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Discharge Planning - June 2012
Welcome to the June 2012 bulletin on Discharge Planning being produced by the HEFT Library Services.
This bulletin is produced to support VITAL for Nurses core skills programme developed in the Trust. This
issue will highlight evidence published in the previous four months. Full text articles can be accessed with
your HEFT Athens ID.
Admission prevention
Reducing unplanned care: a new paradigm.
Rowe, Simon
British Journal of Healthcare Management. February; 18(2) p.104-108
There is a financial need to cut the number of unplanned accident and emergency admissions. In this study,
analysis from NHS Wakefield District was used to reveal two major findings which could help to cut admission
numbers.
Available in fulltext at EBSCOhost
Using ambulatory A&E care to cut admissions.
Hattrick, G. ; Bentham, C.
Nursing Times. April; 108 14(15) p.14-15
Describes a pilot project to implement ambulatory emergency care pathways which reduced admissions and
improved patients' experiences. Available in full text here.
Preventing avoidable rehospitalizations by understanding the characteristics of "frequent
fliers".
Mulder BJ; Tzeng HM; Vecchioni ND
Journal of Nursing Care Quality. January 27(1) p.77-82
This project used chart review to evaluate 22 patients labelled as "frequent fliers," each with 4 to 8 readmissions
over a 6-month period at a Michigan community hospital. The goal was to identify whether the 4 key elements
identified by the Institute for Healthcare Improvement for reducing rehospitalization had been put into place for
these patients. It found that a clear discharge plan was only documented for 15 (68%) of the 22 patients.
Emergency hospital admissions for ambulatory care-sensitive conditions.
Tian, Yang; Dixon, Anna and Gao, Haiyan King's Fund, April 2012
This data briefing considers patterns of admissions for Ambulatory care-sensitive conditions (ACSCs) in terms
of age, sex, condition, socioeconomic group and local authority area and suggests how they could be reduced
as they currently account for more than one in six emergency hospital admissions in England.
Available in full text here.
Bed management
Nothing to report.
Capacity planning
Nothing to report.
Discharge coordination
Preoperative prediction of non-home discharge: a strategy to reduce resource use after
cardiac surgery.
Pattakos G; Johnston DR; Houghtaling PL; Nowicki ER; Blackstone EH
Journal of the American College of Surgeons. February 214(2) p. 140-7
The study hypothesized that preoperatively identifying patients likely to require non-home discharge would allow
earlier discharge planning, shorten length of stay, and thereby reduce resource use. This study sought to develop
a validated tool for preoperative planning of non-home discharge.
Available in fulltext at MD Consult ; Note: You will need to register (free of charge) with MD Consult the first time you use it.
Discharge process
Hospital discharge criteria following colorectal surgery: a systematic review.
Fiore, JF Jr et al.
Colorectal Disease. March 14(3) p. 270-81
The aim of this study was to identify and synthesize the hospital discharge criteria that have been used in the
colorectal surgery literature.
A cost-effectiveness evaluation of hospital discharge counseling by pharmacists.
Chinthammit C.; Armstrong E.P.; Warholak T.L.
Journal of Pharmacy Practice. April 25(2) p.201-208
This study estimated the cost-effectiveness of pharmacist discharge counselling on medication-related morbidity
in both the high-risk elderly and general US population.
Re-engineering the post-discharge appointment process for general medicine patients.
Chang, R; Spahlinger, D; Kim, CS
The Patient: Patient-Centered Outcomes Research. 2012 5(1) p.27-32
The aim was to determine whether actively engaging patients in scheduling post-discharge appointments before
leaving the hospital affects the rate of patients seeing an ambulatory care physician.
The effects of a 'discharge time-out' on the quality of hospital discharge summaries.
Mohta, N et al
BMJ Qual Saf. May 5. Epub ahead of print
High-quality discharge summaries are a key component of a safe transition in care. The purpose of this study was
to determine the effects of standardised feedback and a 'discharge time-out' (DTO) on the quality of discharge
summaries.
Available in fulltext here.
Criteria to determine readiness for hospital discharge following colorectal surgery.
Fiore Jr. J.F. et al Diseases of the Colon and Rectum. April 55(4) p.416-423
The aim of this study is to achieve an international consensus on hospital discharge criteria for patients
undergoing colorectal surgery. Available in fulltext at Ovid.
Carers UK: BAME hospital discharge brief.
Carers UK. April 2012
The purpose of this briefing is to improve the knowledge and practice of supporting black and minority ethnic
carers at the point of hospital discharge. It draws on expertise, knowledge and involvement of carers and
professionals across London.
Available in fulltext here.
Completing discharge summaries reduces delays.
