka ◽  
Amanda Herrmann ◽  
Carol Droegemueller
Keyword(s):  
Primary Care ◽  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Readmission Rate ◽  
Univariate Analysis ◽  
Insurance Plan ◽  
Stroke Center ◽  
The Impact ◽  
Privately Insured

Introduction: Reducing readmission rate is a healthcare priority. The aim of this project is to examine factors associated with readmission after stroke in a privately insured cohort. Methods: Our organization is a health insurance provider as well as a healthcare provider. We retrospectively identified members of our insurance plan who discharged from one of our family of hospitals (one comprehensive stroke center, one primary stroke center, and two stroke ready hospitals) 2014-2018 with a stroke diagnosis. Using insurance claims, we captured all readmissions and ER visits in the 30 days after discharge. Using the same data, we were also able to identify primary care visits in the year preceding and the month following the index stroke. The impact of primary care was examined in a univariate analysis and a multivariate analysis adjusting for age, sex, race, stroke type, and length of stay (LOS). Results: We identified 1177 patients after excluding those who were not members of our insurance plan and those who had a planned admission such as to inpatient rehab (mean age 71±15 years; 53% women; 17% non-white). Stroke types were 72% ischemic stroke; 12% TIA; 7% ICH; 4% SAH. Most common discharge destination was home 68% followed by skilled nursing facility 27%. Overall 30-day all-cause readmission rate was 31% (21% inpatient admission, 8% ER visit, and 2% both). In an unadjusted model, there was a significant association between number of primary care visits and probability of readmission (OR 0.60 [95% CI 0.50-0.72]; p<0.0001). This association remained significant in the multivariate analysis (OR 0.73 [95% CI 0.58-0.91]; p=0.005). Other variables independently associated with readmission include age, LOS, and ischemic type of stroke. There was no association between readmission and sex or race and no interaction between primary care and sex nor between primary care and race. Conclusion: Established primary care is protective from stroke readmission. In high risk patients (older age with ischemic stroke and prolonged length of stay), efforts should be made to arrange for primary care sooner than later.

scholarly journals Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rune Aakvik Pedersen ◽  
Halfdan Petursson ◽  
Irene Hetlevik ◽  
Henriette Thune
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Discourse Analysis ◽  
Knowledge Transfer ◽  
Health Care Services ◽  
Discharge Summary ◽  
Care Services ◽  
Discharge Summaries

Abstract Background The acute treatment for stroke takes place in hospitals and in Norway follow-up of stroke survivors residing in the communities largely takes place in general practice. In order to provide continuous post stroke care, these two levels of care must collaborate, and information and knowledge must be transferred between them. The discharge summary, a written report from the hospital, is central to this communication. Norwegian national guidelines for treatment of stroke, issued in 2010, therefore give recommendations on the content of the discharge summaries. One ambition is to achieve collaboration and knowledge transfer, contributing to integration of the health care services. However, studies suggest that adherence to guidelines in general practice is weak, that collaboration within the health care services does not work the way the authorities intend, and that health care services are fragmented. This study aims to assess to what degree the discharge summaries adhere to the guideline recommendations on content and to what degree they are used as tools for knowledge transfer and collaboration between secondary and primary care. Methods The study was an analysis of 54 discharge summaries for home-dwelling stroke patients. The patients had been discharged from two Norwegian local hospitals in 2011 and 2012 and followed up in primary care. We examined whether content was according to guidelines’ recommendations and performed a descriptive and interpretative discourse analysis, using tools adapted from an established integrated approach to discourse analysis.  Results We found a varying degree of adherence to the different advice for the contents of the discharge summaries. One tendency was clear: topics relevant here and now, i.e. at the hospital, were included, while topics most relevant for the later follow-up in primary care were to a larger degree omitted. In most discharge summaries, we did not find anything indicating that the doctors at the hospital made themselves available for collaboration with primary care after dischargeof the patient. Conclusions The discharge summaries did not fulfill their potential to serve as tools for collaboration, knowledge transfer, and guideline implementation. Instead, they may contribute to sustain the gap between hospital medicine and general practice.

scholarly journals Hospital initiation of benzodiazepines and Z-drugs in older adults and discontinuation in primary care

