Literature Review
Key Literature
Table of Contents:
Patient and Caregiver Involvement
Preparing Patients And Caregivers To Participate In Care Delivered Across Settings: The Care Transitions Intervention.
Coleman EA, et al. J Am Geriatr Soc 2004; 52:1817-1825. PMID: 15507057.
When patients and caregivers take an active role in care transition and management, the patient is less likely to be readmitted to the hospital. Patients who received intervention measures during the transition process were about half as likely to return to the hospital after discharge.
Assessing The Quality Of Preparation For Posthospital Care From The Patient's Perspective: The Care Transitions Measure.
Coleman EA, Mahoney E, and Parry, C. Med Care 2005; 43:246-255. PMID: 15725981.
Care Transitions Measure (CTM) is a way to assess care transition from the patient's perspective. The CTM is a 15-item survey designed to measure the quality of care transition from the patient point of view. The authors suggest further study using this survey to determine its ability to be generalized over large hospital systems and geographical areas. Interesting points about patient perspective on posthospital transitions are raised.
The Care Transitions Intervention Results of a Randomized Controlled Trial.
Coleman, EA, Parry, C, Chalmers, S , Min, SJ. Arch Intern Med. 2006 Sep 25;166(17):1822-8. PMID: 17000937.
Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care transitions may reduce the rates of subsequent rehospitalization.
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Concerns Following Discharge from the Hospital; Reengineering Systems
Executing high-quality care transitions: a call to do it right.
Coleman EA, Williams MV. J Hosp Med 2007; 2:287-290. PMID: 17932992.
BOOSTing the Hospital Discharge.
Williams MV, Coleman EA. J Hosp Med 2009;3:209-210. PMID: 19388063.
A Reengineered Hospital Discharge Program to Decrease Rehospitalization: A Randomized Trial.
Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O'Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. Ann Intern Med. 2009 Feb 3;150(3):178-87. PMID: 19189907.
This trial, based at an academic, inner city, safety net hospital, randomized 749 general medical inpatients to receive a tripartite intervention vs. usual care. The intervention included a "Discharge Advocate," (who assisted with patient discharge preparation, medication reconciliation, national guideline adherence, and obtaining aftercare appointments), a low literacy, pictorial patient care plan (called the "After Hospital Care Plan"), and a follow-up phone call from a clinical pharmacist approximately 3-4 days after discharge. This intervention resulted in a 30% decrease in the combined endpoint of readmission and ED visits as well as improved self-assessed patient preparation for discharge, mitigated the effect of low literacy on readmission rates, and improved follow-up with aftercare providers.
The Impact Of Follow-Up Telephone Calls To Patients After Hospitalization.
Dudas V, Bookwalter T, et, al. Am J Med. 2001 Dec 21;111(9B):26S-30S. PMID: 12021756.
The Incidence And Severity Of Adverse Events Affecting Patients After Discharge From The Hospital.
Forster AJ et al. Ann Intern Med 2003; 138:161-167. PMID: 12558354.
Adverse events occur shortly after discharge from the hospital that could potentially be prevented. 19% of patients in the cohort had adverse events after discharge from the hospital. In 23 of the 76 reported cases, the adverse events were reportedly preventable. Adverse events included: lab errors, symptoms, and drug events.
Patient Safety Concerns Arising From Test Results That Return After Hospital Discharge.
Roy CL, Poon et al. Ann Inter Med 2005; 143:121-128. PMID: 16027454
Results of tests conducted in the hospital are not often available when a patient is discharged; physicians and patients may not be made aware of them. 9.4% of test results (N=2033) may have required action but physicians were not always aware of them.
"I Wish I Had Seen This Test Result Earlier!": Dissatisfaction With Test Result Management Systems In Primary Care.
Poon E, Gandhi T, Sequist T, et, al. Archives of Internal Medicine. 2004;164:2223-2228. PMID: 15534158.
