Background: Pharmacist-led peri-discharge interventions reduce adverse drug events. However, evidence is lacking as to whether there is a business case to fund these non-billable interventions. To test whether such interventions could drive reductions in post-discharge health care utilization to help build a business case, we conducted a pragmatic randomized controlled trial (RCT). Methods: The PHARMacist [...]

Background: Sub-optimal communication during care transitions contributes to poor patient outcomes. Patients who undergo interhospital transfer (IHT, the transfer of patients between hospitals) are at especially high risk given their level of illness severity. In examination of the IHT process at Brigham and Women’s Hospital (BWH), a 740-bed tertiary care referral hospital, we previously found [...]

Background: Physicians and nurses often overestimate patients’ understanding of their illness, medications, treatments, and care plans. Fragmented discussions can lead to inconsistent conveyance of key information to patients and their caregivers. Multidisciplinary bedside rounds are an essential opportunity to facilitate patient-centered care. Our medical-surgical units did not have a standardized approach to ensuring consistent, clear [...]

Case Presentation: A 44-year-old man with multiple myeloma and cardiac amyloidosis on chemotherapy, and atrial fibrillation on apixaban, presented with three days of worsening shortness of breath and edema. He was admitted to the emergency room observation unit for treatment of a mild heart failure exacerbation. He was noted on admission to have rapidly developed [...]

Background: Despite the growing emphasis on high-quality HCT, there remains a paucity of evidence to guide inpatient providers in transitioning adolescents to adult medical care. An inter-professional team at our institution created a video incorporating Self-Determination Theory (SDT) concepts as the educational construct emphasizing key elements of HCT.   The objectives were to determine the effect [...]

Background: Improved outcomes in pediatric to adult-oriented HCT especially for children with special health care needs (SHCN) are a national objective of Healthy People 2020, with only 40% of adolescents with SHCN currently meeting the national core outcomes in pediatric to adult-oriented HCT. Despite the potential of hospitalized AYA being higher utilizers of the health [...]

Background: Project IMPACT (Improving Pediatric Patient-Centered Care Transitions) is a multi-center quality improvement collaborative aiming to improve hospital to home transitions. As part of this project, providers attempt to schedule follow-up visits prior to discharge and conduct post-discharge phone calls. Objective: 1.Determine relationship between scheduling post-discharge follow-up visits and 30-day reutilization rates 2. Characterize patients [...]

Background: The three most common childhood-onset chronic conditions for which adolescents and young adults (YA) use pediatric hospitals are congenital heart disease (CHD), cystic fibrosis (CF), and sickle cell disease (SCD). Existing studies do not establish clear clinical benefits to continued pediatric hospitalization over hospitalization at adult hospitals. We aimed to determine if if continued [...]

Background: The hospital discharge is one of the most important aspects of a patient’s hospitalization, yet in residency training, this process often goes overlooked. Most residents are never properly taught how to effectively discharge a hospitalized patient. As a sequelae, patients often lack understanding about their hospitalization, treatment(s), and follow up plans. This uncertainty can [...]

Background: Communication has been cited as the most common root cause in sentinel events, with failed patient care handoffs contributing to an estimated 80% of serious preventable adverse events. Handoffs to sub-acute care such as nursing homes are at particularly high risk for communication breakdown given high patient complexity and comorbidity. Our healthcare system includes [...]