Hospital corridor

The Effects of Discrete Work Shifts on a Nonterminating Service System

The Effects of Discrete Work Shifts on a Nonterminating Service System

Hospital emergency departments (EDs) provide around‐the‐clock medical care, and as such are generally modeled as nonterminating queues. However, from the care provider's point of view, ED care is not a never‐ending process, but rather occurs in discrete work shifts and may require passing unfinished work to the next care provider at the end of the shift. HIP Investigator, Dr. Brian Patterson et al. used data from a large, academic medical center Emergency Department to show that the patients’ rate of service completion varies over the course of the physician shift. Furthermore, patients that have experienced a physician handoff have a higher rate of service completion than nonhanded off patients.

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Medics and patient

Transitioning from General Pediatric to Adult-Oriented Inpatient Care: National Survey of US Children's Hospitals.

Transitioning from General Pediatric to Adult-Oriented Inpatient Care: National Survey of US Children's Hospitals.

Hospital charges and lengths of stay may be greater when adults with chronic conditions are admitted to children's hospitals. Despite multiple efforts to improve pediatric-adult healthcare transitions, little guidance exists for transitioning inpatient care. In this study, HIP Investigator Dr. Ryan Coller et al. sought to characterize pediatricadult inpatient care transitions across general pediatric services at US children's hospitals.

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young boy patient

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial.

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial.

Complex care programs seek to influence key health outcomes for children with medical complexity (CMC), and investment in program infrastructure is often justified by anticipating savings from lower health care use. HIP Investigator, Dr. Ryan Coller et al. sought to examine the effect of a caregiver coaching intervention, Plans for Action and Care Transitions (PACT), on hospital use among children with medical complexity (CMC) within a complex care medical home. Among CMC within a complex care program, a health coaching intervention designed to identify, prevent, and manage patient-specific crises and postdischarge transitions appears to lower hospitalizations and charges.

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Elderly person falling

Using the Hendrich II inpatient fall risk screen to predict outpatient falls after ED visits

Using the Hendrich II inpatient fall risk screen to predict outpatient falls after ED visits

Dr. Brian Patterson et al. used electronic health record data to evaluate whether routinely collected Hendrich II fall scores can predict returns to the emergency department (ED) for falls within 6 months. The investigators found that using the score alone, the odds of returning to the ED for a fall in 6 months were 1.23 times as high for every 1-point increase in the Hendrich II score. When routinely collected data on other fall risk factors was combined with the fall risk score, the screening performed much better. 

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Patient and nurse at skilled nursing facility

30-day readmission & mortality among Medicare beneficiaries discharged to SNFs after vascular surgery

30-day readmission & mortality among Medicare beneficiaries discharged to SNFs after vascular surgery

Using HIP Chronic Conditions Warehouse data, authors looked at readmissions among vascular surgery patients discharged to skilled nursing facilities (SNFs). They found 36% were readmitted or had died at 30 days. Predictors of readmission or death at 30 days included SNF for-profit status, number of hospitalizations in the previous year, comorbidities, emergency procedures, and complications.

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Man and nurse at skilled nursing facility

Survival of sepsis survivors admitted to skilled nursing facilities

Survival of sepsis survivors admitted to skilled nursing facilities

Dr. William Ehlenbach et al. examined the cognitive and physical impairment among severe sepsis survivors discharged to a skilled nursing facility. Using the Chronic Conditions Warehouse 5% random national Medicare sample, they found discharge to a SNF was associated with shorter survival. Cognitive impairment and activities of daily living dependence were each strongly associated wtih shortened survival.

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Elderly woman fall

Using chief complaint in addition to diagnosis codes to identify falls in the ED

Using chief complaint in addition to diagnosis codes to identify falls in the ED

Dr. Brian Patterson et al. compared the incidence of falls in an emergency department cohort using ICD-9 codes and an expanded definition that included chief complaint. Of the falls evaluated in the retrospective electronic health record review, 80% met the ICD-9 definition of a fall-related visit and 61% met the chief-complaint definition. Nearly 20% were missed when applying the ICD-9 definition alone. 

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Patient in hospital

Apples and oranges: 4 definitions of multiple chronic conditions and their relationship to 30-day rehospitalization

Apples and oranges: 4 definitions of multiple chronic conditions and their relationship to 30-day rehospitalization

In this study, Melissa Dattalo et al. used HIP's Chronic Conditions Warehouse data to examine the extent of agreement of 4 commonly used definitions of multiple chronic conditions (MCC) and compare each definition's ability to predict 30-day hospital readmissions. They found that MCC definitions should not be used interchangeably. The two definitions with the greatest agreement (Charlson Comorbidity Index and Chronic Condition Special Needs Plan) were also the best predictors of readmissions. 

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Nurse talking on phone

Discharge handoff communication and pediatric readmissions

Discharge handoff communication and pediatric readmissions

In this article, Dr. Ryan Coller et al. characterized common handoff practices between hospitals & primary care providers after pediatric hospitalizations. Using data abstracted from administrative, caregiver, and PCP questionnaires, the authors used logistic regression to asseess the relationship between 30-day unplanned readmissions and 11 handoff communication practices. They found that communication practices varied widely and that PCPs were only notified of half of the admissions that occurred. Unplanned readmissions to the hospital were unrelated to most handoff practices, and having PCP follow-up appoinments scheduled prior to discharge was associated with more readmissions.

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C-TraC Nurse on Phone with Patient

Low-cost transitional care with nurse managers making mostly phone contact with patients cut rehospitalization at a VA hospital

Low-cost transitional care with nurse managers making mostly phone contact with patients cut rehospitalization at a VA hospital

The Coordinated-Transitional Care (C-TraC) Program was designed to improve care coordination and outcomes among patients with high-risk conditions discharged to community settings from the hospital. Patients in the C-TraC program experienced one-third fewer rehospitalizations than those in the comparison group and there was an estimated savings of $1,225 per patient. This model may be attractive for providers in rural areas or other care settings challenged by wide geographic dispersion of patients or constrained resources. A toolkit with the C-TraC protocol is available on HIPxChange here.

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