It has long been acknowledged that unplanned re-hospitalizations cost the U.S. health care system billions of dollars each year. Researchers at Boston University Medical Center have been working on a project to reduce readmission rates by improving and standardizing the hospital discharge process. Thanks in part to the intersection of national policy with their clinical goals, the researchers’ work has begun to attract widespread interest. The initiative, called Project Re-Engineered Discharge (RED), is still in a randomized control trial phase, but initial results show that using the RED protocol may significantly reduce readmission rates, says Brian Jack, MD, the project’s principal investigator. Jack is an associate professor and vice chair for academic affairs in the department of family medicine at Boston University School of Medicine and Boston Medical Center.
August 7, 2019
Re-engineering the Discharge Process to Reduce Readmissions
01/21/2011
Newsletter Article
It has long been acknowledged that unplanned re-hospitalizations cost the U.S. health care system billions of dollars each year. Researchers at Boston University Medical Center have been working on a project to reduce readmission rates by improving and standardizing the hospital discharge process. Thanks in part to the intersection of […]
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It has long been acknowledged that unplanned re-hospitalizations cost the U.S. health care system billions of dollars each year. Researchers at Boston University Medical Center have been working on a project to reduce readmission rates by improving and standardizing the hospital discharge process. Thanks in part to the intersection of national policy with their clinical goals, the researchers’ work has begun to attract widespread interest. The initiative, called Project Re-Engineered Discharge (RED), is still in a randomized control trial phase, but initial results show that using the RED protocol may significantly reduce readmission rates, says Brian Jack, MD, the project’s principal investigator. Jack is an associate professor and vice chair for academic affairs in the department of family medicine at Boston University School of Medicine and Boston Medical Center.
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August 7, 2019
Health care transitions: a review of integrated, integrative, and integration concepts
01/21/2011
Journal Article
In this article, several views of the terms integration, integrated, and integrative are considered with the hopes that this brief review will help to raise awareness, clarify various uses of these terms, and add to the continuing discussion of integration and how we might improve health care. Models of integrative […]
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In this article, several views of the terms integration, integrated, and integrative are considered with the hopes that this brief review will help to raise awareness, clarify various uses of these terms, and add to the continuing discussion of integration and how we might improve health care. Models of integrative care, views of integration, and samples of different interpretations and definitions are offered.
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August 7, 2019
Developing the Tools to Administer a Comprehensive Hospital Discharge Program: The Re-Engineered Discharge (RED) Program
01/21/2011
White Paper
Introduction: The hospital discharge is nonstandardized and marked with poor quality. One in five hospital discharges is complicated by an adverse event (AE) within 30 days, many of which lead to emergency department visits and rehospitalizations. Methods: Using an iterative group process, we developed the principles and components of the […]
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Introduction: The hospital discharge is nonstandardized and marked with poor quality. One in five hospital discharges is complicated by an adverse event (AE) within 30 days, many of which lead to emergency department visits and rehospitalizations. Methods: Using an iterative group process, we developed the principles and components of the ReEngineered Discharge (RED), a set of 11 distinct components designed to prepare patients for discharge. Three tools were created: a training manual used to train discharge nurses to provide the RED; an individualized, patient-friendly “After Hospital Care Plan” (AHCP), a booklet used to prepare patients for discharge; and a workstation to integrate all pertinent discharge information used to electronically create the AHCP. Outcomes: The RED was adopted by the National Quality Forum (NQF) as one of their “Safe Practices.” Among the intervention subjects, 89 percent were provided with an AHCP at discharge; it required approximately 1 hour for the discharge advocate to provide the RED intervention. Implications: Use of the AHCP tool can effectively prepare patients for discharge, as recommended by NQF 2006 Safe Practice number 11. These results have important implications for quality of care at discharge and for lowering costs.
