Care Discharge Research Articles

The beneficial effects of transitional care for patients with stroke: A meta-analysis.

Transitional care interventions have emerged as a promising method of ensuring treatment continuity and health care coordination when patients are discharged from hospital to home. However, few studies have investigated the frequency and duration of interventions and the effects of interventions on physical function. Therefore, this study aimed to determine the efficacy of transitional care for patients with stroke. Six databases and the grey literature were searched to obtain relevant articles from October 1, 2022 to March 10, 2023. The primary outcomes studied were motor performance, walking speed, activities of daily living (ADLs) and caregiver burden following hospital-to-home transitional care. The quality of the studies was assessed with Cochrane risk of bias version 2. The quality and sensitivity of the evidence were assessed to ensure rigour of the findings. Meta-analyses were performed using stata 17.0. A total of 2966 patients were identified from 23 studies. Transitional care improved post-stroke motor performance, walking speed and ADLs, and reduced caregiver burden. The findings suggest that provision of transitional care model implementation in patients with stroke is important because it reduces disability in stroke patients and helps to decrease caregivers' burden. The findings of the study emphasize the importance of transitional care programmes for stroke patients after they are discharged from the hospital and returned to their homes. To meet the needs of patients, all levels of health professionals including nurses should be aware of the discharge process and care plan.

Rates of 30-day revisit to the emergency department among older adults living with dementia: a systematic review and meta-analysis.

Older adults visit emergency departments (EDs) at higher rates than their younger counterparts. However, less is known about the rate at which older adults living with dementia visit and revisit EDs. We conducted a systematic review and meta-analysis to quantify the revisit rate to the ED among older adults living with a dementia diagnosis. We searched MEDLINE, Embase, and CINAHL, as well as gray literature, to identify observational studies reporting on older adults living with dementia that revisited an ED within 30days of a prior ED visit. We calculated pooled rates of 30-day revisit as percentages using random effects models, and conducted stratified analyses by study data source, study population, and study period. We assessed between-studies heterogeneity using the I2 statistic and considered [Formula: see text] > 50% to indicate substantial heterogeneity. All analyses were performed in R software. We identified six articles for inclusion. Percentages of 30-day ED revisit among older adults living with dementia ranged widely from 16.1% to 58.0%. The overall revisit rate of 28.6% showed significant heterogeneity. Between-studies heterogeneity across all stratified analyses was also high. By data source, 30-day revisit percentages were 52.3% (public hospitals) and 20.0% (administrative databases); by study population, revisit percentages were 33.5% (dementia as main population) and 19.8% (dementia as a subgroup). By study period, revisit percentages were 41.2% (5years or greater) and 18.9% (5years or less). Existing literature on ED revisits among older adults living with dementia highlights the medical complexities and challenges surrounding discharge and follow-up care that may cause these patients to seek ED care at an increased rate. ED personnel may play an important role in connecting patients and caregivers to more appropriate medical and social resources in order to deliver an efficient and more rounded approach to care.

An interrupted time series evaluation of the effect of cannabis legalization on intentional self-harm in two Canadian provinces: Ontario and Alberta.

Despite the association between cannabis use and higher prevalence of suicidal ideation and attempt, the effect of cannabis legalization and regulation in Canada on intentional self-harm has not been determined. We used an interrupted time series of population-based rates of emergency department (ED) visits and hospitalizations for intentional self-harm per 100 000 in Ontario and Alberta from January/April 2010 to February 2020. Aggregate monthly counts of ED visits and hospitalizations for intentional self-harm (ICD-10 codes X60-X84, R45.8) were obtained from the National Ambulatory Care Reporting System and Discharge Abstract Database, respectively. The legalization and regulation of cannabis in Canada was not significantly associated with a change in rates of ED visits for intentional self-harm in Ontario (level = 0.58, 95% CI: -1.14 to 2.31; trend = -0.17, 95% CI: -0.35 to 0.01) or Alberta (level = -0.06, 95% CI: -2.25 to 2.12; trend = -0.07, 95% CI: -0.27 to 0.13). Hospitalizations for intentional self-harm also remained unchanged in Ontario (level = -0.14, 95% CI: -0.48 to 0.20; trend = 0.01, 95% CI: -0.03 to 0.04) and Alberta (level = -0.41, 95% CI: -1.03 to 0.21; trend = -0.03, 95% CI: -0.08 to 0.03). Legalization and regulation of cannabis in Canada has not increased rates of ED visits or hospitalizations for intentional self-harm in Ontario and Alberta. Individual-level analyses that account for demographic characteristics and include other provinces and territories are needed.

