Background: Transition home after hospitalization carries significant risk of adverse patient events, readmissions and increased costs. Despite significant organizational efforts to improve care transitions, there continue to be challenges in implementing consistent interventions that impact key metrics of patient experience with the care transition and 30-day readmission rates. Purpose: Designing patient-centered systems which improve collaboration [...]

Background: Throughput is a challenge for many hospitals. Discharging patients impacts throughput, but is time-consuming and competes with other physician and nurse tasks, often being left on the “back burner” while attending to sicker patients. Discharge paperwork, patient education, and ride coordination are often incomplete when patients are ready for discharge, adding to delays. Prior [...]

Background: Patients, particularly the elderly and those who have chronic illnesses, often experience adverse events when transitioning from the hospital to home. An estimated 20% of all discharged patients suffer a preventable adverse event (e.g., reaction to medication) within three weeks of discharge and 20% of Medicare patients are readmitted to the hospital within 30 [...]

Background: Bedside medication delivery (BMD) and teaching by pharmacy is gaining popularity as an important component of safe hospital discharge. Having medications in hand at time of discharge and education with home medications has been shown to reduce medication administration errors and decrease readmission rates in pediatric patients with asthma. As part of Project IMPACT [...]

Background: Previous studies demonstrate patient readmissions to the Medical Intensive Care unit (MICU) from the ward are potentially associated with worse outcomes due to breakdowns in communication during ICU-ward transfer. Though previous work highlights the importance of shared mental models (whether clinicians have a mutual understanding) during handoffs, no studies examined the prevalence of a [...]

Background: Hospital length of stay has been an important measure of hospital efficiency and resource utilization. Increase length of stay results in higher cost and increased morbidity to patients. Length of stay outliers or “long stay patients” with complex discharges continue to remain a barrier to length of stay reduction. Purpose: Our institution instituted a [...]

Background: Intensive Care Unit (ICU) beds are limited, so effective triage is important for resource utilization. However, inappropriate triage of critically ill patients to non ICU settings can lead to poor patient outcomes, as early unexpected ICU transfers are associated with increased mortality. Purpose: We sought to describe the effectiveness of Hospital Medicine (HM), Emergency [...]

Background: Transitions of care are critical to maintaining patient safety and decreasing adverse events, but they remain a complex process with many pitfalls. Electronic Medical Record (EMR) based handoffs can enhance communication by centralizing content for serial handoffs between providers, facilitating real-time updates and automatically incorporating patient data elements. Over the past several years, much [...]

Background: Many patients are discharged from the hospital to post-acute rehab in a skilled nursing facility (SNF). These care transitions can be error-prone, hampered by inadequate patient preparation for rehabilitation and insufficient communication between care providers. The readmission rate from SNF was 23.5% in 2006, costing Medicare $4.34 billion. Prior studies show 30% of these [...]

Background: Communication is critical to high-quality care transitions, yet little is known about the quality of information transfer from the hospital to home health care (HHC) setting. We performed a cross-sectional survey of HHC nurses and staff to evaluate their perspective on the completeness of medical information transferred from hospitals to HHC agencies in Colorado. [...]