Post-Discharge Coping Difficulty Research Articles

Readiness for hospital discharge and its association with post-discharge outcomes among oesophageal cancer patients after oesophagectomy: A prospective observational study.

To examine the level and influencing factors of discharge readiness among patients with oesophageal cancer following oesophagectomy and to explore its association with post-discharge outcomes (post-discharge coping difficulty and unplanned readmission). Oesophageal cancer is common and usually treated via oesophagectomy in China. The assessment of patient's discharge readiness gradually attracts attention as patients tend to be discharged more quickly. Prospective observational study. The STROBE statement was followed. In total, 154 participants with oesophageal cancer after oesophagectomy were recruited in a tertiary cancer centre in Southern China from July 2019 to January 2020. The participants completed a demographic and disease-related questionnaire, the Quality of Discharge Teaching Scale and Readiness for Hospital Discharge Scale before discharge. Post-discharge outcomes were investigated on the 21st day (post-discharge coping difficulty) and 30th day (unplanned readmission) after discharge separately. Multiple linear regressions were used for statistical analysis. The mean scores of discharge readiness and quality of discharge teaching were (154.02 ± 31.58) and (138.20 ± 24.20) respectively. The quality of discharge teaching, self-care ability, dysphagia and primary caregiver mainly influenced patient's discharge readiness and explained 63.0% of the variance. The low discharge readiness could predict more risk of post-discharge coping difficulty (r = -0.729, p < 0.01) and unplanned readmission (t = -2.721, p < 0.01). Discharge readiness among patients with oesophageal cancer following oesophagectomy is influenced by various factors, especially the quality of discharge teaching. A high discharge readiness corresponds to good post-discharge outcomes. Healthcare professionals should improve the discharge readiness by constructing high-quality discharge teaching, cultivating patients' self-care ability, mobilizing family participation and alleviating dysphagia to decrease adverse post-discharge outcomes among patients with oesophageal cancer. Patients with oesophageal cancer after oesophagectomy who met the inclusion criteria were recruited.

Reliability and validity of the Chinese post-discharge coping difficulty scale-parent form in parents of premature infants: a multicenter cross-sectional study.

The measurement of the coping difficulties of parents of premature infants after discharge provides objective data for nurses to prepare infants for discharge. However, no Chinese scale has been developed to measure parents' coping difficulties after their premature infants are discharged. To translate the parent version of the Post-Discharge Coping Difficulty Scale (Ped-PDCDS) from English to Chinese and test the reliability and validity of the Chinese version in parents of premature infants. A multicenter cross-sectional study of 356 parents of premature infants was conducted. The scale was symmetrically translated. Validity was evaluated in terms of content, construct, discriminant, and convergent validities. Reliability was assessed in terms of internal consistency, split-half reliability, and test-retest reliability. The Chinese Ped-PDCDS finally contained 11 items. Exploratory and confirmatory factor analyses results showed that the Chinese Ped-PDCDS had three dimensions, and the convergent and discriminant validities of the scale was satisfactory. The overall reliability, split-half reliability, and test-retest reliability of the scale was 0.85, 0.92, and 0.84, respectively. The Chinese Ped-PDCDS has adequate psychometric properties, and is an easy and appropriate instrument for measuring parents' difficulty in coping with premature infants.

The post-discharge coping difficulty of puerperal women in a middle and low-income tourist city during the COVID-19 pandemic

BackgroundSince the coronavirus disease 2019 (COVID-19) pandemic outbreak, the incidence of mental health problems in perinatal women has been high, and particularly prominent in China which was the first country affected by COVID-19. This paper aims to investigate the current situation and the related factors of maternal coping difficulties after discharge during COVID-19.MethodsGeneral information questionnaires (the Perinatal Maternal Health Literacy Scale, Postpartum Social Support Scale and Post-Discharge Coping Difficulty Scale-New Mother Form) were used to investigate 226 puerperal women in the third week of puerperium. The influencing factors were analyzed by single factor analysis, correlation and multiple linear regression.ResultsThe total score of coping difficulties after discharge was 48.92 ± 12.05. At the third week after delivery, the scores of health literacy and social support were 21.34 ± 5.18 and 47.96 ± 12.71. There were negative correlations among health literacy, social support and coping difficulties after discharge (r = -0.34, r = -0.38, P < 0.001). Primipara, family income, health literacy and social support were the main factors influencing maternal coping difficulties after discharge.ConclusionDuring the COVID-19 pandemic, puerperal women in a low- and middle-income city had moderate coping difficulties after discharge and were affected by many factors. To meet the different needs of parturients and improve their psychological coping ability, medical staff should perform adequate assessment of social resources relevant to parturients and their families when they are discharged, so they can smoothly adapt to the role of mothers.

