scholarly journals Reducing Stroke Readmission Through the Implementation of Telehealth

2021 ◽  
Author(s):  
◽  
Leilani Hermosura
Keyword(s):  
Readmission Rate ◽  
Hospital Setting ◽  
Outcome Data ◽  
Stroke Patients ◽  
Post Discharge ◽  
Readmission Rates ◽  
Discharge Care ◽  
Practice Problem ◽  
The Impact

Practice Problem: Readmission occurs frequently among patients with stroke and because of this, the Centers for Medicare and Medicaid Services (CMS) have imposed programs to reduce 30-day readmissions among hospitals. The health care system must respond with transition of care, especially during the period of recent stroke to improve patient outcomes. PICOT: The PICOT question that guided this project was among patients with a recent diagnosis of stroke (P), what is the effect of a telehealth appointment with a nurse practitioner (NP) for post discharge follow-up (I), compared to a standard face-to-face clinic appointment (C), on 30-day readmissions rates (O), within two months (T)? Evidence: Stroke is the fourth leading cause of death and has a readmission rate of 14%. Past studies have demonstrated the effectiveness of telehealth in treating patients outside of the hospital setting, which suggests the potential of telehealth on post-discharge follow-up care. Intervention: To assess the impact of telehealth on 30-day readmission rates, stroke patients received a telehealth follow-up phone visit by a NP within ten days of being discharged to home. Outcome: Data was collected from participant’s electronic health records (EHR) and discharge databases from October 13 to November 13, 2020. Among participants, the implementation of telehealth visits demonstrated a reduced readmission rate of 6.25% for stroke patients. Conclusion: Telehealth is an effective, sustainable, and widely implementable strategy to provide post-discharge care to patients. This study outlined a framework to further analyze the effectiveness of telehealth visits in reducing 30-day readmission rates among stroke patients.

scholarly journals Impact of pharmacist-conducted anticoagulation patient education and telephone follow-up on transitions of care: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lamis R. Karaoui ◽  
Elsy Ramia ◽  
Hanine Mansour ◽  
Nisrine Haddad ◽  
Nibal Chamoun
Keyword(s):  
Tertiary Care ◽  
Intervention Group ◽  
Bleeding Event ◽  
Transitions Of Care ◽  
Control Group ◽  
Published Data ◽  
Post Discharge ◽  
Readmission Rates ◽  
The Impact

Abstract Background There is limited published data in Lebanon evaluating the impact of supplemental education for anticoagulants use, especially DOACs, on clinical outcomes such as bleeding. The study aims to assess the impact of pharmacist-conducted anticoagulation education and follow-up on bleeding and readmission rates. Methods This study was a randomized, non-blinded interventional study conducted between August 2017 and July 2019 in a tertiary care teaching Lebanese hospital. Participants were inpatients ≥18 years discharged on an oral anticoagulant for treatment. Block randomization was used. The control group received the standard nursing counseling while the intervention group additionally received pharmacy counseling. Phone call follow-ups were done on day 3 and 30 post-discharge. Primary outcomes included readmission rates and any bleeding event at day 3 and 30 post-discharge. Secondary outcomes included documented elements of education in the medical records and reported mortality upon day 30 post-discharge. Results Two hundred patients were recruited in the study (100 patients in each study arm) with a mean age of 73.9 years. In the pharmacist-counseled group, more patients contacted their physician within 3 days (14% versus 4%; p = 0.010), received explicit elements of education (p < 0.001) and documentation in the chart was better (p < 0.05). In the standard of care group, patients were more aware of their next physician appointment date (52% versus 31%, p < 0.001). No difference in bleeding rates at day 3 and 30 post-discharge was observed between the groups. Conclusions Although pharmacist-conducted anticoagulation education did not appear to reduce bleeding or readmission rates at day 30, pharmacist education significantly increased patient communication with their providers in the early days post-discharge. Trial registration Lebanon Clinical Trial Registry LBCTR2020033424. Retrospectively registered. Date of registration: 06/03/2020.

scholarly journals Age Based Trends for Unplanned Pediatric Rehospitalizations in the United States

