vidio bokep

LR27 / Re-engineering hospital discharge for  decreasing hospitalization

Romania




Type of Patient Safety Practice
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
"Best fit" category of the reported practice
System resilience
Patient safety theme the SCP/clinical risk management practice is aimed at
RED (Reengineered discharge )is a safe practice aiming to reduce hospital utilization (combined emergency department visits and readmissions), improve patient self-perceived preparation for discharge, and increase PCP follow-up and visits within 30 days of discharge among patients on a general medical service of an urban, academic medical center. The RED Project and a Randomized Trial (with random and control groups) highlight and detail intervention and results obtained by implementing this intervention.
Objective of the CRM practice
To minimize hospital utilization after discharge by an intervention that includes patient-centered education, comprehensive discharge planning, and postdischarge reinforcement and is practical and easily applied to general medical patients.
Short description of the CRM practice, including any references for further information
A nurse discharge advocate (DA) worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment. In a general medical service at an urban, academic, safety-net hospital, about 6 Das were hired to work part-time with intervention participants, and also trained to deliver the RED intervention by using a manual containing detailed scripts, observation of relevant clinical interactions, and simulated practice sessions. The primary goals of the DA were to coordinate the discharge plan with the hospital team and educate and prepare the participant for discharge. At admission, the DA completed the RED intervention components [1; pp 180; table 1]. Additional information about the DA training manual is published elsewhere [3] and can be found at the link: www.bu.edu/fammed/projectred/index.html [2]. With information collected from the hospital team and the participant, the DA created the after-hospital care plan (AHCP), which contained medical provider contact information, dates for appointments and tests, an appointment calendar, a color-coded medication schedule, a list of tests with pending results at discharge, an illustrated description of the discharge diagnosis, and information about what to do if a problem arises. Information for the AHCP was manually entered into a Microsoft Word (Microsoft, Redmond, Washington) template, printed, and spiralbound to produce an individualized, color booklet designed to be accessible to individuals with limited health literacy. By using scripts from the training manual, the DA used a teach-back methodology [11] to review the contents of the AHCP with the participant. On the day of discharge, the AHCP and discharge summary were faxed to the PCP. A clinical pharmacist telephoned the participants 2 to 4 days after the index discharge to reinforce the discharge plan by using a scripted interview. The pharmacist had access to the AHCP and hospital discharge summary and, over several days, made at least 3 attempts to reach each participant. The pharmacist asked participants to bring their medications to the telephone to review them and address medication-related problems; the pharmacist communicated these issues to the PCP or DA.
Innovator of the SCP, country of origin
Boston University Medical Center, USA To date, no study has evaluated a standardized discharge intervention that includes patient education, comprehensive discharge planning, and postdischarge telephone reinforcement in a general medical population.
Involved health care staff
1. 6 nurse discharge advocates (DAs) were hired part-time to work with intervention participants to ensure coverage by 1 DA 7 days a week, 5 hours a day. We trained all Das to deliver the RED intervention by using a manual containing detailed scripts, observation of relevant clinical interactions, and simulated practice sessions. The primary goals of the DA were to coordinate the discharge plan with the hospital team and educate and prepare the participant for discharge. At admission, the DA completed the RED intervention components outlined in Table 1. Additional information about the DA training manual is published elsewhere [3] and can be found on our Web site (www.bu.edu/fammed/projectred/index.html). 2. clinical pharmacist telephoned the participants 2 to 4 days after the index discharge to reinforce the discharge plan by using a scripted interview. The pharmacist had access to the AHCP and hospital discharge summary and, over several days, made at least 3 attempts to reach each participant. The pharmacist asked participants to bring their medications to the telephone to review them and address medication-related problems; the pharmacist communicated these issues to the PCP or DA.
