Literature at a Glance
- Discharge innovation and readmission rates.
- Electronic medical records and outcomes.
- CXR findings predict outcomes.
- NSAIDs and congestive heart failure morbidity.
- Outcomes of interpreter use.
- Predictors and outcomes of postoperative delirium.
- Perioperative beta-blockers.
- Perioperative stroke risk.
Clinical question: Does a standardized discharge intervention lead to a decrease in ED visits and readmission rates following hospital discharge?
Background: Hospital discharge is a complex process that is not standardized at many institutions. Deficiencies in the process can lead to poor outcomes, unnecessary rehospitalizations, and increased costs. Previous studies of peridischarge interventions have yielded mixed results and typically focus on specific patient populations.
Study design: Randomized trial.
Setting: Boston Medical Center, a large, urban, academic medical center.
Synopsis: In this single-institution study, 749 English-speaking hospitalized adults were randomly assigned one of two discharge plans: a multidisciplinary package of discharge services or the usual discharge process. Patients in the intervention group were assigned a nurse discharge advocate who performed patient education, medication reconciliation, discharge coordination, and scheduled follow-up appointments. A pharmacist also telephoned participants two to four days after discharge to reinforce the discharge plan and review medications.
Participants in the intervention group had a 30% relative reduction in hospital utilization (defined as ED visit or hospital readmission) at 30 days. Overall, 21.6% of intervention patients and 26.9% of usual-discharge patients had at least one hospital utilization within 30 days of discharge.
This study was limited to a single center, and 27% of the patients did not meet eligibility criteria. The applicability also is limited by the resource utilization required for the intervention. The authors estimated that 0.5 full-time-equivalent (FTE) nursing time and 0.15 FTE pharmacist time was required to maintain 14 patients per week.
Bottom line: A systematic, intensive approach to discharges can reduce ED return visits and readmission rates.
Citation: Jack B, Chetty V, Anthony D, et al. A re-engineered hospital discharge program to decrease re-hospitalization. Ann Intern Med. 2009:150(3):178-187.