2021 ◽  
Author(s):  
Nupur Amritphale ◽  
Amod Amritphale ◽  
Deepa Vasireddy ◽  
Mansi Batra ◽  
Mukul Sehgal ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Readmission Rate ◽  
Age Groups ◽  
The United States ◽  
Unplanned Readmission ◽  
Post Discharge ◽  
Readmission Rates ◽  
Discharge Care ◽  
Hospital Readmission Rate ◽  
Bowel Diseases

BACKGROUND AND OBJECTIVES: Hospital readmission rate helps to highlight the effectiveness of post- discharge care. There remains a paucity of plausible age based categorization especially for ages below one year for hospital readmission rates. METHODS: Data from 2017 Healthcare cost and utilization project National readmissions database was analyzed for ages 0-18 years. Logistic regression analysis was performed to identify predictors for unplanned early readmissions. RESULTS: We identified 5,529,389 inpatient pediatric encounters which were further divided into age group cohorts. The overall rate of readmissions was identified at 3.2%. Beyond infancy, the readmission rate was found to be 6.7%. Across all age groups, the major predictors of unplanned readmission were cancers, diseases affecting transplant recipients and sickle cell patients. It was determined that reflux, milk protein allergy, hepatitis and inflammatory bowel diseases were significant comorbidities leading to readmission. Anxiety, depression and suicidal ideation depicted higher readmission rates in those older than 13 years. Across ages 1-4 yrs, dehydration, asthma and bronchitis were negative predictors of unplanned readmission. CONCLUSIONS: Thirty-day unplanned readmissions remain a problem leading to billions of tax-payer-dollars lost per annum. Effective strategies for mandatory outpatient follow-up may help the financial aspect of care while also enhancing the quality of care.

scholarly journals A Study of Short Term Outcomes among Covid-19 Patients Discharged without Follow up In the New York Metropolitan Area

2021 ◽  
pp. 85-92
Author(s):  
Louise Molmenti Christine ◽  
Mitra Neil ◽  
Shah Abhinit ◽  
Flynn Anne ◽  
Brown Zenobia ◽  
...  
Keyword(s):  
New York ◽  
Functional Status ◽  
Metropolitan Area ◽  
Phone Call ◽  
Post Discharge ◽  
Readmission Rates ◽  
York Metropolitan Area ◽  
New York Metropolitan Area ◽  
The Impact

Background: A shortage of beds, high case volume, decreased availability of outpatient medical doctors, and limited disease knowledge resulted in the premature discharge and poor follow up of COVID-19 patients in the New York Metropolitan Area. Objective: The primary objective of this retrospective study and phone survey was to characterize the demographics and clinical outcomes (e.g., readmission rates, comorbidities, mortality, and functional status) of COVID-19 patients discharged without follow-up. The secondary objective was to assess the impact of race and comorbidities on readmission rates and the extent to which patients were escalated to another care provider. Methods: Electronic medical records were reviewed for COVID-19 patients discharged from 3 NYMA hospitals in March 2020. Follow up data regarding medical status, ability to perform activities of daily living and functional status was also obtained from patients via phone call. The Chi-square, Fishers exact test and t-tests were used to analyze the data. Results: 349 patients were included in the analysis. The hospital readmission rate was 10.6% (58.8% for pulmonary reasons) and did not differ by race. 74.3% of readmissions were <14 days after release. The post-discharge mortality rate was 2.6%. Hypertension was the most common comorbidity (43%). There was a statistically significant association between mortality and number of comorbidities (p=<0.0001). 82% of patients were contacted by phone. 66.6% of patients returned to pre-COVID baseline function in ≥1 month. As a result of information obtained on the follow up phone call, 4.2% of patients required “escalation” to another provider. Conclusion: Discharging COVID-19 patients without prearranged follow up was associated with high readmission and mortality rates. While the majority of patients recovered, prolonged weakness, lengthy recovery, and the need for additional medical intervention was noted. Further work to assess the effectiveness COVID-19 post-discharge programs is warranted.

scholarly journals Development and implementation of a discharge pathway protocol for detained offenders with intellectual disabilities

2017 ◽  
Vol 8 (3) ◽  
pp. 144-154 ◽  
Author(s):  
John L. Taylor ◽  
Susan Breckon ◽  
Christopher Rosenbrier ◽  
Polly Cocker
Keyword(s):  
Intellectual Disabilities ◽  
Discharge Planning ◽  
Community Services ◽  
Outcome Data ◽  
Post Discharge ◽  
Readmission Rates ◽  
Content Type ◽  
Lengths Of Stay ◽  
The Right ◽  
The Impact

