Discharge Planning Research Articles

Unveiling the Vital Roles of Medical Social Worker in Multidisciplinary Teams in Hospital Settings: Insights from the Literature

This review article seeks to unveil the multifaceted roles of medical social workers in a multidisciplinary team in hospital settings, uncovering insights from the existing literature highlighting their contribution in promoting holistic patients care outcomes and fostering collaborations and coordination as well as overall functioning of the healthcare system This article reviewed online research articles on the roles of medical social workers within a multidisciplinary team in hospital settings. Keywords used in conducting the literature review were: ‘Medical social workers,’ ‘hospital social workers,’ ‘roles of medical/hospital social workers,’ and ‘multidisciplinary teams in hospital/healthcare settings.’ The Boolean Operator Conjunctive “AND” was employed in the association of these keywords to augment the scope of inquiry. The databases used for literature searches were Google Scholar, ProQuest Central, Semantic Scholar Science Direct, and Research Gate. The articles conclude that medical social workers play vital roles within a multidisciplinary team in hospital settings, such as Service provision, The role of patient advocacy and support, Resources mobilization, the role of discharge planning, and Interprofessional collaboration in chronic disease management within a team. Therefore, it is pertinent that medical social workers are vital members of a multidisciplinary team; their vital roles must be recognized, appreciated, and supported to foster the quality of healthcare provided to patients in a hospital setting.

Protocol on a systematic review of nomenclature and outcomes in children with complex critical illness in Paediatric Critical Care: The basis for consensus definition.

Paediatric Critical Care (PCC) supports the recovery of children with severe illness. In the UK, there are 30 PCC units with a total of approximately 400 beds. There is constant demand for these beds with a mean five-day length of stay and admissions increasing at a greater rate than age-specific population growth. Prolonged stay patients account for approximately half of all PCC patient bed days. Children with complex critical illness (CCI) need input from multiple different teams alongside support for their family. CCI often become prolonged PCC-stay patients too. Internationally, there is variation in the definition of CCI, this creates service variation and tensions around what resources can be provided including discharge planning, provision, and support. Objective: The face of Paediatric Critical Care, in the UK and internationally has changed over the last ten years with a growing cohort of complex critically ill patients. This systematic review aims to look at current nomenclature, criteria, and outcome measures of priority in this undefined patient population. Inclusion criteria: All types of studies examining children with complex critical illness (age <18 years) admitted to any paediatric critical care. The review is registered on Prospero. Medline, Embase, Maternity and Infant care, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Trip database will be searched from 2014 to May 2024. The search was limited to ten years as children with complex critical illness are a relatively new concept within PCC. Therefore, the timeline was limited to increase the accuracy and applicability of the review. Search limits included all languages, excluded the setting of neonatal intensive care, and age>18 years old. The final search strategy was developed in Medline and peer-reviewed by a health research librarian not involved in the study. This was translated to other databases as appropriate. Four independent reviewers will screen citations for eligible studies and perform data extraction. A systematic review methodology has been used to develop a broad understanding of the literature which will be used to develop further work in this area. Using a rigorous and stepwise approach, the whole spectrum of scientific publications on children with complex critical illness in paediatric intensive care will be reviewed, ensuring this study is as comprehensive as possible. This includes quantitative, qualitative, theoretical, and grey literature. A limitation of this systematic review is the use of many terms to describe children with complex critical illness in the literature resulting in a high number of publications on this topic.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Cytoreductive Surgery (CRS): Age-Related Outcomes and a Look into the Future

Introduction: Peritoneal carcinomatosis presents significant treatment challenges. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) offers a promising therapeutic approach. Patient selection remains critical, and the role of age as an exclusion criterion requires further investigation. This study evaluates whether age influences postoperative outcomes in CRS-HIPEC patients. Methods: A retrospective review of a prospective comprehensive database of 271 CRS-HIPEC procedures performed between 2018 and 2023 was conducted. Logistic regression assessed the relationship between age and postoperative outcomes. Age groups (18–44, 45–69, ≥70 years) were compared based on demographic data, primary tumor site, Peritoneal Cancer Index scores, and key outcome measures. Results: Across the different age groups, there were no significant differences in PCI scores, recurrence, disease-free survival, 30-day morbidity, or mortality. Length of stay was longer in older patients (p = 0.009). Patients aged ≥70 had higher readmission rates (p = 0.041) and were more often discharged to transitional care facilities (p = 0.001). Older patients were also more likely to experience Clavien–Dindo grade III or higher complications (p = 0.008). Logistic regression confirmed these findings. Continuous age analysis yielded similar results and revealed significant differences in race and primary organ involvement. Conclusions: Age is not a significant predictor of 30-day morbidity, mortality, or survival outcomes in patients undergoing CRS-HIPEC. However, older patients require closer attention to discharge planning and readmission risk management. This study highlights the importance of comprehensive patient assessment beyond age and underscores the need for further research to better understand factors influencing outcomes in this population.