A Structured Discharge Education Intervention for Parents of Newly Diagnosed Pediatric Oncology Patients.

Background: Parents of children newly diagnosed with cancer require specialized knowledge and skills in order to safely care for their children at home. The Children's Oncology Group (COG) developed expert consensus recommendations to guide new diagnosis education; however, these recommendations have not been empirically tested. Methods: We used a sequential two-cohort study design to test a nurse-led Structured Discharge Teaching Intervention (SDTI) that operationalizes the COG expert recommendations in the setting of a tertiary children's hospital. Outcomes included parent Readiness for Hospital Discharge Scale (RHDS); Quality of Discharge Teaching Scale (QDTS); Post-Discharge Coping Difficulty (PDCD); Nurse Satisfaction; and post-discharge unplanned healthcare utilization. Results: The process for discharge education changed significantly before and after implementation of the SDTI, with significantly fewer instances of one-day discharge teaching, and higher involvement of staff nurses in teaching. Overall, parental RHDS, QDTS, and PDCD scores were similar in the unintervened and intervened cohorts. Almost 60% of patients had unplanned healthcare encounters during the first 30 days following their initial hospital discharge. Overall nurse satisfaction with the quality and process of discharge education significantly increased post-intervention. Discussion: Although the structure for and process of delivering discharge education changed significantly with implementation of the SDTI, parent RHDS and QDTS scores remained uniformly high and PDCD scores and non-preventable unplanned healthcare utilization remained similar, while nurse satisfaction with the quality and process of discharge education significantly improved, suggesting that further testing of the SDTI across diverse pediatric oncology settings is warranted.

Parental caregivers' perception of their transition from hospital to home in children with cerebral palsy who have undergone orthopedic surgery

PurposeEvaluate parental perception of the quality of discharge teaching, readiness for discharge, and the impact of these on post discharge coping difficulty and resource utilization in children with cerebral palsy (CP) following surgery. Design and methodsProspective cohort study conducted from September 2017–March 2021 at a pediatric academic medical center. Demographics were collected pre-operatively. Parents completed the Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS) within four hours of discharge. Four weeks post-discharge, parents completed the Post-discharge Coping Difficulty Scale (PDCDS). Utilization of healthcare resources were extracted from the electronic health record for 90 days post-operatively. Associations among demographics, RHDS, QDTS, PDCDS and resource utilization were assessed using general linear models; PDCDS's open-ended questions were analyzed using directed content analysis. Results114 parental caregivers participated. Post discharge coping was significantly associated with additional resource utilization: length of stay (p = 0.046), readmissions (p = 0.001), emergency department visits (p = 0.001), clinic calls (p = 0.001) and unplanned clinic visits (p = 0.006). PDCDS was negatively correlated with the QDTS Quality of Teaching Delivered subscale (r = −0.32; p = 0.004) and three of five RHDS subscales: 1) Child's Personal Status (r = −0.24; p = 0.02); 2) Knowledge (r = −0.30; p = 0.005); and 3) Coping Ability (r = −0.39; p < 0.001). Four themes explicated parental coping difficulties. ConclusionParents experiencing coping difficulties were more likely to have difficulty managing their child's care needs at home and required additional health care resources. Practice implicationsRecognizing that parents' readiness for discharge may not reflect their coping abilities post-discharge requiring nurses to coordinate pre- and post-discharge education and support services.

Postdischarge coping difficulties and influencing factors ofpregnant women with gestational diabetes mellitus: Across-sectional study.

Aims and objectivesTo identify coping difficulties after discharge and influencing factors of pregnant women with gestational diabetes mellitus.DesignA cross‐sectional descriptive survey was conducted with gestational diabetes mellitus women from four tertiary hospitals in the Shandong Peninsula in China.MethodsThe study consists of 252 gestational diabetes mellitus women. Survey measures included demographic information, quality of discharge teaching scale, readiness for hospital discharge scale and postdischarge coping difficulty scale. Multiple linear regression analysis was used to explore the factors of coping difficulties after discharge.ResultsThe situation of coping difficulties in pregnant women with gestational diabetes mellitus after discharge is not optimistic. Age, education level, type of birth, parity, quality of discharge teaching and discharge readiness are six factors that significantly influence postdischarge coping difficulties.

