1
|
van de Riet L, Alsem MW, Beijneveld RSI, van Woensel JBM, van Karnebeek CD. Delineating family needs in the transition from hospital to home for children with medical complexity: part 2, a phenomenological study. Orphanet J Rare Dis 2023; 18:387. [PMID: 38082332 PMCID: PMC10714565 DOI: 10.1186/s13023-023-02747-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND A systematic literature review on the transition from hospital-to-home (H2H) of families with a child with medical complexity (CMC), resulted in nine overarching themes. These demonstrated common needs and experiences despite the widely differing CMC diagnoses and family characteristics. However, none of the reported studies was conducted in the Netherlands, which hampers the creation of a tailored H2H care pathway, deemed essential for our recently established Transitional Care Unit in the Netherlands: the 'Jeroen Pit Huis'. Therefore, the aim of this study was to gain a deeper understanding of the needs and experiences of Dutch CMC parents on H2H transition and integrate these insights with the literature review into an evidence-based H2H care pathway for CMC and their families. METHODS A descriptive phenomenological approach was applied. Heterogeneous purposeful sampling methods were used to recruit participants according to the following criteria: parents of CMC from various regions in the Netherlands, who spoke Dutch fluently and who had been discharged home from a tertiary hospital within the previous five years. Semi-structured, open-ended interviews were conducted via video call by two researchers, who transcribed the audio recordings verbatim. Thematic analysis methods were used to identify emerging themes from the individual transcripts, involving a third and fourth researcher to reach consensus. RESULTS Between March and August 2021, 14 mothers and 7 fathers participated in 14 interviews. They elaborated on the H2H transition of 14 CMC with a wide range of underlying diseases: 7 male, 7 female, aged 6 months to 10 years. Eight overarching themes, consistent with the results of the systematic review, represent CMC parental needs and experiences during the H2H process in the Netherlands: (1) autonomy, (2) division of tasks and roles, (3) family emotions, (4) impact on family life, (5) communication, (6) coordination of care, (7) support system and (8) adaptation. CONCLUSIONS The H2H needs and experiences reported by the CMC families in this study align with the results of our systematic review. The H2H transition process is not linear but continuous, and should extend beyond the specific medical needs of the CMC to holistic care for the family as a whole. The overarching care needs and experiences, expressed by all CMC families, regardless of underlying symptoms and diagnoses, inform the H2H care pathway and its future evaluation. Our studies highlight the necessity to focus on the family needs rather than on the specific illness of the child, as well as the value of our interdisciplinary care team partnering with parents in the 'Jeroen Pit Huis' towards a safe and sustainable transition home.
Collapse
Affiliation(s)
- L van de Riet
- Department of Pediatric Intensive Care, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
| | - M W Alsem
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
| | - R S I Beijneveld
- Department of Pediatric Intensive Care, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
| | - J B M van Woensel
- Department of Pediatric Intensive Care, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands
| | - C D van Karnebeek
- On Behalf of the Transitional Care Unit Consortium, Amsterdam, The Netherlands.
- Emma Center for Personalized Medicine, Departments of Pediatrics and Human Genetics, Amsterdam Gastro-Enterology Endocrinology and Metabolism, Amsterdam UMC, Meibergdreef 9, Amsterdam, The Netherlands.
| |
Collapse
|
2
|
Nelson A, Stuckey H, Snyder B, Van Scoy LJ, Daymont C, Irvin C, Wasserman E, Beck M. Provider Perspectives of Transitions of Care at a Tertiary Care Children's Hospital With a Hospitalist-Run Discharge Clinic. Clin Pediatr (Phila) 2023; 62:926-934. [PMID: 36726290 PMCID: PMC10986183 DOI: 10.1177/00099228221149279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Children's hospitals are discharging patients to home with increasingly complex outpatient needs, making safe transitions of care (ToCs) of vital importance. Our study involved a survey of both outpatient providers and pediatric hospitalists associated with our medical center to better describe providers' views on the ToC process. The survey included questions assessing views on patient care responsibilities, resource availability, our hospitalist-run postdischarge clinic (PDC), and comfort with telemedicine. Our hospitalists generally believed that primary care providers (PCPs) did not have adequate access to important ToC elements, whereas PCPs felt their access was adequate. Both provider types felt it was the inpatient team's responsibility to manage patient events between discharge and PCP follow-up and that a hospitalist-run PDC may reduce interim emergency room visits. This study challenges perceptions about the ToC process in children and describes a generalizable approach to assessing provider perceptions surrounding the ToC within individual health systems.
Collapse
Affiliation(s)
- Abigail Nelson
- Penn State Children’s Hospital, Department of Pediatrics
| | - Heather Stuckey
- Penn State Hershey College of Medicine; Department of Medicine
| | - Bethany Snyder
- Penn State Hershey College of Medicine; Department of Medicine
| | | | - Carrie Daymont
- Penn State Children’s Hospital, Department of Pediatrics
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | | | - Emily Wasserman
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | - Michael Beck
- Penn State Children’s Hospital, Department of Pediatrics
| |
Collapse
|
3
|
Breuner CC, Alderman EM, Jewell JA. The Hospitalized Adolescent. Pediatrics 2023; 151:190499. [PMID: 36995186 DOI: 10.1542/peds.2022-060646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This policy statement is the first published statement in the United States on this topic and the authors aim to provide pediatricians with evidence-based information on the unique aspects required to care for hospitalized adolescents. Included in this policy statement is a description of the possible effects hospitalization may have on the developmental and emotional progress of adolescence, the role of the hospital setting, the importance of confidentiality, and issues related to legal/ethical matters and bias and institutional and systemic racism that may occur during hospitalization.
Collapse
Affiliation(s)
- Cora C Breuner
- Division of Adolescent Medicine, Departments of Pediatrics and Orthopedics and Sports Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
| | - Jennifer A Jewell
- The Barbara Bush Children's Hospital at Maine Medical Center, MaineHealth, Portland, Maine
| |
Collapse
|
4
|
Shapiro MH, Goodman DM, Rodriguez VA. The Perfect Discharge: A Framework for High-Quality Hospital Discharges. Hosp Pediatr 2022; 12:108-117. [PMID: 34961884 DOI: 10.1542/hpeds.2021-006100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Matthew H Shapiro
- Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, California.,Children's Hospital of Orange County, Orange, California
| | - Denise M Goodman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Victoria A Rodriguez
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| |
Collapse
|
5
|
Goodrich N, Dolter S, Snow J, Stoolman S, Kerns E, McCulloh R. Quality Improvement of Primary Care Provider Communication on Hospital Discharge. Hosp Pediatr 2021; 11:1050-1056. [PMID: 34531302 DOI: 10.1542/hpeds.2020-004804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Effective communication between inpatient and primary care providers (PCPs) is important for safe transition of care for hospitalized patients. In 2017, communication with PCPs was prioritized for the pediatric hospital medicine division. Our primary aim was to improve documented attempted communication with PCPs within 72 hours of discharge from 41% to at least 60% by January 1, 2018, and maintain this performance through 2019. METHODS This study included all inpatient encounters discharged by a pediatric hospital medicine provider from March 2017 to April 2020. An electronic health record phrase debuted March 2017. Successful documentation was defined as any attempt to contact the PCP, regardless of whether actual communication occurred. Group and individual audit and feedback occurred in July 2017 to April 2020. Provider communication was financially incentivized in July 2018 to June 2019. An annotated P-chart for the proportion of encounters with documented PCP communication occurring within 72 hours was established. Special-cause variation was determined by using Shewhart rules. RESULTS The mean proportion of encounters with documented PCP communication increased from 41% at baseline (March 2017 through July 2017) to 60% in August 2017 and 66% in December 2017. After the financial incentive was removed in July 2019, documentation decreased to 54%. Phone calls with clinic staff were the most common communication method (40% to 71%). Direct conversations with the PCP occurred rarely (0% to 3%). CONCLUSIONS Even when coupled with audit and feedback with EHR interventions, our work suggests that shifting to external financial motivation may hinder sustainability of behavior change to improve attempted documented PCP communication.
