Background: To address safety risks with transitions from hospital to home, the IMPACT collaborative designed, tested and implemented the Pediatric Patient Centered Care Transition (PACT) Bundle. The bundle element “perfect” handoff (timely and complete) aimed to improve hospitalist handoff to outpatient providers at hospital discharge.Our objective was to  assess outpatient medical provider’s perceptions of hospitalists’ handoff [...]

Background: Traditional readmission case review processes at our tertiary-care academic institution failed to identify obvious target processes for readmission reduction.  Looking for a more nuanced method of readmission review, we turned to our patients.   We conducted over 300 readmitted patient interviews and a focus group to learn from our patient’s experiences.   We then developed a [...]

Background: In shared decision making models, decisional conflict is a measure of uncertainty and readiness and comfort level in making a decision. The literature examining decisional conflict is currently relatively immature. The act of a patient being readmitted is, in part, an effect of multiple small decisions a patient makes in the time between index [...]

Background: At our medical center, there are 14,716 discharges annually from the general medicine services. Post discharge appointments are made by residents, nurse practitioners, and hospitalists. In a baseline survey, clinicians identified logistical barriers to successfully making appointments and revealed that patients are rarely involved in scheduling discharge appointments. Only an estimated 66% of attempted [...]