Abstract TP136: STRACK: A Continuum of Stroke Care, Improving Post-Stroke and Cardiometabolic Patient Outcomes

Background: The STRACK project aims to improve post-stroke patient management and the transition from acute to primary care thanks to improvements in patient pathways and monitoring cardiovascular risk factors: heart failure, diabetes, atrial fibrillation, dyslipidemia and hypertension. Collaboration between primary care centers and hospital staff was essential for the project’s success by delivering personalized care and home monitoring devices to patients through access to a digital platform. STRACK was launched with a european value-based contracting process and Roche Diag. as partner. Methods: The three-year project was launched in May 2021, during first year all specialties and professionals participated in the development and planning of the project and were trained in the use of the devices and own digital platform. First STRACK patient was enrolled in May 2022. Once these post-stroke patients have been identified, they are given a personalized monitoring plan depending on the individuals’ risk factors, the personalized care and rehabilitation plans are tracked and followed. For a year post-discharge, a nursing and administrative team follows the data that the patient enters remotely or is automatically available on their mobile application. Results: STRACK has evolved the continuum of care by 421patient in July 2024 and ongoing, by integrating comprehensive monitoring of cardiometabolic risk factors (heart failure, diabetes, atrial fibrillation, dyslipidemia, hypertension) into a patient discharge plan, identified as key to avoiding stroke recurrence and improving control of vascular risk factors are monitored. Preliminary results of 231 patients (May 2022-2023) with full one year follow-up comparing with historical cohort (May 2018-2019) showed: Reduction in unnecessary visits (weighted): -26,3%. Reduction in admissions for stroke recurrence or related to stroke, (heart attack, angina, peripheral embolism, etc.): Stroke, 30days: -100%; Related to stroke, (365d: -47,7%; 30d: -57,0%). Reduction in cardiovascular admissions ( 30d: -100%; 365d: -31,4%). Best treatment adherence: 81,2% (72% previously) Conclusion: The great value of STRACK is knowing the evolution of stroke patients post-discharge through strict self-monitoring of clinical parameters, following prior health education. STRACK has managed to achieve reduction in stroke recurrence and adverse events and readmissions for cardiovascular risk factors, reducing emergency visits for vascular events.

National Implementation of a Crisis Resolution Home Treatment (CRHT) Team in Malta: Insights From the First Two Years of Operation.

Crisis Resolution Home Treatment (CRHT) teams have become a widespread alternative to psychiatric hospitalisation. Despite their popularisation, Malta has only recently introduced a CRHT team. The aims of the current study were to investigate (i) patient characteristics, (ii) factors influencing patients' length of follow-up (LoFU) and (iii) predictors of clinical outcomes. Descriptive and quantitative non-identifiable data were collected and analysed for patients utilising the CRHT service within its first 2 years of operation (n = 643). One-way ANOVA tests investigated influencing factors for LoFU, whereas binary logistic regressions deduced predictive factors for clinical outcomes. Patients without acute psychiatric disorders had the shortest LoFU, indicating that the team received inappropriate referrals. Patients were most likely to have extended LoFU if they were diagnosed with OCD & related disorders and were most likely to be diagnosed with an underlying personality disorder if they were diagnosed with anxiety & phobic disorders. Continuity of care facilitates discharge planning. Patients receiving the CRHT service in Malta are most comparable with health systems that prefer to hospitalise patients with a higher risk profile. The high occurrence of personality disorders necessitates staff to have interdisciplinary knowledge and an appropriate skill mix.

Modified Frailty Index (mFI-5) as a prognostic tool of mortality, complications, and readmissions in patients undergoing hepatic ablation for hepatocellular carcinoma.