Transition From Hospital to Home Following Hematopoietic Stem Cell Transplantation: A Feasibility Study for “Rooming in”

Background: The experience of hematopoietic stem cell transplant (HSCT) on both the patients and their caregivers is complex and challenging during hospitalization and post discharge. Complex patient populations require heightened attention on discharge practices to ensure that they are prepared for home regimens. "Rooming in" is a standardized intervention implemented prior to discharge that allows patients and caregivers to assume post discharge care with the support of staff. Other complex patient populations have reported positive outcomes related to "rooming in." Aims: The purpose of this study was to assess the feasibility of a standardized "rooming in" intervention for discharge of pediatric HSCT patients. An additional aim was to describe the quality of discharge teaching, readiness for hospital discharge, and postdischarge coping difficulty in a cohort of HSCT patients using validated questionnaires. Method: Data were collected via medical chart review. A prospective cohort completed validated study questionnaires at discharge and 30 days postdischarge. Results: All caregivers of post-HSCT patients were able to complete the "rooming in" intervention. There was no statistically significant difference for length of stay between the retrospective and prospective cohorts. Caregivers enrolled on the study rated the Quality of Discharge Teaching Scale-Parent Form high (Mdn = 165). Conclusion: We conclude that "rooming in" is a feasible discharge intervention for caregivers of pediatric HSCT patients.

Parent Readiness for Hospital Discharge Scale: Psychometrics and Association With Postdischarge Outcomes.

The purpose of this study is to validate the Readiness for Hospital Discharge Scale (RHDS) for use with parents of hospitalized children. PedRHDS is a structured tool for a discharge readiness assessment before pediatric discharge. Using combined data from four studies with 417 parents, psychometric testing and item reduction proceeded with principal component analysis for factor structure delineation, Cronbach's alpha for reliability estimation, and regression analysis for predictive validity. A 23-item PedRHDS retained the a priori factor structure. Reliability ranged from 0.73 to 0.85 for the 23-item and 10- and 8-item short scales. PedRHDS (all forms) was associated with postdischarge coping difficulty (explaining 12%-16% of variance) and readmission (odds ratio = 0.71-0.80). The PedRHDS and both short forms (PedRHDS-SF10 and PedRHDS-SF8) are reliable and valid measures of parental discharge readiness that can be used as outcome metrics of hospital care and risk indicators for postdischarge coping difficulty and readmission.

Effects of Implementing a Health Team Communication Redesign on Hospital Readmissions Within 30 Days.

Poor communication between health team members can interfere with timely, coordinated preparation for hospital discharge. Research on daily bedside interprofessional health team rounds and nursing bedside shift handoff reports provides evidence that these strategies can improve communication. To improve health team communication and collaboration about hospital discharge; improve patient experience of discharge measured by patient-reported quality of discharge teaching, readiness for discharge, and postdischarge coping difficulty; and reduce readmissions and emergency department (ED) visits postdischarge. A two-sample pre- and postintervention design provided baseline data for redesign of health team communication processes and comparison data for evaluation of the new process' impact. Health team members (n=105 [pre], n=95 [post]) from two surgical units of an academic medical center in the midwestern United States provided data on discharge-related communication and collaboration. Patients (n=413 [pre], n=191 [post]) provided data on their discharge experience (quality of discharge teaching, readiness for discharge, postdischarge coping difficulty) and outcomes (readmissions, ED visits). Chi-square and t tests were used for unadjusted pre- and postintervention comparisons. Logistic regression of readmissions with a matched pre- and postintervention sample included adjustments for patient characteristics and hospitalization factors. Readmissions decreased from 18% to 12% (p<.001); ED visits decreased from 4.4% to 1.5% (p<.001). Changes in health team communication and collaboration and patients' experience of discharge were minimal. The targeted outcomes of readmission and ED visits improved after the health team communication process redesign. The process indicators did not improve; potential explanations include unmeasured hospital and unit discharge, and other care process changes during the study timeframe. Evidence from daily interprofessional team bedside rounding and bedside shift report studies was translated into a redesign of health team communication for discharge. These strategies support readmission reduction efforts.