Social Vulnerability and Frailty in Hospitalized Older Adults.

Social vulnerability is the accumulation of disadvantageous social circumstances resulting in susceptibility to adverse health outcomes. Associated with increased mortality, cognitive decline, and disability, social vulnerability has primarily been studied in large population databases rather than frail hospitalized individuals. We examined how social vulnerability contributes to hospital outcomes and use of hospital resources for older adults presenting to the Emergency Department. We analyzed patients 65 years of age or older admitted through the Emergency Department and consulted to internal medicine or geriatrics at a Canadian tertiary care hospital from July 2009 to September 2020. A 20-item social vulnerability index (SVI) and a 57-item frailty index (FI) were calculated, using a deficit accumulation approach. Outcomes were length of stay (LOS), extended hospital LOS designation, alternative level of care (ALC) designation, in-hospital mortality, and discharge to long-term care (LTC). In 1,146 patients (mean age 80.5±8.3, 54.0% female), mean SVI was 0.40±0.16 and FI was 0.44±0.14. The SVI scores were not associated with admission to hospital. Amongst those admitted, for every 0.1 unit increase in SVI, LOS increased by 1.15 days (p<.001) after adjusting for age, sex and FI. SVI was associated with staying over the expected LOS (aOR: 1.19, 1.05-1.34, p=.009) and ALC status (aOR 1.39, 1.12-1.74, p<.004). SVI was not associated with in-hospital mortality, but was associated with incident discharge to LTC (aOR 1.03, 1.02-1.04, p<.001). Independent of frailty, being socially vulnerable was associated with increased LOS, designation as ALC, and being discharged to LTC from hospital. Consideration of social vulnerability's influence on prolonged hospitalization and long-term care needs has implications for screening and hospital resources.

Healthcare Utilization After Thermal Injury: An Analysis Using a Commercial Claims Database

Abstract Burn injuries affect more than 500,000 people per year in the United States but no previous studies have looked at the impact on the healthcare system. Several prior studies have shown decreased unplanned healthcare utilization after acute care discharge and increased healthcare costs for patients who have undergone burn injury grafting. This study describes postacute care hospitalization healthcare use in burn patients. A retrospective commercial claims database review was performed utilizing Truven MarketScan (MS) database. In a 10-year MS sample, 23,262 patients with burn injuries were identified and matched to a control population in a 1:1 ratio based on age, sex, and total time in the MS database. Pre- and postburn utilization of therapy, emergency department, nutritional support, psychiatry/psychology, home health, skilled nursing facility, inpatient, and outpatient visits were recorded. For controls, pre- and postburn periods were defined using the burn event date of the matched case adjusted by the pair’s relative difference in enrollment into the MS database. A series of negative binomial regressions were completed to evaluate the data. For every outcome, except skilled nursing facility, healthcare utilization was greater in the preinjury burn group relative to controls. Healthcare utilization for the burn cohort postinjury was greater for every outcome compared to controls and remained higher for at least 25-month postinjury and did not return to preinjury levels during this time frame. Relatively higher healthcare utilization prior to injury in burn patients may indicate an important difference in baseline health, and an opportunity for injury prevention.

The Value of Using a Quality Assurance Follow-Up Team to Address Incidental Findings After Emergency Department or Urgent Care Discharge: A Cost Analysis

