Background:

Hospital discharge is a stressful and hazardous venture for older adults. Recent research documents that up to 49% of patients experience at least one medical error, and one in five patients discharged from the hospital suffer an adverse event. More than half of these adverse events are preventable or ameliorable. A common result of a “failed” hospital discharge is subsequent rehospitalization. Regulatory pressures also contribute to an increased focus on care transitions. Based on such concerns and worrisome findings from research, Project BOOST (Better Outcomes for Older adults through Safe Transitions) was developed by the SHM (Society of Hospital Medicine) to provide resources to optimize the hospital discharge process and mitigate many of these problems. We decided to implement Project BOOST at our facility with the goal of improving our discharge process. Project BOOST is a Nationwide Quality Improvement Initiative. It is an Evidence Based, Patient centered, Multidisciplinary Team Approach to making the discharge process safer.

Purpose:

Improve flow of information between hospital and outpatient providers; Identify high–risk patients and target risk–specific interventions to mitigate their risks for adverse events; Improve patient and family preparation for discharge; Reduce 30 day readmission rates for general medicine patients; Improve patient satisfaction scores related to discharge; Reduce Length of Stay.

Description:

Institutional support was obtained, and an application was made to the SHM to be considered for mentored implementation of Project BOOST (Fall 2010 cohort). Upon selection, a multidisciplinary team was assembled, and team training and process mapping was completed. The team included Physicians, Nursing, Case Management, Pharmacy, and Administration. Project BOOST was piloted on a 39–bed Medical Surgical Unit. All patients on the unit had the intervention tools applied. These include a risk assessment tool, with targeted risk specific interventions and a discharge checklist. The “teachback” method was used to educate patients on their diagnosis, discharge medications and available resources post discharge. Patients receive a follow–up telephone call 72 hours post discharge, and outpatient providers receive standardized discharge communication. Implementation was mentored with longitudinal support from a Society of Hospital Medicine Mentor throughout planning and implementation. In addition, we are able to communicate with and learn from other sites via the BOOST Listserv and online community site. Data is tracked on an ongoing basis. Adjustments to the intervention tools were made on an ongoing basis.

Conclusions:

Mentored Implementation of Project BOOST, an evidence based, patient–centered, multidisciplinary quality improvement initiative to make the discharge process safer resulted in decreased length of stay without negatively impacting readmission rates. Other results include improved patient satisfaction and improved staff satisfaction.

Table 1Project BOOST Pilot Unit (4 Dawson) Length of Stay

Figure 1HCAHPS Scores – Project BOOST Pilot Unit.