Background: Financial readmission penalties hold hospitals responsible for 30-day readmissions regardless of whether the patient was readmitted to another hospital.  Emerging evidence suggests patients readmitted to non-index hospitals may experience higher mortality rates.  Hospitals with large proportions of patients readmitted elsewhere may need to alter their approach to these readmissions, but how often patients are [...]

Background: Transfers to academic tertiary care centers often involve complicated patients requiring subspecialty consultation and coordination of care.   Therefore appropriate handoff and communication from sending to receiving institution is needed to streamline care and minimize redundancies. At our institution, we received approximately 1200 transfer requests annually.  Process improvement carries the potential to impact many patients [...]

Background: Readmissions after hospitalisation are a healthcare quality indicator and carry considerable financial penalties in some healthcare systems. Internationally, readmission rates at 28 – 30 days for medical inpatients range between 10 – 22%. However there is almost no information available around readmissions for medical inpatients in the Middle East region. We conducted a pilot [...]

Background: Homeless patients have a higher incidence of medical and psychiatric diagnoses, which often necessitate hospitalization. Studies show that homeless persons have increased lengths of stay with an average excess of 4.1 days, accounting for an average excess cost of $2414 per admission. Additionally, homeless persons have high rates of 30-day inpatient readmissions, as high [...]

Background: Patients are discharged home on medications different than those they were taking before admission.  New and discontinued medications as well as dosage changes contribute to medication-related adverse events.  Purpose: To help address this problem, interns in our program developed a standard process during their quality improvement (QI) curriculum to ensure that at least 95% [...]

Background: Poor communication between healthcare providers has been identified as an important contributor to poor patient outcomes and adverse events. The transition period from inpatient to outpatient care is a particularly high risk time for patients in which they are vulnerable to adverse events. Enhanced communication between inpatient and outpatient providers may improve outcomes during [...]

Background: Hospital readmissions remain highly prevalent despite being the target of policies and financial penalties.  Evidence comparing effectiveness and costs of interventions to reduce readmissions is lacking, leaving healthcare systems with little guidance on how to improve quality and avoid costly penalties.   Effective interventions likely need to bridge inpatient and outpatient settings, incorporate information technology, [...]

Background: According to Medicare Payment Advisory Commission, about 75% of hospital readmissions are potentially preventable, representing an estimated $12 billion in Medicare spending. Prompt follow-up of hospital patients before primary care and subspecialist appointment may decrease readmissions.Methods: This is a prospective single-site cohort study.We developed a Transitional Medical Clinic (TMC) at Mission Hospital (Mission Viejo, CA) to [...]

Background: Inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) exposes patients to risks of discontinuity of care and remains a largely unstudied process of care. In this study, we aimed to investigate patient experiences with IHT.Methods: Interview guides were developed using themes extracted from prior research along with expert opinion and stakeholder [...]

Background: Patients are often transferred between hospitals to provide access to required specialty services. However, prior research suggests that transfer destinations are often chosen based on institutional relationships rather than solely on patient need. In this national study, we evaluated the appropriateness of transfer, as measured by the frequency of required specialty services available at [...]