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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 25 of 190 Research Studies Displayed
Anderson AJ, Noyes K, Hewner S
Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge.
This report discussed the challenges for implementing cross-sector collaboration (CSC). A recuperative care collaborative in Buffalo, NY, provided care transition support at an acute care hospital discharge via a medical respite program for people who had experienced homelessness. Using the Expert Recommendations for Implementing Change (ERIC) framework and feedback from the cross-sector collaborative team, implementation strategies were derived from three validated ERIC implementation strategy clusters: development of stakeholder relationships, use of evaluative and iterative strategies, and changes to infrastructure. The authors concluded that future research would address external organizational influences and emphasize CSC as central to interventions.
Citation: Anderson AJ, Noyes K, Hewner S . Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge. Front Health Serv 2023 Sep 8; 3:1124054. doi: 10.3389/frhs.2023.1124054..
Keywords: Hospital Discharge, Chronic Conditions, Vulnerable Populations, Care Coordination, Transitions of Care
Squires A, Engel P, Ma C
Continuity of care versus language concordance as an intervention to reduce hospital readmissions from home health care.
The purpose of this study was to examine the relative effectiveness of continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. Participants included over 22,000 non-English-speaking patients from the New York City area who were admitted to their home health site following hospital discharge. Findings revealed that high continuity of care and high language concordance significantly decreased readmissions, along with high continuity of care and low language concordance; low continuity of care and high language concordance did not significantly impact readmissions. The authors concluded that enhancing continuity of care for those with language barriers the US home health system may help to address disparities and reduce hospital readmission rates.
Citation: Squires A, Engel P, Ma C . Continuity of care versus language concordance as an intervention to reduce hospital readmissions from home health care. Med Care 2023 Sep; 61(9):605-10. doi: 10.1097/mlr.0000000000001884..
Keywords: Hospital Readmissions, Transitions of Care, Home Healthcare
Sparling JL, France D, Abraham J
Handoff Effectiveness Research in periOperative environments (HERO) Design Studio: a conference report.
This conference report reviewed the historical background which led to the Handoff Effectiveness Research in periOperative environments (HERO) Design Studio. The objectives of the HERO Design Studio were to examine the existing literature base, create a national research agenda, and build the research infrastructure necessary to address critical evidence gaps in perioperative handoff quality and safety. The authors described how they prepared for the research conference and synthesized the conference’s results. They also recommended future directions regarding perioperative handoff improvement.
Citation: Sparling JL, France D, Abraham J . Handoff Effectiveness Research in periOperative environments (HERO) Design Studio: a conference report. Jt Comm J Qual Patient Saf 2023 Aug; 49(8):422-30. doi: 10.1016/j.jcjq.2023.02.004..
Keywords: Health Information Technology (HIT), Workflow, Transitions of Care, Electronic Health Records (EHRs), Evidence-Based Practice
Bristol AA, Elmore CE, Weiss ME
Mixed-methods study examining family carers' perceptions of the relationship between intrahospital transitions and patient readiness for discharge.
Intrahospital transitions (IHTs) may disrupt care coordination. Family caregivers often serve as liaisons between the patient and healthcare professionals, yet caregivers are often excluded from care planning during IHTs. The aim of this sequential, explanatory mixed-methods study was to examine family caregiver’s perceptions about IHTs, patient and caregiver ratings of patient discharge readiness, and caregiver self-perception of level of preparedness for engaging in care at home. The researchers conducted a retrospective analysis of hospital inpatients from a parent study for whom patient and family caregiver Readiness for Hospital Discharge Scale (RHDS) score frequency of IHTs and patient and caregiver characteristics were available. The study found that a total of 268 patients discharged from July 2020 to April 2021 had completed the RHDS and 23 completed the semi-structured interviews. The majority of patients experienced 0-2 IHTs and reported high levels of discharge readiness. No association was found between IHTs and patients' RHDS scores in the quantitative analysis. However, caregiver’s perceptions of patient discharge readiness were negatively correlated with increased IHTs. In addition, non-spouse caregivers reported lower RHDS scores than spousal caregivers. During interviews, caregivers shared barriers experienced during IHTs and described the importance of being included in discharge care planning.
AHRQ-funded; HS026248; HS026505.
Citation: Bristol AA, Elmore CE, Weiss ME . Mixed-methods study examining family carers' perceptions of the relationship between intrahospital transitions and patient readiness for discharge. BMJ Qual Saf 2023 Aug; 32(8):447-56. doi: 10.1136/bmjqs-2022-015120..