2020 ◽  
Author(s):  
Sean Coll ◽  
Mary E Walsh ◽  
Tom Fahey ◽  
Frank Moriarty
Keyword(s):  
Primary Care ◽  
Hospital Discharge ◽  
Multivariate Regression ◽  
Benzodiazepine Receptor ◽  
Electronic Record ◽  
Discharge Summary ◽  
Record Data ◽  
Discharge Summaries

Objective: To examine factors associated with continuation of hospital-initiated benzodiazepine receptor agonists (BZRAs) among adults aged ≥65 years, specifically instructions on hospital discharge summaries. Methods: This retrospective cohort study involved anonymised electronic record data on prescribing and hospitalisations for 38,229 patients aged ≥65 from forty-four GP practices in Ireland 2011-2016. BZRA initiations were identified among patients with no BZRA prescription in the previous 12 months. Multivariate regression examined whether instructions on discharge messages for hospital-initiated BZRA prescriptions was associated with continuation after discharge in primary care and time to discontinuation. Results: Most BZRA initiations occurred in primary care, however the rate of hospital-initiated BZRAs was higher. Almost 60% of 418 hospital initiations had some BZRA instructions (e.g. duration) on the discharge summary. Approximately 40% (n=166) were continued in primary care. Lower age, being prescribed a Z-drug or great number of medicines were associated with higher risk of continuation. Of those continued in primary care, in 98 cases (59.6%) the BZRA was discontinued during follow-up (after a mean 184 days). Presence of instructions was associated with higher likelihood of discontinuation (hazard ratio 1.67, 95%CI 1.09-2.55). Conclusions: Improved communication to GPs after hospital discharge may be important in avoiding long-term BZRA use.

Improving Coded Data Entry by an Electronic Patient Record System

1996 ◽  
Vol 35 (02) ◽  
pp. 108-111 ◽  
Author(s):  
F. Puerner ◽  
H. Soltanian ◽  
J. H. Hohnloser
Keyword(s):  
Phase I ◽  
Electronic Patient Record ◽  
Data Entry ◽  
Discharge Summary ◽  
Patient Record ◽  
Phase Iii ◽  
Electronic Patient Record System ◽  
Record System ◽  
Data Encoding ◽  
Discharge Summaries

AbstractData are presented on the use of a browsing and encoding utility to improve coded data entry for an electronic patient record system. Traditional and computerized discharge summaries were compared: during three phases of coding ICD-9 diagnoses phase I, no coding; phase II, manual coding, and phase III, computerized semiautomatic coding. Our data indicate that (1) only 50% of all diagnoses in a discharge summary are encoded manually; (2) using a computerized browsing and encoding utility this percentage may increase by 64%; (3) when forced to encode manually, users may “shift” as much as 84% of relevant diagnoses from the appropriate coding section to other sections thereby “bypassing” the need to encode, this was reduced by up to 41 % with the computerized approach, and (4) computerized encoding can improve completeness of data encoding, from 46 to 100%. We conclude that the use of a computerized browsing and encoding tool can increase data quality and the percentage of documented data. Mechanisms bypassing the need to code can be avoided.

Pain-Prescription Differences - An Analysis of 500,000 Discharge Summaries

2019 ◽  
Vol 11 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Saskia Preissner ◽  
Vishal B. Siramshetty ◽  
Mathias Dunkel ◽  
Paul Steinborn ◽  
Friedrich C. Luft ◽  
...  
Keyword(s):  
Pain Therapy ◽  
Opioid Analgesic ◽  
Developed Countries ◽  
Discharge Summary ◽  
Pain Reliever ◽  
Regulatory Guidelines ◽  
The Usa ◽  
Prescription Rates ◽  
East West ◽  
Discharge Summaries