610 Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer deaths, often diagnosed late, limiting curative options. Transarterial chemoembolization, Y-90 radioablation, radiofrequency ablation, and thermoablation are commonly used for downstaging, transplant bridging, and palliation in unresectable HCC. Frailty, linked to postoperative complications, has not been studied in hepatic ablation patients. This study evaluates the predictive value of the modified frailty index (mFI-5) for mortality, readmissions, complications, redo procedures, and discharges. Methods: We utilized the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2019, querying cases of hepatic ablation for CPT codes: 47370 (closed hepatic ablation, single site) and 47380 (open hepatic ablation, single site). Selected cases were analyzed for frailty using the mFI-5 criteria. A multivariate analysis was performed using mFI-5 frailty scores, stratified into non-frail (0), pre-frail (1), frail (2), and severely frail (3+). The outcomes analyzed included mortality, discharge to a destination other than home, major complications, minor complications, readmission, and reoperation. Results: We identified 1921 patients as: 737 non-frail, 701 pre-frail, 442 frail and 41 severely frail. The rates of readmission (5.4%), reoperation (1.4%), major (5.3%) and minor (3.5%) complications were low. Eight patients died following hepatic ablation, and 79 patients were discharged to a destination other than home. In multivariate analysis, most outcomes were not significantly associated with increasing frailty. However, discharge to a destination other than home was significantly more likely in patients with higher frailty scores. In frail patients, the odds ratio (OR) was 2.325 (95% CI 1.228–4.402), and in severely frail patients, this increased to 8.720 (95% CI 3.389–22.435). Conclusions: Hepatic ablation is generally well tolerated with low complication rates; however, frailty significantly influences postoperative outcomes. Frail and severely frail patients are more likely to be discharged to care facilities rather than returning home, suggesting that even in the absence of major complications, these patients require a higher level of post-procedural care. This underscores the need for tailored discharge planning and resource allocation based on patient frailty.

P-967. Impact of simulated ID rounds for third year pharmacy students (P3s) in an infectious diseases (ID) elective

Abstract Background ID Rounds simulate real-world multidisciplinary ID rounds for P3s enrolled in the ID elective. Two faculty play the ID attending and 4th year pharmacy students on their Advanced Pharmacy Practice Experiences play the roles of the ICU fellow, nurse, microbiologist, and radiologist. An ID consult for a patient with post-influenza pneumonia along with the patient’s general information and basic labs are presented. P3s are guided to navigate the patient care process, collecting and assessing information, and formulating, implementing, and evaluating therapeutic recommendations. Challenges incorporated include a weight discrepancy, altering antimicrobials, monitoring drug levels, following cultures, and discharge planning. The purpose of this study was to assess the impact of ID Rounds on achieving Doctor of Pharmacy educational outcomes and professional activities. Methods An anonymous, electronic survey was distributed to P3s to assess the impact of ID Rounds. Survey questions were designed in accordance with the standards set by the American Association of Colleges of Pharmacy Curriculum Outcomes and Entrustable Professional Activities, using a Likert scale. Student perceptions were also collected. Results 36 P3s responded and all strongly agreed or agreed that ID Rounds helped them learn foundational knowledge of inpatient rounds and enhanced their professional skills by building and maintaining trust among their colleagues. Majority strongly agreed or agreed that ID Rounds helped them understand the role of a pharmacist in optimizing antimicrobial use (94.5%, 34/26), become better communicators (94.5%, 34/36), and support the achievement of shared goals on a team (97.2%, 35/26). Majority rated ID Rounds a 4 out of 5 in difficulty, found the activity as an engaging way of learning about inpatient rounds, and enjoyed participating. Conclusion ID Rounds allowed pharmacy students to achieve key standards in Doctor of Pharmacy educational outcomes and professional activities. Students responded positively to ID Rounds, which actively involved them in a real-world scenario, enabling the application of critical skills such as collaborative practice, critical thinking, and effective communication. These competencies are fundamental to the practice of pharmacy. Disclosures All Authors: No reported disclosures

P-739. Injection-Related Skin Ulcers: a Common and Poorly Addressed Risk Factor for Rehospitalization among People who Inject Drugs in the CHOICE+ Cohort

