scholarly journals Thirty-day medical and surgical readmission following prenatal versus postnatal myelomeningocele repair

2019 ◽  
Vol 47 (4) ◽  
pp. E14 ◽  
Author(s):  
Michael Cools ◽  
Weston Northam ◽  
William Goodnight ◽  
Graham Mulvaney ◽  
Scott Elton ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Lengths Of Stay ◽  
Surgery Patient ◽  
Csf Diversion ◽  
Surgery Rates ◽  
Repair Group

OBJECTIVEHospital readmission is an important quality metric that has not been evaluated in prenatal versus postnatal myelomeningocele (MMC) repair. This study compares hospital readmission outcomes between these two groups as well as their etiologies.METHODSThe medical records of patients who had undergone MMC repair in the period from 2011 to 2017 at a single academic medical center were retrospectively reviewed. Collected clinical data included surgery and defect details, neonatal intensive care unit (NICU) stay, and any readmissions or surgical procedures up to 1 year after surgery. Patient and defect characteristics, readmission outcomes at 30 and 60 days and 1 year after discharge from the NICU, and cerebrospinal fluid (CSF) diversion surgery rates were analyzed with the two-tailed t-test and/or k-sample test on the equality of medians.RESULTSA total of 24 prenatal and 34 postnatal MMC repairs were completed during the study period. Prenatally repaired patients were born more prematurely (p < 0.001) and with lower birth weights (p < 0.001), although the NICU stay was similar between the two groups (p = 0.59). Fewer prenatally repaired patients were readmitted at 30 days (p = 0.005), 90 days (p = 0.004), and 1 year (p = 0.007) than the postnatal repair group. Hydrocephalus was the most common readmission etiology, and 29% of prenatal repair patients required CSF diversion at 1 year versus 81% of the postnatal repair group (p < 0.01). Prenatal patients who required CSF diversion had a higher body weight (p = 0.02) and an older age (p = 0.01) at the time of CSF diversion surgery than the postnatal group.CONCLUSIONSPatients with prenatal MMC repair had fewer hospital readmissions at 30 days, 60 days, and 1 year than the postnatal repair group, despite similar NICU lengths of stay. The prenatal repair group had lower requirements for CSF diversion at 1 year and was older with greater body weights at the time of CSF diversion surgery, compared to those of the postnatal repair group. Future study of hospital quality metrics such as readmissions should be performed to better understand outcomes of these two procedures.

scholarly journals Advancing Pharmacy Practice through an Innovative Ambulatory Care Transitions Program at an Academic Medical Center

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 40
Author(s):  
Jamie Cavanaugh ◽  
Nicole Pinelli ◽  
Stephen Eckel ◽  
Mark Gwynne ◽  
Rowell Daniels ◽  
...  
Keyword(s):  
Usual Care ◽  
Hospital Readmission ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Care Transition ◽  
Day Hospital ◽  
Transition Intervention ◽  
Academic Medical

Hospital readmissions are common and often preventable, leading to unnecessary burden on patients, families, and the health care system. The purpose of this descriptive communication is to share the impact of an interdisciplinary, outpatient clinic-based care transition intervention on clinical, organizational, and financial outcomes. Compared to usual care, the care transition intervention decreased the median time to Internal Medicine Clinic (IMC) or any clinic follow-up visit by 5 and 4 days, respectively. By including a pharmacist in the hospital follow-up visit, the program significantly reduced all-cause 30-day hospital readmission rates (9% versus 26% in usual care) and the composite endpoint of 30-day health care utilization, which is defined as readmission and emergency department (ED) rates (19% versus 44% usual care). Over the course of one year, this program can prevent 102 30-day hospital readmissions with an estimated cost reduction of $1,113,000 per year. The pharmacist at the IMC collaborated with the Family Medicine Clinic (FMC) pharmacist to standardize practices. In the FMC, the hospital readmission rate was 6.5% for patients seen by a clinic-based pharmacist within 30 days of discharge compared to 20% for those not seen by a pharmacist. This transitions intervention demonstrated a consistent and recognizable contribution from pharmacists providing direct patient care and practicing in the ambulatory care primary care settings that has been replicated across clinics at our academic medical center.

scholarly journals Effect of a Pediatric Prescription Medication Discharge Program on Reducing Hospital Readmission Rates

2017 ◽  
Vol 22 (2) ◽  
pp. 94-101 ◽  
Author(s):  
Laura A. Leathers ◽  
Kristy L. Brittain ◽  
Kelly Crowley
Keyword(s):  
Hospital Readmission ◽  
Medical Center ◽  
Heart Defects ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Prescription Medication ◽  
Primary Objective ◽  
Counseling Program