Shebli,K et al
British Journal of Healthcare Management. March 18(3) p.141-143
Describes how completing discharge summaries in operating theatres can help to reduce length of patient stay
and improve patient satisfaction, as well as maintaining patient care standards.
Available in fulltext at EBSCOhost
Education and Practice
Nothing to report.
Estimating dates for discharge
The relationship between inpatient discharge timing and emergency department boarding.
Powell, E.S et al.
Journal of Emergency Medicine. February 42(2) p.186-196
This study uses computer modelling to analyse the impact of inpatient discharge timing on ED boarding. Three
policies were tested: a sensitivity analysis on shifting the timing of current discharge practices earlier; discharging
75% of inpatients by 12:00 noon; and discharging all inpatients between 8:00 a.m. and 4:00 p.m.
Multidisciplinary team discharges
Multidisciplinary initiate cuts length of stay.
Hospital Case Management. January 20(1) p.13-4
Available in fulltext at EBSCOhost Available in fulltext at ProQuest
Early Stroke Discharge Team: a participatory evaluation.
Moule, Pam, Young, Pat, Glogowska, Margaret, Weare, Jayne
International Journal of Therapy and Rehabilitation. June 18(6) p.319-328
Qualitative research investigating how multidisciplinary Early Stroke Discharge (ESD) team members and
external stakeholders experienced the development and introduction of an ESD service. ESD team members'
experiences of setting up the team; multidisciplinary team working and the team's ability to achieve its aims
including positive feedback from patients are discussed.
Available in fulltext at EBSCOhost
Nurse-led discharge
Evaluation of nurse-led discharge following laparoscopic surgery.
Graham, Lisa et al
Journal of Evaluation in Clinical Practice. February 18(1) p.19-24
The article highlights a research undertaken in a hospital in Leicester to evaluate the value of patient discharge by
a laparoscopic nurse specialist after day surgery. Criteria for discharge are listed and time taken before discharge
when carried out by the nurse or by a doctor is considered.
From hospital to home: a brief nurse practitioner intervention for vulnerable older adults.
Enguidanos, Susan; Gibbs, Nancy; Jamison, Paula
Journal of Gerontological Nursing. March 38(3) p.40-50
This is a randomized controlled trial that was conducted to evaluate the impact of a brief nurse practitioner (NP)
intervention on care transitions among older hospitalized adults discharged to home (N = 199).
Available in fulltext at ProQuest
Improving nursing satisfaction and quality through the creation of admission and discharge
nurse team.
Spiva L, Johnson D
Journal of Nursing Care Quality. January 27(1) p.89-93
The admission and discharge (AD) process involves a significant amount of nursing time. The organization
explored the use of an AD nurse team on the basis on recommendations from the organization's aging nurse
workforce and in an effort to provide bedside nurses more time in direct patient care. A pre-post design was
used to evaluate the intervention.
Effectiveness of heart failure management programmes with nurse-led discharge planning in
reducing re-admissions.
Lambrinou, Ekaterini et al
International Journal of Nursing Studies. May 49(5) p.610-624
This article highlights a meta-analysis that was undertaken to estimate the effect of Heart failure –management
programmes (HF-MP) with a nurse-driven pre-discharge phase on the outcomes of HF and all-cause re-
admission.
Patient centred discharges
Frequent-user patients: reducing costs while making appropriate discharges.
Fader H.C.; Phillips C.N.
Healthcare financial management. March 66(3) p.98-100, 102, 104
Premature discharge of homeless patients who lack access to the health resource can result in their being
readmitted to the hospital in a short time, leading to higher costs for the hospital. Hospitals can address this
problem by developing clear, effective homeless discharge policies and by developing ongoing relationships with
appropriate medical respite care providers.
Available in fulltext at EBSCOhost
Available in fulltext at ProQuest
Readmissions
Planned readmissions: a potential solution.
Berkowitz SA, Anderson GF
Archives of Internal Medicine. February; 172(3) p.269-270
Available in fulltext at Highwire Press
The relationship between in-hospital mortality, readmission into the intensive care nursing
unit and nurse staffing levels.
Diya, Luwis, Van den Heede, Koen, Sermeus, Walter, Lesaffre, Emmanuel
Journal of Advanced Nursing. May; 68(5) p. 1073-1081
The aim of this article was to assess the relationship between (1) in-hospital mortality and/or (2) unplanned
readmission to intensive care units or operating theatre and nurse staffing variables.
Available in fulltext at Ovid
Reducing Hospital Readmissions.
Birk, Susan
Healthcare Executive. March; 27(2) p. 16-22
The article offers information on the reduction of hospital readmissions. It cites the early team-based intervention
during hospitalization combined with follow-up communication as the centre piece of the strategy to reduce
readmissions at SSM St. Mary's Health Center.