BackgroundIncidental finding (IF) follow-up is of critical importance for patient safety and is a source of malpractice risk. Laboratory, imaging, or other types of IFs are often uncovered incidentally and are missed, not addressed, or only result after hospital discharge. Despite a growing IF notification literature, a need remains to study cost-effective non–electronic health record (EHR)–specific solutions that can be used across different types of IFs and EHRs. ObjectiveThe objective of this study was to evaluate the utility and cost-effectiveness of an EHR-independent emergency medicine–based quality assurance (QA) follow-up program in which an experienced nurse reviewed laboratory and imaging studies and ensured appropriate follow-up of results. MethodsA QA nurse reviewed preceding-day abnormal studies from a tertiary care hospital, a community hospital, and an urgent care center. Laboratory values outside preset parameters or radiology over-reads resulting in clinically actionable changes triggered contact with an on-call emergency physician to determine an appropriate intervention and its implementation. ResultsOf 104,125 visits with 1,351,212 laboratory studies and 95,000 imaging studies, 6530 visits had IFs, including 2659 laboratory and 4004 imaging results. The most common intervention was contacting a primary care physician (5783 cases [88.6%]). Twenty-one cases resulted in a patient returning to the ED, at an average cost of $28,000 per potential life-/limb-saving intervention. ConclusionsAlthough abnormalities in laboratory results and imaging are often incidental to patient care, a dedicated emergency department QA follow-up program resulted in the identification and communication of numerous laboratory and imaging abnormalities and may result in changes to patients’ subsequent clinical course, potentially increasing patient safety.

Can machine learning models predict prolonged length of hospital stay following primary total knee arthroplasty based on a national patient cohort data?

The total length of stay (LOS) is one of the biggest determinators of overall care costs associated with total knee arthroplasty (TKA). An accurate prediction of LOS could aid in optimizing discharge strategy for patients in need and diminishing healthcare expenditure. The aim of this study was to predict LOS following TKA using machine learning models developed on a national-scale patient cohort. The ACS-NSQIP database was queried to acquire 267,966 TKA cases from 2013 to 2020. Four machine learning models-artificial neural network (ANN), random forest, histogram-based gradient boosting, and k-nearest neighbor were trained and tested on the dataset for the prediction of prolonged LOS (LOS exceeded the 75th of all values in the cohort). The model performance was assessed by discrimination (area under the receiver operating characteristic curve [AUC]), calibration, and clinical utility. ANN delivered the best performance among the four models. ANN distinguished prolonged LOS in the study cohort with an AUC of 0.71 and accurately predicted the probability of prolonged LOS for individual patients (calibration slope: 0.82; calibration intercept: 0.03; Brier score: 0.089). All models demonstrated clinical utility by generating positive net benefits in decision curve analyses. Operation time, pre-operative transfusion, pre-operative laboratory tests (hematocrit, platelet count, and white blood cell count), and BMI were the strongest predictors of prolonged LOS. ANN demonstrated modest discrimination capacity and excellent performance in calibration and clinical utility for the prediction of prolonged LOS following TKA. Clinical application of the machine learning models has the potential to improve care coordination and discharge planning for patients at high risk of extended hospitalization after surgery. Incorporating more relevant patient factors may further increase the models' prediction strength.

Using emergency department triage for machine learning-based admission and mortality prediction.

Patient admission is a decision relying on sparsely available data. This study aims to provide prediction models for discharge versus admission for ward observation or intensive care, and 30 day-mortality for patients triaged with the Manchester Triage System. This is a single-centre, observational, retrospective cohort study from data within ten minutes of patient presentation at the interdisciplinary emergency department of the Kepler University Hospital, Linz, Austria. We trained machine learning models including Random Forests and Neural Networks individually to predict discharge versus ward observation or intensive care admission, and 30 day-mortality. For analysis of the features' relevance, we used permutation feature importance. A total of 58323 adult patients between 1 December 2015 and 31 August 2020 were included. Neural Networks and Random Forests predicted admission to ward observation with an AUC-ROC of 0.842 ± 0.00 with the most important features being age and chief complaint. For admission to intensive care, the models had an AUC-ROC of 0.819 ± 0.002 with the most important features being the Manchester Triage category and heart rate, and for the outcome 30 day-mortality an AUC-ROC of 0.925 ± 0.001. The most important features for the prediction of 30 day-mortality were age and general ward admission. Machine learning can provide prediction on discharge versus admission to general wards and intensive care and inform about risk on 30 day-mortality for patients in the emergency department.

Association between physical therapy frequency and postacute care for a national cohort of patients hospitalized with pneumonia.

