A Reengineered Hospital Discharge Program to Decrease Rehospitalization

摘要: One in 5 hospitalizations is complicated by postdischarge adverse events (1, 2), some of which may lead to preventable emergency department visits or readmissions. Despite this finding, hospital discharge procedures have not been standardized (3). In addition, the declining presence primary care providers (PCPs) hospitals has adequately accompanied systems ensure that patient data are transferred subsequent caregivers (4, 5). For example, summaries frequently lack critical and sent PCP a timely fashion (6, 7), resulting outpatient clinicians being unaware test results were pending at (8) evaluations scheduled be done after completed (9). Similarly, patients often left unprepared discharge; many do understand their medications cannot recall chief diagnoses (10). With more than 32 million adult discharges United States each year (11), these deficiencies transition increase illness, unnecessary utilization, cost. Some peridischarge interventions shown reduction readmission rates cost (12-14), (15), (16), whereas little no effect (17-20). Peridischarge also improved follow-up work-ups (21) higher satisfaction (15). Most studies focused on specific (14, 22, 23) highly selected populations, such as geriatric adults (12, 13, 19, 24). Some aspects discharge, increasing access (25), connecting with transitional nursing services (26), improving patients′ ability advocate for themselves (12). To date, study evaluated intervention includes education, comprehensive planning, telephone reinforcement general medical population. Context Emergency rehospitalizations common discharge. Contribution This trial demonstrated nurse clinical pharmacist working together coordinate educate patients, reconcile led fewer usual alone. Caution The was conducted single center, all eligible enrolled. Implication A systematic approach can reduce health service use. —The Editors In 2004, we began an in-depth examination designed package minimize failures—a process called reengineered (RED) (Table 1) (3, 27). We did randomized, controlled evaluate implementing RED among admitted service. Table 1 Components Reengineered Hospital Discharge