Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Randomized Controlled Trial Multicenter Study
Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle.
Care coordination has shown inconsistent results as a mechanism to reduce hospital readmission and postdischarge emergency department (ED) visit rates. ⋯ A targeted care bundle delivered to high-risk elderly inpatients decreased unplanned acute health care utilization up to 30 days following discharge. Dissipation of this effect by 60 days postdischarge defines reasonable expectations for analogous hospital-based educational interventions. Further research is needed regarding the impacts of similar care bundles in larger populations across a variety of inpatient settings.
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Deficits in information transfer between inpatient and outpatient physicians are common and potentially dangerous. ⋯ The use of an electronic discharge summary significantly improved the quality and timeliness of discharge summaries.
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The addition of clinical data or present on admission (POA) codes to administrative databases improves the accuracy of predicting clinical outcomes, such as inpatient mortality. Other POA information may also explain variation in hospital outcomes, such as length of stay (LOS), but this potential has not been previously explored. ⋯ Diagnosis discrepancy is associated with longer LOS. Diagnosis discrepancy on admission may be a marker of diagnosis uncertainty or poor patient assessment/documentation. Further research is needed to understand the underlying reasons for this discrepancy and its association with LOS, and, potentially, clinical outcomes.