OBJECTIVES To evaluate the pediatric prescription medication discharge delivery and counseling program, implemented at an 186-bed children's hospital integrated within a larger academic medical center, and its effectiveness on reducing hospital readmissions. METHODS This study was a retrospective chart review of existing data in the electronic medical record from patients &lt;21 years of age who were discharged from our institution between September 1, 2014, and November 30, 2014. Patients who participated in the pediatric discharge program were compared to non-participants. The primary objective was to determine if the patient was readmitted within 30 days. Secondary objectives included time until readmission, diagnosis at discharge, and hospital unit at discharge. RESULTS In total, 1804 patients were assessed. After exclusions, 932 subjects were included in the analysis. In total, 393 (42.2%) patients participated in the pediatric medication discharge and counseling program, and 539 did not participate. Of the patients who participated in the program, 52 were readmitted within 30 days (13.2%), compared with 67 patients (12.4%) who did not participate in the discharge program, p = 0.717. Patients with the diagnoses of malignancy and kidney injury were more likely to be readmitted within this time frame, and those with the diagnoses of heart defects or cardiology disorders and malignancy were more likely to participate in the pediatric prescription medication discharge program. CONCLUSION Participation in the pediatric discharge medication delivery and counseling program did not reduce hospital readmission rate within 30 days.

Pharmacist Transition-of-Care Services Improve Patient Satisfaction and Decrease Hospital Readmissions

2020 ◽  
pp. 089719002095826
Author(s):  
Katherine L. March ◽  
Michael J. Peters ◽  
Christopher K. Finch ◽  
Lauchland A. Roberts ◽  
Katie M. McLean ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Control Group ◽  
Readmission Rates ◽  
Improve Patient Satisfaction ◽  
Phone Calls ◽  
Improve Patient

Background: Pharmacists ability to directly impact patient satisfaction through increases in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys utilizing transitions-of-care (TOC) services is unclear. Methods: Retrospective analysis of TOC patients from 07/01/2018 to 03/31/2019 was conducted. Intervention (INV) patients received pharmacist medication reconciliation and education prior to discharge and post-discharge telephone follow-up. All other patients served as control group (CON). Primary outcome: Evaluate impact of TOC services on HCAHPS scores for “Communication about Medicines” and “Care Transitions.” Secondary outcomes: 30-day readmissions, quantification of prevented potential safety events, assessment of discharge prescriptions sent to the academic medical center outpatient pharmacy (MOP) for TOC patients. Results: Of 1,728 patients screened, 414 patients met inclusion criteria (INV = 414, CON = 1314). A significant improvement (14.7%; p = <0.0001) in overall medication-related HCAHPS results was seen when comparing pre- vs post-implementation of the TOC service. Statistically significant increases for individual questions “staff told you what the medicine was for” (14.2%; p = 0.018), “staff describe possible effects” (21.2%; p = 0.004), and “understood the purpose of taking medications” (11.4%; p = 0.035) were observed. A non-significant decrease in 30-day readmission rates for the groups was observed (CON 16.4%, INV 13.3%; p = 0.133); however, an unplanned subgroup analysis evaluating impact of discharge phone calls on 30-day readmission rates revealed a significant reduction of 17.3% to 12.4% (p = 0.007). One hundred forty-three medication safety event(s) were potentially prevented by the TOC pharmacist. Lastly, 562 prescriptions were captured at the MOP as a result of the TOC initiative. Conclusions: Pharmacy-based TOC models can improve patient satisfaction, prevent hospital readmissions, and generate revenue.

scholarly journals Rates and Types of Medication-Related Problems in Patients Rehospitalized Within 30 Days of Discharge From a Community Hospital

2019 ◽  
Vol 36 (2) ◽  
pp. 47-53
Author(s):  
Julie B. Cooper ◽  
Elizabeth Jeter ◽  
Cory John Sessoms
Keyword(s):  
Internal Medicine ◽  
Hospital Readmission ◽  
Adverse Drug Events ◽  
Community Hospital ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Readmission Rates ◽  
General Internal ◽  
Hospital Readmission Rates ◽  
Context Specific

Background: Impact of medication-related problems (MRPs) on persistently high hospital readmission rates are not well described. Objective: The purpose of this study was to determine the rate and type of MRPs attributed to rehospitalization within 30 days of discharge from a general internal medicine hospitalists’ service at a nonacademic medical center. Methods: A retrospective cohort study was conducted evaluating consecutive patients readmitted within 30-days after discharge to home from an internal medicine hospitalist service. Readmissions attributed to MRPs in physician documentation were systematically classified as indication, effectiveness, adverse drug reaction, or nonadherence problems and evaluated for possible preventability. Descriptive statistics were used to describe the rate and type of MRP. Results: Evaluation of consecutive 30-day readmissions (n = 203) to a nonteaching community hospital identified 50.2% of admissions attributed to MRPs. MRPs (n = 102) were categorized as problems of indication (34.3%), efficacy (19.6%), adverse drug events (18.6%), and nonadherence (27.5%). One third of 30-day readmissions in this cohort were attributed to potentially preventable MRPs. Conclusion: MRPs are frequently implicated in 30-day hospital readmissions in a nonteaching community hospital representing an opportunity for context-specific improvements.