The Hospital Discharge: A Review Of A High Risk Care Transition With Highlights Of A Reengineered Discharge Process.
Greenwald, JL. Denham, CR. Jack BW. J Patient Saf 2007;3:97-106. No PubMed abstract available. Last Accessed at http://www.bu.edu/fammed/projectred/publications.html March 4, 2008.
Reviews modifiable components of the hospital discharge process related to adverse events and rehospitalizations, including characteristics of the hospital, patient, and clinician. Through multi method analysis, describes principles thought to be important to the discharge process and delineates the reengineered discharge, a set of 11 discrete and mutually reinforcing components for hospital discharge.
Approximately One-Quarter Of Patients Had An AE After Hospital Discharge, And Half Of The AEs Were Preventable Or Ameliorable.
Adverse Events Among Medical Patients after Discharge from Hospital. Forster, AJ, Clark, H, Menard, A, et,al. CMAJ. 2004 Feb 3;170(3):345-9 PMID: 14757670
Tying Up Loose Ends: Discharging Patients With Unresolved Medical Issues.
Moore C, McGinn T, Halm E. Arch Intern Med. 2007 Jun 25;167(12):1305-11. PMID: 17592105.
Noncompletion of recommended outpatient workups after hospital discharge is common. PCP access to discharge summaries documenting the recommended workup is associated with better completion of recommendations.
Patient Safety Concerns Arising From Test Results Through Hospital Discharge.
Roy, C,. Poon,E, Karson, A, et, al. Ann Intern Med. 2005 Jul 19;143(2):121-8. PMID: 16027454
Many patients are discharged from hospitals with test results still pending, and physicians are often unaware of potentially actionable test results returning after discharge. Further work is needed to design better follow-up systems for test results returning after hospital discharge.
Safe Practices For Better Healthcare – 2006 Update: A Consensus Report.
National Quality Forum (NQF). Last Accessed at http://216.122.138.39/publications/reports/safe_practices_2006.asp March 4, 2008.
The Impact of Follow-Up Telephone Patients After Hospitalization.
Deficits In Communication And Information Transfer Between Hospital-Based And Primary Care Physicians: Implications For Patient Safety And Continuity Of Care.
Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW.JAMA. 2007 Feb 28;297(8):831-41. PMID: 17327525
Deficits in communication and information transfer at hospital discharge are common and may adversely affect patient care. Interventions such as computer-generated summaries and standardized formats may facilitate more timely transfer to primary care physicians.
Lost In Transition: Challenges And Opportunities For Improving The Quality Of Transitional Care.
Coleman EA, Berenson RA. Annals of Internal Medicine. Oct 5 2004;141(7):533-536. PMID: 15466770.
Closing The Quality Gap: A Critical Analysis Of Quality Improvement Strategies: Volume 7—Care Coordination, Structured Abstract.
Publication No. 04(07)-0051-7, June 2007. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/clinic/tp/caregaptp.htm accessed May 30, 2008.
Role Of Pharmacist Counseling In Preventing Adverse Drug Events After Hospitalization.
Schnipper JL, Kirwin JL, Cotugno MC, et al. Archives of Internal Medicine. Mar 13 2006;166(5):565-571. PMID: 16534045.
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Medication Reconciliation
Posthospital Medication Discrepancies: Prevalence And Contributing Factors.
Coleman EA, Smith JD, Raha D, Min SJ. Arch Intern Med 2005 Sept 12; 165:1842-7. PMID: 16157827.
Medical error and its relation to potentially serious warrants further investigation into medication reconciliation. Using the Medication Discrepancy Tool, a sample analysis of the geriatric population finds errors equally split between patient-associated and system-associated factors.
Unintended Medication Discrepancies At The Time Of Hospital Admission.
Cornish P, Knowles S, Marchesano R, et al. Arch Intern Med. 2005 Feb 28;165:424-9. PMID: 15738372.