Abstract Background Injection-related skin ulcers (IRSU) are a cause of acute bacterial infection among people who inject drugs (PWID). We aimed to measure the prevalence, characteristics, and risk factors for IRSU, and the risk of readmission, among a cohort of PWID hospitalized for infections. Table 1 SD, standard deviation. Methods CHOICE+ is a multisite retrospective cohort study of adults hospitalized at four healthcare systems with infections due to injection opioid use between 1/1/2018 and 3/31/2022. Data were collected by abstraction of the electronic medical record and were analyzed by chi-square, multivariable logistic regression, and unpaired t-test. Factors statistically significant for IRSU in bivariate analysis were examined by multivariate logistic regression. Detailed data on IRSU were recorded from the Baltimore site. Table 2 GWU, George Washington University; MOUD, medication for opioid use disorder; UMB, University of Maryland Baltimore; WVU, West Virginia University. Results Of 1652 included patients, 221 (13%) had a documented IRSU. Key demographics were similar between those with and without IRSU (Table 1). The odds of IRSU were higher among those who were positive for fentanyl and older age (Table 2). Baseline IRSU was associated with increased odds of readmission (aOR 1.4, p = 0.02) and a greater number of readmissions within 1 year (1.2 v. 0.9, p = 0.01, Figure 1). Among 116 patients from Baltimore with documented IRSU and detailed data, IRSU was the primary reason for admission in 66%. Xylazine use was not noted in any records. Most patients had &amp;lt; 4 ulcers and ulcers &amp;lt; 10 cm. 13% of patients received sharp debridement and 6% were treated with limb amputation. IRSU was more frequently addressed in the discharge note if IRSU was the primary reason for admission (71% v 50%, p &amp;lt; 0.05). Only 16 (14%) patients were advised or scheduled to attend an outpatient wound care appointment; only 3 (3%) did so within 30 days of discharge (Figure 2). Figure 1 **, p=0.01. Conclusion Among PWID hospitalized for infection, IRSU were common, especially among older patients and those testing positive for fentanyl. Xylazine exposure was likely under-assessed. Importantly, IRSU was associated with an increased risk of hospital readmission, but outpatient planning and follow up were rare. Clinicians caring for PWID must address IRSU alongside other infectious diseases, addiction, and harm reduction interventions. Figure 2 Discharge planning and outpatient care within 30 days of discharge. DC, discharge; *, p=0.048) Disclosures Elana S. Rosenthal, MD, Gilead Sciences: Grant/Research Support|Merck: Grant/Research Support

Assessing Family Caregiver Readiness for Hospital Discharge of Patients With Serious or Life-Limiting Illness Using Electronic Health Record (EHR) and Self-Reported Data.

To assess how patient and caregiver factors influence caregiver readiness for hospital discharge in palliative care patients. This transitional care study uses cross-sectional data from a randomized controlled trial conducted from 2018 to 2023 testing an intervention for caregivers of hospitalized adult patients with a serious or life-limiting illness who received a palliative care consult prior to transitioning out of the hospital. Caregiver readiness was measured with the Family Readiness for Hospital Discharge Scale (n = 231). Caregiver demographic, intra- and interpersonal factors were self-reported. Patient demographic, comorbidity score, and risk score for complicated discharge planning were extracted from electronic health records. Stepwise regression models estimated variance explained (r2) in caregiver readiness for patient hospital discharge. Patient demographics and complexity were not statistically associated with caregiver readiness for discharge. Caregiver depressive symptoms, poor caregiver-patient relationship quality, and fewer hours spent caregiving prior to hospitalization explained 29% of the variance in caregiver readiness. Reliance on patient data may not be sufficient for explaining caregiver readiness for discharge. Assessing caregiver factors may be a better alternative for identifying caregivers at risk for low discharge readiness and those in need of additional support. ClinicalTrials.gov on November 13, 2017, (No. NCT03339271).

Unmet Social Needs of Older Adults With Mobility Limitations Following Inpatient Rehabilitation Discharge in Nigeria: A Qualitative Narrative Inquiry Study.