Keywords: Caregiving, Hospital Discharge, Transitions of Care
Sparling JL, Hong Mershon B, Abraham J
Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review.
This narrative review synthesized prior research on electronic tools for perioperative handoffs, limitations of current tools and barriers to their implementation, and use of AI and machine learning in perioperative care. Results showed that several efforts have incorporated electronic tools to improve perioperative handoffs, but were limited by imprecision in selecting handoff elements. AI and machine learning use and integration into handoff workflows were not yet being studied. Existing technology such as mobile applications, barcode scanners, and radio-frequency identification tags to advance perioperative safety were similarly not applied to handoffs.
Citation: Sparling JL, Hong Mershon B, Abraham J . Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review. Jt Comm J Qual Patient Saf 2023 Aug; 49(8):410-21. doi: 10.1016/j.jcjq.2023.03.009..
Keywords: Health Information Technology (HIT), Workflow, Transitions of Care, Electronic Health Records (EHRs), Evidence-Based Practice
Guo W, Cai S, Caprio T
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
This study’s objective was to examine the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations. This cohort study included Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662). The authors found end-of-life care transitions were observed among 34.89% of our study sample in the last 30 days before death, and among 17.25% in the last 7 days. Higher frequency of care transitions in the last 7 days of life was associated with higher regulatory specificity of licensed [incidence risk ratio (IRR) = 1.08] and direct care worker staffing (IRR = 1.22). Greater regulatory specificity of direct care worker training (IRR = 0.75) was associated with fewer transitions. Similar associations were found for direct care worker staffing (IRR = 1.15) and training (IRR = 0.79) and transitions within 30 days of death. There were significant variations in the number of care transitions in different states.
Citation: Guo W, Cai S, Caprio T . End-of-life care transitions in assisted living: associations with state staffing and training regulations. J Am Med Dir Assoc 2023 Jun; 24(6):827-32.e3. doi: 10.1016/j.jamda.2023.02.002..
Keywords: Transitions of Care, Long-Term Care, Policy, Palliative Care, Elderly
May HP, Griffin JM, Herges JR
Comprehensive acute kidney injury survivor care: protocol for the Randomized Acute Kidney Injury in Care Transitions Pilot trial.
The researchers developed the multidisciplinary acute kidney injury (AKI) in Care Transitions (ACT) program, which incorporates post-AKI care in patients' primary care clinic. The purpose of this pilot trial, which received funding from the Agency for Health Care Research and Quality on April 21, 2021, and was approved by the Institutional Review Board on December 14, 2021, is to test the feasibility and acceptability of the ACT program and related study protocol, including recruitment and retention, procedures, and outcome measures. The study will include individuals who have stage 3 AKI during hospitalization, do not need dialysis upon discharge, have a local primary care provider, and are discharged to their home. Recipients of any transplant within 100 days of enrollment are excluded. As of March 14, 2023, seventeen participants each have been enrolled in the intervention and usual care groups. Patients who provide consent are randomized to receive the ACT program intervention or usual care. The ACT program includes predischarge kidney health education and coordinated postdischarge laboratory monitoring and follow-up with a primary care provider and pharmacist within 14 days. The usual care group receives no study-related intervention. This study includes qualitative interviews and surveys with patients and staff and will explore the feasibility of the ACT program. Notes of clinical encounters will be reviewed for dialogue and care plans related to kidney health. Quantitative measures of the feasibility and acceptability of ACT will be summarized via descriptive analyses.
Citation: May HP, Griffin JM, Herges JR . Comprehensive acute kidney injury survivor care: protocol for the Randomized Acute Kidney Injury in Care Transitions Pilot trial. JMIR Res Protoc 2023 May 22; 12:e48109. doi: 10.2196/48109..
Keywords: Kidney Disease and Health, Transitions of Care
Karlic KJ, Valley TS, Cagino LM
Identification of patient safety threats in a post-intensive care clinic.
This observational cohort study examined patient safety threats at a post-ICU clinic in an academic, tertiary care medical center and whether post-ICU clinics improve patient safety. The study identified 83 patients, of which 60 patients had 96 separate safety threats. The threats were categorized into 7 themes: medication errors (27%); inadequate medical follow-up (25%); inadequate patient support (16%); high-risk behaviors (5%); medical complications (5%); equipment/supplies failures (4%); and other (18%). They were also categorized as 41% preventable, 27% ameliorable, and 32% were neither preventable nor ameliorable.