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August 7, 2019
Hospitalists as emerging leaders in patient safety: lessons learned and future directions
01/21/2011
Journal Article
OBJECTIVE To examine the results of a multi-institution, hospitalist-centered consortium designed to disseminate knowledge of best practices relevant to patient safety and to facilitate institutional innovation around such practices. METHODS The Hospitalists as Emerging Leaders in Patient Safety (HELPS) consortium consisted of a hospitalist lead and a patient safety representative […]
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OBJECTIVE To examine the results of a multi-institution, hospitalist-centered consortium designed to disseminate knowledge of best practices relevant to patient safety and to facilitate institutional innovation around such practices. METHODS The Hospitalists as Emerging Leaders in Patient Safety (HELPS) consortium consisted of a hospitalist lead and a patient safety representative from each of 9 health care systems in southeastern Michigan. The consortium's aim was to provide rapid dissemination of best practices in patient safety through regular group meetings and to facilitate implementation and analysis of hospitalist-led patient safety initiatives. Key safety targets included prevention of device-related infections, creating a culture of safety, care transitions, medication safety, fall prevention, perioperative care, intensive care unit safety, and end-of-life care. Participating institutions were free to implement any of the best practices and had access to the expertise of the HELPS coordinating site. Surveys were used to assess knowledge dissemination among participants. RESULTS Participating institutions described their patient safety initiative and identified several key barriers and facilitators encountered during implementation. Common themes emerged among both barriers and facilitators. In postmeeting surveys to measure dissemination, consortium participants answered a mean of 84.2% (SD = 19.2) of the questions correctly. CONCLUSIONS The HELPS consortium successfully disseminated knowledge regarding best practices and identified common barriers and facilitators faced by hospitalists and institutions attempting to improve safety. The next step is to transform the consortium into a robust quality collaborative that leverages key facilitators and prospectively addresses barriers to implementing high-impact interventions in a multihospital setting.
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August 7, 2019
Center to Advance Palliative Care (CAPC)
01/01/2014
Web Site
Center to Advance Palliative Care (CAPC). [Web site]. http://www.capc.org/ . Updated 2014. Accessed July 29, 2014. The Center to Advance Palliative Care (CAPC) provides health care professionals with the tools, training and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings.
Center to Advance Palliative Care (CAPC). [Web site]. http://www.capc.org/ . Updated 2014. Accessed July 29, 2014. The Center to Advance Palliative Care (CAPC) provides health care professionals with the tools, training and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings.
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August 7, 2019
Hospital at Home
01/21/2011
Web Site
As the number of older adults with acute health needs grows, hospitals need more innovative and cost effective ways to treat these patients. Hospital at Home provides safe, high-quality, hospital-level care to older adults in the comfort of their own homes. Developed by the Johns Hopkins School of Medicine and […]
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As the number of older adults with acute health needs grows, hospitals need more innovative and cost effective ways to treat these patients. Hospital at Home provides safe, high-quality, hospital-level care to older adults in the comfort of their own homes. Developed by the Johns Hopkins School of Medicine and tested at medical centers across the country, this innovative care model reduces complications, is highly rated by patients and caregivers, diminishes caregiver stress, and lowers health care costs by nearly one-third. If you are looking for innovative care solutions to solve your hospital’s growing business challenges, we can help you implement this program and bring quality care to your patients.
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August 7, 2019
Nursing home procedures on transitions of care
01/21/2011
Journal Article
OBJECTIVE To identify nursing home standards through a nationwide survey of directors of nursing regarding transitions of care for residents transferred from acute care hospitals to skilled nursing facilities (SNFs). METHODS A national survey was distributed online and was completed by 241 directors of nursing of SNFs. The directors of […]
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OBJECTIVE To identify nursing home standards through a nationwide survey of directors of nursing regarding transitions of care for residents transferred from acute care hospitals to skilled nursing facilities (SNFs). METHODS A national survey was distributed online and was completed by 241 directors of nursing of SNFs. The directors of nursing were asked about communication methods, transfer of records, and staff involvement with admissions from acute care hospitals. RESULTS The results of the survey demonstrated widespread use of an admission coordinator in the nursing home to direct admissions to the facility. Admission nurses consistently had the most responsibility for ascertaining the correct medication regimen on admission to the facility. Although there was a variation in types of records received from the hospitals, more than 80% received medication administration record or discharge/transfer sheet within 1hour of a patient's arrival. CONCLUSION The results of this survey demonstrate that although direct verbal communication is not the norm, communication via paper documentation of transfer information is highly common. There was a statistically significantly increased likelihood of the SNF receiving the discharge/transfer sheet and the last medication list when it was directly affiliated with the transferring hospital. These affiliations would increase as a result of proposed payment changes that would bundle Medicare Part A acute hospital payments with the SNF payment.
