Background: Discharge to post-acute care settings (PACs), such as skilled nursing facilities (SNFs), requires significant, complex discharge planning which often needs to be started early during hospitalization to be complete by time of discharge. This study sought to identify and model factors which predict a given patient’s likelihood of requiring PAC after discharge, using routinely [...]

Background: A fifth of older adults discharged from the hospital require readmission within 30 days. Readmissions impose an enormous burden on both patients and the healthcare system. Previous investigations have found that less than half of discharged patients are able to understand and execute the discharge plan and are likely to overestimate their comprehension of [...]

Background: Frequently hospitalized patients represent a vulnerable population due to discontinuity between episodes of inpatient, outpatient, and specialty care. This discontinuity puts patients at risk for unnecessary over-treatment, dangerous under-treatment, medication errors, and loss of trust due to conflicting messages from healthcare providers. Providers face rising clinical volumes, decreasing familiarity between providers, and ever more [...]

Background: At academic centers the work of discharge planning has historically fallen on housestaff. The medical education community’s efforts to improve the trainee experience have led to an iterative process of duty hour reform and re-design. One effect has been “work compression” – each day a trainee is required to complete more tasks in less [...]

Background: Tests Pending at Discharge (TPAD) is a common patient safety concern at transitions of care due to provider discontinuity, suboptimal communication, and lack of ownership. A significant proportion of inpatients, up to 70%, are discharged with one or more TPAD. Recent studies show that 30-40% of resulted TPAD warrant a change in patient management. [...]

Background: Persons with opioid use disorder (OUD) represent an estimated 4-11% of hospitalized patients and are increasingly admitted for opioid-related complications. In response to the opioid epidemic, national organizations have recommended hospitals develop protocols to engage patients with OUD in opioid agonist treatment (OAT) during hospitalization. Buprenorphine is an effective OAT for OUD that is [...]

Background: Vaso-occlusive acute pain crises are the leading cause for hospitalization in adult sickle cell patients. For our academic hospitalist group at a quaternary care center in New York, acute pain crises in 2017 accounted for 65 admissions, with an average length of stay (LOS) of 10.28 days, and readmission index (observed-over-expected ) of 1.10. [...]

Background: In response to a national movement toward increasing value in health care, hospitals are seeking to better support patients after discharge. Older patients with functional limitations are frequently referred to receive home health care services at hospital discharge, including skilled nursing and therapy. Caregivers of patients with functional limitations receiving often have a key [...]

Background: Peripherally inserted central catheters (PICCs) are often used as devices to extend intravenous treatment for hospitalized patients in post-acute settings. Variation between hospitals, indications for use, device characteristics, and outcomes for patients who receive PICCs and are discharged to skilled nursing facilities (SNFs) is not well known. Methods: Trained abstractors used a standardized approach [...]

Background: Cognitive load (CL) is increasing in healthcare leading to provider frustration and poor performance. Human factors design principles like cognitive load theory (CLT) may mitigate the negative impacts of CL. This study examined the impact of a post-hospital dashboard (PHD) designed using CLT on provider performance and perceptions of workload in the post-hospitalization visit. [...]