Approximately, 30% to 60% of older adults experience functional decline following hospitalization, which has implications for their ability to meet social needs after discharge. Exploring the unmet social needs of older adults following discharge is warranted to rethink the elements of hospital discharge in low-resource countries. This study explored the unmet social needs of older adults with mobility limitations following discharge from an inpatient rehabilitation unit in a state hospital in Northern Nigeria. This narrative qualitative study is based on the social constructivism paradigm guided by the 3-Dimensional Narrative Inquiry Space (3-D NIS) methodology. We purposively selected and conducted telephone interviews with 12 older adults, aged 55years and older, with mobility limitations and discharged from inpatient rehabilitation units. The 3-D NIS guided the thematic analysis of the data. Two author coders independently conducted a thematic analysis of the transcripts. Reflexivity was maintained throughout the research process. Two related themes [6 sub-themes] emerged: "limitations in social functioning" [leisure activity, religious engagement, and instrumental activities of daily living modifications]; and "accepting the status quo" [Care/support from relatives, friends, and strangers, regrets and aspirations, and adaptation to psychological needs]. Seven tensions from the participants' transcripts were embedded in emotions, focused on belief, well-being, and spirituality, COVID-19 pandemic impact, desire to be "normal," limited finance, non-age-friendly homes and community settings, and undetailed rehabilitation discharge planning. This study highlights the substantial unmet social needs of older adults with mobility limitations following discharge from inpatient rehabilitation units in Northern Nigeria, underscoring the importance of a holistic approach to hospital discharge planning. Future research in low-resource countries should delve deeper into developing comprehensive discharge strategies that integrate social workers and rehabilitation professionals to effectively address these multifaceted social needs.

Case management in Emergency Care: Impact Evaluation of the CARED Program.

Hospitals face mounting pressure to reduce unplanned utilization amid rising healthcare demands from an aging population. The Case management for At-Risk patients in the Emergency Department (CARED) program is among the first ED transitional care strategies to focus on both frail older adults and Emergency Department (ED) re-attenders to reduce acute hospital utilization. This study aims to evaluate the effectiveness of the CARED program in reducing hospital (re)admissions and ED re-attendances within 30- and 60-days post-discharge. A retrospective, propensity-matched study was conducted from April 2022 to July 2023 in the ED of Ng Teng Fong General Hospital in Singapore. The CARED program identifies and enrols at-risk patients i.e., frail older adults and patients who re-attend the ED within 30 days of hospital discharge, for a geriatric assessment. This is followed by multidisciplinary team care, discharge planning and right siting of care from the ED to community-based services by ED case managers. The primary outcomes were hospital (re)admissions and ED re-attendances within 30- and 60-days post-discharge. Secondary outcomes were cost avoidance and bed occupancy days from reduced acute hospital usage. Nearest-neighbour 1:1 propensity score matching matched 1,615 intervention group to 1,615 control group. Baseline characteristics of the intervention and control groups did not differ significantly. Difference-in-differences (DID) analyses showed significantly lower 30-day (3.96%; 95% CI 2.71% to 5.23%) and 60-day (6.69%; 95% CI 5.47% to 7.91%) hospital admissions, as well as 30-day (4.89%; 95% CI 3.83% to 5.95%) and 60-day (6.50%; 95% CI 5.28% to 7.72%) ED re-attendances in the intervention group compared to the control group. Additionally, the reduced admission and ED re-attendance rates resulted in 30-day and 60-day inpatient admission costs avoidance ($1,553,548.96 (69.86%); 95% CI $1,525,827.76 to $1,581,270.15; P = 0.006; and $1,400,047.07 (32.56%); 95% CI $1,365,484.79 to $1,434,609.37; P = 0.048 respectively), ED attendance costs avoidance ($25,849.92 (23.70%); 95% CI $25,091.93 to $26,607.89; P = 0.096; and $37,538.39 (18.09%); 95% CI $36,470.27 to $38,606.53; P = 0.086 respectively) and bed occupancy days saved (1,212 days; 95% CI 1,191.80 days to 1,232.20 days; P = 0.003; and 1,267 days; 95% CI 1,242.58 days to 1,291.42 days; P = 0.011 respectively). CARED program effectively reduced unplanned hospital use within 30- and 60-days post-ED discharge for at-risk patients. It also significantly lowered inpatient admission and ED attendance costs and hospital bed occupancy days, highlighting its potential to improve patient outcomes and reduce healthcare expenses.

Proposal of a Machine Learning Based Prognostic Score for Ruptured Microsurgically Treated Anterior Communicating Artery Aneurysms.

