Background: Patients frequently admitted to the hospital use a disproportionate amount of healthcare resources. However, scant information exists about the clinical and social characteristics of this population, as well as the quality of their transitions of care. Qualitative and quantitative descriptions of these patients may aid in developing strategies for reducing future readmissions. Methods: We […]

Background: Older adults have a 19% risk of 30–day readmission, and medication safety plays an important role in reducing this risk. We conducted telephone–based interviews as part of a qualitative study to better understand the needs of older adults around medication management following hospital discharge. Methods: The study population included patients discharged from the general […]

Background: Interdisclinlinary rounds (IDR) are commonly used to improve collaboration among hospital team members. To our knowledge, no studies have evaluated teamwork during IDR. Methods: This study was conducted on six general medicine units (three teaching and three nonteaching hospitalist units) at an urban 897–bed hospital. All units conducted structured interdisciplinary rounds (SIDR), which combines […]

Background: The search for alternative care structures that improve quality and lower costs is intensifying. Alternative care organizations (ACOs) offer promise but must demonstrate their cost–effectiveness for widespread adoption to occur. Readmissions to the hospital are a prime target for ACOs, as they are common, costly, and will increasingly be penalized by Medicare. We undertook […]

Background: Readmissions after hospital discharge are a common and costly occurrence in our health care system. Published models describing risk factors for hospital readmission inadequately stratify low–risk and high–risk patients. Patients with psychiatric illness or a history of substance abuse may be at high risk for hospital readmission but have not been adequately studied. We […]

Background: Recently adopted resident work hour restrictions from the Accreditation Council for Graduate Medical Education have encouraged separate day and night patient care models. Dividing day and night responsibilities results in “admission handoffs,” in which ongoing inpatient care is handled by a different physician than the admitting physician. Inexperience with cross–cover or service transitions has […]

Background: Approximately 20% of patients are either readmitted or have additional visits to emergency rooms or urgent care clinics within 30 days of hospital discharge. Patients discharged from our urban, academic safety net hospital are given the phone number for a Nurse Advice Line and are instructed to call, if they have questions or experience […]

Background: Because of recent efforts to improve safe transitions from hospital to home, ensuring quality care for patients hospitalized with asthma and COPD has become a priority. A critical factor for safe care transitions may be improving patient self–management skills prior to discharge. However, the most effective intervention to provide self–management skills, particularly for addressing […]

Background: Poor handoffs may lead to adverse health outcomes. We sought to determine rates of self–reported handoffs from inpatient to outpatient providers, to examine predictors of successful handoffs, and to determine the association between successful handoffs and 30–day readmissions. Methods: Starting in 2010, we mandated that discharging providers electronically document communication (or lack thereof) with […]

Background: Thirty–day readmissions in chronic obstructive pulmonary disease (COPD) patients are frequent and costly. National efforts to reduce 30–day readmissions often suggest a follow–up visit with a physician despite conflicting evidence about the value of such visits. Many studies on the effect of follow–up visits on readmissions have not been disease specific and have not […]