A review of admissions into a Canadian medical facility reveals a drug discrepancy rate of 53.6%, with 38.6% of these errors that may lead to poor health.
Medication Use Leading To Emergency Department Visits For Adverse Drug Events In Older Adults.
Budnitz, D.S., Shehab, N. Ann Intern Med. 2007 Dec 4;147(11):755-65. PMID: 18056659.
Conclusion: Compared with other medications, Beers criteria medications caused low numbers of and few risks for emergency department visits for adverse events. Performance measures and interventions targeting warfarin, insulin, and digoxin use could prevent more emergency department visits for adverse events.
Standardizing Medication Labels: Confusing Patients Less. Workshop Summary Excerpt.
Hernandez, L.M., Rapporteur, Roundtable on Health Literacy. http://www.iom.edu/Default.aspx?id=53764 Accessed June 1, 2008.
Marked Improvement in Identifying and Preventing Medical Errors Found after Performing Reconciliation Process.
Medication Reconciliation: Verifying Medication Orders And Clarifying Discrepancies Should Be Standard Practice.
Ketchum K., Grass C., Padwojski A. AJN 2005;105(11):78-85. PMID: 16264317.
Comprehensive review of medication reconciliation, including tips for identifying errors, an admission/discharge home medication list, and online resources.
Medication Reconciliation In Acute Care: Ensuring An Accurate Drug Regimen On Admission And Discharge.
Rodehaver C, Fearing D. Jt Comm J Qual Patient Saf. 2005 Jul; 31(7): 406-13. PMID: 16130984.
As the result of a recent study in an Ohio medical system, 175 medical errors were reported per every 100 patient records reviewed. After executing the reconciliation concept, the error rate was reduced to 0.35%.
Patient Pre-Discharge Appointment
Evaluation Of A Medication Program For Elderly Hospital In-Patients.
Shen Q, Karr M, Ko A, et al. Geriatric Nursing. 2006 May-Jun;27(3):184-92. PMID: 16757390.
Before discharge medication education, one study reveals participants very limited knowledge of the brand names, prescribed frequency, dosage, and purpose of their medications. Pre-discharge review of medications provided improved patient understanding and reduced occurrences of medication error.
Risk Assessment-Determining Patients of Highest Risk of Readmission
Predicting Non-Elective Hospital Re-Admissions: A Multi-Site Study.
Smith D, Giobbie-Hurder A, Weinberger M, et al. Journal of Clinical Epidemiology 2000, 53 1113-8. PMID: 11106884.
31-50% of elderly hospitalized general medicine patients are experience non-elective readmissions within 90 days of discharge. Prior health care management, access to emergency care, and disease severity are among the top predicting factors of hospital readmissions.
Readmissions: A primary Care Examination Of Reasons For Readmission Of Older People And Possible Readmission Risk Factors.
Dobrzanska L, Newell R. Journal of Clinical Nursing. 2006 May;15(5):599-606. PMID: 16629969.
Pilot study indicates that patients readmitted from home experienced a patients discharged from home had a longer mean duration of readmission stay (14•14 days), compared to patients discharged to other settings (10•72 days). Patients from home also were readmitted later than those from another source (home: 14•65 - in care: 10 •75).
Interdisciplinary Collaboration
Effects Of A Multidisciplinary, Post-Discharge Continuance Of Care Intervention On Quality Of Life, Discharge Satisfaction, And Hospital Length Of Stay: A Randomized Controlled Trial.
Preen D, Bailey B, Wright A, et al. Int J Qual Health Care. 2005; Feb 17(1):43-51. PMID: 15668310.
Collaboration of health care providers improves mental quality of life, patient satisfaction.
From Vision To Reality: How To Actualize The Vision Of Discharging Patients From A Hospital, With An Increased Focus On Prevention.
Olsen L, Wagner L. Int Nurs. Rev. 2000 Sep;47(3):142-56. PMID: 11043484.