Transition from Hospital to Home Following Hematopoietic Stem Cell Transplantation

Topic Significance & Study Purpose/Background/Rationale Transition from hospital to home following hematopoietic stem cell transplantation (HSCT) is a challenging and vulnerable time for the caregiver due to the complexity of care needed in the home and may increase the risk of readmission. Methods, Intervention, & Analysis The “rooming in” intervention consists of 24-48 hours prior to discharge, the caregiver assumes all care requiring coordination of medications, feedings, line care and other needs with the RN. Discharge education is completed prior to initiating rooming in. The objective of this study is to evaluate if the current clinical practice of “rooming in” decreases readmission rates within 30 days post-discharge for HSCT patients. Secondary goals include describing the caregiver's perspective of the transition from hospital to home measured by post-discharge coping, hospital discharge readiness, and the quality of the discharge process. This 2-group, non-concurrent study compared readmission rates between 35 historical controls and 35 prospective patients who received the “rooming-in” intervention prior to discharge. Findings & Interpretation Prospective group patient demographics include ages 9 months to 17 years with an average length of stay of 48 days. 28 patients received allogeneic and 7 received autologous transplants. Retrospective patient demographics include ages from 13 months to 21 years with an average length of stay of 43 days. 27 patients received allogeneic and 8 received autologous transplants. Common themes expressed by the families regarding the transition to home are difficult without support of family, difficulty of juggling patient care with other dependents and work, complexity of medication regimen and compliance, and diet requirements. The number of home medications discharged with are significantly associated with the Post-Discharge Coping Difficulty score. Preparation using the Rooming-In intervention does not make a statistically significant difference in readmission rates between the two cohorts. Discussion & Implications A “rooming in” program provides preparation, oversight, and reassurance by the medical team for caregivers. Rooming in allows the provider to identify deficits that the caregiver may struggle with in the home that may result in unnecessary readmissions or poor compliance.

Social resource assessment: Application of a novel communication tool during hospital discharge

ObjectiveTo evaluate an interactive tool designed to help patients communicate their social resources supportive of home recovery to health care providers. MethodsSeventy medical and surgical inpatients completed the D-CEGRM social resource interview, demographic queries, and discharge readiness surveys (RHDS) at discharge. Two weeks later, patients completed post-discharge coping difficulty surveys (PDCDS). Nurses unassociated with patients’ clinical care reviewed structured clinical notes created from the D-CEGRM and categorized patients as likely to have “inadequate” or “adequate” supportive resources for home self-management. Nurse decision making was tracked using an adjudication process, and post-hoc comparisons in patient characteristics, RHDS, and PDCDS were conducted. ResultsNurses categorized 36 patients (51%) as having inadequate resources. Number and accessibility of supports, presence of negative relationships, and previous struggles meeting health-related needs were important decision-making factors. Post-hoc comparisons revealed significant differences in demographic risk factors and discharge readiness ratings for those with inadequate vs. adequate resources. ConclusionThe D-CEGRM may be an efficient tool for patients to communicate access to social resources, and an effective facilitator of transitional care planning.Practice Implications: The D-CEGRM may provide a useful assessment of patients’ home context and guide for transitional care planning.

Parental Adverse Childhood Experiences and Resilience on Coping After Discharge.

Adults with a history of adverse childhood experiences (ACEs) (eg, abuse) have suboptimal health outcomes. Resilience may blunt this effect. The effect of parental ACEs (and resilience) on coping with challenges involving their children (eg, hospitalization) is unclear. We sought to quantify ACE and resilience scores for parents of hospitalized children and evaluate their associations to parental coping after discharge. We conducted a prospective cohort study at a children's hospital (August 2015-May 2016). Eligible participants were English-speaking parents of children hospitalized on the Hospital Medicine or Complex Services team. The ACE questionnaire measured the responding parent's past adversity (ACE range: 0-10; ≥4 ACEs = high adversity). The Brief Resilience Scale (BRS) was used to measure their resilience (range: 1-5; higher is better). The primary outcome was measured by using the Post-Discharge Coping Difficulty Scale via a phone call 14 days post-discharge (range: 0-100; higher is worse). Associations were assessed by using multivariable linear regression, adjusting for parent- and patient-level covariates. A total of 671 (81% of eligible parents) responded. Respondents were primarily women (90%), employed (66%), and had at least a high school degree (65%); 60% of children were white, 54% were publicly insured. Sixty-four percent of parents reported ≥1 ACE; 19% had ≥4 ACEs. The mean Brief Resilience Scale score for parents was 3.95. In adjusted analyses, higher ACEs and lower resilience were significantly associated with more difficulty coping after discharge. More parental adversity and less resilience are associated with parental coping difficulties after discharge, representing potentially important levers for transition-focused interventions.

