Browsing by Subject "Patient Discharge"
Now showing 1 - 4 of 4
- Results Per Page
- Sort Options
Item Empowering Patients: Simplifying Discharge Instructions(2019-03-28) DeSai, Charisma; Reed, W. Gary; Blomkalns, Andra; McDonald, SamuelBACKGROUND: Studies have shown that many patients leave the ED with partial comprehension of their visit and discharge instructions. Patients who are not adequately informed as to their discharge plans have decreased compliance with medications and treatment plans, decreased patient safety, increased Emergency Department (ED) recidivism, and poor patient satisfaction. The fast-paced and unpredictable environment of the ED makes thorough communication a challenge, so it is especially important to ensure that patients are given accessible and easy-to-understand information given the acuity and urgency of these patients' conditions. LOCAL PROBLEM: This project's objective is to develop and implement a method to assess and improve patient understanding of treatment and discharge plan at the Clements University Hospital Emergency Department, an academic urban hospital ED that sees approximately 43,500 patients per year. Written instructions provided to patients at the beginning of the study were found to be long and tedious, and important information was often difficult to find. METHODS: The PDSA (Plan, Do, Study, Act) cycle was employed throughout the project. Planning occupied a large portion of the project, with the determination of stakeholders, mapping of the current state, and developing an algorithm for assessment of patient understanding. ED discharge process was mapped with a flow diagram to understand the process of educating patients upon discharge from Clements University Hospital. The authors developed a questionnaire to assess patient knowledge using CMS OP-19 Transfer Record and Joint Commission recommendations, areas of communication deficits reported in other papers, and ED staff and provider input. A baseline study was conducted with fifty patients to measure patient understanding of their discharge instructions (Do). Responses from patient interviews were then scored against the medical record (Study). Three scorers graded all patient responses, and inter-rater reliability was calculated using the kappa statistic. INTERVENTIONS: Based on patient scores in the baseline study, stakeholder interviews, and fishbone diagrams examining reasons for lower scores, a decision matrix was created to decide on the most effective intervention (Act, Plan). The intervention chosen was creating a new, short discharge document. We developed the one-page Simplified Information Page (SIP) targeted to teach patients their most relevant discharge instructions. Next, we tested the SIP on one hundred eighteen patients to see its effect on patient understanding (Do). RESULTS: None (0%) of the fifty patients in the initial survey had complete comprehension of their ED visit and discharge instructions, although most patients stated they understood their discharge instructions and thought that their discharge instructions were useful. The lowest scoring questions were medication instructions (dosing and frequency) and indications to return to the ED. Median score improved after implementation of the SIP, with statistically significant changes in score distribution across all questions assessed with the Wilcoxon signed-rank test. Repeated measures ANOVA did not reveal any significant relationship between improvement in scores and any demographic criteria. Inter-rater reliability between scorers was high (kappa = 0.84). CONCLUSION: Healthcare providers often spend valuable time educating their patients, and it is important to assess the effectiveness of this teaching to identify areas in which we may improve health literacy and patient understanding. We found that the majority of patients do not fully comprehend their ED discharge instructions. Our project has shown that a simple, easy-to-read page with patient input significantly improved ED discharge knowledge.Item Non-Home Discharge and Prolonged Length of Stay after Cytoreductive Surgery and HIPEC(2018-01-23) Burguete, Daniel; Mokdad, Ali A.; Augustine, Martin M.; Minter, Rebecca; Mansour, John C.; Choti, Michael A.; Polanco, PatricioINTRODUCTION: The ability to preoperatively anticipate prolonged length of stay (PLOS) or transition to an extended care facility (non-home discharge, i.e., NHD) may facilitate discussion of patient expectations and improve utilization of hospital resources. No data has been reported on the rate and risk factors associated with NHD and PLOS in patients following cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal carcinomatosis. The aim of this study is to identify risk factors for NHD and PLOS following CRS/HIPEC in a national cohort of patients. METHODS: Patients that underwent CRS/HIPEC from 2011-2012 were identified from the National Surgical Quality Improvement Project (NSQIP) dataset. NHD/PLOS and home discharge (within 30 days) groups were compared using Pearsonメs chi-squared test and two-sample t-test with unequal variances. A univariate analysis was used to compare patient demographics, diagnosis, comorbidities, CCI, operative details and types of resection and post-operative complications among both groups. A multivariate analysis was used to identify independent predictors of NHD and PLOS. RESULTS: A total of 556 CRS/HIPEC patients were identified, 44 (7.9%) of which were not discharged to home within 30 days. From these 44 patients, 12 were discharged to a skilled care facility and 11 were discharged to a rehabilitation facility, accounting for a NHD rate of 4.1%. Twenty-one patients remained hospitalized at ~30 days accounting for a PLOS rate of 3.7% On univariate analysis, advancing age, COPD, HTN, and low preoperative albumin were identified as preoperative risk factors for NHD/PLOS (p<0.05). On multivariate analysis, age ≥ 65, pre-op albumin < 3.0 g/dL, and having a multi-visceral resection were identified as independent predictors of NHD/PLOS. If all three predictors are met preoperatively, the probability of NHD/PLOS is 30.2%. CONCLUSION: In this national cohort of patients, advanced age, hypoalbuminemia, and multi-visceral resection constituted the main risk factors for NHD/PLOS following CRS/HIPEC. Timely identification of these risk factors may facilitate preoperative discussions with patients, and improve discharge planning and resource utilization.Item The Roles of Infection Risk and Caretaker Education in Reducing Emergency Department Readmissions Among Pediatric Tracheostomy Patients(2022-02-01) Beams, Dylan R.; Chorney, Stephen R.; Kou, Yann-Fuu; Teplitzky, Taylor B.; Wynings, Erin; Johnson, Romaine F.OBJECTIVES: To determine factors associated with frequent emergency department (ED) visits and hospitalizations among pediatric tracheostomy patients. METHODS: A longitudinal cohort of children with tracheostomies were followed for the first 24 months after index discharge. Multiple logistic regression analyses identified associated factors for frequent health care utilization (> 4 visits in 24 months). RESULTS: 239 children requiring 1285 total visits to the ED or hospital after index discharge were included, with 112 children (46.7%) having four or more visits. Respiratory-related illness was the most common indication (N=699 visits, 54%), followed by gastrostomy tube issues (N = 119, 9.3%). Variables predicting frequent utilization on regression analysis included Black race (OR = 2.01, 95% CI = 1.18 - 3.70), mechanical ventilation (OR = 2.74, 95% CI = 1.35 - 5.59), and Spanish language (OR = 3.86, 95% CI = 1.47 - 10.11). There were no predictors of visits for tracheostomy-related complications, which accounted for 4.8% of all encounters. A sub-analysis showed that Hispanic race and gestational age predicted visits for respiratory failure. CONCLUSION: 47% of pediatric tracheostomy patients necessitate frequent ED and hospital utilization in the first two years after placement. Strategies related to reducing respiratory- and gastrostomy-related admissions may have the most impact given their high frequency. The significance of primary Spanish language and mechanical ventilation may emphasize the importance of quality caretaker education prior to patient discharge.Item Transitions of care: research, implementation science, and public policy(2021-10-01) Kripalani, Sunil