Discharge Development


A multidisciplinary pre-discharge intervention—one that hospitalists can advocate for and help lead—resulted in a 30% reduction in hospital utilization within 30 days, according to a single-center study published in the Feb. 3 Annals of Internal Medicine (2009;150(3):178-187).

Researchers, including hospitalist Jeffrey Greenwald, MD, followed 749 adult patients over 30-day periods at Boston Medical Center to test the effects of a nurse discharge advocate program. A nurse arranged follow-up appointments and confirmed medication, while a clinical pharmacist called patients two to four days after discharge to reinforce the discharge plan.

"It isn't realistic that the hospitalists become the primary-care doctors after the discharge," says Dr. Greenwald, director of HM at Boston Medical Center and associate professor of medicine at Boston University School of Medicine. "It's critical that the hospitalists take a lead role in taking responsibility for the pitfalls into which the patients are likely to fall."

Dr. Greenwald thinks hospitalists can push for interventions at their respective centers to reduce rehospitalizations. The research team already is working on a new study to determine which measures could be automated to ensure their completion.

"All we're asking is that, as a team, you put in place the common stopgaps. ... None of this is gene therapy," Dr. Greenwald says. "This is low brain activity. The problem is that it's not low resource intense, and it's not low culture change."

Dr. Greenwald plans to submit information about his study to SHM's Project BOOST (Better Outcomes for Older Adults through Safe Transitions), a mentoring program meant to help hospitalists redesign their discharge process to improve patient outcomes. He says programs like Project BOOST are helping to draw attention to post-discharge protocols at hospitals around the country.

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