Citation: Karlic KJ, Valley TS, Cagino LM . Identification of patient safety threats in a post-intensive care clinic. Am J Med Qual 2023 May-Jun; 38(3):117-21. doi: 10.1097/jmq.0000000000000118..
Keywords: Patient Safety, Transitions of Care, Adverse Events
Desai AD, Tolpadi A, Parast L
Improving the quality of written discharge instructions: a multisite collaborative project.
This study assessed the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. The authors conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). They obtained data from a random sample of pediatric patients (n = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. The study periods consisted of 3 phases: 1) a 14-month pre-collaborative phase; 2) a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3) a 12-month postcollaborative phase. Among hospitals with high baseline performance, measure scores improved beyond expected for the precollaborative trend, but hospitals with low baseline performance, measure scores increased at a lower than expected rate.
Citation: Desai AD, Tolpadi A, Parast L . Improving the quality of written discharge instructions: a multisite collaborative project. Pediatrics 2023 May; 151(5):e2022059452. doi: 10.1542/peds.2022-059452..
Keywords: Hospital Discharge, Transitions of Care, Hospitals
Kuzma N, Khan A, Rickey L
Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions.
This study’s objective was to compare the effect of the intervention Patient and Family Centered (PFC)I-PASS on adverse events (AE) rates in children with and without complex chronic conditions (CCCs). A cohort of 3106 hospitalized children from seven North American pediatric hospitals between December 2014 and January 2017 were included. An effect modification analysis did not show difference in the intervention on children with and without CCCs. There was no statistically significant change in AEs for children with or without CCCs.
Citation: Kuzma N, Khan A, Rickey L . Effect of Patient and Family Centered I-PASS on adverse event rates in hospitalized children with complex chronic conditions. J Hosp Med 2023 Apr;18(4):316-20. doi: 10.1002/jhm.13065.
Keywords: Children/Adolescents, Patient-Centered Healthcare, Chronic Conditions, Adverse Events, Inpatient Care, Transitions of Care
Fernandes-Taylor S, Yang Q, Yang DY
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
The availability of emergency surgical services has diminished as the rural workforce has decreased. The growing need for interhospital patient transfers makes care coordination across different settings essential for maintaining high-quality care. The purpose of this study was to investigate the impact of recurrent patient-sharing between hospitals on the outcomes of emergency general surgery (EGS) patient transfers. A multicenter analysis was conducted involving inpatient acute care hospital stays in Wisconsin that required the transfer of EGS patients. Data was sourced from the Wisconsin Hospital Association (WHA), a comprehensive statewide hospital discharge database for the years 2016-2018. We postulated that a higher percentage of patients transferred between hospitals would lead to improved outcomes. The relationship between the proportion of EGS patient transfers and patient outcomes, such as in-hospital morbidity, mortality, and duration of stay, was examined. Additional factors considered were hospital organizational features and patient sociodemographic and clinical attributes. The researchers found that during the two-year study period, 118 hospitals transferred 3,197 EGS patients; 1,131 of these patients experienced in-hospital complications, death, or an extended stay (beyond the 75th percentile). The average patient age was 62 years, with 50% being female and 5% non-white. In the mixed-effects model, the proportion of shared patients between hospitals was linked to a reduced likelihood of in-hospital complications. Specifically, when the proportion of shared patients doubled between two hospitals, the relative odds of any adverse outcome shifted by 0.85.
Citation: Fernandes-Taylor S, Yang Q, Yang DY . Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients. J Trauma Acute Care Surg 2023 Apr;94(5):592-98. doi: 10.1097/ta.0000000000003789.
Keywords: Emergency Department, Hospitals, Surgery, Transitions of Care
Zhang A, Spiegel T, Bundy A
Evaluation of a transitions clinic to bridge emergency department and primary care.
This paper evaluated the outcomes of using a clinical transition clinic (CTC) to bridge emergency department (ED) and primary care. Main outcomes were 30-day ED revisits and hospital readmissions. From March 2021 to March 2022, 373 patients were referred to the CTC totaling 405 appointments, with half (53%) completed with a median follow-up time of 4 days. The most common care types provided were wound care (44%) and clinical problem management (33%). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment. The same effect was not seen for CTC appointment completion on hospital readmission.
Citation: Zhang A, Spiegel T, Bundy A . Evaluation of a transitions clinic to bridge emergency department and primary care. J Hosp Med 2023 Mar; 18(3):217-23. doi: 10.1002/jhm.13056..