Available in fulltext at EBSCOhost Available in fulltext at ProQuest
Acute kidney injury (AKI) and risk of readmissions in patients with heart failure.
Thakar C.V., Parikh P.J., Liu Y.
American Journal of Cardiology. May; 109(10) p.1482-1486
In this study, 6,535 patients discharged with primary diagnoses of heart failure (HF) derived from a state wide
inpatient database were examined. The association between Acute Kidney Injury, with and without chronic kidney
disease, and risk for 30-day readmission with HF was assessed.
Available in fulltext at MD Consult; Note: You will need to register (free of charge) with MD Consult the first time
you use it.
Association of National Hospital Quality Measure adherence with long-term mortality and
readmissions.
Shahian DM et al
BMJ Quality and Safety. April 21(4) p.325-36. Epub 2012 Mar 2.
In existing studies, the association between adherence with recommended hospital care processes and
subsequent outcomes has been inconsistent. This has substantial implications because process measure scores
are used for accountability, quality improvement and reimbursement. This study addresses methodological
concerns with previous studies to better clarify the process-outcomes association for three common conditions.
Available in full text here.
Thirty-day readmissions--truth and consequences.
Joynt KE, Jha AK
New England Journal of Medicine. April 366(15) p.1366-9
Available in print at Good Hope Hospital Library.
Variations in hospital standardised mortality ratios (HSMR) as a result of frequent
readmissions.
van den Bosch WF, Spreeuwenberg P, Wagner C.
BMC Health Services Research. April 12(1):91 Epub ahead of print
The study investigated the impact that variations in the frequency of readmissions had upon a hospital's
standardised mortality ratio (HSMR). An adapted HSMR model was used in the study. Calculations were based
on the admissions of 70 hospitals in the Netherlands during the years 2005 to 2009.
Available in full text here.
Postdischarge follow-up phone call.
Michelle, Mourad; Stephanie, Rennke
Agency for Healthcare Research and Quality M&M Rounds. Published online March 2012
This 'spotlight case' and accompanying commentary about a patient with chronic obstructive pulmonary disease
(COPD) in the USA shows how a hospital readmission was prevented.
Available in full text here.
International variation in and factors associated with hospital readmission after myocardial
infarction.
Kociol RD et al
JAMA. January 307(1) p.66-74
To determine international variation in and predictors of 30-day readmission rates after STEMI and country-level
care patterns.
Available in fulltext at EBSCOhost EJS; Note: Go to link "Available on Publisher's Site:"
Hospital Readmission Rates Higher for Chronic Conditions.
Agency for Healthcare Research and Quality
AHRQ News and Numbers. March 7 2012.
The readmission rate following a hospital stay for a chronic condition such as congestive heart failure or diabetes
can be substantially higher than for an acute condition like pneumonia or a heart attack, according to the latest
News and Numbers from the Agency for Healthcare Research and Quality (AHRQ).
Available in full text here.
Re-engineered discharge cuts readmissions.
Hospital Case Management. May 20(5) p.70-75
By re-engineering its discharge process, a medical centre in USA reduced the number of readmissions within
30 days from 29% to 15%. This article highlights the steps they took to achieve this.
Available in fulltext at EBSCOhost Available in fulltext at ProQuest
Simple discharges and Complex discharges
Gender as risk factor for 30 days post-discharge hospital utilisation.
Woz, S et al
BMJ Open. 18 April; 2(2) e000428 Print 2012
This study evaluated the association between gender and hospital utilisation within 30 days of discharge.
Available in fulltext here.
Designing and implementing a COPD discharge care bundle.
Hopkinson NS et al
Thorax. January; 67(1) p. 90-2
The study developed a care bundle, comprising a short list of evidence-based practices to be implemented prior
to discharge for all patients admitted with this condition, based on a review of national guidelines and other
relevant literature, expert opinion and patient consultation.
Available in fulltext at Highwire Press
Further Information
Multiple sources – websites, journals and healthcare databases – have been searched for evidence published
in the last four weeks are identified and highlighted here. For a detailed list of sources that have been scanned,
please contact Preeti via Preeti[email protected] or call ext 47836 (Good Hope Hospital).
To request articles where there is no full text link, please complete an online article request form available on
HEFT Library website www.heftlibrary.nhs.uk under ‘Electronic Forms’ menu. Please note that there is now a
charge of £1 for such requests.
For more information on how to register for Athens, access the Athens Registration leaflet via HEFT Library
website www.heftlibrary.nhs.uk under the ‘Publications’ menu.
Please login with your Athens ID on www.evidence.nhs.uk ‘before’ clicking on any of the journal full text links
in this bulletin for seamless access.