scholarly journals Factors Associated With Extended Length of Stay and 90-Day Readmission Rates Following ACDF

2019 ◽  
Vol 10 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Brian L. Dial ◽  
Valentine R. Esposito ◽  
Richard Danilkowicz ◽  
Jeffrey O’Donnell ◽  
Barrie Sugarman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Multivariable Logistic Regression Analysis ◽  
Day Hospital ◽  
Readmission Rates ◽  
Factors Associated ◽  
Asa Score ◽  
Surgery Patient ◽  
Extended Length

Study Design: Retrospective. Objective: Identify patient risk factors for extended length of stay (LOS) and 90-day hospital readmissions following elective anterior cervical discectomy and fusion (ACDF). Methods: Included ACDF patients from 2013 to 2017 at a single institution. Eligible patients were subset into LOS <2 and LOS ≥2 days, and no 90-day hospital readmission and yes 90-day hospital readmission. Patient and surgical factors were compared between the LOS and readmission groups. Multivariable logistic regression analysis was utilized to determine the association of independent factors with LOS and 90-day readmission rates. Results: Our sample included 1896 patients; 265 (14%) had LOS ≥2 days, and 121 (6.4%) had a readmission within 90 days of surgery. Patient and surgical factors associated with LOS included patient age ≥65 years (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.15-2.56), marriage (OR 0.57, 95% CI 0.43-0.79), private health insurance (OR 0.28, 95% CI 0.15-0.50), American Society of Anesthesiologists (ASA) score (OR 1.52, 95% CI 1.12-1.86), African American race (OR 1.95, 95% CI 1.38-2.72), and harvesting iliac crest autograft (OR 4.94, 95% CI 2.31-10.8). Patient and surgical factors associated with 90-day hospital readmission included ASA score (OR 1.81, 95% CI 1.32-2.49), length of surgery (OR 1.002, 95% CI 1.001-1.004), and radiculopathy as indication for surgery (OR 0.60, 95% CI 0.39-0.96). Conclusions: Extended LOS and 90-day hospital readmissions may lead to poorer patient outcomes and increased episode of care costs. Our study identified patient and surgical factors associated with extended LOS and 90-day readmission rates. In general, preoperative patient factors affected these outcomes more than surgical factors.

scholarly journals The HOSPITAL score as a predictor of 30 day readmission in a university affiliated community hospital

2016 ◽  
Author(s):  
Robert Robinson
Keyword(s):  
High Risk ◽  
Hospital Readmission ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Assessment Tools ◽  
Medical Patients ◽  
Value Based Purchasing ◽  
Discriminatory Ability ◽  
Kaplan Meier ◽  
Increased Risk

Introduction Hospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP) program. Risk assessment tools have been developed to identify patients at high risk of hospital readmission so they can be targeted for interventions aimed at reducing the rate of readmission. One such tool is the HOSPITAL score that uses 7 readily available clinical variables to predict the risk of readmission within 30 days of discharge. The HOSPITAL score has been internationally validated in large academic medical centers. This study aims to determine if the HOSPITAL score is similarly useful in a moderate sized university affiliated hospital in the midwestern United States. Materials and Methods All adult medical patients discharged from the SIU-SOM Hospitalist service from Memorial Medical Center from October 15, 2015 to March 16, 2016, were studied retrospectively to determine if the HOSPITAL score was a significant predictor of hospital readmission within 30 days. Results During the study period, 998 discharges were recorded for the SIU-SOM Hospitalist service. The analysis includes data for the 963 patients who were discharged alive. Of these patients, 118 (12%) were readmitted to the same hospital within 30 days. The patients who were readmitted were less likely to have a length of stay greater than or equal to 5 days (45% vs. 59%, p = 0.003) but were more likely to have been admitted to the hospital within the last year. A receiver operating characteristic evaluation of the HOSPITAL score for this patient population shows a C statistic of 0.762 (95% CI 0.720 - 0.805), indicating good discrimination for hospital readmission. Kaplan-Meier analysis of 30-day readmission free survival showed a significant (p < 0.001) increase in the risk of readmission in patients with a HOSPITAL score of 5 or more. Discussion This single center retrospective study indicates that the HOSPITAL score has good discriminatory ability to predict hospital readmissions within 30 days for a medical hospitalist service a university-affiliated hospital. This data for all causes of hospital readmission is comparable to the discriminatory ability of the HOSPITAL score in the international validation study (C statistics of 0.72 vs. 0.762) conducted at considerably larger hospitals (975 average beds vs 507 at Memorial Medical Center) for potentially avoidable hospital readmissions. Higher risk patients, identified as having a HOSPITAL score of 5 or more, clearly show an increased risk of hospital readmission within 30 days. Conclusions The internationally validated HOSPITAL score may be a useful tool in moderate sized community hospitals to identify patients at high risk of hospital readmission within 30 days. This easy to use scoring system using readily available data can be used as part of interventional strategies to reduce the rate of hospital readmission.

