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Electronic Medical Record Tool Facilitates Earlier Hospital Discharges Without Increasing Risk of Readmission

Added on June 24, 2014 in General News, Press Releases

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(Oak Brook, Ill.) Joint Commission Resources today announced the release of the June 2014 issue of The Joint Commission Journal on Quality and Patient Safety. The issue features an article by Kusum S. Mathews, M.D., M.P.H. and co-authors, “Using the Red/Yellow/Green Discharge Tool to Improve the Timeliness of Hospital Discharges,” on the use of a new tool to facilitate earlier hospital discharges.

As part of the Safe Patient Flow Initiative at Yale-New Haven Hospital, Connecticut, physician leadership developed the Red/Yellow/Green (RYG) Discharge Tool, an electronic medical record–based prompt to identify the likelihood of patients’ next-day discharge: green (very likely), yellow (possibly) and red (unlikely).

Growth in inpatient admissions had caused the hospital to operate at near-capacity, delaying care and straining resources, noted the authors. Before the RYG Discharge Tool was implemented, the discharge process was non-standardized among medical units, and there was no process for communicating a patient’s readiness for discharge. As a result, advanced planning prior to discharge was lacking. The discharge decision often occurred on the day of actual discharge, resulting in a bottleneck of patients requiring discharge preparation, particularly by house staff services.

After implementation of the RYG Discharge Tool, the overall 11 a.m. discharge rate improved from 10.4 percent to 21.2 percent from 2007 to 2011 at the hospital. Patients with RYG assignments who were discharged by 11 a.m. also had a lower length of stay but did not have an associated increased risk of readmission. 

The authors concluded, “We showed that a simple electronic discharge prediction tool could help facilitate earlier discharges but that accuracy depends on experience and timing of completion. This type of tool can be replicated in other hospitals’ electronic medical records to help facilitate flow.”  

The remaining articles from the June 2014 issue are:

Adverse Events
Root Cause Analysis of Serious Adverse Events Among Older Patients in the Veterans Health Administration 
Alexandra Lee, M.S.; Peter D. Mills, M.S., Ph.D.; Julia Neily, M.S., RN, M.P.H.; Robin R. Hemphill, M.D., M.P.H. 

Preventable adverse events are more likely to occur among older patients because of the clinical complexity of their care. A retrospective, cross-sectional review of root cause analysis reports for all Department of Veterans Affairs (VA) hospitals from January 2010 to January 2011 identified 325 reports for patients ≥ 65 years of age. Falls (34.8 percent), diagnosis and/or treatment delays (11.7 percent), unexpected death (9.9 percent) and medication errors (9.0 percent) were the most commonly reported adverse events. Communication accounted for 43.9 percent of reported root causes. 

Evidence-Based Medicine
Standardizing Documentation and the Clinical Approach to Apnea of Prematurity Reduces Length of Stay, Improves Staff Satisfaction and Decreases Hospital Cost
T. Jeffrey Butler, M.D.; Kimberly S. Firestone, B.S., RRT; Jennifer L. Grow, M.D.; Anand D. Kantak, M.D. 

A prospective, single-center comparison was conducted at a Level 2 special care nursery. Twenty-two (35 percent) of the 63 infants in the prestandard-approach group experienced discharge delays because of poor documentation, resulting in 59 additional hospital days (mean length-of-stay [LOS] increase, 5.7 days). The standard-approach group of 72 infants experienced no discharge delays and LOS decreased (both p < .0001). Annual charges were reduced by more than $58,000 by avoiding unnecessary hospital days. Readmission occurred for five infants (7.9 percent) in the prestandard-approach group, but none of the infants in the standard-approach group (p = .0203). Overall compliance with the standardization process has been maintained at ≥ 96 percent.

Methods, Tools and Strategies
Reductions in Invasive Device Use and Care Costs After Institution of a Daily Safety Checklist in a Pediatric Critical Care Unit 
Rod Tarrago, M.D.; Jeffrey E. Nowak, M.D.; Christopher S. Leonard; Nathaniel R. Payne, M.D.

A number of omission-related adverse events in a pediatric ICU (PICU) prompted development of a checklist. During a 21-month period, three iterations of the PICU Safety Checklist were used to prompt the care team to address quality and safety items during rounds. Improvements on all quality and safety metrics were identified, including invasive device use, medication costs, antibiotic and laboratory test use, and compliance with standards of care. 

Rapid Response Systems
System-Based Interprofessional Simulation-Based Training Program Increases Awareness and Use of Rapid Response Teams 
Hania Wehbe-Janek, Ph.D.; Jose Pliego, M.D.; Simon Sheather, Ph.D.; Frank Villamaria, M.D., M.P.H.

After a rapid response team (RRT) program was implemented at a 600-plus-bed Level 1 trauma center, simulation-based team training was provided to enhance learning about RRT activation. In the six-month training period, 10 hospital units and 359 participants, including 278 unit nurses, completed the program. For the August 2006–January 2009 study, a mean of 4.2, 15.6 and 17.2 RRTs per 1,000 admissions occurred 12 months before, during and 12 months after the training. Such simulation training programs may enable institutions to address underuse of RRTs due to system barriers. 


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