Collapse
Affiliation(s)
- Nathaniel Goodrich
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Stephen Dolter
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Joseph Snow
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Sharon Stoolman
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Ellen Kerns
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| | - Russell McCulloh
- Department of Pediatrics, Division of Pediatric Hospital Medicine, University of Nebraska Medical Center, Children's Hospital & Medical Center, Omaha, Nebraska
| |
Collapse
|
6
|
Kaissi M, Solan LG. Staying Connected: Using Quality Improvement to Bridge the Communication Gap Between Pediatric Hospitalists and Primary Care Providers. Hosp Pediatr 2021; 11:e263-e265. [PMID: 34531303 DOI: 10.1542/hpeds.2021-006188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Maha Kaissi
- University of Rochester Golisano Children's Hospital, Rochester, New York
| | - Lauren G Solan
- University of Rochester Golisano Children's Hospital, Rochester, New York
| |
Collapse
|
7
|
Wray J, Sugarman H, Davis L, Butler C, McIntyre D, Hewitt R. Improving community-based care for children with a rare condition: The example of long-segment congenital tracheal stenosis and perceptions of health professionals, parents and teachers. Int J Pediatr Otorhinolaryngol 2021; 143:110651. [PMID: 33662711 DOI: 10.1016/j.ijporl.2021.110651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/08/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Long segment congenital tracheal stenosis (LSCTS) is a rare, complex condition which is often poorly understood by community-based health professionals (HPs). Anecdotally, such HPs often lack confidence providing care for children, resulting in children being brought to the tertiary centre more frequently than necessary. We wanted to identify the information and support needs of HPs in primary and secondary care looking after a child with LSCTS, the views of those providing education to these children, and elicit parents' perceptions about community-based services, to improve overall care for children and families. METHOD Questionnaires were sent to 175 community-based HPs and 34 teachers involved in the care of children with LSCTS. Face-to-face or telephone interviews were conducted with 12 parents of patients with LSCTS to establish their perceptions of community-based services. RESULTS Ninety (51%) completed questionnaires were returned from HPs and 18 (53%) from teachers. Responses indicated low levels of knowledge of LSCTS. Physical, practical and communication information needs were identified by all respondent groups, together with general and condition-specific concerns. Interviews with parents indicated that they thought the level of knowledge about LSCTS in the community was low, which had a negative impact on their willingness to consult local services. Better information provision for HPs, teachers and parents was identified as a means of improving outcomes. CONCLUSION Professionals caring for children with LSCTS in the community and in schools have unmet information and support needs, with consequences for children, families, HCPs in both the community and tertiary hospital, and teachers.
Collapse
Affiliation(s)
- Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK.
| | - Hannah Sugarman
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
| | - Laura Davis
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
| | - Colin Butler
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
| | - Denise McIntyre
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
| | - Richard Hewitt
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
| |
Collapse
|
8
|
Beamon BD, Cortright LM, Pawlowski CB, Vasquez-Rios V, Tumin D. Communication Between Primary Care Pediatricians and the Pediatric Emergency Department. Pediatr Emerg Care 2021; 37:92-95. [PMID: 33512888 DOI: 10.1097/pec.0000000000002331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to measure the quality of communication from primary care pediatricians (PCPs) to the pediatric emergency department (ED). We also sought to determine whether the quality of this communication affected patient outcomes. METHODS We conducted a retrospective chart review of patients sent from their pediatrician to the pediatric ED during a 4-year period. The quality of communication was classified as no communication, incomplete communication, or complete communication, based on compliance with Joint Commission requirements. Outcome measures included overnight admission, total length of hospital stay, repetition of diagnostic tests, ED revisits, hospital readmissions, and initial follow-up pediatrician visit. RESULTS Fifty-five patients were included in the analysis. Communication was complete in 22% of cases, incomplete in 16% of cases, and absent in 62% of cases. Medications and allergies were most often missing. The quality of communication was not associated with any of the prespecified covariates or outcome measures. Chief complaint of respiratory distress and greater severity score were associated with a greater likelihood of hospital admission from the ED. CONCLUSIONS Our study demonstrates a lack of documented communication between PCPs and a pediatric ED, albeit with no statistically significant impact on patient outcomes. Practices to increase the quality of PCP-ED communication could include standardizing interfacility referrals, maximizing shared electronic health record use between clinical environments, and increased collaboration between ED physicians and PCPs. Further research to investigate subjective outcomes, such as patient expectations or satisfaction associated with PCP-ED communication, may reveal other consequences of incomplete communication.
Collapse
Affiliation(s)
- Bradley D Beamon
- From the Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC
| | | | | | | | | |
Collapse
|
9
|
Nageswaran S, Sebesta MR, Golden SL. Transitioning Children With Medical Complexity From Hospital to Home Health Care: Implications for Hospital-Based Clinicians. Hosp Pediatr 2020; 10:657-662. [PMID: 32631842 DOI: 10.1542/hpeds.2020-0068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES There is limited research about best practices for transitioning children with medical complexity (CMC) from hospital to home. Our objectives were to describe issues related to transitioning CMC from hospital to home health care and identify strategies to improve this transition. METHODS This qualitative study was conducted in western North Carolina between 2012 and 2014 and involved a focus group of 14 hospital- and community-based stakeholders and 4 focus groups of 18 home health nurses. Focus groups were audio-recorded and transcribed verbatim, and transcriptions were managed in ATLAS.ti software. By using content analysis, recurrent themes related to transitioning CMC from hospital to home were identified. RESULTS Themes in 4 domains emerged. (1) Home health orders: home health care providers desired hospital-based providers to write accurate and specific orders, notify them in advance about discharge to order specialized supplies, and avoid changing orders at the last minute. (2) Communication: participants found discharge summaries useful but did not always receive them. Communication between hospital-based clinicians, home health care providers, and the child's primary care physician about the hospitalization and home care was important. (3) Resources: home health care providers needed hospital-based clinicians to be a resource during the early period of transition home. (4) Caregiver preparation: participants emphasized caregiver preparation about medical care of CMC, home health nursing, and the differences between hospital and home care practices in the care of CMC. CONCLUSIONS There are gaps in the system of transitional care of CMC. Potential strategies to improve transitional care of CMC between the hospital and home health care services exist.
Collapse
Affiliation(s)
- Savithri Nageswaran
- Departments of Pediatrics and
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Shannon L Golden
- Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
10
|
Munchhof A, Gruber R, Lane KA, Bo N, Rattray NA. Beyond Discharge Summaries: Communication Preferences in Care Transitions Between Hospitalists and Primary Care Providers Using Electronic Medical Records. J Gen Intern Med 2020; 35:1789-1796. [PMID: 32242311 PMCID: PMC7280409 DOI: 10.1007/s11606-020-05786-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ineffective transitions of care continue to be a source of risk for patients. Although there has been widespread implementation of electronic medical record (EMR) systems, little is currently known about hospitalists' and primary care providers' (PCPs) direct communication preferences at discharge using messaging capabilities in a shared EMR system. OBJECTIVE We examined how hospitalists and PCPs with a shared EMR prefer to directly communicate at the time of hospital discharge by identifying preferred modes, information prioritization, challenges, facilitators, and proposed solutions. DESIGN A sequential, explanatory mixed methods study with surveys and semi-structured interviews. PARTICIPANTS Thirty-eight academic hospitalists and 63 PCPs working in outpatient clinics in a single safety net hospital system with a shared EMR. MAIN APPROACH Descriptive statistics were used to analyze survey responses. Interviews were analyzed using immersion/crystallization and a mixture of inductive and deductive thematic analysis. KEY RESULTS PCPs preferred direct communication at discharge through a message within the EMR while hospitalists preferred a message within the EMR and email. Qualitative results identified key themes related to patient care and direct communication: value of direct communication, safety, social determinants of health, and clinical judgment. Both groups prioritized direct communication for high-risk medications, pending and follow-up studies, and high-risk patients that hospitalists were concerned about. Overall, both hospitalists and PCPs reported that ensuring patient safety, flagging patients with social challenges, and expressing concerns about patients based on clinical judgment were key communication priorities. CONCLUSIONS Hospitalists and primary care providers report considerable overlap in preferences for direct communication at the time of hospital discharge through a shared EMR. Specifically, both groups reported similar concerns regarding patient safety and continuity during transitions. Direct messaging within the EMR could enable "closed loop" communication that helps ensure safe transitions of care for high-risk patients.