Annually more than 300,000 patients hospitalized for pneumonia need postacute care. Patients and systems prefer home discharge, but physical limitations often necessitate postacute care. It is unknown whether frequency of physical therapy in the hospital affects postacute care discharges. Examine the relationship between physical therapy visit frequency and disposition among a national sample of patients hospitalized with pneumonia. Observational cohort study. Acute care hospital. Adult patients with primary diagnosis of pneumonia in the Premier Data Set who received physical therapy in the hospital during a 5-day window, with therapy on at least days 1 and 5. Physical therapy visit frequency. Discharge disposition (home or postacute care). We included 18,886 patients from 595 hospitals. Just over half were discharged home (n = 9638; 51.0%) and 558 (2.95%) died. Patients getting more frequent therapy were older, non-Hispanic white, treated in small non-teaching rural hospitals in the West, Midwest, or South, and had fewer severe illness indicators. In adjusted models, patients who received physical therapy on 100% of days were 7% [(95% confidence interval, 4.3-9.7), p < .0001] more likely to go home than patients who received physical therapy on 40% of days. As a falsification test, we found that there was no relationship between physical therapy frequency and all-cause mortality. Physical therapy visit frequency was positively associated with discharge to home. Increasing visit frequency of physical therapy in hospitals might reduce the need for postacute care, but randomized controlled trials are needed to confirm the effect.

The effect of discharge care plans on statin prescription rates.

Stroke discharge care bundles have been proposed to address inadequate provider statin prescription rates. Discontinuation of statins has been associated with a 37% relative risk increase in mortality in patients with a stroke diagnosis. The project site had a statin prescription rate of 86.2%. The project was initiated at a 641-bed regional community teaching medical center. Statin prescription rates upon discharge on patients with the diagnosis of transient ischemic attack or stroke were evaluated and noted to be below the benchmark of 95%. Possible interventions to improve this benchmark were discussed with key stakeholders such as the information technology team, stroke care outcomes team, and neurology service providers. The proposed intervention was incorporated into the electronic health record. Provider prescription rates were tracked monthly along with the use of the proposed intervention. A one-sided z-test was used to analyze the data collected. A stroke discharge power plan within an electronic health record was modified to increase the rate of statin prescriptions. The key modification included checking off the prescription of a statin on discharge. Reinforcement of its use was done through monthly reminders. Use of discharge care plan yielded 100% compliance. Overall compliance was 9.7%. The null hypothesis of the one-sided z-test was 89%. The p-value for all tests was <0.05. The use of a stroke discharge care plan within an electronic health record can positively affect secondary stroke prevention by increasing statin prescription rates.

Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.

Evidence-based strategies to improve outcomes in minority children with uncontrolled asthma discharged from the emergency department (ED) are needed. This multicenter pragmatic clinical trial was designed to compare an ED-only intervention (decision support tool), an ED-only intervention and home visits by community health workers for 6 months (ED-plus-home), and enhanced usual care (UC). Children aged 5 to 11 years with uncontrolled asthma were enrolled. The change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers were the primary outcomes. The secondary outcomes included guideline-recommended ED discharge care and self-management. Recruitment was significantly lower than expected (373 vs 640 expected). Of the 373 children (64% Black and 31% Latino children), only 63% completed the 6-month follow-up visit. In multivariable analyses that accounted for missing data, the adjusted odds ratios and 98% CIs for differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, guideline-recommended ED discharge care was significantly improved in the intervention groups versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups. The ED-based interventions did not significantly improve the primary clinical outcomes, although the study was likely underpowered. Although guideline-recommended ED discharge care and self-management did improve, their effect on clinical outcomes needs further study.

Effects of Maternal SARS-CoV-2 Infection on Neonatal Discharge Planning and Care: Exacerbation of Racial and Ethnic Healthcare Disparities.

To determine if SARS-CoV-2 disproportionately impacted infants born to racial and ethnic minorities and if virus exposure led to decreased access to care. This study was an observational case-control study, between March 2020 and March 2022 in Portland, Maine. Forty-seven cases and 47 controls were enrolled. Cases were infants born to mothers diagnosed with SARS-CoV-2 at delivery, and controls were infants matched by date of birth, born to SARS-CoV-2 negative women. Demographic data, maternal clinical data, infant outcomes, and infant discharge plans were compared using Chi squared or Fisher Exact tests. Logistic regression was used to examine the impact of race on neonatal SARS-CoV-2 exposure. Infants exposed to SARS-CoV-2 were more likely Black or Hispanic than White and Non-Hispanic early in the pandemic, with reversal during the second year. SARS-CoV-2-exposed infants experienced delays in routine newborn outpatient care, although delay improved over the pandemic. Infants exposed to SARS-CoV-2 were initially more likely to be infants of color. During this time, infants exposed to SARS-CoV-2 were also experiencing significant delays in newborn care.