Using Technology to Enhance Discharge Teaching and Improve Coping for Patients After Stroke.

A diagnosis of stroke is a life-changing event. Effective discharge teaching after a stroke is crucial for recovery, but the overload of information can be overwhelming for patients and caregivers. The purpose of this study was to examine differences in discharge readiness and postdischarge coping in patients admitted for stroke after the use of individualized postdischarge information/education provided via a technology package (including patient online portal access, e-mail/secure messaging) compared with current standard discharge teaching methods (verbal/written instructions). This study used a descriptive comparative design to evaluate the difference between the nonintervention group A and the intervention group B. Patients in group B received additional discharge information via secured e-mail messaging at postdischarge days 2, 6, and 10. Two validated tools, Readiness for Hospital Discharge Form and Post-Discharge Coping Difficulty Scale, were used. One hundred patients were recruited for the study, but the final number of complete data sets collected was 86-42 in group A and 44 in group B. There was no statistically significant difference between the groups in discharge readiness. There was a significant difference in coping scores between the 2 groups, with the technology group exhibiting higher coping. New technology affords new options to improve discharge readiness and contribute to positive patient coping after stroke. The researchers hope that this study will contribute to the growing body of evidence showing success using aspects of technology to enhance discharge teaching and follow-up after discharge.

Discharge Teaching, Readiness for Discharge, and Post-discharge Outcomes in Parents of Hospitalized Children

PurposeThis study explored the sequential relationships of parent perceptions of the quality of their discharge teaching and nurse and parent perceptions of discharge readiness to post-discharge outcomes (parental post-discharge coping difficulty, readmission and emergency department visits). Design/methodsIn this secondary analysis of data from a longitudinal pilot study of family self-management discharge preparation, the correlational design used regression modeling with data from a convenience sample of 194 parents from two clinical units at a Midwest pediatric hospital. Data were collected on the day of discharge (Quality of Discharge Teaching Scale; Readiness for Hospital Discharge Scale), at 3weeks post-discharge (Post-Discharge Coping Difficulty Scale), and from electronic records (readmission, ED visits). ResultsParent-reported quality of discharge teaching delivery (the way nurses teach), but not the amount of content, was positively associated with parent perception (B=0.54) and nurse assessment (B=0.16) of discharge readiness. Parent-reported discharge readiness was negatively associated with post-discharge coping difficulty (B=−0.52). Nurse assessment of discharge readiness was negatively associated with readmission; a one point increase in readiness (on a 10 point scale) decreased the likelihood of readmission by 52%. ConclusionThere is a sequential effect of quality of discharge teaching delivery on parent discharge readiness, which is associated with parent coping difficulty and child readmission. Practice ImplicationsEfforts to improve discharge outcomes should include strategies to build nurse teaching skills for high-quality delivery of discharge teaching. In addition, routine nurse assessment of discharge readiness can be used to identify children at risk for readmission and trigger anticipatory interventions.

Quality of Transition From Hospital to Home: The Influence of Nurse- and Patient-Reported Readiness.

Identifying those at risk of poor outcomes after hospital discharge is a central focus of health care systems. Our purpose was to better understand whether and how patient- and nurse-assessed readiness for discharge (Pt- and RN-RHDS) is related to patient experiences after discharge. We conducted a prospective survey of 70 Veterans and their assigned nurses on the day of, and again with Veterans 2 weeks after, hospital discharge. The predictive model for post-discharge coping difficulty included educational level ( p = .05) and an interaction between Pt-RHDS ratings and Pt-RN RHDS discordance ( p = .01). The predictive model for patient-reported quality of hospital to home transition experience included Pt-RN RHDS discordance and an interaction between Pt-RHDS and the number of people living with the patient ( p = .05). Our findings demonstrate that agreement between Pt- and RN-RHDS may be an important measure in work aiming to improve patient outcomes post-hospitalization.

Early and Intermediate Hospital-to-Home Transition Outcomes of Older Adults Diagnosed With Diabetes.