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August 7, 2019
Improving handoffs in the emergency department
01/21/2011
Journal Article
Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure […]
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Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care. The purpose of this article is to provide the most up-to-date evidence and collective thinking about the process and safety of handoffs between physicians in the ED. It offers perspectives from other disciplines, provides a conceptual framework for handoffs, and categorizes models of existing practices. Legal and risk management issues are also addressed. A proposal for the development of handoff quality measures is outlined. Practical strategies are suggested to improve ED handoffs. Finally, a research agenda is proposed to provide a roadmap to future work that may increase knowledge in this area.
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August 7, 2019
AAHSA White Paper— National Studies in Caregiving: Implications for Providers
01/21/2011
White Paper
As the aging Baby Boom generation swells the ranks of America’s older population over the next 20 years, there will be an ever-increasing need for family caregiver support. In 2004, it was estimated that there were 44 million family caregivers in the U.S.1 To date, 80 percent of the long-term […]
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As the aging Baby Boom generation swells the ranks of America’s older population over the next 20 years, there will be an ever-increasing need for family caregiver support. In 2004, it was estimated that there were 44 million family caregivers in the U.S.1 To date, 80 percent of the long-term care provided in the home is provided by a family member. 2 Other reports show that family caregivers represent an economic value to our society of $375 billion annually in the care they provide our seniors.3 While the role of family caregivers is essential, it is often overlooked and undervalued by health care professionals for a variety of reasons, not the least of which is that many family caregivers do not self-identify. In addition, many health care professionals do not view family caregivers as part of a primary care team.
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August 7, 2019
A quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes
01/21/2011
Journal Article
OBJECTIVES To study the feasibility and effectiveness of a discharge planning intervention. DESIGN Quasi-experimental pre-post study design. SETTING General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital. PARTICIPANTS All patients aged 65 and older admitted to the hospitalist services. INTERVENTION […]
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OBJECTIVES To study the feasibility and effectiveness of a discharge planning intervention. DESIGN Quasi-experimental pre-post study design. SETTING General medicine wards at three hospitals: an academic medical center, a community teaching hospital, and a community-based nonteaching hospital. PARTICIPANTS All patients aged 65 and older admitted to the hospitalist services. INTERVENTION The intervention toolkit had five core elements: admission form with geriatric cues, facsimile to the primary care provider, interdisciplinary worksheet to identify barriers to discharge, pharmacist-physician collaborative medication reconciliation, and predischarge planning appointments. MEASUREMENTS Thirty-day readmission and return to emergency department rates and patient satisfaction with discharge. Odds ratios were determined, and site effects were examined accordig to interaction terms and Breslow Day statistics. RESULTS Two hundred thirty-seven patients were followed during the preintervention period, and 185 were exposed to the intervention. Patients characteristics were similar across the two time periods. The proportion of patients with high-quality transitions home, measured according to Coleman's Care Transition Measures, increased from 68% to 89% (odds ratio (OR)=3.49, 95% confidence interval (CI)=2.06-5.92). Return to the emergency department within 3 days of discharge was lower in the intervention period (10% vs 3%, OR=0.25, 95% CI=0.10-0.62). At 30 days, there was a lower rate of readmission (22% vs 14%, OR=0.59, 95% CI=0.34-0.97) and fewer visits to the emergency department (21% vs 14%, OR=0.61, 95% CI=0.36-1.03) (P=.06). CONCLUSION When hospitalized elderly patients are treated with consideration of their specific needs, healthcare outcomes can be improved.
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