Evaluating the Validity of the Responses to Illness Severity Quantification Score to Discriminate Illness Severity and Level of Care Transitions in Hospitalized Children with Severe Acute Malnutrition

To evaluate the validity of the Responses to Illness Severity Quantification (RISQ) score to discriminate illness severity and transitions between levels of care during hospitalization. A prospective observational study conducted in Maiduguri, Nigeria, enrolled inpatients aged 1-59months with severe acute malnutrition. The primary outcome was the RISQ score associated with the patient state. Heart and respiratory rate, oxygen saturation, respiratory effort, oxygen use, temperature, and level of consciousness are summed to calculate the RISQ score. Five states were defined by levels of care and hospital discharge outcome. The states were classified hierarchically, reflecting illness severity: hospital mortality was the most severe state, then intensive care unit (ICU), care in the stabilization phase (SP), care in the rehabilitation phase (RP), and lowest severity, survival at hospital discharge. A multistate statistical model examined performance of the RISQ score in predicting clinical states and transitions. Of 903 children enrolled (mean age, 14.6months), 63 (7%) died. Mean RISQ scores during care in each phase were 3.5 (n=2265) in the ICU, 1.7 (n=6301) in the SP, and 1.5 (n=2377) in the RP. Mean scores and HRs for a 3-point change in score at transitions: ICU to death, 6.9 (HR, 1.80); SP to ICU, 2.8 (HR, 2.00); ICU to SP, 2.0 (HR, 0.5); and RP to discharge, 1.4 (HR, 0.91). The RISQ score can discriminate between points of escalation or de-escalation of care and reflects illness severity in hospitalized children with severe acute malnutrition. Evaluation of clinical implementation and demonstration of benefit will be important before widespread adoption.

Maternal satisfaction with reduced postnatal length of stay in Brussels: evidence from the KOZI&Home program

BackgroundReducing the length of stay (LOS) after childbirth is a trend, including cost savings, a more family-centered approach and lower risk for nosocomial infection. Evaluating the impact of reduced LOS is important to improve the outcomes of care, which include maternal satisfaction. The aim of this study was to compare the maternal satisfaction, before and after the reduced LOS.MethodsThis study was conducted in the University Hospital Brussels, before and after implementing the KOZI&Home program (intervention). This KOZI&Home program consisted of a reduced length of stay of at least one day for both vaginal delivery and caesarean section. It also included three extra antenatal visits with the midwife, preparing for discharge and postnatal home care by an independent midwife. Women completed a questionnaire, including the Maternity Satisfaction Questionnaire (MSQ) and Home Satisfaction Questionnaire (HSQ), respectively at discharge and two weeks postpartum. Satisfaction was split into five dimensions: ‘Midwives time investment’, ‘Provision of information’, ‘Physical environment’, ‘Privacy’ and ‘Readiness for discharge’. A combination of forward and backward model selection (both directions) was used for statistical analysis.ResultsIn total, 585 women were included in this study. 332 women in the non-intervention group and 253 women in the intervention group. Satisfaction with ‘provision of information’ at home had a higher mean score of 4.47/5 in the intervention group versus 4.08/5 in the non-intervention group (p < 0.001). Women in the KOZI&Home group were more satisfied regarding ‘privacy at home’ (mean 4.74/5 versus 4.48/5) (p < 0.001) and ‘readiness for discharge’ (p = 0.02).ConclusionThe intervention was associated with a higher score in some of dimensions of satisfaction. Our study concludes that this integrated care program is acceptable for postpartum women and associated with some favourable outcomes.

Development and validation of a survey designed to measure patient experience of and preference for surgical wound care discharge education: A pilot study

Aim of the studyTo develop and undertake validation testing of a survey designed to measure patients’ experiences of and preferences for surgical wound care discharge education. Materials and methodsA literature review and content analysis was undertaken on patients' experiences of and preferences for surgical wound care discharge education. Four themes were uncovered in the literature (wound care discharge education, preferences for discharge education delivery, participation in wound care decisions and patient ability to manage their surgical wound to prevent wound complications), which guided item generation. Three types of validity testing occurred including: 1) face validity testing by the research team; 2) content validity testing (using Delphi study) with an international panel of experts including patients, clinicians and researchers; and 3) content validity (using pilot-testing) of the survey with seven patients from the target population. ResultsInitially 106 items were generated from the literature, and of these, 55 items were subjected to content validity testing by an international panel of 41 experts. After two Delphi rounds, 18 items were retained. Most patients provided limited and very minor feedback during pilot-testing. However, pilot-testing resulted in a revised survey administration plan to deliver the survey via telephone, including adding prompts and preambles to items. ConclusionAn 18-item survey comprised of three groups of items and an individual item was rigorously developed. The survey requires further testing among a larger sample of patients to confirm the items reflect important aspects of patients’ experiences of and preferences for surgical wound care discharge education.