Collapse
Affiliation(s)
- Amy Munchhof
- Department of General Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. .,Hospital Medicine Eskenazi Medical Group, Eskenazi Health Hospital, Indianapolis, IN, USA.
| | - Rachel Gruber
- Regenstrief Institute Inc., Center for Health Services Research, Indianapolis, IN, USA
| | - Kathleen A Lane
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Na Bo
- Department of Biostatistics, Indiana University, Indianapolis, IN, USA
| | - Nicholas A Rattray
- Department of General Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute Inc., Center for Health Services Research, Indianapolis, IN, USA.,Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Anthropology, Indiana University-Purdue University, Indianapolis, IN, USA
| |
Collapse
|
11
|
Ravid NL, Zamora K, Rehm R, Okumura M, Takayama J, Kaiser S. Implementation of a multidisciplinary discharge videoconference for children with medical complexity: a pilot study. Pilot Feasibility Stud 2020; 6:27. [PMID: 32099662 PMCID: PMC7027051 DOI: 10.1186/s40814-020-00572-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The hospital to home transition for children with medical complexity (CMC) poses many challenges, including suboptimal communication between the hospital and medical home. Our objective was to evaluate the implementation of a discharge videoconference incorporating the patient, caregiver, primary care provider (PCP), hospitalist physician, and case manager. METHODS We evaluated implementation of this pilot intervention at a freestanding tertiary care children's hospital using mixed methods. A discharge videoconference was conducted for hospitalized children (< 18 years old) meeting complex chronic disease (C-CD) criteria. We collected field notes and conducted surveys and semi-structured interviews. Outcomes included adoption, cost, acceptability, feasibility, and appropriateness. Adoption, cost, and acceptability were analyzed using descriptive statistics. Acceptability, feasibility, and appropriateness were summarized using thematic content analysis. RESULTS Adoption: A total of 4 CMC (9% of the 44 eligible children) had discharge videoconferences conducted. Cost (in provider time): On average, videoconferences took 5 min to schedule and lasted 21.5 min. Acceptability: All hospitalists involved (n = 4) were very likely to participate again. Interviews with caregivers (n = 4) and PCPs (n = 5) demonstrated that for those participating, videoconferences were acceptable and appropriate due to benefits including development of a shared understanding, remote physical assessment by the PCP, transparency, and humanization of the care handoff, and increased PCP comfort with care of CMC. Feasibility: Barriers included internet connection quality and scheduling constraints. CONCLUSIONS This novel, visual approach to discharge communication for CMC had low adoption, possibly related to recruitment strategy. The videoconference posed low time burdens, and participating physicians and caregivers found them acceptable due to a variety of benefits. We identified several feasibility barriers that could be targeted in future implementation efforts.
Collapse
Affiliation(s)
- Noga L. Ravid
- Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA
| | - Kayla Zamora
- San Francisco School of Medicine, University of California, 513 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Roberta Rehm
- Department of Family Health Care Nursing, University of California at San Francisco, 2 Koret Way, San Francisco, CA 94143 USA
| | - Megumi Okumura
- Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA
| | - John Takayama
- Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA
| | - Sunitha Kaiser
- Department of Pediatrics, University of California, San Francisco, 550 16th St. 5th floor, Box 0110, San Francisco, CA 94143 USA
| |
Collapse
|
12
|
Zackoff MW, Graham C, Warrick D, Pulda K, Gosdin C, Simpson B, Marischen J, Bunch P, Vossmeyer M, Mussman GM. Increasing PCP and Hospital Medicine Physician Verbal Communication During Hospital Admissions. Hosp Pediatr 2019; 8:220-226. [PMID: 29559504 DOI: 10.1542/hpeds.2017-0119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES During hospital admission, communication between primary care physicians (PCPs) and hospital medicine (HM) physicians provides an opportunity for collaboration. Two-way communication facilitates collaboration by allowing the receiver to ask and respond to questions. At our institution, most HM-to-PCP communication occurred by telephone call after discharge. Our specific aim was to increase the percentage of patients for whom a telephone conversation occurred between HM and PCPs during hospital admission from 40% to >80%. METHODS An improvement team that included PCPs and HM physicians redesigned the process for communication with PCPs to emphasize collaboration during hospitalization. Interventions were used to target key drivers of information transparency, PCP and HM provider buy-in, the value of early call initiation, process standardization, accommodating provider availability, and preoccupation with failure. We used improvement-science methods and run charts to measure our progress and attain our goal. RESULTS The median weekly percentage of patients with a phone call completed during hospitalization increased from 40% to 85% at the satellite campus and 40% to 80% at the main campus. In addition to the standardized use of a telephone operator system to route calls and follow-up on unplaced calls, critical interventions included feedback on PCP call preferences to providers and the provider script for calls. CONCLUSIONS PCPs and HM physicians applied quality-improvement methodology to ensure reliable HM-PCP communication during hospital admission. Interventions to facilitate communication between providers and learners (who may otherwise have limited interaction), such as the scripting of phone calls and feedback from PCPs to HM physicians, were important for success.
Collapse
Affiliation(s)
| | - Camille Graham
- Divisions of General and Community Pediatrics.,Mid-City Pediatrics Inc, Cincinnati, Ohio; and
| | | | - Kathleen Pulda
- Physician Priority Link, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - Paul Bunch
- Divisions of General and Community Pediatrics.,Springdale-Mason Pediatric Associates Inc, Cincinnati, Ohio
| | | | | |
Collapse
|
13
|
Solan LG, Beck AF, Shardo SA, Sauers-Ford HS, Simmons JM, Shah SS, Sherman SN. Caregiver Perspectives on Communication During Hospitalization at an Academic Pediatric Institution: A Qualitative Study. J Hosp Med 2018; 13:304-310. [PMID: 29345256 DOI: 10.12788/jhm.2919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/11/2017] [Accepted: 08/18/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Communication among those involved in a child's care during hospitalization can mitigate or exacerbate family stress and confusion. As part of a broader qualitative study, we present an in-depth understanding of communication issues experienced by families during their child's hospitalization and during the transition to home. METHODS Focus groups and individual interviews stratified by socioeconomic status included caregivers of children recently discharged from a children's hospital after acute illnesses. An open-ended, semistructured question guide designed by investigators included communication-related questions addressing information shared with families from the medical team about discharge, diagnoses, instructions, and care plans. By using an inductive thematic analysis, 4 investigators coded transcripts and resolved differences through consensus. RESULTS A total of 61 caregivers across 11 focus groups and 4 individual interviews participated. Participants were 87% female and 46% non-white. Analyses resulted in 3 communication-related themes. The first theme detailed experiences affecting caregiver perceptions of communication between the inpatient medical team and families. The second revealed communication challenges related to the teaching hospital environment, including confusing messages associated with large multidisciplinary teams, aspects of family-centered rounds, and confusion about medical team member roles. The third reflected caregivers' perceptions of communication between providers in and out of the hospital, including types of communication caregivers observed or believed occurred between medical providers. CONCLUSIONS Participating caregivers identified various communication concerns and challenges during their child's hospitalization and transition home. Caregiver perspectives can inform strategies to improve experiences, ease challenges inherent to a teaching hospital, and determine which types of communication are most effective.
