Discharge Follow-up Of Patients Research Articles

60 A Retrospective Review of Factors Influencing Post-Hospital Discharge Follow-up in Patients with Burn Injuries

Abstract Introduction Approximately 486,000 burn injuries, requiring hospitalization and/or outpatient care occur annually. Physical and psychosocial problems may develop at any time during recovery and it is important that care continue after discharge to maximize outcomes. Often, patients discharge themselves from clinic for unknown reasons. The purpose of this study was to identify factors related to self-discharge. Methods A retrospective chart review of patients admitted to the burn center and outpatient follow up visits in 2018 was performed. Patients were grouped by lost to follow up (LTF) versus completed patients (COM). The LTF were further stratified by distance from clinic (≤ 50 miles vs. > 50 miles). COM were categorized as those who were discharged from clinic as PRN follow up visits. Results A total of 211 patients were scheduled for outpatient visits, mean age was 36.4 years and 74% were male. Most were Caucasian (41%) and Hispanic (31%). The most frequent payor sources were Medicaid (58%)/ Medicare (17%). Mean TBSA was 5.8 %, the most common mechanisms were Flame/Flash and Scald (30% each). Mean length of stay was 10.3 days, mean number of surgeries was 1.5. The majority of patients were discharged Home (71%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. LTF patients had a smaller TBSA (4.69%) compared to COM (9.62%). Comparison between LTF and COM, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=< 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p< 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group. When LTF were stratified by distance, Native Americans were significantly more likely to live > 50 miles from the clinic (p < .00001). Conclusions A large percentage of patients discharged themselves from clinic. Factors associated with self-discharge include healed wounds, no scarring issues, smoking, substance abuse and mental illness. Given the geographic distribution of races and ethnicities in our state, it is unsurprising that Native Americans live distant to our clinic. This provides an opportunity to expand our outreach efforts and incorporate the use of technology to improve access to care for this population.

805 A Retrospective Review of Factors Influencing Post-hospital Discharge Follow-up in Patients with Burn Injuries and Necrotizing Soft Tissue Infections

Abstract Introduction Approximately 486,000 burn injuries requiring medical treatment occur each year. Medical treatments for burns vary and are dependent on the extent of the injury. Several physical and psychosocial problems may develop after discharge, including pain, itching, scarring, anxiety and depression, making it important and necessary for burn care treatment to continue even after discharge. Often, patients do not continue outpatient care due to unknown circumstances. The purpose of this study is to help identify factors that affect outpatient burn clinic visits after hospital discharge. Methods A retrospective chart review of patients admitted to the burn center who had an outpatient follow up visit in 2018 was performed. Patients were grouped by lost to follow up versus completed patients. Completed patients were categorized as those who were discharged from clinic as PRN follow up visits. Results A total of 211 patients were scheduled for outpatient visits in 2018, mean age was 36.4 years and 74% were male. Population consisted mainly of Caucasian (41%) and Hispanic (31%). The most common payor source was Medicaid (58%) and Medicare (17%). The mean TBSA was 5.8 % with the most common mechanisms were Flame/Flash and Scald (30% each). The mean length of stay was 10.3 days, mean number of surgeries was 1.5. Majority of patients were discharged Home (71%) and SNF (20%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. Lost to follow up (LTF) patients had a smaller TBSA (4.69%) compared to those who completed follow-up (9.62%). Comparison between LTF and completed patients, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=< 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p< 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group. Conclusions There were a large percentage of patients who discharged themselves from clinic care. Factors that were associated with self-discharge include healed wounds, no scarring issues noted, and patients with complications, smokers, substance abuse and mental illness. Self-discharge / LTF may be related to resolution of ongoing issues prior to last scheduled appointment. Applicability of Research to Practice Additional research is needed to determine additional factors affecting lost to follow up in our outpatient burn clinic.

A378 Feasibility and utility of a telemedicine protocol for post discharge follow-up in patients undergoing Bariatric surgery.