Factors Associated with Return Visits by Elders within 72 Hours of Discharge from the Emergency Department.

Elders have a higher rate of return visits to the emergency department (ED) than other patients. It is critical to understand the risk factors for return visits to the ED by elders. The aim of this study was to determine the factors associated with return visits to the ED by elders. This study retrospectively reviewed the hospital charts of elders who returned to the ED within 72 h after discharge from ED. The risk factors identified in the Triage Risk Screening Tool were applied in this study. Of the elders discharged from the ED, 8.64% made a return visit to the ED within 72 h. The highest revisit rate occurred within 24 h after discharge. Factors associated with return ED visits within 24 h by elders were difficulty walking and having discharge care needs. The factor associated with ED return visits within 24-48 h was polypharmacy. Difficulty walking, having discharge care needs, and hospitalization within the past 120 days were associated with return visits made within 48-72 h following discharge. Identifying the reasons for return visits to the ED and providing a continuous review of geriatric assessment and discharge planning could reduce unnecessary revisits.

Racial disparities in hospitalization outcomes among patients with cholangiocarcinoma.

6631 Background: Studies have reported on the rising incidence and mortality outcomes among patients diagnosed with cholangiocarcinoma (CCA) but racial disparities in outcomes among inpatients have not been explored in this population. We examined the racial disparities in outcomes among adult hospitalized patients with a diagnosis of CCA. Methods: Retrospective cohort analyses were conducted using data from the National Inpatient Sample (NIS), 2016-2020. Multivariate logistic and linear regression models were used to examine the association between race/ethnicity and patient disposition, length of stay, elective admissions, and total hospital charges. Results: In the adjusted analyses, while Black patients had 14% higher odds (95% Confidence Interval (CI): 1.04–1.25) of being discharged to a facility/home with home health care versus routine discharge when compared to their White counterparts, Hispanics had 14% lower odds (95% CI: 0.79–0.95). Black patients had 39% higher risk (95% CI: 1.19–1.63) of death versus routine discharge relative to the White patients. Compared to White patients, Blacks (AOR: 1.23; 95% CI: 1.13–1.34), Hispanics (AOR: 1.15; 1.06–1.25) and other race/ethnicities (AOR: 1.20; 1.10–1.31) were more likely to have a length of hospital stay greater than 5 days relative to 5 days or less. Hispanics (β: $16,789; 95% CI: $11,480–$22,099) were found to have higher total hospital charges when compared to the White CCA patients. Additionally, Black (AOR: 0.68; 95% CI: 0.60–0.78) and Hispanic patients (AOR: 0.87; 95% CI: 0.77–0.99) were less likely to be admitted electively to the hospital. Conclusions: Despite advances made in treatment of patients with CCA, the prognosis remains poor. We report disparities in various hospitalization outcomes among adult patients with a diagnosis of CCA. Health care providers need to be aware that these disparities exist and health policies should be implemented to narrow the gap in existing disparities. [Table: see text]

Prediction of In-Hospital Falls Using NRS, PACD Score and FallRS: A Retrospective Cohort Study.