Literature review identifies barriers of partnership between healthcare professionals and demonstrates tools to actuate optimal patient discharge.
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Adverse Events After Discharge
The Incidence And Severity Of Adverse Events Affecting Patients After Discharge From The Hospital.
Forster A, et al. Ann Intern Med. 2003; 138: 161- 167. PMID: 12558354.
A study of 400 patients discharged from the medical service. Of the study population, 76 patients (19%) of patients suffered adverse events (AE). One third of the AEs were preventable. Another third were ameliorable. Ineffective communication contributed to many of these events. The most common types of AEs were:
- 66% related to drugs (e.g., analgesics, steroids, cardiovascular)
- 17% related to procedures
- A few related to infections and falls
This article concludes that nearly one in five patients experiences an adverse event (AE) during the transition from the hospital to home. Communications to the PCP at the time of discharge should not only include the new medication regimen, it should also contain specific information about what the follow-up MDs need to do, when they should do it, and what they should watch for. In addition, more effort must be made to effectively communicate this information to the patient.
Tying Up Loose Ends: Discharging Patients With Unresolved Medical Issues.
Moore C et al. Arch Intern Ned 2007;167:1305-1311. PMID: 17592105.
A study on 693 discharges found that 240 (27.6%) of patients had outpatient workups recommended. 35.9% of recommended workups were not completed. The top three failures involved diagnostic procedures (47.9%), subspecialty referrals (35.4%), and laboratory tests (16.7%). The most common diagnostic procedures not completed were diagnostic CT scans to follow up abnormalities seen on previous x-rays and endoscopic procedures to follow up on gastrointestinal bleeding.
The need for policies and service agreements between PCP and Hospitalists to clearly define whose job it is to order and follow up on these studies.
Frequency Of New Or Worsening Symptoms In The Posthospitalization Period.
Epstein K et al. Journal of Hospital Medicine 2007;2:58-68. PMID: 17431881.
A study of 15,767 patients contacted by a nurse within 5 days of hospital discharge. 1876 (11.9%) of patients reported symptoms that were new or worsened since hospital discharge. Of the patients with new or worsened symptoms, 37% required no nurse intervention since they had already notified a doctor or were doing something about the symptom. 63% had not notified their doctor and the nurse intervention in 72% of these cases was to notify the primary care provider or specialist.
Supports the need for early follow up, sometimes within 2-3 days of hospital discharge.
Adverse Events Among Medical Patients After Discharge From Hospital
Forster, AJ, et,al.. CMAJ. 2004 Feb 3;170(3):345-9. PMID: 14757670.
Medication Use Leading To Emergency Department Visits For Adverse Drug Events In Older Adults.
Budnitz, D.S., Shehab, N. Ann Intern Med. 2007 Dec 4;147(11):755-65. PMID: 18056659.
Conclusion: Compared with other medications, Beers criteria medications caused low numbers of and few risks for emergency department visits for adverse events. Performance measures and interventions targeting warfarin, insulin, and digoxin use could prevent more emergency department visits for adverse events.
Addressing Postdischarge Adverse Events: A Neglected Area.
Tsilimingras D, Bates DW. Jt Comm J Qual Patient Saf. 2008 Feb;34(2):85-97.
PMID: 18351193.
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Handoff Communication and Discharge
Transitions of Care Consensus Policy Statement American College of Physicians-Society of General Internal Medicine- Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians-Society of Academic Emergency Medicine.
Snow V, Beck D, Budnitz T, Miller DC, Potter J, Wears RL, Weiss KB, Williams MV. J Hosp Med 2009; 4:364-370. PMID: 19479781.
Promoting Effective Transitions Of Care At Hospital Discharge: A Review Of Key Issues For Hospitalists.
Kripilani S. Journal of Hospital Medicine 2007;2:314-323. PMID: 17935242.