Keywords: Transitions of Care, Emergency Department, Primary Care
Starmer AJ, Spector ND, O'Toole JK
Implementation of the I-PASS handoff program in diverse clinical environments: a multicenter prospective effectiveness implementation study.
The purpose of this study was to assess I-PASS patient handoff intervention implementation across diverse settings to evaluate whether there it impacted pediatric patient safety and communication. External teams provided coaching over 18 months to hospital residents from diverse specialties across 32 hospitals (12 community, 20 academic) with 2735 resident physicians and 760 faculty champions from multiple specialties (16 internal medicine, 13 pediatric, 3 other) participating. The researchers collected 1942 error surveillance reports. Following I-PASS implementation, major and minor handoff-related reported adverse events decreased 47%. Intervention implementation was related with increased inclusion of all five key handoff data elements in verbal and written handoffs, as well as increased frequency of handoffs with high quality verbal and written patient summaries, verbal and written contingency plans, and verbal receiver syntheses.
Citation: Starmer AJ, Spector ND, O'Toole JK . Implementation of the I-PASS handoff program in diverse clinical environments: a multicenter prospective effectiveness implementation study. J Hosp Med 2023 Jan; 18(1):5-14. doi: 10.1002/jhm.12979..
Keywords: Transitions of Care, Implementation, Communication
Xiao Y, Smith A, Abebe E
Understanding hazards for adverse drug events among older adults after hospital discharge: insights from frontline care professionals.
The purpose of this study was to utilize a systems approach to examine hazards to medication safety for older adults during care transitions. The researchers interviewed 38 hospital-based professionals (5 hospitalists, 24 nurses, 4 clinical pharmacists, 3 pharmacy technicians, and 2 social workers) from 4 hospitals about ADE risks after hospital discharge among older adults. For each concern the participants provided, the hazard for medication-related harms was coded and grouped by its sources utilizing a human factors and systems engineering model. The study found that the hazards fell into 6 groups: 1) medication tasks related at home, 2) patient and caregiver related, 3) hospital work system related, 4) home resource related, 5) hospital professional-patient collaborative work related, and 6) external environment related. The type of medications indicated most frequently when describing concerns included anticoagulants, insulins, and diuretics. The types of hazards coded the most were: complex dosing, patient and caregiver knowledge gaps in medication management, errors in discharge medications, unaffordable cost, inadequate understanding about changes in medications, and gaps in access to care or in sharing medication information.
Citation: Xiao Y, Smith A, Abebe E . Understanding hazards for adverse drug events among older adults after hospital discharge: insights from frontline care professionals. J Patient Saf 2022 Dec 1;18(8):e1174-e80. doi: 10.1097/pts.0000000000001046..
Keywords: Elderly, Adverse Drug Events (ADE), Medication, Medication: Safety, Hospital Discharge, Hospitals, Transitions of Care
Williams PH, Gilmartin HM, Leonard C
The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs.
This study’s objective was to examine changes from pre- to post-hospitalization in total, inpatient, and outpatient 30-day healthcare utilization costs for Veterans Affairs Healthcare System Rural Transitions Nurse Program (TNP) enrollees compared to controls. Although findings showed no difference in change in total costs between veterans enrolled in TNP and controls, TNP was associated with a smaller increase in direct inpatient medical costs and a larger increase in direct outpatient medical costs, suggesting a shifting of costs from the inpatient to outpatient setting.
Citation: Williams PH, Gilmartin HM, Leonard C . The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs. J Gen Intern Med 2022 Nov;37(14):3529-34. doi: 10.1007/s11606-022-07401-y..
Keywords: Rural Health, Nursing, Transitions of Care, Healthcare Utilization, Healthcare Costs
Harrison JD, Sudore RL, Auerbach AD
Automated telephone follow-up programs after hospital discharge: do older adults engage with these programs?
The purpose of this study was to examine whether and how older adults experience automated post-hospital discharge telephone follow-up programs and characterize the prevalence of patient-reported post-discharge issues. Eighteen thousand and seventy-six patients, all part of a post-hospital discharge program between May 1, 2018 and April 30, 2019, were included and categorized into age groups. The study found that more patients 65-84 years old were reached compared to patients 64 years old or less (84.3% compared to 78.9%). Patients aged 85 or older were more likely to have questions about their follow-up plans and require assistance scheduling appointments compared to those 64 years old or less (19.0% vs. 11.9%). The researchers concluded that post-hospital automated telephone calls are effective at reaching older adults.