Collapse
Affiliation(s)
- Lauren G Solan
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- University of Rochester Medical Center, Division of Pediatric Hospital Medicine, Rochester, New York
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, Ohio
| | - Stephanie A Shardo
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- Summa Akron City Hospital, Cooper Cancer Center, Akron, Ohio
| | - Hadley S Sauers-Ford
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- UC Davis Health System, Pediatric Telemedicine, Sacramento, California
| | - Jeffrey M Simmons
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center, Division of Hospital Medicine, Cincinnati, Ohio
- Cincinnati Children's Hospital Medical Center, Division of Infectious Diseases, Cincinnati, Ohio
| | | | | |
Collapse
|
14
|
Canary HE, Wilkins V. Beyond Hospital Discharge Mechanics: Managing the Discharge Paradox and Bridging the Care Chasm. QUALITATIVE HEALTH RESEARCH 2017; 27:1225-1235. [PMID: 28682741 DOI: 10.1177/1049732316679811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hospital discharge processes are complex and confusing, and can detrimentally affect patients, families, and providers. This qualitative study investigated pediatric hospital discharge experiences from the perspectives of parents of children with acute and chronic health conditions, primary care providers, and hospitalists. Focus groups and interviews with parents, primary care providers, and hospitalists were used to explore discharge experiences and ideas for improvement offered by participants. Using an iterative approach to analyze data resulted in five major themes for discharge experiences: (a) discharge problems, (b) teamwork, (c) ideal discharge, (d) care chasm, and (e) discharge paradox. The first three themes concern practical issues, whereas the last two themes reflect negative emotional experiences as well as practical problems encountered in the discharge process. Improvements in communication were viewed as a primary strategy for improving the discharge process for better outcomes for patients, their families, and providers.
Collapse
|
15
|
Ponce de Leon M, Hohler AD. Safety Considerations During Transitions of Care From Inpatient to Outpatient Settings. Continuum (Minneap Minn) 2017; 23:877-881. [DOI: 10.1212/con.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
16
|
Rosenthal JL, Romano PS, Kokroko J, Gu W, Okumura MJ. Receiving Providers' Perceptions on Information Transmission During Interfacility Transfers to General Pediatric Floors. Hosp Pediatr 2017; 7:335-343. [PMID: 28559362 DOI: 10.1542/hpeds.2016-0152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pediatric patients can present to a medical facility and subsequently be transferred to a different hospital for definitive care. Interfacility transfers require a provider handoff across facilities, posing risks that may affect patient outcomes. OBJECTIVES The goal of this study was to describe the thoroughness of information transmission between providers during interfacility transfers, to describe perceived errors in care at the posttransfer facility, and to identify potential associations between thoroughness of information transmission and perceived errors in care. METHODS We performed an exploratory prospective cohort study on communication practices and patient outcomes during interfacility transfers to general pediatric floors. Data were collected from provider surveys and chart review. Descriptive statistics were used to summarize survey responses. Logistic regression was used to analyze the association of communication deficits with odds of having a perceived error in care. RESULTS A total of 633 patient transfers were reviewed; 218 transport command physician surveys and 217 frontline provider surveys were completed. Transport command physicians reported higher proportions of key elements being included in the verbal handoff compared with frontline providers. The written key element transmitted with the lowest frequency was a summary document (65.2%), and 13% of transfers had at least 1 perceived error in care. Transfers with many deficits were associated with higher odds of having a perceived error in care. CONCLUSIONS Information transmission during pediatric transfers is perceived to be inconsistently complete. Deficits in the verbal and written information transmission are associated with odds of having a perceived error in care.
Collapse
Affiliation(s)
| | - Patrick S Romano
- Departments of Pediatrics and.,Internal Medicine, and.,Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California; and
| | | | | | - Megumi J Okumura
- Department of Pediatrics and Internal Medicine, University of California, San Francisco, San Francisco, California
| |
Collapse
|
17
|
Coller RJ, Klitzner TS, Saenz AA, Lerner CF, Alderette LG, Nelson BB, Chung PJ. Discharge Handoff Communication and Pediatric Readmissions. J Hosp Med 2017; 12:29-35. [PMID: 28125824 DOI: 10.1002/jhm.2670] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Improvement in hospital transitional care has become a major national priority, although the impact on children's postdischarge outcomes is unclear. OBJECTIVE To characterize common handoff practices between hospital and primary care providers (PCPs), and test the hypothesis that common handoff practices would be associated with fewer unplanned readmissions. DESIGN, SETTING, AND PATIENTS This prospective cohort study enrolled randomly selected pediatric patients during an acute hospitalization at a tertiary children's hospital in 2012-2014. MEASUREMENTS Primary care and patient data were abstracted from administrative, caregiver, and PCP questionnaires on admission through 30 days postdischarge. The primary outcome was 30-day unplanned readmission to any hospital. Logistic regression assessed relationships between readmissions and 11 handoff communication practices. RESULTS We enrolled 701 children, from which 685 identified PCPs. Complete data were collected from 84% of PCPs. Communication practices varied widely--verbal handoffs occurred rarely (10.7%); PCP notification of admission occurred for 50.8%. Caregiver experience scores, using an adapted Care Transitions Measure-3, were high but were unrelated to readmissions. Thirty-day unplanned readmissions to any hospital were unrelated to most handoff practices. Having PCP follow-up appointments scheduled prior to discharge was associated with more readmissions (adjusted odds ratio, 2.20; 95% confidence interval, 1.08-4.46). CONCLUSION Despite their presumed value, common handoff practices between hospital providers and PCPs may not lead to reductions in postdischarge utilization for children. Addressing broader constructs like caregiver self-efficacy or social determinants is likely necessary. Journal of Hospital Medicine 2017;12:29-35.
Collapse
Affiliation(s)
- Ryan J Coller
- Department of Pediatrics, University of Wisconsin, Madison School of Medicine and Public Health, Madison, WI, USA
| | - Thomas S Klitzner
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Adrianna A Saenz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carlos F Lerner
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lauren G Alderette
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Bergen B Nelson
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Los Angeles, CA, USA
| | - Paul J Chung
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- RAND Health, The RAND Corporation, Santa Monica, CA, USA
| |
Collapse
|
18
|
Leyenaar JK, Desai AD, Burkhart Q, Parast L, Roth CP, McGalliard J, Marmet J, Simon TD, Allshouse C, Britto MT, Gidengil CA, Elliott MN, McGlynn EA, Mangione-Smith R. Quality Measures to Assess Care Transitions for Hospitalized Children. Pediatrics 2016; 138:peds.2016-0906. [PMID: 27471218 PMCID: PMC9534577 DOI: 10.1542/peds.2016-0906] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Transitions between sites of care are inherent to all hospitalizations, yet we lack pediatric-specific transitions-of-care quality measures. We describe the development and validation of new transitions-of-care quality measures obtained from medical record data. METHODS After an evidence review, a multistakeholder panel prioritized quality measures by using the RAND/University of California, Los Angeles modified Delphi method. Three measures were endorsed, operationalized, and field-tested at 3 children's hospitals and 2 community hospitals: quality of hospital-to-home transition record content, timeliness of discharge communication between inpatient and outpatient providers, and ICU-to-floor transition note quality. Summary scores were calculated on a scale from 0 to 100; higher scores indicated better quality. We examined between-hospital variation in scores, associations of hospital-to-home transition quality scores with readmission and emergency department return visit rates, and associations of ICU-to-floor transition quality scores with ICU readmission and length of stay. RESULTS A total of 927 charts from 5 hospitals were reviewed. Mean quality scores were 65.5 (SD 18.1) for the hospital-to-home transition record measure, 33.3 (SD 47.1) for the discharge communication measure, and 64.9 (SD 47.1) for the ICU-to-floor transition measure. The mean adjusted hospital-to-home transition summary score was 61.2 (SD 17.1), with significant variation in scores between hospitals (P < .001). Hospital-to-home transition quality scores were not associated with readmissions or emergency department return visits. ICU-to-floor transition note quality scores were not associated with ICU readmissions or hospital length of stay. CONCLUSIONS These quality measures were feasible to implement in diverse settings and varied across hospitals. The development of these measures is an important step toward standardized evaluation of the quality of pediatric transitional care.