Background: Aneurysmal subarachnoid hemorrhage (aSAH) carries significant mortality and disability rates, with rebleeding posing a grave risk, particularly in anterior communicating artery (AcoA) aneurysms. This retrospective study aims to analyze preoperative and intraoperative variables of patients with ruptured AcoA aneurysms, evaluating the association of these variables with patient outcomes using machine learning techniques, proposing a prognostic score. Materials and Methods: A retrospective study was conducted on 50 patients who underwent microsurgical clipping for a ruptured AcoA aneurysm at San Giovanni Bosco Hospital, Turin, Italy. The clinical and aneurysmal data-including clinical evaluations, risk factors, aneurysmal characteristics, and intra- and postoperative details-were examined. The study population was analyzed using machine learning techniques such as the MRMR algorithm for feature selection, and the LASSO method was employed to construct linear predictive models based on these features. Results: The study cohort had a mean age of 54 years, with 26 female and 24 male patients. Temporary clipping of main vessels was performed in 96% of procedures, with a mean duration of 3.74 min. Postoperatively, the mean Intensive Care Unit (ICU) stay was 7.28 days, with 14% mortality at 30 days and 4% within the first week. At the six-month follow-up, 63% of discharged patients had a Glasgow outcome scale (GOS) of 5, with radiological confirmation of complete aneurysm exclusion in 98% of cases. Machine learning techniques identified the significant predictors of patient outcomes, with LASSO algorithms generating linear models to predict the GOS at discharge and at 6 months follow-up. Conclusions: Preoperative factors like the BNI score, Vasograde, and preoperative cerebral edema demonstrate significant correlations with patient outcomes post-clipping. Notably, intraoperative bleeding and extended temporary clipping durations (over 3 min) emerge as pivotal intraoperative considerations. Moreover, the AcoA prognostic score shows promise in predicting patient outcomes, discharge plans, and ICU duration.

Experiences of eating disorder services for people caring for a loved one with an eating disorder in the UK: national survey.

Research suggests that those caring for a loved one with an eating disorder in the UK report unmet needs and highlight areas for improvement. More research is needed to understand these experiences on a wider, national scale. To disseminate a national survey for adults who had experience caring for a loved one with an eating disorder in the UK, informed by the findings of a smaller scale, qualitative study with parents, siblings and partners in the UK. A cross-sectional web-based survey was disseminated to adults who had experience caring for a loved one with an eating disorder in the UK. A total of 360 participants completed the survey. Participants described experiences of care received in both children and young people's, and adult services. Those receiving care from children and young people's services generally reported more timely care, greater involvement in care and more confidence managing their loved one's symptoms post-discharge. In both settings, participants identified a number of areas for improvement, including more timely access to care, improved transition processes and discharge planning, and increased involvement in their loved one's care. This survey captures the experiences of individuals caring for a loved one with an eating disorder in the UK. There are identified discrepancies between experiences of care in children and young people services compared with adult services. Clinical implications and recommendations for improvement are discussed, including improved transition and discharge processes, increased involvement of and/or support for carers themselves, and more timely access to support services for the unwell individual.

Predictors against discharge to home in geriatric emergency general surgery patients.

This study aims to identify predictors of discharge to post-acute care in geriatric emergency general surgery (EGS) patients. This is a retrospective study of geriatric emergency general surgery (EGS) patients at a tertiary care facility between 2017 and 2018. Inclusion criteria were ≥ 65years old and presented directly from home. Non-survivors or those admitted from a healthcare facility were excluded. The primary outcome was discharge to home versus post-acute care. Out of 577 patients, the median age was 74, and 36.9% were discharged to a post-acute care facility. Factors predicting discharge to post-acute care were: mobility aid use (1.92, [1.19-3.11], p = 0.008), cerebrovascular accident (4.67, [1.99-10.94], p < 0.001), delirium (11.06, [2.29-53.43], p = 0.003), pre-operative transfusion (2.39, [1.13-5.08], p = 0.023), fall history (3.74, [1.90-7.36], p < 0.001), AKI (5.42, [2.61-11.25], p < 0.001), and lack of capacity to consent (4.11, [2.10-8.02], p < 0.001). Non-operative management was protective against discharge to post-acute care (0.38, [0.24-0.60], p < 0.001). Early recognition of the role of these factors in influencing discharge disposition may help with clinical decision-making and discharge planning.