Harmful in-hospital falls with subsequent injuries often cause longer stays and subsequently higher costs. Early identification of fall risk may help in establishing preventive strategies. To assess the predictive ability of different clinical scores including the Post-acute care discharge (PACD) score and nutritional risk screening score (NRS), and to develop a new fall risk score (FallRS). A retrospective cohort study of medical in-patients of a Swiss tertiary care hospital from January 2016 to March 2022. We tested the ability of the PACD score, NRS and FallRS to predict a fall by using the area under curve (AUC). Adult patients with a length of stay of ≥ 2 days were eligible. We included 19,270 admissions (43% females; median age, 71) of which 528 admissions (2.74%) had at least one fall during the hospital stay. The AUC varied between 0.61 (95% confidence interval (CI), 0.55-0.66) for the NRS and 0.69 (95% CI, 0.64-0.75) for the PACD score. The combined FallRS score had a slightly better AUC of 0.70 (95% CI, 0.65-0.75) but was more laborious to compute than the two other scores. At a cutoff of 13 points, the FallRS had a specificity of 77% and a sensitivity of 49% in predicting falls. We found that the scores focusing on different aspects of clinical care predicted the risk of falls with fair accuracy. A reliable score with which to predict falls could help in establishing preventive strategies for reducing in-hospital falls. Whether or not the scores presented have better predictive ability than more specific fall scores do will need to be validated in a prospective study.

Safe Discharge Needs Following Emergency Care for Intimate Partner Violence, Sexual Assault, and Sex Trafficking.

For survivors of gender-based violence (GBV) seeking care in hospital emergency departments (ED) the need for medical care and safe discharge is acute. In this study we evaluated safe discharge needs of GBV survivors following hospital-based care at a public hospital in Atlanta, GA, in 2019 and between April 1, 2020-September 30, 2021, using both retrospective chart review and evaluation of a novel clinical observation protocol for safe discharge planning. Of 245 unique encounters, only 60% of patients experiencing intimate partner violence (IPV) were discharged with a safe plan and only 6% were discharged to shelters. This hospital instituted an ED observation unit (EDOU) to support GBV survivors with safe disposition. Then, through the EDOU protocol, 70.7% were able to achieve safe disposition, with 33% discharged to a family/friend and 31% discharged to a shelter. Safe disposition following experience or disclosure of IPV and GBV in the ED is difficult, and social work staff have limited bandwidth to assist with navigation of accessing community-based resources. Through an average 24.3 hours of an extended ED observation protocol, 70% of patients were able to achieve a safe disposition. The EDOU supportive protocol substantially increased the proportion of the GBV survivors who experienced a safe discharge.

Developing a reflection and analysis tool (We-ReAlyse) for readmissions to the intensive care unit: A quality improvement project

BackgroundReadmissions to the intensive care unit are associated with poorer patient outcomes and health prognoses, alongside increased lengths of stay and mortality risk. To improve quality of care and patients’ safety, it is essential to understand influencing factors relevant to specific patient populations and settings. A standardized tool for systematic retrospective analysis of readmissions would help healthcare professionals understand risks and reasons affecting readmissions; however, no such tool exists. PurposeThis study’s purpose was to develop a tool (We-ReAlyse) to analyze readmissions to the intensive care unit from general units by reflecting on affected patients’ pathways from intensive care discharge to readmission. The results will highlight case-specific causes of readmission and potential areas for departmental- and institutional-level improvements. MethodA root cause analysis approach guided this quality improvement project. The tool’s iterative development process included a literature search, a clinical expert panel, and a testing in January and February 2021. ResultsThe We-ReAlyse tool guides healthcare professionals to identify areas for quality improvement by reflecting the patient's pathway from the initial intensive care stay to readmission. Ten readmissions were analyzed by using the We-ReAlyse tool, resulting in key insights about possible root causes like the handover process, patient's care needs, the resources on the general unit and the use of different electronic healthcare record systems. ConclusionsThe We-ReAlyse tool provides a visualization/objectification of issues related to intensive care readmissions, gathering data upon which to base quality improvement interventions. Based on the information on how multi-level risk profiles and knowledge deficits contribute to readmission rates, nurses can target specific quality improvements to reduce those rates. Implications for clinical practice and researchWith the We-ReAlyse tool, we have the opportunity to collect detailed information about ICU readmissions for an in-depth analysis. This will allow health professionals in all involved departments to discuss and either correct or cope with the identified issues. In the long term, this will allow continuous, concerted efforts to reduce and prevent ICU readmissions. To obtain more data for analysis and to further refine and simplify the tool, it may be applied to larger samples of ICU readmissions. Furthermore, to test its generalizability, the tool should be applied to patients from other departments and other hospitals. Adapting it to an electronic version would facilitate the timely and comprehensive collection of necessary information. Finally, the tool’s emphasis comprises reflecting on and analyzing ICU readmissions, allowing clinicians to develop interventions targeting the identified problems. Therefore, future research in this area will require the development and evaluation of potential interventions.