Reduced Postdischarge Incidents After Implementation of a Hospital-to-Home Transition Intervention for Children With Medical Complexity
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Published:2023-09-05
Issue:7
Volume:19
Page:493-500
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ISSN:1549-8425
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Container-title:Journal of Patient Safety
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language:en
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Short-container-title:J Patient Saf
Author:
Huth Kathleen, Hotz Arda, Emara Norah1, Robertson Bryanna1, Leaversuch Marissa1, Mercer Alexandra N.1, Khan Alisa, Campos Maria-Lucia1, Liss Isabella1, Hahn Phillip D.2, Graham Dionne A., Rossi Laura3, Thomas Margaret V.4, Elias Nahel4, Morris Marie1, Glader Laurie5, Pinkham Amy1, Bardsley Kristin M.1, Wells Sarah1, Rogers Jayne1, Berry Jay G., Mauskar Sangeeta, Starmer Amy J.
Affiliation:
1. Department of Pediatrics, Boston Children's Hospital 2. Program for Patient Safety and Quality, Boston Children’s Hospital 3. Center for Quality and Safety 4. Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 5. Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio.
Abstract
Objectives
Prior research suggests that errors occur frequently for patients with medical complexity during the hospital-to-home transition. Less is known about effective postdischarge communication strategies for this population. We aimed to assess rates of 30-day (1) postdischarge incidents and (2) readmissions and emergency department (ED) visits before and after implementing a hospital-to-home intervention.
Methods
We conducted a prospective intervention study of children with medical complexity discharged at a children’s hospital from April 2018 to March 2020. A multistakeholder team developed a bundled intervention incorporating the I-PASS handoff framework including a postdischarge telephone call, restructured discharge summary, and handoff communication to outpatient providers. The primary outcome measure was rate of postdischarge incidents collected via electronic medical record review and family surveys. Secondary outcomes were 30-day readmissions and ED visits.
Results
There were 199 total incidents and the most common were medication related (60%), equipment issues (15%), and delays in scheduling/provision of services (11%). The I-PASS intervention was associated with a 36.4% decrease in the rate of incidents per discharge (1.51 versus 0.95, P = 0.003). There were fewer nonharmful errors and quality issues after intervention (1.27 versus 0.85 per discharge, P = 0.02). The 30-day ED visit rate was significantly lower after intervention (12.6% versus 3.4%, per 100 discharges, P = 0.05). Thirty-day readmissions were 15.8% versus 10.2% postintervention (P = 0.32).
Conclusions
A postdischarge communication intervention for patients with medical complexity was associated with fewer postdischarge incidents and reduced 30-day ED visits. Standardized postdischarge communication may play an important role in improving quality and safety in the transition from hospital-to-home for vulnerable populations.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Public Health, Environmental and Occupational Health,Leadership and Management
Reference50 articles.
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