Collapse
Affiliation(s)
| | - Arti D. Desai
- Department of Pediatrics, University of Washington, Seattle, Washington,Seattle Children’s Research Institute, Seattle, Washington
| | | | | | | | | | - Jordan Marmet
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Tamara D. Simon
- Department of Pediatrics, University of Washington, Seattle, Washington,Seattle Children’s Research Institute, Seattle, Washington
| | | | - Maria T. Britto
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Courtney A. Gidengil
- RAND Corporation, Boston, Massachusetts,Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | | | - Elizabeth A. McGlynn
- Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, California
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington,Seattle Children’s Research Institute, Seattle, Washington
| |
Collapse
|
19
|
Solan LG, Sherman SN, DeBlasio D, Simmons JM. Communication Challenges: A Qualitative Look at the Relationship Between Pediatric Hospitalists and Primary Care Providers. Acad Pediatr 2016; 16:453-459. [PMID: 26979780 DOI: 10.1016/j.acap.2016.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/26/2016] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Primary care providers (PCPs) and hospitalists endorse the importance of effective communication yet studies illustrate critical communication problems between these 2 provider types. Our objective was to develop deeper insight into the dimensions of and underlying reasons for communication issues and determine ways to improve communication and remove barriers by eliciting the perspectives of pediatric PCPs and hospitalists. METHODS Using qualitative methods, 2 sets of focus groups were held: 1) mix of local PCPs serving diverse populations, and 2) hospitalists from a free-standing, pediatric institution. The open-ended, semistructured question guides included questions about communication experiences, patient care responsibilities, and suggestions for improvement. Using inductive thematic analysis, investigators coded the transcripts, and resolved differences through consensus. RESULTS Six PCP (n = 27) and 3 hospitalist (n = 15) focus groups were held. Fifty-six percent of PCPs and 14% of hospitalists had been practicing for >10 years. Five major themes were identified: problematic aspects of communication, perceptions of provider roles, push-pull, postdischarge responsibilities/care, and proposed solutions. Aspects of communication included specific problem areas with verbal and written communication. Perceptions of provider roles highlighted the issue of PCPs feeling devalued. Push-pull described conflicting expectations about a counterpart's role and responsibilities. Postdischarge responsibilities/care addressed unclear responsibilities related to patient follow-up. Proposed solutions were suggested for ways to improve communication. CONCLUSIONS Deficiencies in communication hinder successful collaboration and can cause tension between providers in inpatient and outpatient settings. Understanding specific issues that contribute to poor communication like perceptions about provider roles is critical to improving relationships and facilitating combined efforts to improve patient care.
Collapse
Affiliation(s)
- Lauren G Solan
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | | | - Dominick DeBlasio
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey M Simmons
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
20
|
Bhansali P, Washofsky A, Romrell E, Birch S, Winer JC, Hoffner W. Parental Understanding of Hospital Course and Discharge Plan. Hosp Pediatr 2016; 6:449-55. [PMID: 27369094 DOI: 10.1542/hpeds.2015-0111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Hospital discharge marks an important transition in care from the inpatient team to the family and primary care provider. Parents must know the hospital course and discharge plan to care for their child at home and provide background for future providers. Our study aimed to determine parental knowledge of key aspects of their child's hospital course and discharge plan and to identify markers of increased risk for incomplete or incorrect knowledge among participants. METHODS We conducted a descriptive prospective cohort study of parents within 24 hours of hospital discharge. The primary outcome was concordance of parent responses to verbal interview questions about their child's hospital treatment, laboratory testing, imaging, procedures and discharge plan with the medical record. RESULTS Of 174 participants, 15% felt less than "completely prepared" to explain the hospital course to their primary care provider or to provide care after discharge. There was >83% overall concordance with interview responses and the medical record, with concordance higher for hospital course events than discharge plan. There were few significant differences in understanding between trainee-based teams and the attending physician-run unit. No patient or family characteristics were consistently associated with poor understanding of hospital course or discharge plan. CONCLUSIONS Although parents were generally knowledgeable about hospital course and discharge plan, areas for improved communication were identified. Individualized counseling about hospital course and discharge plan should be initiated for all parents early during hospitalization. Methods that assess and bolster caregiver comprehension and minimize dependence on written instructions may help with transition to outpatient care.
Collapse
Affiliation(s)
- Priti Bhansali
- Children's National Health System, Washington, District of Columbia; and
| | - Anne Washofsky
- Children's National Health System, Washington, District of Columbia; and
| | - Evan Romrell
- The George Washington School of Medicine and Health Sciences, Washington, District of Columbia
| | - Sarah Birch
- Children's National Health System, Washington, District of Columbia; and
| | - Jeffrey C Winer
- Children's National Health System, Washington, District of Columbia; and
| | - Wendy Hoffner
- Children's National Health System, Washington, District of Columbia; and
| |
Collapse
|
21
|
Luu NP, Pitts S, Petty B, Sawyer MD, Dennison-Himmelfarb C, Boonyasai RT, Maruthur NM. Provider-to-Provider Communication during Transitions of Care from Outpatient to Acute Care: A Systematic Review. J Gen Intern Med 2016; 31:417-25. [PMID: 26691310 PMCID: PMC4803688 DOI: 10.1007/s11606-015-3547-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/03/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Most research on transitions of care has focused on the transition from acute to outpatient care. Little is known about the transition from outpatient to acute care. We conducted a systematic review of the literature on the transition from outpatient to acute care, focusing on provider-to-provider communication and its impact on quality of care. METHODS We searched the MEDLINE, CINAHL, Scopus, EMBASE, and Cochrane databases for English-language articles describing direct communication between outpatient providers and acute care providers around patients presenting to the emergency department or admitted to the hospital. We conducted double, independent review of titles, abstracts, and full text articles. Conflicts were resolved by consensus. Included articles were abstracted using standardized forms. We maintained search results via Refworks (ProQuest, Bethesda, MD). Risk of bias was assessed using a modified version of the Downs' and Black's tool. RESULTS Of 4009 citations, twenty articles evaluated direct provider-to-provider communication around the outpatient to acute care transition. Most studies were cross-sectional (65%), conducted in the US (55%), and studied communication between primary care and inpatient providers (62%). Of three studies reporting on the association between communication and 30-day readmissions, none found a significant association; of these studies, only one reported a measure of association (adjusted OR for communication vs. no communication, 1.08; 95% CI 0.92-1.26). DISCUSSION The literature on provider-to-provider communication at the transition from outpatient to acute care is sparse and heterogeneous. Given the known importance of communication for other transitions of care, future studies are needed on provider-to-provider communication during this transition. Studies evaluating ideal methods for communication to reduce medical errors, utilization, and optimize patient satisfaction at this transition are especially needed.