Background: Pain-relief prescriptions have led to an alarming increase in drug-related abuse. Objective: In this study, we estimate the pain reliever prescription rates at a major German academic hospital center and compare with the nationwide trends from Germany and prescription reports from the USA. Methods: We analysed >500,000 discharge summaries from Charité, encompassing the years 2006 to 2015, and extracted the medications and diagnoses from each discharge summary. Prescription reports from the USA and Germany were collected and compared with the trends at Charité to identify the frequently prescribed pain relievers and their world-wide utilization trends. The average costs of pain therapy were also calculated and compared between the three regions. Results: Metamizole (dipyrone), a non-opioid analgesic, was the most commonly prescribed pain reliever at Charité (59%) and in Germany (23%) while oxycodone (29%), a semi-synthetic opioid, was most commonly ordered in the USA. Surprisingly, metamizole was prescribed to nearly 20% of all patients at Charité, a drug that has been banned for safety reasons (agranulocytosis) in most developed countries including Canada, United Kingdom, and USA. A large number of prospective cases with high risk for agranulocytosis and other side effects were found. The average cost of pain therapy greatly varied between the USA (125.3 EUR) and Charité (17.2 EUR). Conclusion: The choice of pain relievers varies regionally and is often in disagreement with approved indications and regulatory guidelines. A pronounced East-West gradient was observed with metamizole use and the opposite with prescription opioids.

scholarly journals P044 Can an electronic prescribing system ensure clear anticoagulation discharge communication?

2019 ◽  
Vol 104 (7) ◽  
pp. e2.49-e2
Author(s):  
Susie Gage
Keyword(s):  
Patient Safety ◽  
Discharge Summary ◽  
Electronic Prescribing ◽  
List Type ◽  
Heparin Infusion ◽  
National Patient Safety Agency ◽  
High Dependency ◽  
National Patient ◽  
Discharge Summaries

AimThe National Patient Safety Agency (NPSA)1 identified heparin as a major cause of adverse events associated with adverse incidents, including some fatalities. By ensuring good communication, this should be associated with risk reduction.1 The aim of this study was to ensure there is clear anticoagulation communication on discharge, from the paediatric intensive care unit (PICU) electronic prescribing system (Philips), to the paediatric cardiac high dependency unit and paediatric cardiac ward. To investigate whether the heparin regimen complies with the hospital’s anticoagulant guidelines and if there is any deviation; that this is clearly documented. To find out if there is an indication documented for the heparin regimen chosen and if there is a clear long term plan documented for the patient, after heparin cessation.MethodsA report was generated for all patients who were prescribed a heparin infusion on PICU, between 1st January 2018 and 30th June 2018, from the Philips system. All discharge summaries from the PICU Philips system were reviewed. Only paediatric cardiac patients were included that had a heparin infusion prescribed on discharge, all other discharge summaries were excluded from the study. Each discharge summary was reviewed in the anticoagulant section; for the heparin regimen chosen, whether it complies with the hospital’s anticoagulant guidelines and if there was any deviation whether this was documented. The indication documented of which heparin regimen was chosen and whether a clear long term plan was documented after heparin cessation; for example if the patient is to be transferred onto aspirin, clopidogrel, warfarin or enoxaparin.Results82 discharge summaries were reviewed over the 6 month period between 1st January 2018 and 30th June 2018; 16 were excluded as were not paediatric cardiac, leaving 66 paediatric cardiac discharge summaries that were reviewed. 45 out of 66 (68%) complied with the hospital’s heparin anticoagulation guidelines. Of the 32% that deviated from the protocol; only 33% (7 out of 21) had a reason documented. Only 50% (33) of the summaries reviewed had an indication for anticoagulation noted on the discharge summary and 91% of discharge summaries had a long term anticoagulant plan documented.ConclusionThe electronic prescribing system can help to ensure a clear anticoagulation communication as shown by 91% of the anticoagulation long term plan being clearly documented; making it a more seamless patient transfer. On the Philips PICU electronic prescribing system there is an anticoagulant section on the discharge summary that has 3 boxes that need to be completed; heparin regimen, indication and anticoagulation long term plan. However, despite these boxes; deviations from the anticoagulant protocol were poorly documented as highlighted by only 33% having the reason highlighted in the discharge summary, only 50% of the indications were documented. Despite having prompts for this information on the discharge summary, the medical staffs needs to be aware to complete this information, in order to reduce potential medication errors and risk.ReferenceThe National Patient Safety Agency (NPSA). Actions that make anticoagulant therapy safer. NPSA; March 2007.

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