Research Activities, September 2013
Early discharge planning at hospital admission can lower mortality after a heart attack
Hospitals vary widely in their 30-day mortality rates for patients with heart attacks. One key to lowering these rates is to employ early and comprehensive discharge planning and processes. The most successful hospitals start these discharge processes immediately upon hospital admission, according to a new study. Also, once patients are released, they are followed up by their primary care physicians 2 days after discharge.
The researchers selected hospitals that were at the top 5 percent and the bottom 5 percent of hospital 30-day risk-standardized mortality rates for heart attack patients. All hospitals were in either category for 2 consecutive years. Visits were made to 14 sites where 57 in-depth interviews were conducted. Those participating in these interviews ranged from physicians, nurses, and chief medical officers to quality management staff.
High-performing hospitals tended to start discharge planning immediately after the patient was admitted to the hospital. Low-performing hospitals tended to conduct discharge planning at the end of the patient’s stay, focusing on complying with guidelines rather than individual patient needs. High-performing hospitals also had strong, multidisciplinary case management services. At these sites, patients were not discharged until a plan was in place. In addition, there was a strong shared responsibility to educate and follow up with patients about their medications and post-hospital care. Education focused on both the patient and their families. Finally, in high-performing hospitals, primary care physicians were contacted within 1 to 2 days after discharge. At lower performing hospitals, the burden of passing discharge information along to the primary care physician was placed on the patient.
The authors call for more efforts to improve communication among different hospital departments and to foster a culture that uses creative problem solving when it comes to improving discharge planning for these patients. The study was supported in part by AHRQ (HS16929).
See "Features of high quality discharge planning for patients following acute myocardial infarction," by Emily J. Cherlin, Ph.D., M.S.W., Leslie A. Curry, Ph.D., M.P.H., Jennifer W. Thompson, M.P.P., and others in the Journal of General Internal Medicine 28(3), pp. 436-443, 2013.