scholarly journals Readmission Rates of Patients with Schizophrenia Treated with Depot Antipsychotics versus Oral Antipsychotics in a Community Hospital

Cureus ◽  
2018 ◽  
Author(s):  
Eduardo D Espiridion ◽  
Callum Lewandrowski ◽  
Shiva Shahriari ◽  
Dorothy F Bestoyong
Keyword(s):  
Community Hospital ◽  
Readmission Rates ◽  
Depot Antipsychotics

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.

Implementation of the Re-Engineered Discharge (RED) Toolkit to Decrease All-Cause Readmission Rates at a Rural Community Hospital

2014 ◽  
Vol 23 (3) ◽  
pp. 169-177 ◽  
Author(s):  
Carol J. Adams ◽  
Kimberly Stephens ◽  
Kimberly Whiteman ◽  
Hal Kersteen ◽  
Jeanne Katruska
Keyword(s):  
Rural Community ◽  
Community Hospital ◽  
Readmission Rates

Abstract 238: Heart Failure: Do We Get With the Guidelines?

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Jugeet Kanwal ◽  
NEHA PURI ◽  
Jonathan Finkel ◽  
Muhammad Sattar ◽  
Muhammad Usman Ali ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Medical Therapy ◽  
Real World ◽  
Community Hospital ◽  
Acute Decompensated Heart Failure ◽  
Real World Data ◽  
Readmission Rates ◽  
Salt Restriction ◽  
Reduced Ejection Fraction

Background: Acute decompensated heart failure is a leading cause of hospitalizations in adults older than 65 years. While randomized trials have shown medical therapy to be effective in reducing heart failure hospitalisations, real-world data showing the effectiveness of their implementation and impact on readmissions is scarce. This study aimed to evaluate ACC/AHA directed discharge practices for patients with heart failure with reduced ejection fraction (HFrEF) at a community hospital and its effect on 30-day readmission rates. Methods: This was a retrospective analysis of 868 patients admitted to a community hospital with HFrEF. HFrEF was confirmed for patients based on their most recent Echocardiogram. Data collection points included age, comorbidities (HTN, DM, CKD) and ejection fraction on last Echo. There were 2 primary measured outcomes: medications at discharge and 30-day readmission rates for HFrEF. Discharge medications were subdivided into a combination of either {ACEI/ARB, Beta-blocker (BB) and Spironolactone} or {ACEI/ARB and BB} or {Nitrates/Hydralazine}-all combinations recognised as guideline directed medical therapy (GDMT); or BB alone or ACEI alone. Secondary outcomes included fluid and salt restriction recommendations on discharge and its effect on 30-day readmission rates. Results: After applying exclusion criteria, 320 patients admitted from 2016-2019 for HFrEF were assessed. Using descriptive analyses, it was found that 77% of patients (247/320) were appropriately discharged on GDMT including a combination of {ACEI/ARB, BB and Spironolactone (59/320)}, {ACEI/ARB and BB (173/320)} and {Nitrates/Hydralazine (15/320)}, respectively. The remaining 23% patients were discharged on ACEI or BB alone (73/320). Only 4.38% of patients discharged on ACEI/ARB, BB and Spironolactone were readmitted within 30 days. Similar results were seen across the ACEI/ARB and BB arm (9.38%) and the Nitrates/Hydralazine arm (1.88%). Readmission was significantly higher for patients discharged on a BB alone (27.78%) or ACEI alone (28.57%). Readmission rates for patients recommended fluid and salt restriction versus those who were not, were not statistically significant. Conclusion: While ACC/AHA guidelines in accordance with Target HF, recommend early initiation of GDMT in HFrEF, our study aimed to assess real world implementation of these guidelines at a community hospital. Our study found that while our readmission rates remained higher than the national average (21.9%) in patients discharged on ACEI or BB alone, in agreement with trials, readmission rates were significantly lower in patients discharged in each combination of GDMT. Our study highlights the importance of greater focus on providing high-value care with high compliance with GDMT to reduce readmissions and improve patient outcomes.

scholarly journals Effective Decentralization of a Pharmacy Technician to Facilitate Delivery of Medications Prior to Discharge in a Community Hospital