A nice overview of the challenges faced at discharge and approaches to improvement. States that nearly half (49%) of hospitalized patients experience at least one medical error in medication continuity, diagnostic workup, or test follow-up. The challenges discussed include discontinuity between hospitalists and primary care physicians, changes to the medication regimen, new self-care responsibilities, and complex discharge instructions.
Deficits In Communication And Information Transfer Between Hospital-Based And Primary Care Physicians
Kripilani S. JAMA Feb 2007; 297(8):831-841. PMID: 17327525.
An extensive review of literature to characterize the prevalence of deficits in communication and information transfer at hospital discharge and to identify interventions to improve the process. The review included 55 observational studies and 18 controlled studies. Data from the observational studies were extracted on the availability, timeliness, content and format of discharge communications, as well as primary care physician satisfaction.
The availability of a discharge summary at the first post discharge visit was low (12-34%) and remained poor (51-77%) at 4 weeks, affecting the quality of care in approximately 25% of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results, discharge medications, test results pending at discharge, patient or family counseling, and follow-up plans.
Several interventions, including computer-generated discharge summaries and using patients as couriers, shortened the delivery time of discharge communications.Use of standardized formats to highlight the most pertinent information improved the perceived quality of documents.
Key Legal Principles For Hospitalists
Alpers, A. Am J Med 2001; 111(9B):5S-9S. PMID: 11790361.
The Hospitalist’s duty is two-fold: First, he or she must provide the patient with the information about the ongoing care required and the risks of not receiving such care. Second, the Hospitalist must ensure the PCP has enough information to provide high quality care when the patient presents in clinic.
The article asserts that the best risk-management (and patient safety) strategy after discharge will be to provide the patient with comprehensive, clear information and to ensure good communication between the Hospitalist and the PCP. The Hospitalist does not discharge ongoing obligations to the patient by discharging him or her from the hospital. Nor is the PCP excused from the responsibility for obtaining information about hospitalizations.
Key Recommendations of this article include: 1) Both Hospitalist and PCP assume responsibility for discharged patient 2) Inform patient of importance of follow-up care 3) Inform patient and PCP of pending or changed test results 4) Hospitalist and PCP coordinate contacting patients who miss follow-up care.
Primary Care Physician Attitudes Regarding Communication With Hospitalists.
Pantilat SZ, Lindenauer PK, Katz PP, Wachter RM. American Journal of Medicine.2001;111(9B):15S-20S. PMID: 11790363.
Continuity Of Care And Patient Outcomes After Hospital Discharge.
van Walraven C, Mamdani M, Fang J, Austin P. Journal of General Internal Medicine. 2004;19:624-631. PMID: 15209600.
A Quality Improvement Intervention to Facilitate the Transition of Older Adults from Three Hospitals Back to Their Homes
Param Dedhia, MD, Steve Kravet, MD, MBA, John Bulger, DO, Tony Hinson, MD, Anirudh Sridharan, MD, Ken Kolodner, ScD, Scott Wright, MD, and Eric Howell, MD PMID: 19694865
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Readmission
Rehospitalizations Among Patients in the Fee-for-Service Medicare Program.
Jencks SF, Williams MV, Coleman EA. N Engl J Med 2009;360(14): 1418-28. PMID: 19339721.
A Reengineered Hospital Discharge Program to Decrease Rehospitalization: A Randomized Trial.
Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O'Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. Ann Intern Med. 2009 Feb 3;150(3):178-87. PMID: 19189907.
This trial, based at an academic, inner city, safety net hospital, randomized 749 general medical inpatients to receive a tripartite intervention vs. usual care. The intervention included a "Discharge Advocate," (who assisted with patient discharge preparation, medication reconciliation, national guideline adherence, and obtaining aftercare appointments), a low literacy, pictorial patient care plan (called the "After Hospital Care Plan"), and a follow-up phone call from a clinical pharmacist approximately 3-4 days after discharge. This intervention resulted in a 30% decrease in the combined endpoint of readmission and ED visits as well as improved self-assessed patient preparation for discharge, mitigated the effect of low literacy on readmission rates, and improved follow-up with aftercare providers.
