Background: Over 8 million Americans with diabetes require insulin for disease management. Insulin is a high-risk medication with immense potential for harm. Transitions of care from the hospital to ambulatory settings are particularly prone to error. Studies have suggested a substantial number of insulin prescriptions at hospital discharge contain errors which can result in increased [...]

Background: Understanding patient readiness for discharge requires communication between the many disciplines who care for patients. Team members use different tools in the electronic health record (EHR) to document and communicate discharge-related information, which can result in inefficient communication, delays in discharge, and adverse patient outcomes. EHR-based discharge coordination tools have potential to improve discharge [...]

Background: Increased hospital capacity causes significant strain on medical institutions. Patients who are clinically ready for discharge but “stuck” awaiting post-acute resources are thought to contribute to this capacity strain. Here, we aim to provide a clinically relevant measurement of the prevalence (proportion of patients) and weight (proportion of days) for patients who have spent [...]

Background: To support patients after hospital discharge, we developed and implemented a 30-day automated text-messaging intervention. The program was piloted in a single practice in Philadelphia, and was associated with a significant reduction in 30 day readmission and utilization of acute care resources. However, we wanted to understand the timing and nature of patient needs [...]

Background: One of the tools providers use in the discharge process to promote a safe transition of care is the written discharge instructions. Optimization of these instructions has been identified by physicians as a potential strategy to prevent readmissions. Our survey aimed to assess knowledge, attitudes, and self-reported practices of providers related to anticipatory guidance [...]

Background: Efficient discharge planning for hospital medicine patients requires alignment across multiple disciplines. Understanding how clinicians communicate information about discharge readiness can identify opportunities to improve discharge coordination and impact length of stay, hospital capacity, and patient satisfaction. The objective of this study was to outline the existing information gathering and communication pathways around discharge [...]

Background: Hospital discharge summaries are critical to transitions of care as they are oftentimes the only substantive form of communication that accompanies patients to their next care setting. The lack of interoperability in our healthcare IT ecosystem amplifies the need for discharge summaries to mitigate subsequent duplication of services and increased costs. These documents must [...]

Background: Discharge delays adversely affect patient flow leading to prolonged Emergency Department (ED) boarding time and decrease in hospital bed availability. Discharge improvement processes can mitigate these delays, but in practice it has been difficult to implement and create substantial impact on discharge delays. Purpose: To develop and implement a discharge physician assistant (DAP) role [...]

Background: Effective discharge education is important to help patients understand their medications and follow up appointments, thereby improving adherence and reducing risk of readmissions. Our institution’s electronic medical record has a standard After Visit Summary (AVS) that is utilized by nursing staff to educate patients on the discharge care plan and then given to patients [...]

Background: Hospital overcrowding and extended Emergency Department (ED) wait times are challenges facing most urban hospitals today. There is growing evidence to show that overcrowding in the ED is associated with increased morbidity, mortality and patient dissatisfaction. To improve overcrowding, hospitals have focused on discharge before noon (DBN) as an impactful and sustainable remedy. While [...]