Collapse
Affiliation(s)
- Ngoc-Phuong Luu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Samantha Pitts
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brent Petty
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melinda D Sawyer
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA
| | - Cheryl Dennison-Himmelfarb
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA.,Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Romsai Tony Boonyasai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Nisa M Maruthur
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| |
Collapse
|
22
|
Desai AD, Durkin LK, Jacob-Files EA, Mangione-Smith R. Caregiver Perceptions of Hospital to Home Transitions According to Medical Complexity: A Qualitative Study. Acad Pediatr 2016; 16:136-44. [PMID: 26703883 DOI: 10.1016/j.acap.2015.08.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore caregiver needs and preferences for achievement of high-quality pediatric hospital to home transitions and to describe similarities and differences in caregiver needs and preferences according to child medical complexity. METHODS Qualitative study using semistructured telephone interviews of 18 caregivers of patients aged 1 month to 18 years discharged from Seattle Children's Hospital between September 2013 and January 2014. Grounded theory methodology was used to elucidate needs and preferences identified to be important to caregivers. Medical complexity was determined using the Pediatric Medical Complexity Algorithm. Thematic comparisons between medical complexity groups were facilitated using a profile matrix. RESULTS A multidimensional theoretical framework consisting of 3 domains emerged to represent caregiver needs and preferences for hospital to home transitions. Caregiver self-efficacy for home care management emerged as the central domain in the framework. Caregivers identified several needs to promote their sense of self-efficacy including: support from providers familiar with the child, opportunities to practice home care skills, and written instructions containing contingency plan information. Many needs were consistent across medical complexity groups; however, some needs and preferences were only emphasized by caregivers of children with chronic conditions or caregivers of children with medical complexity. Distinct differences in caregiver preferences for how to meet these needs were also noted on the basis of the child's level of medical complexity. CONCLUSIONS Caregivers identified several needs and preferences for enhancement of their sense of self-efficacy during hospital to home transitions. These findings inform quality improvement efforts to develop family-centered transition systems of care that address the needs and preferences of broad pediatric populations.
Collapse
Affiliation(s)
- Arti D Desai
- Department of Pediatrics, University of Washington, Seattle, Wash; Seattle Children's Research Institute, Seattle, Wash.
| | | | | | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Wash; Seattle Children's Research Institute, Seattle, Wash
| |
Collapse
|
23
|
Desai AD, Popalisky J, Simon TD, Mangione-Smith RM. The effectiveness of family-centered transition processes from hospital settings to home: a review of the literature. Hosp Pediatr 2015; 5:219-31. [PMID: 25832977 DOI: 10.1542/hpeds.2014-0097] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The quality of care transitions is of growing concern because of a high incidence of postdischarge adverse events, poor communication with patients, and inadequate information transfer between providers. The objective of this study was to conduct a targeted literature review of studies examining the effectiveness of family-centered transition processes from hospital- and emergency department (ED)-to-home for improving patient health outcomes and health care utilization. METHODS We conducted an electronic search (2001-2012) of PubMed, CINAHL, Cochrane, PsycInfo, Embase, and Web of Science databases. Included were experimental studies of hospital and ED-to-home transition interventions in pediatric and adult populations meeting the following inclusion criteria: studies evaluating hospital or ED-to-home transition interventions, study interventions involving patients/families, studies measuring outcomes≤30 days after discharge, and US studies. Transition processes, principal outcome measures (patient health outcomes and health care utilization), and assessment time-frames were extracted for each study. RESULTS The search yielded 3458 articles, and 16 clinical trials met final inclusion criteria. Four studies evaluated pediatric ED-to-home transitions and indicated family-tailored discharge education was associated with better patient health outcomes. Remaining trials evaluating adult hospital-to-home transitions indicated a transition needs assessment or provision of an individualized transition record was associated with better patient health outcomes and reductions in health care utilization. The effectiveness of postdischarge telephone follow-up and/or home visits on health care utilization showed mixed results. CONCLUSIONS Patient-tailored discharge education is associated with improved patient health outcomes in pediatric ED patients. Effective transition processes identified in the adult literature may inform future quality improvement research regarding pediatric hospital-to-home transitions.
Collapse
Affiliation(s)
- Arti D Desai
- Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
| | - Jean Popalisky
- Seattle Children's Research Institute, Seattle, Washington
| | - Tamara D Simon
- Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
| | - Rita M Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
| |
Collapse
|
24
|
Sheu L, Fung K, Mourad M, Ranji S, Wu E. We need to talk: Primary care provider communication at discharge in the era of a shared electronic medical record. J Hosp Med 2015; 10:307-10. [PMID: 25755159 DOI: 10.1002/jhm.2336] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Poor communication between hospitalists and outpatient physicians can contribute to adverse events after discharge. Electronic medical records (EMRs) shared by inpatient and outpatient clinicians offer primary care providers (PCPs) better access to information surrounding a patient's hospitalization. However, the PCP experience and subsequent expectations for discharge communication within a shared EMR are unknown. METHODS We surveyed PCPs 1 year after a shared EMR was implemented at our institution to assess PCP satisfaction with current discharge communication practices and identify areas for improvement. RESULTS Seventy-five of 124 (60%) clinicians completed the survey. Although most PCPs reported receiving automated discharge notifications (71%), only 39% felt that notifications plus discharge summaries were adequate for safe transitions of care. PCPs expressed that complex hospitalizations necessitated additional communication via e-mail or telephone; only 31% reported receiving such communication. The content most important in additional communication included medication changes, follow-up actions, and active medical issues. CONCLUSIONS Despite optimized access to information provided by a shared EMR, only 52% of PCPs were satisfied with current discharge communication. PCPs express a continued need for high-touch communication for safe transitions of care. Further standardization of discharge communication practices is necessary.