The purpose of this study was to identify factors affecting early and intermediate hospital-to home transition outcomes of older adults with preexisting diabetes mellitus. A mixed-methods design was used. A sample of 96 hospitalized older adults with a prior diagnosis of diabetes were recruited within 4 hours of discharge. Data reflective of general health status, diabetes status, perceived discharge readiness (Readiness for Hospital Discharge Scale), hospitalization, and anticipated postdischarge support were gathered upon enrollment. Transition outcome data including unplanned care encounter occurrences, perceived transition quality (Care Transition Measure-15), and postdischarge difficulty (scale and free responses to the Post-Discharge Coping Difficulty Scale [PDCDS]) were obtained by telephone interview 7 and 30 days after discharge. Three unique, dichotomous variables were created from recurrent subthemes that emerged during content analysis of free-response data and were used in statistical testing. Binary logistic regression was performed to identify predictive factors for an unplanned care encounter within 30 days of discharge. Multimorbidity was prevalent in participants. Difficulties managing medications, blood glucose, and chronic illnesses other than diabetes were common problems. Higher PDCDS scores 7 and 30 days following discharge and difficulty managing a nondiabetes chronic health problem were predictive of an unplanned care encounter within 30 days of discharge. Multimorbidity complicates home recovery of older adults with diabetes. Diabetes adds complexity to hospital-to-home care transitions. Transition difficulties predict higher risk for an unplanned care encounter. More intensive follow-up of older adults with diabetes during the first month following discharge is recommended.

Broadening the Horizons on Predictors of Discharge Teaching, Discharge Readiness, and Postdischarge Outcomes

Paper Presentation Objective To explore the predictors of postpartum mothers' perceptions of the quality of discharge teaching, readiness for hospital discharge, and associated outcomes with postdischarge coping difficulty and use of health care. Design An exploratory research design was used to identify relationships among intrapartum and postpartum variables on postdischarge coping difficulty and use of health care. Setting Southwestern women's specialty hospital with 209 beds. Sample A powered sample size of one 185 English and Spanish speaking, mixed parity, postpartum mothers who had vaginal or cesarean births of healthy infants were included in the sample. Methods A conceptual model adapted from the middle range theory of Meleis provided a framework for exploring transition concepts relevant to postpartum mothers going home. Participants completed a demographic questionnaire that included items related to the nature of transition and transition conditions that affect patterns of response during labor and postpartum. These mothers also completed a quality of discharge teaching questionnaire and readiness for hospital discharge questionnaire prior to discharge. Discharge teaching was the pattern of response under investigation during hospital transition from to home. Postdischarge coping questionnaires to measure coping difficulty and collect information on health care use were completed at home by the participants and were the end outcomes of the patterns of response. Results Gestational age, maternal education, and number of children were predictive of postpartum mothers' perceptions of the quality of discharge teaching. Maternal/infant length of stay, delivery mode, and the quality of discharge teaching were predictive of the readiness for hospital discharge; 26% of the variance was explained by the quality of discharge teaching. Readiness for hospital discharge, particularly the physical status of the participants, accounted for 27% of the variance in postdischarge coping difficulty. Information needed and nurses' delivery of discharge teaching were also predictive of postdischarge coping difficulty and use of health care services. Patient demographics, delivery of information, and key educational content themes emerged from the qualitative responses that reinforced the quantitative findings. Conclusion/Implications for Nursing Practice These data provide evidence of the critical role of the nurse in educating patients and families to facilitate a smooth transition home after childbirth.

Abstract 358: Patient Satisfaction and Preference Assessment Post Outpatient Electrophysiology Procedures: Same Day versus Next Day Discharge