Purpose Building the Right Support, a national plan for people with intellectual disabilities (ID) in England aims to avoid lengthy stays in hospital for such people. Discharge planning is understood to be helpful in facilitating successful transition from hospital to community services, however, there is little guidance available to help those working with detained patients with ID and offending histories to consider how to affect safe and effective discharges. The paper aims to discuss these issues. Design/methodology/approach In this paper, the development and implementation of a multi-faceted and systemic approach to discharge preparation and planning is described. The impact of this intervention on a range of outcomes was assessed and the views of stakeholders on the process were sought. Findings Initial outcome data provide support for the effectiveness of this intervention in terms of increased rates of discharge, reduced lengths of stay and low readmission rates. Stakeholders viewed the intervention as positive and beneficial in achieving timely discharge and effective post-discharge support. Practical implications People with ID are more likely to be detained in hospital and spend more time in hospital following admission. A planned, coordinated and well managed approach to discharge planning can be helpful in facilitating timely and successful discharges with low risks of readmission. Originality/value This is the first attempt to describe and evaluate a discharge planning intervention for detained offenders with ID. The intervention described appears to be a promising approach but further evaluation across a range of service settings is required.

scholarly journals Decreasing Readmissions in Medically Complex Children

2020 ◽  
Author(s):  
◽  
Colleen Bartlett
Keyword(s):  
Medication Reconciliation ◽  
Hospital Readmissions ◽  
Outcome Evaluation ◽  
Evidence Based ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital System ◽  
Practice Problem ◽  
Telephone Calls

Practice Problem: There was a report of an existing practice problem of increased 30-day readmission rates in medically complex children at an outpatient clinic within an extensive hospital system. Hospital readmissions can cause clinical, social, and financial burdens to the patients and their families and thus reflected a need for interventions to reduce readmissions. PICOT: The PICOT question that guided this change project: In medically complex pediatric patients ages 0-17, what is the effect of a discharge intervention bundle in reducing all-cause 30-day hospital readmissions compared to current practice within an 8-week timeframe? Evidence: The literature revealed 18 pertinent studies that fit the inclusion and exclusion criteria that promoted a discharge intervention bundle. The themes within the evidence included post-discharge telephone calls, follow-up appointments, medication reconciliation, and education with teach-back to reduce overall readmission rates. Intervention: The evidence-based intervention utilized the bundle of post-discharge telephone calls within 72 hours, follow up appointments within 7 days, and medication reconciliation with education and teach-back through in-person and virtual care. The clinic nurses championed the intervention and tracked all the data using a check sheet. Outcome: Evaluation of the outcome measures confirmed a decrease in all-cause 30-day readmissions from 23% to 14.5% within the project timeframe. Implications of the findings support the existing evidence for implementing a multifaceted bundle to decrease readmissions. Conclusion: The evidence-based change project decreased all-cause 30-day readmissions rates. The results of the project proved that implementing consistent discharge standards in medically complex children helped guide medical staff, improved patient outcomes, saved costs to the organization, and reduced 30-day all-cause hospital readmissions.

scholarly journals Evaluation of Bronchodilator Use During Chronic Obstructive Pulmonary Disease Exacerbation Inpatient Admissions

2018 ◽  
Vol 54 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Sarah E. Petite ◽  
Julie A. Murphy
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Hospital Admission ◽  
Pulmonary Disease ◽  
Readmission Rate ◽  
Hospital Setting ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease ◽  
The Impact

