Background: Delays in the discharge process of hospitalized patients impact patient flow and lead to increased costs and slower progression of care. As hospitalist work becomes increasingly shift based, there are concerns for proper patient handoffs and hesitancy with clinical progression of care overnight. This leads to daytime patient flow congestion and is a significant […]

Background: The Improving Pediatric Patient-Centered Care Transitions (IMPACT) Multi-site Quality Improvement Collaborative aims to improve discharge transitions by testing a patient-centered transition bundle. Teach-back is a core component. This is a well-established method of confirming understanding. However, limited evidence exists about the effect of using teach-back for pediatric discharge education on parental knowledge/understanding of essential […]

Background: Over the last several years we have seen the rapid growth of the specialty of hospital medicine across the country. One of the unintended consequences of this expansion has been the decrease in direct teaching responsibilities of the medical subspecialists on the inpatient medical teaching services. As these responsibilities have been subsumed by our […]

Background: In April 2015, CMS released first ever star ratings on Hospital Compare related to patient satisfaction. Based on the HCAHPS survey scores, hospitals received scores between 1 and 5 on 12 domains, including a summary star rating for the hospital. Critics contend that star ratings may be a gross over simplification and misleading. Elite […]

Background: Patient discharge is a complex process, requiring effective coordination between physicians, the interdisciplinary care team, patients, and their families. Patients often remain in the hospital after they are medically ready for discharge due to avoidable delays and inefficiencies in the discharge process.   Purpose: Consequences of delayed discharge include patient dissatisfaction, increased potential for […]

Background: Previous studies have shown that malnutrition, which is associated with increased medical complications in older patients, can be attenuated by providing oral nutritional supplements (ONS). This study evaluates the cost-effectiveness of an ONS in malnourished older hospitalized patients using data from a randomized controlled trial. Methods: A multicenter, prospective study (NOURISH) was conducted in […]

Background: The Center for Medicare and Medicaid Services (CMS) instituted the Readmissions Reduction Program to incentivize improvements in care transitions for patients with several common and serious illnesses, including heart failure, acute myocardial infarction, pneumonia, and more recently COPD exacerbations. The HOSPITAL score has been shown to accurately identify medical patients at high-risk for 30-day […]

Background: Improper care transitions account for more than 12 billion dollars in estimated added health care costs.  In a prospective observational study performed at our institution to identify gaps in care transitions, only 37% of primary care physician’s (PCP’s) were contacted by hospitalist upon discharge. The objective of this study was to evaluate the effect […]

Background: Patient care increasingly involves collaborative, team-based approaches in both inpatient and outpatient settings. Optimal transitions of care between the community and the hospital require bidirectional communication and collaboration. This presentation describes a structured, multidisciplinary electronic communication bundle implemented by an academic inpatient service to support care transitions in the management of patients between San […]

Background: Executing safe transitions of care for hospitalized patients is important because of the vulnerability of patients during this time period.  While hospital-based providers frequently schedule appointments on behalf of their patients prior to discharge, cancellations and non-attendance (“no-shows”) for post-discharge follow-up appointments are anecdotally common and diminish the quality  of patient care.  Little is […]