The Care Transitions Intervention
Coleman, Eric. Arch Intern Med 2006; 166:1822-1828. PMID: 17000937.
A randomized control trial of 750 patients ages 65 and above, comparing intervention versus usual care. Intervention patients received: 1) tools to promote cross-site communication, 2) encouragement to take a more active role in their care and to assert their preferences, and 3) continuity across settings and guidance from a “transition coach”.
Intervention patients had lower rehospitalization rates at 30, 90, and 180 days. Recognizing the key roles that patients and their caregivers play in improving care transitions appears to significantly reduce the rates of rehospitalizations, even in a heavily penetrated Medicare Advantage market. The cost of the intervention was $74,310, far less than a conservative projected annual cost savings of $295,594.
The Association Between The Quality Of Inpatient Care And Early Readmission.
Ashton CM et al. Ann Intern Med 1995;122(6): 415-421. PMID: 7856989.
A study of 2513 VA patients discharged after hospitalization for diabetes, chronic obstructive pulmonary disease, or heart failure. Studied the impact of three major process of care criteria with readmission in 14 days. The three process of care categories which defined “standard” versus “substandard care” were: 1) admission workup, 2) evaluation and treatment, and 3) readiness for discharge. For patients with diabetes and heart failure, increased risk of readmission was correlated with decreased readiness for discharge scores. For patients with COPD, increased readmission was correlated with decreased admission workup scores. Thus, 1 of 7 readmissions for diabetes, 1 of 5 readmissions for heart failure, and 1 of 12 readmissions for COPD were attributable to “substandard” care.
This study defines “readiness for discharge” criteria specific to chronic conditions of diabetes, CHF, and COPD. May help with CMI assessment of patient needs during care transitions.
Predicting Non-Elective Hospital Readmissions: A Multi-Site Study.
Smith DM et al. Journal of Clinical Epidemiology 2000;53:1113-1118. PMID: 11106884.
A study of 1378 patients from 9 VA medical centers to examine clinical and patient-centered factors predicting hospital readmission. The study population included patients discharged from the medical service with a diagnosis of diabetes mellitus, congestive heart failure, and/or chronic obstructive pulmonary disease. 23.3% of patients were readmitted. The two patient-centered factors significantly and independently associated with readmission were lower mental health status (SF-36) scores and higher satisfaction with access to emergency care. Of the disease variables, COPD increased risk for readmission.
Suggests importance of mental health/cognitive status and looking at particularly high-risk disease states for unmet medical, nursing, and social support needs at discharge.
Understanding Rehospitalization Risk: Can Hospital Discharge Be Modified To Reduce Recurrent Hospitalization?
Strunin L et al. Journal of Hospital Medicine 2007;2:297-304. PMID: 17935257.
Study of 21 patients interviewed after hospital discharge to assess continuity of care after discharge, need for and availibility of social support, and ability to obtain follow-up medical care.
The study population may not be generalizable (younger patients admitted to a public hospital) but study concludes that social circumstances rather than lack of medical knowledge posed a greater barrier to recuperation.
Readmissions: A Primary Care Examination of Reasons For Readmission Of Older People And Possible Readmission Risk Factors.
Dobrzanska L, Newell R. Journal of Clinical Nursing 2006; 15: 599-606. PMID: 16629969.
Study of patients aged 77 and older to examine reasons for emergency readmission within 28 days of hospital discharge. 69.7% of patients were readmitted for deterioration of existing medical condition. The mean days to readmission was 13.5. Weekend and holiday discharges were associated with increased likelihood of readmission.
Transition Of Care For Hospitalized Elderly Patients--Development Of A Discharge Checklist For Hospitalists.