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
Tested in one country –USA, respectively in the Boston University Medical Center [2]
Summary of evidence for effectiveness, including references
The RED intervention decreased hospital utilization (combined emergency department visits and readmissions) within 30 days of discharge by about 30% among patients on a general medical service of an urban, academic medical center. More intervention group participants reported seeing their PCP for follow-up within 30 days and reported higher levels of preparedness for discharge. In addition, the intervention was successful in reducing hospital utilization among participants who frequently used hospital services. 1. Outcome Follow-up: 83% of both groups (usual and intervention patients) sent data during teh next 32 days after discharge. 2. Hospital utilisation: Intervention participants had a lower rate of hospital utilization than usual care participants (incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]); P =0.009). 3. Secondary Outcomes: Participants receiving the intervention could identify their index discharge diagnosis (242 [79%] vs. 217 [70%] participants; P _ 0.017) and PCP name (292 [95%] vs. 275 [89%] participants; P _ 0.007) more often than usual care participants. Intervention participants also reported a higher PCP follow-up rate than usual care participants (190 [62%]) vs. 135 [44%]; P _ 0.001). Intervention group participants reported being more prepared for discharge at 30 days. Each component of the AHCP tool was highly rated by intervention participants (Appendix Table, available at www.annals.org). More intervention group participants reported seeing their PCP for follow-up within 30 days and reported higher levels of preparedness for discharge. 4. Time Spent Providing Intervention: The total DA time was estimated to be 87.5 minutes per participant. Estimated weekly DA time (following 14 participants per week) was 20.4 hours or approximately 0.5 full-time equivalent; Median total pharmacist time was approximately 26 minutes (IQR, 18 to 36 minutes) per participant. Estimated weekly pharmacist time (following 14 participants per week) was 6.1 hours or approximately 0.15 full-time equivalent. 5. Outcome Cost Analysis: The difference between study groups in total cost (combining actual hospital utilization cost and estimated outpatient cost) for 738 participants was $149 995—an average of $412 per person who received the intervention. This represents a 33.9% lower observed cost for the intervention group [p. 183-184; 1]. 6. Patient satisfaction: The RED (re-engineered discharge) intervention has been proven to reduce rehospitalizations and yields high rates of patient satisfaction [2].
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
The experience and results obtained by implementing the RED safe practice in a medical center could represent a good prerequisite the RED safe practice could be successfully implemented in other hospitals. The data in this Randomized Trial support implementation of a comprehensive program for hospital discharge among similar hospitals [p. 184; 1]. 1. Description of the context for which the Patient Safety Practices was designed: The RED intervention was designed to be implemented locally, respectively for the discharge process in a general medical service of an urban, academic medical center (Boston, USA). In 2004, the research team began an in-depth examination of hospital discharge, then being designed a package of services to minimize discharge failures—a process called reengineered discharge (RED) [3,10]. They did a randomized, controlled trial to evaluate the clinical effect of implementing RED among patients admitted to a general medical service. 2. -Guidance on implementation practice is detailed and specific: The coordinates of this practice are described as results of the current randomized trial where it can be found the steps and description of intervention, but also, the research group at Boston Medical center provide online guidance for further implementation and these guidelines are comprised in „The Project RED Toolkit*” available at the link: https://www.bu.edu/fammed/projectred/toolkit.html See also the section : Existing implementation tools, including references 3. Generalisability assured by non-specific nature of focus of the Patient Safety: These data support implementation of a comprehensive program for hospital discharge among similar hospitals. 4. Concepts and draft definitions Key aspects of the concepts –Practice: See RED toolkit available at the link: https://www.bu.edu/fammed/projectred/toolkit.html See components of RED: https://www.bu.edu/fammed/projectred/components.html 4. -Transferability evaluation focuses on process and results: Project RED has started to implement the re-engineered discharge at other hospitals serving diverse patient populations. We are also looking at the transitional needs from inpatient to outpatient care of specific populations (i.e., those with depressive symptoms). Finally, we are about to start a patient-centered project to create a tool that hospitals can use to discover factors (i.e., medical legal, social, etc.) in patients' readmissions [https://www.bu.edu/fammed/projectred/].
Summary of available information on feasibility, including references
There is no evidence available on feasibility of implementation of RED safe clinical practice. The RED toolkit (available at the link: https://www.bu.edu/fammed/projectred/toolkit.html) provides complete implementation guidance and is adapted to address language barriers, cross cultural issues and disparities in health care communication and trust. The toolkit includes five tools that provide step-by-step instructions to provide a springboard for hospitals to proactively address avoidable readmissions. The RED intervention has 3 core elements: the DA, the AHCP, and the follow-up telephone call by those of the pharmacist. No previous studies have evaluated this trio of interventions together, although the roles of the DA and the pharmacist build on previous literature [5, 7, 8]. -For example, peridischarge nursing support services have been shown to improve discharge for patients with heart failure [6, 9, 12, 13]. -Coleman and colleagues [4] used a nurse “transition coach” to demonstrate reduced readmissions at 30 and 90 days among elderly patients. -Naylor and coworkers [5] found that nurse specialists involved during and after discharge also effectively reduced acute readmissions. Several studies have analyzed pharmacist interventions. -Dudas and colleagues [7] randomly assigned patients to receive a telephone call by a pharmacist after discharge and demonstrated fewer emergency department visits. -Schnipper and coworkers [8] used pharmacist counseling before and after discharge and showed reductions in preventable adverse drug events and medication-related readmissions and emergency department visits. -Al-Rashed and colleagues [14] found that predischarge pharmacist-based counseling for elderly patients followed by a postdischarge home visit resulted in fewer unplanned primary care visits and fewer readmissions.