Background: It is unknown whether the timing of initiation of a long-acting bronchodilator (LABD) during a chronic obstructive pulmonary disease (COPD) exacerbation or the method of short-acting bronchodilator (SABD) delivery may aid in improving patient outcomes. Objective: The goal of this study was to determine the impact of bronchodilator management in the hospital setting on clinical outcomes in patients with COPD exacerbation. Methods: This retrospective, single-center study evaluated patients admitted to the non-intensive care unit setting with a COPD exacerbation as defined by the International Classification of Diseases, Ninth Revision codes. The primary outcome was difference in 30-day readmission rates for early LABD therapy (<24 hours from hospital admission) versus late/no LABD therapy (>24 hours from hospital admission or not during hospitalization). Secondary objectives included length of stay (LOS) for this group, and 30-day readmission rates and LOS for the SABD via inhaler versus nebulizer groups. Results: Two hundred twenty patients were included. There was no difference in 30-day readmission rate (15.2% vs 18.2%, P = .6) and LOS (median 4 [interquartile range, IQR 3-6]) days for both groups, P = .34) between early versus late/no LABD therapy initiation, respectively. No difference was observed in 30-day readmission rate (16.7% vs 16.6%) and LOS (median 2.5 [IQR 1.1-3.9] days vs median 4 [IQR 2-6] days) between inhaler and nebulizer SABD therapy groups. Conclusions: No difference was observed in 30-day readmission rates or LOS when utilizing early LABD compared with late/no LABD therapy or comparing inhaler and nebulizer SABD delivery methods during COPD exacerbation.

Abstract 106: Success in Failure: Reduction in 30-Day Readmissions in Primary and Secondary Heart Failure

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Sushee Gadde ◽  
Catharine Aune ◽  
Bassam Omar ◽  
Barbara Burckhartt
Keyword(s):  
Heart Failure ◽  
Nurse Practitioners ◽  
Readmission Rate ◽  
Positive Impact ◽  
Heart Association ◽  
High Morbidity ◽  
Post Discharge ◽  
Readmission Rates ◽  
Heart Failure Patients ◽  
The Impact

Background: Heart failure (HF) remains an epidemic with high morbidity, mortality and cost, which has been largely attributed to 30-day readmissions, with a national average of 23%. OBJECTIVE: To assess the impact on readmission rates of a heart failure clinic dedicated to taking care of advanced heart failure patients with limited resources and multiple readmissions. Methods: A multidisciplinary heart failure team was established, including a lead physician, case managers, pharmacist, social service, dietary, nurse manager, nurse practitioners and HF RN. Guideline-directed medical therapy (GDMT) was enforced through standardized inpatient and outpatient order sets and algorithms, post-discharge one week follow-up appointments, and a structured transition of patient care from the inpatient to the outpatient setting. Free medications were secured when needed. The 30-day readmission rates were analyzed over a 3-year period since the inception of the program, using the Chi-square test. Results: The total 30-day readmission rate prior to implementation of the heart failure team was 12.4%, with 4.9% readmitted with heart failure as a primary cause (primary), and 7.5% readmitted with heart failure as a secondary cause (secondary). In the following year, the total readmission rate was 10.5% (4.9% primary and 5.6% secondary). Two years later, the total readmission rate fell drastically to 5.7% (1.8% primary and 3.9% secondary, P < 0.05). Increased compliance with clinic visit appointments and adherence to GDMT recommendations were documented, in addition to demonstration of overall institutional cost-saving. Discussion: Congestive heart failure is an extremely morbid and costly epidemic associated with high mortality. The 30-day readmission rates add tremendously to the cost of caring for heart failure patients, in addition to further worsening the overall morbidity and mortality. We report the experience of a small university-based program in addressing this problem utilizing a multidisciplinary team, in addition to external resources, to enforce GDMT, and improve patient participation and compliance with treatment recommendations. The total readmission rates significantly declined, with the biggest impact observed when heart failure was the primary diagnosis. The heart failure team was awarded the American Heart Association Get With The Guidelines (GWTG) Heart Failure Gold Plus Quality Achievement Award, in recognition of the significant positive impact the team had on the overall care of heart failure patients. Our model should be applicable to other practices, with little additional resources and with increased coordination, yielding tremendous clinical improvements and overall net financial savings.

Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

2020 ◽  
pp. 1-6
Author(s):  
Paul Park ◽  
Victor Chang ◽  
Hsueh-Han Yeh ◽  
Jason M. Schwalb ◽  
David R. Nerenz ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Spinal Surgery ◽  
Readmission Rate ◽  
Rating Scale ◽  
Short Term ◽  
Readmission Rates ◽  
Opioid Prescribing ◽  
Number Of Patients ◽  
Before And After ◽  
The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

scholarly journals 763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S340
Author(s):  
Kathleen R Sheridan ◽  
Joshua Wingfield ◽  
Lauren McKibben ◽  
Natalie Clouse
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Model Of Care ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

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