The Role of the Discharge Planning Team on the Length of Hospital Stay and Readmission in Patients with Neurological Conditions: A Single-Center Retrospective Study.

Background: Emerging evidence highlights the critical role of discharge planning teams in enhancing patient care. However, there is lack of data regarding how the implementation of a discharge planning system influences the length of stay (LOS) in hospital and readmission rates among patients with neurological diseases. We conducted a retrospective analysis to examine the effects of discharge planning application on the LOS and readmission rates for patients admitted under the neurology service in Saudi Arabia. Methods: This is a retrospective study conducted at King Abdulaziz Medical City-Western region of Saudi Arabia. We included all patients admitted and discharged under the neurology service between January 2018 and December 2019. The included patients who were divided into the 2018 group (not exposed to discharge planner) and the 2019 group (exposed to discharge planner). The primary endpoints were the LOS and readmission rates. Results: The study included 856 patients (436 allocated to the 2019 group and 420 allocated to the 2018 group). There was no difference between the two groups in the LOS after adjusting confounding factors (β = -0.58, 95% CI [-2.79, 1.61], p = 0.60). However, the 2019 group were more likely to be discharged within three days compared to the 2018 group (41% vs. 26%, p < 0.005). Our analysis showed that patients in the 2019 group were less likely to be readmitted compared to the 2018 group (adjusted odds ratio = 0.70, 95% CI [0.49-0.99], p = 0.0442). Conclusions: Implementation of a discharge planning team was associated with higher early discharge rates and lower hospital readmissions, suggesting potential benefits for healthcare resource utilization in neurological services.

Understanding the Challenges of Readiness for Hospital Discharge in Stoma Patients: A Mixed-Methods Study.

To identify key factors influencing readiness for hospital discharge and delve into the experiences of stoma patients regarding their discharge. A mixed-methods study. A total of 374 colorectal cancer patients with stomas were involved to assess discharge readiness and its influencing factors. Additionally, 28 stakeholders-comprising surgeons, nursing managers, surgical nurses, enterostomal therapists, stoma patients and their family caregivers-participated in semistructured interviews. Data on discharge readiness, discharge teaching quality, stoma self-efficacy and social support were collected using validated scales. In-depth interviews provided further insights into discharge preparation experiences. Multivariate logistic regression analysis using IBM SPSS 26.0 and thematic analysis via NVivo 12.0 were employed for data analysis. Six variables accounted for 80% of the variance in discharge readiness: quality of discharge teaching, stoma self-efficacy, social support, age, gender and family income. Four main themes emerged: ambivalence towards discharge, insufficient preparation time, inadequate communication of discharge information and personal planning needs. Discharge readiness among stomas patients is influenced by perceived discharge teaching quality, self-efficacy, social support, age, gender and family income. Insufficient preparation and poor communication hinder effective discharge information transfer. Enhanced, patient-centred discharge planning is expected to improve the transition from hospital to home. To improve hospital discharge readiness and facilitate a smooth transition to family care, it is essential to implement patient-centred discharge planning. Reported with the Mixed Methods Reporting in Rehabilitation & Health Sciences guidelines. None. ClinicalTrials.gov identifier: ChiCTR2200058756. https://www.chictr.org.cn/bin/home.

Exploring the Nutrition Care Journey of People Living With Obesity in Acute Care.

Recent studies show a high prevalence in hospital populations and best practice evidence indicates that people living with obesity should receive dietetic advice. However, patients often do not receive this care in acute settings. Understanding the experiences of people living with obesity is crucial to designing successful strategies for management. This qualitative study aimed to understand the experience of nutrition care for patients living with obesity in the acute hospital setting and to redesign an optimised patient journey using a design approach. Using patient journey mapping, nutrition care across the inpatient admission was explored. A lived experience perspective was applied to reflect on the patient journey and interactions of patients with dietetic services in the acute setting. A co-creation session was conducted with dietitians and consumers to redesign the patient journey. The patient journey revealed that for patients living with obesity, discussions about weight were absent from the journey from all healthcare professionals. For patients receiving dietetic care, the Nutrition Care Process was followed; nutrition intervention focused on acute nutrition issues with increased energy and protein prescription: a lack of goal setting and absence of discharge planning. The redesign of the nutrition care journey identified pivot points in the pathway to support engagement in obesity-related care. The findings from this study provide new insights into current nutrition care for people living with obesity in the acute setting. These findings can inform future education, research and advocacy for practice changes to improve dietetic care for people living with obesity.