Collapse
Affiliation(s)
- Leslie Sheu
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | | | | | | |
Collapse
|
25
|
Blank L, Baxter S, Woods HB, Goyder E, Lee A, Payne N, Rimmer M. What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03240] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BackgroundDemand management describes any method used to monitor, direct or regulate patient referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure.ObjectiveThis research aimed to conduct an inclusive systematic review and logic model synthesis in order to better understand factors impacting on the effectiveness of interventions targeting referral between primary and secondary medical health care.DesignThe approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes.SettingPrimary health care.Main outcome measuresReferral from primary to secondary care.Review methodsSystematic searches were undertaken to identify recent, relevant studies. Quality of individual studies was appraised, with consideration of overall strength of evidence. A narrative synthesis and logic model summary of the data was completed.ResultsFrom a database of 8327 unique papers, 290 were included in the review. The intervention studies were grouped into four categories of education interventions (n = 50); process change interventions (n = 49); system change interventions (n = 38); and patient-focused interventions (n = 3). Effectiveness was assessed variously in these papers; however, there was a gap regarding the mechanisms whereby these interventions lead to demand management impacts. The findings suggest that, although individual-level interventions may be popular, the stronger evidence relates only to peer-review and feedback interventions. Process change interventions appeared to be more effective when the change resulted in the specialist being provided with more or better quality information about the patient. System changes including the community provision of specialist services by general practitioners, outreach provision by specialists and the return of inappropriate referrals appeared to have evidence of effect. The pathway whereby interventions might lead to service-wide impact was complex, with multiple factors potentially acting as barriers or facilitators to the change process. Factors related, first, to the doctor (including knowledge, attitudes and beliefs, and previous experiences of a service), second, to the patient (including condition and social factors) and, third, to the influence of the doctor–patient relationship. We also identified a number of potentially influential factors at a local level, such as perceived waiting times and the availability of a specialist. These elements are key factors in the pathway between an intervention and intended demand management outcomes influencing both applicability and effectiveness.ConclusionsThe findings highlight the complexity of the referral process and multiple elements that will impact on intervention outcomes and applicability to a local area. Any interventions seeking to change referral practice need to address factors relating to the individual practitioner, the patient and also the situation in which the referral is taking place. These conclusions apply especially to referral management in a UK context where this whole range of factors/issues lies well within the remit of the NHS. This work highlights that intermediate outcomes are important in the referral pathway. It is recommended that researchers include measure of these intermediate outcomes in their evaluation of intervention effectiveness in order to determine where blocks to or facilitators of system-wide impact may be occurring.Study registrationThe study is registered as PROSPERO CRD42013004037.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Lindsay Blank
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Lee
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Nick Payne
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Melanie Rimmer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
26
|
Leyenaar JK, Bergert L, Mallory LA, Engel R, Rassbach C, Shen M, Woehrlen T, Cooperberg D, Coghlin D. Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis. Acad Pediatr 2015; 15:61-8. [PMID: 25444655 PMCID: PMC4371737 DOI: 10.1016/j.acap.2014.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 07/18/2014] [Accepted: 07/19/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Effective communication between inpatient and outpatient providers may mitigate risks of adverse events associated with hospital discharge. However, there is an absence of pediatric literature defining effective discharge communication strategies at both freestanding children's hospitals and general hospitals. The objectives of this study were to assess associations between pediatric primary care providers' (PCPs) reported receipt of discharge communication and referral hospital type, and to describe PCPs' perspectives regarding effective discharge communication and areas for improvement. METHODS We administered a questionnaire to PCPs referring to 16 pediatric hospital medicine programs nationally. Multivariable models were developed to assess associations between referral hospital type and receipt and completeness of discharge communication. Open-ended questions asked respondents to describe effective strategies and areas requiring improvement regarding discharge communication. Conventional qualitative content analysis was performed to identify emergent themes. RESULTS Responses were received from 201 PCPs, for a response rate of 63%. Although there were no differences between referral hospital type and PCP-reported receipt of discharge communication (relative risk 1.61, 95% confidence interval 0.97-2.67), PCPs referring to general hospitals more frequently reported completeness of discharge communication relative to those referring to freestanding children's hospitals (relative risk 1.78, 95% confidence interval 1.26-2.51). Analysis of free text responses yielded 4 major themes: 1) structured discharge communication, 2) direct personal communication, 3) reliability and timeliness of communication, and 4) communication for effective postdischarge care. CONCLUSIONS This study highlights potential differences in the experiences of PCPs referring to general hospitals and freestanding children's hospitals, and presents valuable contextual data for future quality improvement initiatives.
Collapse
Affiliation(s)
- JoAnna K. Leyenaar
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, MA
| | - Lora Bergert
- Division of Pediatric Hospital Medicine, Department of Pediatrics, The John A Burns School of Medicine, Honolulu, HI
| | - Leah A. Mallory
- Division of Pediatric Hospital Medicine, Department of Pediatrics, The Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME
| | - Richard Engel
- University of Arizona College of Medicine-Phoenix, Phoenix Children’s Hospital, Phoenix, AZ
| | - Caroline Rassbach
- Stanford University School of Medicine, Lucile Packard Children’s Hospital, Palo Alto, CA 94304
| | - Mark Shen
- Dell Children’s Medical Center of Central Texas
| | - Tess Woehrlen
- Michigan State University College of Osteopathic Medicine, East Lansing MI
| | - David Cooperberg
- Drexel University College of Medicine, St. Christopher’s Hospital for Children, Philadelphia, PA
| | - Daniel Coghlin
- The Warren Alpert Medical School of Brown University, Hasbro Children’s Hospital, Providence, RI
| |
Collapse
|
27
|
Coghlin DT, Leyenaar JK, Shen M, Bergert L, Engel R, Hershey D, Mallory L, Rassbach C, Woehrlen T, Cooperberg D. Pediatric discharge content: a multisite assessment of physician preferences and experiences. Hosp Pediatr 2014; 4:9-15. [PMID: 24435595 DOI: 10.1542/hpeds.2013-0022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Professional medical societies endorse prompt, consistent discharge communication to primary care providers (PCPs) on discharge. However, evidence is limited about what clinical elements to communicate. Our main goal was to identify and compare the clinical elements considered by PCPs and pediatric hospitalists to be essential to communicate to PCPs within 2 days of pediatric hospital discharge. A secondary goal was to describe experiences of the PCPs and pediatric hospitalists regarding sending and receiving discharge information. METHODS A survey of physician preferences and experiences regarding discharge communication was sent to 320 PCPs who refer patients to 16 hospitals, with an analogous survey sent to 147 hospitalists. Descriptive statistics were calculated, and χ² analyses were performed. RESULTS A total of 201 PCPs (63%) and 71 hospitalists (48%) responded to the survey. Seven clinical elements were reported as essential by >75% of both PCPs and hospitalists: dates of admission and discharge; discharge diagnoses; brief hospital course; discharge medications; immunizations given during hospitalization; pending laboratory or test results; and follow-up appointments. PCPs reported reliably receiving discharge communication significantly less often than hospitalists reported sending it (71.8% vs 85.1%; P < .01), and PCPs considered this communication to be complete significantly less often than hospitalists did (64.9% vs 79.1%; P < .01). CONCLUSIONS We identified 7 core clinical elements that PCPs and hospitalists consider essential in discharge communication. Consistently and promptly communicating at least these core elements after discharge may enhance PCP satisfaction and patient-level outcomes. Reported rates of transmission and receipt of this information were suboptimal and should be targeted for improvement.
Collapse
Affiliation(s)
- Daniel T Coghlin
- The Warren Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, Rhode Island
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Effective communication requires direct interaction between the hospitalist and the primary care provider using a standardized method of information exchange with the opportunity to ask questions and assign accountability for follow-up roles. The discharge summary is part of the process but does not provide the important aspects of handoff, such as closed loop communication and role assignments. Hospital discharge is a significant safety risk for patients, with more than half of discharged patients experiencing at least one error. Hospitalist and primary care providers need to collaborate to develop a standardized system to communicate about shared patients that meets handoff requirements.
Collapse
|
29
|
Nageswaran S, Radulovic A, Anania A. Transitions to and from the acute inpatient care setting for children with life-threatening illness. Pediatr Clin North Am 2014; 61:761-83. [PMID: 25084723 DOI: 10.1016/j.pcl.2014.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with life-threatening illnesses (LTIs) are hospitalized more often and spend more days in the hospital than children without LTIs. Hospitalizations may be associated with changes in health status of children with LTIs and thus alter their care needs significantly. Transitional care is particularly relevant for this population. Pediatric palliative care clinicians and teams are well-positioned to improve transitional care of children with LTIs by facilitating communication between clinicians and educating clinicians about issues related to children with LTIs.