2017 ◽  
Vol 33 (4) ◽  
pp. 123-127 ◽  
Author(s):  
Charles M. Van Gorder ◽  
Scott H. Yost ◽  
Jenna M. Negrelli ◽  
Scott H. Anderson ◽  
Carolyn Chew
Keyword(s):  
Community Hospital ◽  
Delivery Time ◽  
Readmission Rates ◽  
Improvement Project ◽  
Future Studies ◽  
Delivery Service ◽  
Pharmacy Technician ◽  
Time Period ◽  
Number Of Patients ◽  
Discharge Prescription

Background: There are many benefits to a well-designed prescription process and delivery service at the time of discharge from the hospital. However, the discharge prescription delivery service in our hospital has historically been infrequently utilized. Objective: To assess the number of patients with prescriptions in hand prior to discharge, the number of prescriptions filled, the duration of time to get discharge prescriptions to the floor, and the motivation patients had for declining the service. Methods: This single-center, quality improvement project was initiated as a pilot program from March through December 2015, utilizing a certified pharmacy technician (CPhT) on a 56-bed cardiovascular floor from Monday through Friday, 9:00 am to 5:30 pm. All patients discharged during the pilot time period were included in the analysis. The CPhT was responsible for collecting, inputting, processing, delivering, and charging for discharge prescriptions. Results: The number of patients utilizing the service increased from an average of 68 to 132 per month, pre- and postintervention, respectively. Total prescriptions increased from 296 preintervention to 456 postintervention per month. Prescription delivery time to the patient was decreased by 28 minutes. Conclusions: The utilization of a decentralized CPhT in a 56-bed cardiology unit at a large community hospital increased both the number of patients and total number of prescriptions filled prior to discharge. Future studies are warranted to evaluate medication interventions at discharge and readmission rates in patients who have prescriptions in hand prior to discharge versus those that do not.

Abstract 15503: Reasons for Incomplete Decongestion at Heart Failure Discharge from a Tertiary Center and Community Hospital

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Lauren G Gilstrap ◽  
Akshay S Desai ◽  
Roya Ghazinouri ◽  
Christina Carr ◽  
Roy Small ◽  
...  
Keyword(s):  
Heart Failure ◽  
Community Hospital ◽  
Care Center ◽  
Venous Pressure ◽  
Tertiary Care ◽  
Common Reason ◽  
Average Weight ◽  
Readmission Rates ◽  
Tertiary Referral Center ◽  
Tertiary Center

Introduction: Standardized Clinical Assessment and Management Plans (SCAMPs) are a novel tool forthe prospective auditing of clinical outcomes and quality improvement in areas of practice variation. Using the SCAMP methodology to address heart failure (HF) discharges, two sites collaborated to investigate adherence to guideline-recommended achievement of optimal volume status and reasons for deviation in clinical practice. Methods: Consecutive patients hospitalized for chronic HF at a tertiary referral center (Brigham and Women’s Hospital, Boston MA, n=108, 55.3%) and community hospital with a dedicated heart failure program (Lancaster General Hospital, Lancaster PA, n=87, 44.6%) were enrolled in a HF SCAMP which recommended discharge only after complete decongestion (defined by jugular venous pressure <8cmH20 and absence of lower extremity edema, orthopnea and rales). Reasons for deviation from were documented by the attending physician. 90 day readmission rates were recorded. Results: There were 195 patients enrolled. The average age at BWH was 64 years compared to 79 year at LGH. Overall, 57 (29%) patients had residual congestion at discharge, 37% of patients at BWH and 20% at LGH (p=0.01). However, the average weight change was -4.3kg at BWH and -3.8Kg at LGH. At BWH, the most common reason for inadequate decongestion was renal dysfunction (34% BWH vs. 6% LGH, p=0.04). At LGH, non-cardiac/chronic edema (“edema resistant”) was the most common reason (44% LGH vs. 17% BWH (p=0.08). Plan for continued diuresis at home was more common at LGH (LGH 19% vs. BWH 0%, p=0.03). At 90 days, 37% of congested patients and 23% of completely decongested patients had been readmitted (p=0.08). Conclusions: Nearly 1 in 3 patients admitted for worsening HF were discharged with residual congestion, which was more common at the tertiary care center and trended with higher readmission rates. The reasons for inadequate decongestion were different between sites.

The community-hospital library

JAMA ◽  
1965 ◽  
Vol 194 (10) ◽  
pp. 1097-1099
Author(s):  
D. Dralle
Keyword(s):  
Community Hospital
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