Citation: Harrison JD, Sudore RL, Auerbach AD . Automated telephone follow-up programs after hospital discharge: do older adults engage with these programs? J Am Geriatr Soc 2022 Oct;70(10):2980-87. doi: 10.1111/jgs.17939..
Keywords: Elderly, Patient and Family Engagement, Hospital Discharge, Transitions of Care, Telehealth, Health Information Technology (HIT)
Alagoz E, Saucke M, Arroyo N
Communication during interhospital transfers of emergency general surgery patients: a qualitative study of challenges and opportunities.
This study’s objective was to understand the nature of and challenges to communication between referring (RP) and accepting (AP) providers transferring emergency general surgery (EGS) patients from the transfer center nurse’s (TCN) perspective. Worse outcomes have been shown to be experienced by transferred EGS patients than directly admitted patients. The authors interviewed 17 transfer center nurses (TCNs) at an academic medical center regarding (in)efficient and (in)effective communication between RPs and APs. The in-person interviews were recorded, transcribed and managed in NVivo. Four researchers developed a codebook, which was then co-coded with the transcripts. A consensus was developed to discuss emergency themes and arrive at higher-level concepts. Issues relating to ineffective communication included RPs that provided incomplete information because of a lack of necessary infrastructure, personnel, or technical knowledge; competing clinical demands; or a fear of the transfer request being rejected. Inefficient communication resulted from RPs being unfamiliar with the information APs expected and the lack of a structured process to share information and communication also failed when providers disagreed about the necessity of the transfer.
Citation: Alagoz E, Saucke M, Arroyo N . Communication during interhospital transfers of emergency general surgery patients: a qualitative study of challenges and opportunities. J Patient Saf 2022 Oct 1;18(7):711-16. doi: 10.1097/pts.0000000000000979..
Keywords: Care Coordination, Communication, Transitions of Care, Surgery
Bourgoin A, Balaban R, Hochman M
AHRQ Author: Perfetto D, Hogan EM
Improving quality and safety for patients after hospital discharge: primary care as the lead integrator in postdischarge care transitions.
The purpose of this study was to explain primary care-based transition workflow processes for hospitalized patients. The researchers conducted interviews with primary care thought leaders, staff at 9 primary care sites, community agency staff, and recently discharged patients. The researchers found that primary care postdischarge workflows vary across the different settings, rarely include communications with the patient or the inpatient team during the hospitalization and vary widely across settings. The researchers recommended the use of principles for primary care practices to encourage active participation in the full spectrum of postdischarge care, from admission through the first postdischarge visit to primary care.
AHRQ-authored; AHRQ-funded; 233201500019I/HHSP23337002T.
Citation: Bourgoin A, Balaban R, Hochman M . Improving quality and safety for patients after hospital discharge: primary care as the lead integrator in postdischarge care transitions. J Ambul Care Manage 2022 Oct-Dec;45(4):310-20. doi: 10.1097/jac.0000000000000433..
Keywords: Quality of Care, Patient Safety, Hospital Discharge, Transitions of Care, Hospitals, Workflow
Vaughn VM, Ratz D, Greene MT
Antibiotic stewardship strategies and their association with antibiotic overuse after hospital discharge: an analysis of the Reducing Overuse of Antibiotics at Discharge (ROAD) home framework.
Researchers sought to understand strategies to optimize antibiotic prescribing at discharge. Surveying Michigan hospitals on their antibiotic stewardship strategies for community-acquired pneumonia (CAP) and urinary tract infection (UTI), they found that the more stewardship strategies a hospital reported, the lower its antibiotic overuse at discharge.
Citation: Vaughn VM, Ratz D, Greene MT . Antibiotic stewardship strategies and their association with antibiotic overuse after hospital discharge: an analysis of the Reducing Overuse of Antibiotics at Discharge (ROAD) home framework. Clin Infect Dis 2022 Sep 29;75(6):1063-72. doi: 10.1093/cid/ciac104..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Hospital Discharge, Transitions of Care
Saxena FE, Bierman AS, Glazier RH
AHRQ Author: Bierman AS
Association of Early Physician Follow-up With Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease.
Investigators assessed whether hospitalized patients with early physician follow-up after discharge had lower rates of overall and condition-specific readmissions within 30 days and 90 days of discharge. Studying adults in Ontario, Canada, with first admission for acute myocardial infarction, congestive heart failure, or chronic obstructive pulmonary disease, the findings suggested that early follow-up in conjunction with a comprehensive transitional care strategy for hospitalized patients with medically complex conditions coupled with ongoing effective chronic disease management may be associated with reduced 90-day readmissions.