Collapse
Affiliation(s)
- Savithri Nageswaran
- Department of Pediatrics, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
| | - Andrea Radulovic
- Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA
| | - Aura Anania
- Department of Pediatrics, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| |
Collapse
|
30
|
Bergert L, Patel SJ, Kimata C, Zhang G, Matthews WJ. Linking patient-centered medical home and asthma measures reduces hospital readmission rates. Pediatrics 2014; 134:e249-56. [PMID: 24936001 DOI: 10.1542/peds.2013-1406] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to achieve 100% compliance with all 3 Children's Asthma Care (CAC; CAC-1, CAC-2, CAC-3) measures and track attendance at follow-up appointments with the patient-centered medical home. The impact of these measures on readmission and emergency department utilization rates was evaluated. METHODS This quality improvement study evaluated compliance with CAC measures in pediatric patients aged 2 to 18 years old hospitalized with a primary diagnosis of asthma from January 1, 2008, through June 30, 2012. A multidisciplinary Asthma Task Force was assembled to develop interventions. Attendance at the follow-up appointment was tracked monthly from January 1, 2009. Readmission and emergency department utilization rates were compared between the preimplementation period (January 1, 2006, through December 31, 2007) and the postimplementation period (January 1, 2008, through June 30, 2012). RESULTS The preimplementation period included 231 subjects and the postimplementation period included 532 subjects. Compliance with CAC-3 was 95% from October 1, 2009, through June 30, 2012. Compliance with the postdischarge follow-up appointment was 69% from January 1, 2009 through September 30, 2009, increasing significantly to 90% from October 1, 2009, through June 30, 2012 (P < .001). Postimplementation readmission rates significantly decreased in the 91- to 180-day postdischarge interval (odds ratio: 0.29; 95% confidence interval: 0.11-0.78). CONCLUSIONS In children hospitalized with asthma, compliance with the asthma core measures and the postdischarge follow-up appointment with the primary care provider was associated with reduced readmission rates at 91 to 180 days after discharge. We attribute our results to a comprehensive set of interventions designed by our multidisciplinary Asthma Task Force.
Collapse
Affiliation(s)
- Lora Bergert
- Departments of Pediatrics, andKapi'olani Medical Center for Women and Children, Honolulu, Hawaii; and
| | - Shilpa J Patel
- Departments of Pediatrics, andKapi'olani Medical Center for Women and Children, Honolulu, Hawaii; and
| | | | - Guangxiang Zhang
- Biostatistics and Data Management Core, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Wallace J Matthews
- Departments of Pediatrics, andKapi'olani Medical Center for Women and Children, Honolulu, Hawaii; and
| |
Collapse
|
31
|
Shen MW, Hershey D, Bergert L, Mallory L, Fisher ES, Cooperberg D. Pediatric hospitalists collaborate to improve timeliness of discharge communication. Hosp Pediatr 2014; 3:258-65. [PMID: 24313096 DOI: 10.1542/hpeds.2012-0080] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The transition of care from hospital to primary care provider (PCP) at discharge carries the potential for significant information loss. There is evidence that the timeliness and content of discharge communication are often unreliable during this handoff. Suboptimal transitions of care at discharge have been associated with adverse outcomes, and efficient solutions are required to transform the current state. Our specific aim was the achievement 90% documentation of hospitalist-PCP communication within 2 days of hospital discharge in < 12 months. METHODS As part of a grassroots collaborative improvement organization, pediatric hospitalist groups engaged in parallel quality improvement projects to improve the timeliness and reliability of discharge communication at their local institutions. After an initial face-to-face meeting, e-mail and regular conference calls were used to promote shared effort and learning. The study period lasted 12 months, with > 16 weeks of continuous data required for inclusion. RESULTS The mean rate of documentation of timely discharge communication across the collaborative increased from 57% to 85% over the study period. For the 7 hospitals that were able to collect > 16 weeks of data before July 2010, the mean rate of communication was > 90%. Participants reported that the context of the collaborative contributed to their success. CONCLUSIONS Timely hospitalist-PCP communication was inconsistent at the beginning of the study. This low-resource quality improvement collaborative was able to achieve rapid improvement and resulted in improved perceptions of quality improvement knowledge among participants.
Collapse
Affiliation(s)
- Mark W Shen
- Dell Children's Medical Center of Central Texas, Austin, Texas 78723, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Abstract
Pediatric hospital medicine programs have an established place in pediatric medicine. This statement speaks to the expanded roles and responsibilities of pediatric hospitalists and their integrated role among the community of pediatricians who care for children within and outside of the hospital setting.
Collapse
|
33
|
|
34
|
Abstract
PURPOSE OF REVIEW The present review focuses on the latest evidence from the past 18 months related to pediatric hospitalist medicine. RECENT FINDINGS The number of hospitalists continues to increase despite many programs not being financially self-supporting. Reports in the past have shown decreased length of stay, resource utilization, and costs with the hospitalist model. There are an increasing number of studies examining patient safety, quality initiatives, and communication issues such as 'handoffs' and family-centered rounds. The teaching role continues to broaden in scope and is highly valued by trainees. Pediatric hospitalist fellowship training programs are in an early stage of development. A list of core competencies as a framework for a pediatric hospital medicine curriculum has recently been published and should help to facilitate and standardize training. Recent publications suggest that there is still significant variation in the approach to and management of many common inpatient illnesses. SUMMARY In general, there continue to be reports of positive outcomes as a result of the introduction of the hospitalist model in pediatrics. Much of the current literature is geared toward reporting on alternative models of care, inpatient quality and safety initiatives, and hospitalist teaching. What is still somewhat lacking is multicenter collaborative prospective clinical trials for common inpatient general pediatric conditions. The variation reported in the management of common conditions presents an opportunity for improving the quality, safety, resource utilization, and appropriateness of care.
Collapse
|
35
|
Nkoy FL, Fassl BA, Wolfe D, Colling D, Hales JW, Maloney CG. Sustaining compliance with pediatric asthma inpatient quality measures. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2010; 2010:547-551. [PMID: 21347038 PMCID: PMC3041425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
To reduce readmission risk in children hospitalized with asthma, The Joint Commission (JC) mandated hospitals to initiate preventive measures and provide patients/caregivers with a home management plan of care (HMPC) at discharge. Standard methods for recording HMPC compliance require hospitals to commit considerable resources. We developed an asthma-specific "reminder and decision support" (RADS) system to facilitate patient discharge while supporting many clinical and administrative needs, including: 1) providers' compliance with asthma preventive measures, 2) creation of patient's discharge instructions, 3) recording HMPC components for JC accreditation, and 4) creation of discharge summaries with auto-faxing mechanism to primary care providers for follow-up. RADS resulted in significant increased and sustained HMPC compliance (73% vs. 89%, p<0.01) and reduced labor time (53 vs. 15 hours/week, p=0.02) compared to standard methods. Most quality improvement interventions achieve short-term goals, but long-term improvements require decision support tools that support multiple needs while minimizing resource use.
Collapse
Affiliation(s)
- Flory L Nkoy
- University of Utah School of Medicine, Salt Lake City, UT and
| | | | | | | | | | | |
Collapse
|
36
|
Harlan GA, Nkoy FL, Srivastava R, Lattin G, Wolfe D, Mundorff MB, Colling D, Valdez A, Lange S, Atkinson SD, Cook LJ, Maloney CG. Improving transitions of care at hospital discharge--implications for pediatric hospitalists and primary care providers. J Healthc Qual 2010; 32:51-60. [PMID: 20854359 DOI: 10.1111/j.1945-1474.2010.00105.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.
Collapse
Affiliation(s)
- Gregory A Harlan
- Medical Affairs, IPC-The Hospitalist Company, North Hollywood, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
The hospitalist model was founded on the premise that it could improve the quality and reduce the cost of hospital care. Many randomized studies have all but definitively proven this original assertion. Nevertheless, the hospitalist specialty raises lingering classical ethical issues: protecting the patient-physician relationship in an environment of increasing specialization and discontinuity of care, preserving patient autonomy and choice when structural changes are made in the provision of care, and ensuring that a model founded on efficiency and cost-effectiveness does not erode the public trust in hospitalists to always serve their patients' best interests. This work aims to serve as an update of these initial criticisms, showing how some questions have been answered, while some have not.
Collapse
Affiliation(s)
- Adam Haley Rosenbloom
- Medical School for International Health, Ben-Gurion University of the Negev, Columbia University Medical Center, Be'er Sheva, Israel.
| | | |
Collapse
|
38
|
Percelay JM. Toto, I don't think we're on the adult inpatient unit anymore. J Hosp Med 2009; 4:145-8. [PMID: 19301405 DOI: 10.1002/jhm.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|