Download Clinical II Inservice

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Feb 23, 2014 (3 years and 6 months ago)

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Sara Cordell

February 16, 2011


“Development of discharge plan for follow
-
up
services for a patient prior to leaving hospital
with the aim of containing costs and
improving patient outcomes”


Includes many disciplines: care coordinators,
nurses, social workers, physicians,
occupational therapists, physical therapists


Effective communication


Collaboration with other disciplines


Thorough evaluation


Detection of red flags


Advocate for patient


Proper education


Follow through



Maximizes patient’s potential


Decreases safety risk


Decreases readmission rate


Allocates resources appropriately


Decreases health care costs


Informs patients


Lack of elements of proper discharge
planning


Discharged prematurely


Discharged to inappropriate setting


Inadequate education or resources


Lack of insurance coverage


Patient cannot reach potential


Risk for readmission


Increased health care costs


Decreased resources for other patients


Adverse events or conditions


Over 80 years old


Inadequate support system


Multiple health problems (CHF, DM, ESRD)


History of depression


Moderate to severe functional impairment


Multiple hospitalizations in 6 months


Hospitalization in past 30 days


Patient rates health as fair or poor


History of non
-
compliance


Living alone (50% chance of early readmission)


Limited education (42% chance)


*Function and disability pre
-
admission and
currently


Wants and needs of patient and family


Ability to participate in care


Life context



Diagnosis


Prognosis


Comorbidities



Cognition


Functional abilities


Ability to perform ADLs


Demographic characteristics


Insurance coverage


Level of pain


Financial resources


Prior use of services


Overall opinion of safety


Therapist experience


Input from other disciplines


Mathematical models, screenings or
standardized tests??



Unsworth

et al


Mobility


Ability to perform ADLs


Level of social support


Morrow
-
Howell and Proctor


Medical factors (pathology, level of dependency,
cognitive state)


Jensen et al


Current and prior function


Patient’s interests and motivation


743 patients examined


Average hospital stay of 11 days


PT evaluated day 4 on average


Discharge locations:


Home without PT 44%


Home with home PT 26%


Subacute

rehab/SNF 19%


Acute rehab 5.5%


Expired 2.5%


Home with outpatient PT 2%


Extended care facility without PT 1%


Discharge plan matched PT recommendations
83% of the time


When PT recommendations ignored, patient
2.9 times more likely to be readmitted


Patients discharged to extended care facility
without PT were 6.9 times more likely to be
readmitted


Patients discharged to acute rehab less likely
to be readmitted


18% readmitted within 30 days


43% over age of 60 discharged home
reported unmet PT needs



Study examined use in preventing
readmission and/or institutionalization of
elderly


Significantly more patients discharged home if in
care management group


Discharge management significantly decreased risk
of institutionalization


Number of readmissions from 15
-
90 days post
discharge not significantly different


Suggest higher involvement in education and
follow
-
up


RED is package of discharge services to
decrease unsuccessful discharge


Decreased hospital utilization by 30% after
discharge


Increased patient knowledge and
understanding


Model includes:


Patient centered education


Comprehensive discharge planning


Post
-
discharge reinforcement


Pharmacist counseling and follow
-
up phone call


18% readmitted, but study does not highlight
reason for readmission


Recommendations followed 83% of the time
indicating worth


Experience does not effect discharge
recommendations


PTs provide most information and offer the
most insight about patient and his/her
discharge status


Concluded physical therapist input extremely
important in discharge planning process


Communication


Follow through


Thoroughly evaluate


Evidence supports collaborating with other
disciplines


Many aspects from nursing/care coordinator
perspective


Screenings?


Standardized tests?


Models?


Jette

DU, Grover L, Keck CP. A qualitative study of clinical decision
making in recommending discharge placement from the acute care
setting.
Phys
Ther
. 2003; 83: 224
-
236.


Smith BA, Fields CJ, Fernandez N. Physical therapists make accurate and
appropriate discharge recommendations for patients who are
accutely

ill.
Phys
Ther
. 2010; 90: 693
-
703.


Steeman

E, Moons P,
Milisen

K, et al. Implementation of discharge
management for geriatric patients at risk for readmission or
institutionalization.
Int

Jounral

for Quality in Health Care.

2006; 18: 352
-
358.


Minott
, J. Reducing hospital readmissions. Academy Health.
http://www.academyhealth.org/files/publications/Reducing_Hospital_Re
admissions.pdf.


Jack BW,
Chetty

VK, Anthony D, et al. A reengineered hospital discharge
program to decrease
rehospitalization
.
Annals of Internal Medicine.

2009; 150: 178
-
187.


Arbaje

AI, Wolff JL, Yu Q, et al.
Postdischarge

environmental and
socioeconomic factors and likelihood of early hospital readmission
among
commmunity

dwelling Medicare beneficiaries.
The Gerontologist
.
2007; 48: 495
-
504.