Objectives: Multiple studies have reported the safety of same day discharge (SDD) post-electrophysiology (EP) procedures, while patient satisfaction associated with this approach has not been well- studied. We sought to evaluate whether SDD would be associated with a comparable patient satisfaction rate compared with next day discharge (NDD) in various EP procedures. Furthermore, we aimed to assess patient preferences regarding discharge timing. Methods: A cohort of patients was identified using our institutional record of all outpatient EP lab procedures from August 2013 to November 2014. From this list, 6 groups were created based on discharge timing “SDD/NDD” and procedure “Ablation (A)/Pacemaker (P)/ICD (I)”. All operators offered SDD and were included. We excluded generator change and lead extraction procedures. Patients who stayed more than one night were also excluded. Post-discharge phone surveys were conducted starting from the most recent procedure until the target number was reached. The research team gathering surveys was blind to patient characteristics. The survey was composed of 24 questions, 10 of which were for Post-Discharge Coping Difficulty Scale (PDCDS). Results: We surveyed 132 patients, 53F/79M, 66 SDD/66 NDD with mean age (SD) of 63 (15). We had 29 patients in each A group, 17 in each I group, and 20 in each P group. Patients’ rating of overall satisfaction and readiness for discharge, as well as, calculated PDCDS outcomes were not significantly different in SDD vs. NDD for all procedures, I+A only, and A only ( p &gt;.05). Patient characteristics and procedural complications between groups did not differ significantly, though different operators did differ in numbers of SDD or NDD procedures. No significant interactions were found between various covariates and study outcomes including age, gender, BMI, number of home medications, operator, and type of procedure. Approximately1/3 of patients (43/132) were given the choice of the two discharge strategies by the operator. The majority of them (93%; 40/43) opted for SDD and rated “the opportunity for this choice” with a mean of 9.1 (1-10 scale, 10 excellent) in comparison to a mean of 6.7 for those who were not given the choice ( p &lt;. 0001). Only 12% (8/66) of SDD patients wished they had the alternative discharge strategy (P &lt; .0001), in comparison to 38% of NDD patients (25/66) ( p &lt;. 07). Overall, 51% (67/132) of all patients preferred SDD if they were to undergo similar procedure in the future. Conclusions: SDD strategy resulted in similar patient satisfaction to NDD strategy across different EP procedures and operators. Patients significantly appreciated the choice of SDD. The SDD group was more willing to repeat their discharge experience. This further supports following SDD strategy, whenever possible, to improve quality of care; in addition to the cost savings and increased efficiency associated with this approach.

Pediatric solid organ transplant recipients: transition to home and chronic illness care.

Pediatric SOT recipients are medically fragile and present with complex care issues requiring high-level management at home. Parents of hospitalized children have reported inadequate preparation for discharge, resulting in problems transitioning from hospital to home and independently self-managing their child's complex care needs. The aim of this study was to investigate factors associated with the transition from hospital to home and chronic illness care for parents of heart, kidney, liver, lung, or multivisceral recipients. Fifty-one parents from five pediatric transplant centers completed questionnaires on the day of hospital discharge and telephone interviews at three wk, three months, and six months following discharge from the hospital. Care coordination (p = 0.02) and quality of discharge teaching (p < 0.01) was significantly associated with parent readiness for discharge. Readiness for hospital discharge was subsequently significantly associated with post-discharge coping difficulty (p = 0.02) at three wk, adherence with medication administration (p = 0.03) at three months, and post-discharge coping difficulty (p = 0.04) and family management (p = 0.02) at six months post-discharge. The results underscore the important aspect of education and care coordination in preparing patients and families to successfully self-manage after hospital discharge. Assessing parental readiness for hospital discharge is another critical component for identifying risk of difficulties in managing post-discharge care.

Assessing Patient-Reported Outcomes and Preferences for Same-Day Discharge After Percutaneous Coronary Intervention

Same-day discharge after percutaneous coronary intervention (PCI) may be safe for some patients. Few data are available on patient-reported outcomes and preferences for same-day discharge after PCI. Between March 2008 and March 2010, a total of 298 patients undergoing elective PCI via femoral access at 2 medical centers (Mount Sinai Hospital, New York, NY, and Baylor Medical Center, Dallas, TX) were randomized to same-day (n=150) or next-day (n=148) discharge. The primary outcome was high patient coping during the 7 days after discharge defined as scores <20 on the validated postdischarge coping difficulty scale. Safety outcomes, clopidogrel adherence, and patient preferences were secondary outcomes. Before discharge, patients randomized to same-day and next-day discharge were similar with respect to sociodemographic and clinical characteristics. High-coping ability, assessed 7 days after PCI, was present for 79% of patients randomized to same-day discharge and for 77% of patients randomized to next-day discharge. The difference in high coping ability, 2 (95% confidence interval, -7 to 11), did not cross the noninferiority threshold of -12% (P<0.001 that same-day discharge is not noninferior to next-day discharge). At 30 days after PCI, clopidogrel adherence, physician and emergency room visits, and hospitalization were similar in the 2 randomization groups. In addition, 80% and 68% of those randomized to same-day and next-day discharge, respectively, stated they would prefer same-day discharge if they were to have another PCI procedure. Same-day discharge after PCI was associated with patient-reported and clinical outcomes similar to those of next-day discharge and was preferred by most patients.