Existing implementation tools, including references
The RED toolkit provides complete implementation guidance and is adapted to address language barriers, cross cultural issues and disparities in health care communication and trust. The toolkit includes five tools that provide step-by-step instructions to provide a springboard for hospitals to proactively address avoidable readmissions. Below is a list of guidance for these aspects: An Overview of the RED Toolkit (PDF 958 KB) How to Begin the ReEngineered Discharge (RED) Implementation at Your Hospital (PDF 1.0 MB) How to Deliver the ReEngineered Discharge at Your Hospital (PDF 1.14 MB) How to Deliver the ReEngineered Discharge to Diverse Populations (PDF 1.02 MB) How to Conduct a Post-discharge Follow-up Phone Call (PDF 1.07 MB) How To Monitor RED Implementation and Outcomes (PDF 1.06 MB) After Hospital Care Plan (AHCP) Template - English (.doc)
Potential for/description of patient involvement in the CRM practice, including references
The RED intervention is based on the communication by medical staff involved (DAs and pharmacist) and patient. By using scripts from the training manual, the DA used a teach-back methodology [11] to review the contents of the AHCP with the participant. The pharmacist asked participants to bring their medications to the telephone to review them and address medication-related problems (pp.180;1].
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
1.  Brian W. Jack et all.; „A Reengineered Hospital Discharge Program to Decrease Rehospitalization A Randomized Trial”; 3 February 2009; Annals of Internal Medicine; Volume 150; Number 3; pp.178-187 2. https://www.bu.edu/fammed/projectred/index.html; „Project RED (Re-Engineered Discharge)“; official site of the project, available at 11 March 2013 3. Greenwald JL, Denham CR, Jack BW. The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process. J Patient Saf. 2007;3:97-106. 4. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166: 1822-8. [PMID: 17000937] 5. Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, et al. omprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999;281:613-20. [PMID: 10029122] 6. Anderson C, Deepak BV, Amoateng-Adjepong Y, Zarich S. Benefits of comprehensive inpatient education and discharge planning combined with outpatient support in elderly patients with congestive heart failure. Congest Heart Fail. 2005;11:315-21. [PMID: 16330907] 7. Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow-up telephone calls to patients after hospitalization. Am J Med. 2001;111:26S-30S. [PMID: 11790365] 8. Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166:565-71. [PMID: 16534045] 9. Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S, Rubin HR. Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis. JAMA. 2004;291:1358-67. [PMID: 15026403] 10. Anthony D, Chetty VK, Kartha A, McKenna K, DePaoli RM, Jack B. Patient safety at time of discharge—an example of a multifaceted process evaluation. In: Henriksen K, Battles JB, Marks ESL, Lewin DI, eds. Advances in Patient Safety: From research to Implementation. vol. 2. Concepts and Methodology. Rockville, MD: Agency for Healthcare Research and Quality; 2005. 11. Paasche-Orlow MK, Riekert KA, Bilderback A, Chanmugam A, Hill P, Rand CS, et al. Tailored education may reduce health literacy disparities in asthma self-management. Am J Respir Crit Care Med. 2005;172:980-6. [PMID: 16081544] 12. Blue L, Lang E, McMurray JJ, Davie AP, McDonagh TA, Murdoch DR, et al. Randomised controlled trial of specialist nurse intervention in heart failure. BMJ. 2001;323:715-8. [PMID: 11576977] 13. Tsilimingras D, Bates DW. Addressing postdischarge adverse events: a neglected area. Jt Comm J Qual Patient Saf. 2008;34:85-97. [PMID: 18351193] 14. Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002;54:657-64. [PMID: 12492615]
Reviewer
Dr. Marius Ciutan, National School of Public Health and Management, Romania
Organisation
National School of Public Health and Management
Any additional information on the CRM (e.g. implementation barriers and drivers)
There is no specified text here
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