A378 Feasibility and utility of a telemedicine protocol for post discharge follow-up in patients undergoing Bariatric surgery.

Cross-sectoral collaboration by telehealth for prevention of acute admissions in elderly

Introduction: High age is associated with an increased risk of hospital-demanding disease. In only 20 years, the number of 80+ in Denmark will double from approximately 238,000 in 2015 to 470,000 in 2035. Despite the increasing number of aged persons, the number of hospital beds in Denmark are being reduced as new ‘super-hospitals’ are built across the country. In response, health care delivery organisations and authorities have focused their efforts on avoiding acute short-term ( Description of care practice: Consequently, there is a demanding need for rethinking current practices and finding alternative ways by which it is possible to diagnose potentially acute patients quickly and initiate proper treatment. Building on the existing collaboration and practises in the Danish healthcare system between general practices, home care delivered by the municipalities and secondary care (hospitals) and the technological infrastructure available in Region of Southern Denmark, PAATH (Prevention of Acute Admissions by Telehealth) will facilitate new cross-sectoral procedures that strengthen the collaboration for the benefit of patients (70+). PAATH’s aim is to demonstrate if by utilising existing technological solutions, we can develop and demonstrate a complete process from home-monitoring of patient’s vital signs to remote specialist consultation that can ultimately prevent acute admissions to hospital. Acute team nurses in Svendborg Municipality are equipped with a “GERI-suitcase” containing a range of devices to measure vital signs, blood tests, bladder scan etc. The data from the devices are automatically transferred via a tablet (which also enables real-time video consultation) to a joint IT platform, where the GP, hospital, home care and the patient all have access and are able to see the data. The treating doctor will thus have immediate access to the data and a much clearer picture of the patient’s current situation and thereby a qualified foundation for deciding the treatment and next steps, i.e. if the patient can be treated at home, at the geriatric outpatient clinic or admissions is required. The GERI-suitcase concept is tested for an eight-month period between July 2016 and February 2017. Conclusion and discussion: With the intention of demonstrating the potential in new cross-sectoral work procedures and telehealth supported home-monitoring by acute team for the prevention of acute admissions of elderly medical patients, PAATH began in January 2016 and is in the process of testing the GERI-suitcase in real-life settings. The purpose of PAATH is to demonstrate if it is technically, medically, organisationally and culturally feasible. Effectiveness (reduction in acute admissions, contacts to GP and home care services) will be far more scientifically and rigorously evaluated in further studies that are planned to succeed PAATH.

Comprehensive discharge follow-up in patients’ homes by GPs and district nurses of elderly patients

Objectives. Many hospital admissions are due to inappropriate medical treatment, and discharge of fragile elderly patients involves a high risk of readmission. The present study aimed to assess whether a follow-up programme undertaken by GPs and district nurses could improve the quality of the medical treatment and reduce the risk of readmission of elderly newly discharged patients. Design and setting. The patients were randomized to either an intervention group receiving a structured home visit by the GP and the district nurse one week after discharge followed by two contacts after three and eight weeks, or to a control group receiving the usual care. Patients. A total of 331 patients aged 78+ years discharged from Glostrup Hospital, Denmark, were included. Main outcome measures. Readmission rate within 26 weeks after discharge among all randomized patients. Control of medication, evaluated 12 weeks after discharge on 293 (89%) of the patients by an interview at home and by a questionnaire to the GP. Results. Control-group patients were more likely to be readmitted than intervention-group patients (52% v 40%; p = 0.03). In the intervention group, the proportions of patients who used prescribed medication of which the GP was unaware (48% vs. 34%; p = 0.02) and who did not take the medication prescribed by the GP (39% vs. 28%; p = 0.05) were smaller than in the control group. Conclusion. The intervention shows a possible framework securing the follow-up on elderly patients after discharge by reducing the readmission risk and improving medication control.