scholarly journals Peripheral optical coherence tomography assisted by scleral depression in retinopathy of prematurity

2021 ◽  
Author(s):  
Brittni A. Scruggs ◽  
Shuibin Ni ◽  
Thanh-Tin P. Nguyen ◽  
Susan Ostmo ◽  
Michael F. Chiang ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Peripheral Retina ◽  
Optical Coherence ◽  
Rapid Acquisition ◽  
Study Participants ◽  
Rop Screening

Objective: To determine whether handheld widefield optical coherence tomography (OCT) can be used to document retinopathy of prematurity (ROP) stage while using scleral depression to improve peripheral views. Design: Prospective observational study. Participants: Consecutive neonates admitted to the neonatal intensive care unit (NICU) in a single academic medical center who also met criteria for ROP screening and consented for research imaging. Methods: Scleral depression was combined with widefield OCT using an investigational 400-kHz, 55-degree field of view handheld OCT during ROP screening from October 28, 2020 to March 03, 2021. Main Outcome Measures: Acquisition of en face and B-scan imaging of the peripheral retina to objectively assess early vitreoretinal pathology, including the demarcation between vascularized and anterior avascular retina, the presence of early ridge formation, and small neovascular tufts. Results: Various stages of ROP were detected using a rapid acquisition OCT system. In one neonate, serial OCT imaging over a five-week period demonstrated accumulation of neovascular tufts with progression to stage 3 ROP with extraretinal fibrovascular proliferation along the ridge. Videography of this technique is included in this report for instructional purposes. Conclusions: Serial examinations using widefield OCT and scleral depression may improve detection and documentation of ROP disease progression. Earlier detection of ROP-related proliferation may prevent vitreoretinal traction, retinal detachment, and blindness.

Holiday Discharges Are Associated with Higher 30-Day General Internal Medicine Hospital Readmissions at an Academic Medical Center

2019 ◽  
Vol 112 (6) ◽  
pp. 338-343
Author(s):  
Ajay Dharod ◽  
Brian J. Wells ◽  
Kristin Lenoir ◽  
Wesley G. Willeford ◽  
Michael W. Milks ◽  
...  
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
General Internal ◽  
Academic Medical

Implementation of a medication education training program for student pharmacists employed within an academic medical center

2020 ◽  
Vol 77 (3) ◽  
pp. 206-213
Author(s):  
Kisha A Dunkley ◽  
Doneisha Evelyn ◽  
Veronica Timmons ◽  
Tara T Feller
Keyword(s):  
Patient Education ◽  
Training Program ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Johns Hopkins Hospital ◽  
Adult Inpatient ◽  
Education Training ◽  
Survey Responses

Abstract Purpose To describe the implementation of a student pharmacist medication education training program (the REWARDS Method), to determine if training was effective in preparing employed student pharmacists to provide medication education, and to assess medication education completion rates. Summary Hospital readmissions are often attributable to poor transitions of care (TOC), and medication education prior to discharge may improve TOC. To expand upon existing medication education efforts, the Johns Hopkins Hospital Adult Inpatient Pharmacy (AIP) designed and implemented the REWARDS Method, a training program to prepare employed second- and third-year student pharmacists to provide medication education. The REWARDS Method includes 6 distinct steps, which incorporate student self-directed and pharmacist-facilitated learning. Students were trained to provide patient education targeting 4 classes of high-risk medications (anticoagulants, inhalers, insulin, and naloxone) on multiple inpatient units served by the AIP. A total of 43 hours of pharmacist time was needed to complete training for the 10 employed student pharmacists. A survey was used to assess preparedness for completing medication education. Survey responses indicated that participants were sufficiently to exceedingly prepared to perform medication education. The division’s completion rate for patients requiring education was 79% in 2017, compared to 86% in 2018 (p = 0.006). Conclusion The REWARDS Method is an effective training program that successfully incorporated employed student pharmacists into medication education efforts. Our study demonstrated high rates of students successfully completing training and an increase in the rate of patient education completion.

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