Association between previous work experience in general healthcare and recovery orientation among mental health professionals during the COVID-19 pandemic in Japan

Recovery orientation constitutes a core competency in mental health professionals. Working with primary care helps professionals learn and translate the concept of recovery into practice. In Japan where primary care system is not established yet, previous work experience in general healthcare may substitute for the absence of primary care work experience. However, the evidence quantifying the association is limited. We investigated the association between work experience in general healthcare and recovery orientation. We conducted a cross-sectional online questionnaire survey of hospital workers in Japan between July 2022 and March 2023. Sixty-two participants responded about the level of recovery orientation, personal stigma against people with mental illness, completion of on-the-job training courses, and the impact of the COVID-19 pandemic on their practice. Poor recovery orientation was significantly associated with previous work experience in general healthcare and worse stigma. Participants remarked that pandemic-related measures challenged discharge planning and person-centred practices. Their poor recovery orientation may reflect prioritizing patient safety in inpatient care settings, that could be compounded by the dilemma between infection measures and their mission as mental health organisations during the pandemic. In conclusion, mental health professionals with general healthcare work experience should be prioritised in educational initiatives. Modifiable factors for personal stigma need further clarification. Mental health policies should also reflect on the challenges that COVID-19 poses to hospital-based services.

Identifying Components of an Enhanced Recovery Pathway for Primary Cleft Palate Repair: A Scoping Review.

This study aims to map the existing sources of evidence on perioperative care and recovery strategies for primary cleft palate repair, to identify elements that should be included in an enhanced recovery pathway (ERP), and to identify gaps in current knowledge. Scoping review. ERPs are evidence-based, patient-centered, multimodal, perioperative care pathways designed to reduce surgical stress and improve postoperative outcomes and are increasingly being reported in the cleft lip and palate literature. PubMed, Embase, Cochrane, and Scopus databases were searched. Results were uploaded to Covidence systematic review software. Studies were included for analysis if they described strategies or elements for enhanced recovery following primary cleft palate repair. ERP elements and outcome measures were recorded and collated. Forty-seven studies were included. Frequently reported topics included anesthesia, peri-operative analgesia, and parent education. There was a dearth of evidence about peri-operative nursing care. Based on the extracted data, we propose that the following elements be included in any ERP for primary cleft palate repair: preoperative parent/caregiver education; minimization of preoperative fasting time; preoperative analgesia; local anesthetic nerve blocks; perioperative antibiotics and ondansetron; postoperative non-opioid analgesia; early postoperative oral feeding and discharge planning. The findings provide the framework to develop an institutional ERP for primary cleft palate repair. The positive contribution of consistent nursing care to enhanced recovery is obvious but under-investigated in the literature to date. The impact of ERPs on parent-reported outcomes also warrants further investigation.

Reduction of Antibiotic Prescription in Complicated Appendicitis through Behavioral Change Measures

Abstract Background Variability in the prescription of antibiotics constitutes an area for improvement related to patient safety issues, including the risk of infection and health care efficiency based on evidence. Objectives The study aims to evaluate the effect of an intervention to reduce the duration of antibiotic treatment in complicated appendicitis. Methods A quality improvement program was implemented in the surgical department of The Cuban Hospital (Doha, Qatar). During a 3-month baseline period, data about antibiotic duration, consumption (daily defined doses), and cost (in Qatary Riyals) were identified, as well as during two plan-do-study-act (PDSA) intervention periods. Interventions include action focused on staff education, monitoring antibiotic use, feedback, and reminders during discharge planning. Results At baseline, 13 patients with complicated appendicitis were documented, while there were 41 and 15 patients during PDSA cycles 1 and 2, respectively. A 29.5% reduction in days of antibiotic treatment was observed during the PDSA cycle 2 in comparison with the baseline. Accordingly, a reduction of 38.7% in the consumption of antibiotics and a reduction of 24.6% in cost were observed, with no adverse outcomes for patients during the 30-day follow-up period. Conclusion The intervention resulted in an improvement in antibiotic use with satisfactory patient outcomes and an additional effect on the efficiency of health care and the prevention of microbial resistance and other adverse effects.