Citation: Saxena FE, Bierman AS, Glazier RH . Association of Early Physician Follow-up With Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease. JAMA Netw Open 2022 Jul;5(7):e2222056. doi: 10.1001/jamanetworkopen.2022.22056..
Keywords: Hospital Readmissions, Hospitalization, Cardiovascular Conditions, Respiratory Conditions, Transitions of Care
Topham EW, Bristol A, Luther B
Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home.
The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted post-discharge patient outcomes. Through interviews with four English-speaking caregivers, findings showed that, once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to post-discharge knowledge gaps. This study of caregiver experiences suggests that AHRQ’s IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
Citation: Topham EW, Bristol A, Luther B . Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home. Prof Case Manag 2022 Jul-Aug;27(4):181-93. doi: 10.1097/ncm.0000000000000563..
Keywords: Hospital Discharge, Transitions of Care, Caregiving
Giesler DL, Krein S, Brancaccio A
Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study.
This article described a single-center, controlled pilot study of a pharmacist-facilitated antibiotic timeout prior to hospital discharge. The timeout addressed key elements of duration and was designed and implemented using iterative cycles with rapid feedback. The authors evaluated implementation outcomes related to feasibility, including usability, adherence, and acceptability. The pharmacists conducted 288 antibiotic timeouts with a mean duration of 2.5 minutes. Pharmacists recommended an antibiotic change in 25% of timeouts with 70% of recommended changes accepted by hospitalists. Barriers included unanticipated and weekend discharges. There were no differences in antibiotic use after discharge during the intervention compared to control services.
Citation: Giesler DL, Krein S, Brancaccio A . Reducing overuse of antibiotics at discharge home: a single-center mixed methods pilot study. Am J Infect Control 2022 Jul;50(7):777-86. doi: 10.1016/j.ajic.2021.11.016..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Hospital Discharge, Transitions of Care
May HP, Krauter AK, Finnie DM
Optimising transitions of care for acute kidney injury survivors: protocol for a mixed-methods study of nephrologist and primary care provider recommendations.
Gaps in proper kidney care after acute kidney injury (AKI) in hospital patients can contribute to long term complications for those individuals. The purpose of this study is to provide an in-depth assessment of nephrologists’ and primary care providers’ approaches to follow-up care after in-hospital acute kidney injury (AKI). The researchers will utilize a mixed-methods study to assess provider recommendations and decision-making for post-AKI care.
Citation: May HP, Krauter AK, Finnie DM . Optimising transitions of care for acute kidney injury survivors: protocol for a mixed-methods study of nephrologist and primary care provider recommendations. BMJ Open 2022 Jun 22;12(6):e058613. doi: 10.1136/bmjopen-2021-058613..
Keywords: Kidney Disease and Health, Transitions of Care
Usher MC, Tignanelli CJ, Hilliard B
Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation
Researchers sought to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital. They found that, with standardized communication, interhospital transfers were a safe and effective method of cohorting COVID-19 patients, were well-received by health care providers, and had the potential to improve care quality.
AHRQ-funded; HS026379; HS026732.
Citation: Usher MC, Tignanelli CJ, Hilliard B . Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation J Patient Saf 2022 Jun 1;18(4):287-94. doi: 10.1097/pts.0000000000000916..
Keywords: COVID-19, Hospitals, Healthcare Delivery, Public Health, Care Coordination, Transitions of Care
Yu A, Jordan SR, Gilmartin H
"Our hands are tied until your doctor gets here": nursing perspectives on inter-hospital transfers.
The purpose of this study was to characterize the experiences of inpatient floor-level bedside nurses caring for inter-hospital transfer (IHT) patients and to identify care coordination challenges and solutions. Results from this study are mapped to AHRQ’s Care Coordination Measurement Framework domains of communication, assessing needs and goals, and negotiating accountability. Findings showed that three key themes characterized nurses' experiences with IHT related to these domains: challenges with information exchange and team communication during IHT, environmental and information preparation needed to anticipate transfers, and determining responsibility and care plans after the IHT patient has arrived at the accepting facility.
Citation: Yu A, Jordan SR, Gilmartin H . "Our hands are tied until your doctor gets here": nursing perspectives on inter-hospital transfers. J Gen Intern Med 2022 May;37(7):1729-36. doi: 10.1007/s11606-021-07276-5..
Keywords: Transitions of Care, Hospitals, Provider: Nurse