Halasyamani L, Kripalani S, Coleman E, et al. Journal of Hospital Medicine. Nov 2006;1(6):354-360. PMID: 17219528.
To view the checklist, visit the Clinical Tools, Discharge Planning & Education section.
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Preparing Patients for Discharge
Better Transitions: Improving Comprehension of Discharge Instructions.
Chugh A, Williams MV, Grigsby J, Coleman EA. Frontiers 2009;25:11-31. PMID: 19382514.
Patients Understanding Of Their Treatment Plans And Diagnosis At Discharge.
Makaryus, AN, Friedman EA. Mayo Clin Proc. Aug 2005;80(8):991-994. PMID: 16092576.
A study of 43 patients surveyed at discharge to assess their knowledge of discharge diagnosis, medication treatment plan, and common side effects of prescribed medications. Only 27.9% were able to list all their medications, 37.2% were able to state the purpose of their medications, and 14% were able to state common side effects. Only 41.9% were able to state their diagnosis or diagnoses. The mean number of medications at discharge was 3.89. Patients were excluded if they were not oriented to person, place, and time or did not speak English.
Patients Understanding Of And Compliance With Medications: The Sixth Vital Sign?
Rosenow EC. Mayo Clin Proc. Aug 2005;80(8):983-987. PMID: 16092574.
Editorial regarding article above points out the following:
- It was estimated that direct costs of noncompliance of medication was greater that $50 billion and indirect costs were an additional $50 billion
- Health literacy in the US: 15% of English-speaking people are illiterate, 15% are marginally literate. Another 15-20% of the US population speak a language other than English as their primary language. This means that 50% of the US population are at high risk of misunderstanding the management plan and noncompliance.
- A study of 325 elderly patients, average age 78, showed that 39% were undable to read the prescription labels, 67% did not fully understand them, and as a result 45% were noncompliant.
Hospital Discharge Information And Older Patients: Do They Get What They Need?
Flacker J et al. Journal of Hospital Medicine 2007; 2:291-296. PMID: 17935256.
Study of 269 patients age 70 years or older. Telephone interview within 3 days of discharge to determine recall of discharge instructions by hospital staff, and to determine feasibility of posthospitalization survey in an urban, public hospital population.
More than half (54.2%) of respondents did not recall anyone talking with them about how to care for themselves after hospitalization. For patients who did recall receiving instructions, there was a positive correlation between the following: receiving both written and verbal instructions and patient understanding of instructions; provision of information and medication compliance; provision of information on what to do if problems arose and number of calls made to providers after discharge.
The study notes that implementation of process measures are reasonable but need to be evaluated for effectiveness. For example, even when discharge counselling is documented to have occurred, effective transmission of information and patient understanding should be assessed.
In-Room Display Of Day And Time Patient Is Anticipated To Leave Hospital: A "Discharge Appointment".
Manning DM, Tammel KJ, Blegen RN, et al. Journal of Hospital Medicine. Jan 2007;2(1):13-16. PMID: 17274043.
A Qualitative Exploration Of A Patient-Centered Coaching Intervention To Improve Care Transitions In Chronically Ill Older Adults.
Parry C, Kramer HM, Coleman EA. Home Health Care Services Quarterly. 2006;25(3-4):39-53. PMID: 17062510.
Discharge Planning From Hospital To Home.
Parkes J, Shepperd S, McClaren J, Phillips C. Cochrane Database Syst Rev. 2000;(4):CD000313. PMID: 11034682.
Perceived Readiness For Hospital Discharge In Adult Medical-Surgical Patients.
Weiss ME, Piacentine LB, Lokken L, et al. Clinical Nurse Specialist.Jan-Feb 2007;21(1):31-42. PMID: 17213738.
Geographic Ward Improvement
A Unit-Based Approach: Practicality favors most hospitalist patients in one place.
John Nelson, MD, FHM, FACP. The Hospitalist, September 2007
www.the-hospitalist.org
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