A New Tool to Assess Clinician Experience With Patient Care Transitions.

Background And Objectives: Clinician experience of intrahospital patient care transfers can drive transfer success and safe patient care. Measuring clinician experience can provide insights into opportunities to improve transfer processes that impact patient care. As part of a quality improvement project, we developed a brief survey to gauge clinician experience with patient care transfers that occur within a hospital.

A taxonomy and cultural analysis of intra-hospital patient transfers.

Existing research on intra-hospital patient transitions focuses chiefly on handoffs, or exchanges of information, between clinicians. Less is known about patient transfers within hospitals, which include but extend beyond the exchange of information. Using participant observations and interviews at a 1,541-bed, academic, tertiary medical center, we explored the ways in which staff define and understand patient transfers between units.

Predictors for patients understanding reason for hospitalization.

Objective: To examine predictors for understanding reason for hospitalization.

Methods: This was a retrospective analysis of a prospective, observational cohort study of patients 65 years or older admitted for acute coronary syndrome, heart failure, or pneumonia and discharged home. Primary outcome was complete understanding of diagnosis, based on post-discharge patient interview.

Quasi-Experimental Evaluation of the Effectiveness of a Large-Scale Readmission Reduction Program.

Importance: Feasibility, effectiveness, and sustainability of large-scale readmission reduction efforts are uncertain. The Greater New Haven Coalition for Safe Transitions and Readmission Reductions was funded by the Center for Medicare & Medicaid Services (CMS) to reduce readmissions among all discharged Medicare fee-for-service (FFS) patients.

Objective: To evaluate whether overall Medicare FFS readmissions were reduced through an intervention applied to high-risk discharge patients.

Using the red/yellow/green discharge tool to improve the timeliness of hospital discharges.

Background: As part of Yale-New Haven Hospital (Connecticut)'s Safe Patient Flow Initiative, the physician leadership developed the Red/Yellow/Green (RYG) Discharge Tool, an electronic medical record-based prompt to identify likelihood of patients' next-day discharge: green (very likely), yellow (possibly), and red (unlikely). The tool's purpose was to enhance communication with nursing/care coordination and trigger earlier discharge steps for patients identified as "green" or "yellow."

Methods: Data on discharge assignments, discharge dates/ times, and team designation were collected for all adult medicine patients discharged in October-December 2009 (Study Period 1) and October-December 2011 (Study Period 2), between which the tool's placement changed from the sign-out note to the daily progress note.

Electronic handoff instruments: a truly multidisciplinary tool?

The objective was to assess use of a physician handoff tool embedded in the electronic medical record by nurses and other non-physicians. We administered a survey to nurses, physical therapists, discharge planners, social workers, and others to assess integration into daily practice, usefulness, and accuracy of the handoff tool. 231 individuals (61% response) participated.

Quality of discharge practices and patient understanding at an academic medical center.

Importance: With growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding.

Objective: To conduct a multifaceted evaluation of transitional care from a patient-centered perspective.

Design: Prospective observational cohort study, May 2009 through April 2010.

The revolving hospital door: hospital readmissions among patients who are homeless.

Background: National attention is increasingly focused on hospital readmissions. Little prior research has examined readmissions among patients who are homeless.

Objective: The aim of the study was to determine 30-day hospital readmission rates among patients who are homeless and examine factors associated with hospital readmissions in this population.

Comprehensive quality of discharge summaries at an academic medical center.

Background: Discharge summaries are essential for safe transitions from hospital to home.

Objective: To conduct a comprehensive quality assessment of discharge summaries.

Design: Prospective cohort study.

Republished: Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators.

Objective: The objective of this study was to qualitatively describe the impact of a Rapid Response Team (RRT) at a 944-bed, university-affiliated hospital.

Methods: We analysed 49 open-ended interviews with administrators, primary team attending physicians, trainees, RRT attending hospitalists, staff nurses, nurses and respiratory technicians.

Results: Themes elicited were categorised into the domains of (1) morale and teamwork, (2) education, (3) workload, (4) patient care, and (5) hospital administration.

An institution-wide handoff task force to standardise and improve physician handoffs.

Background: Transfers of care have become increasingly frequent and complex with shorter inpatient stays and changes in work hour regulations. Potential hazards exist with transfers. There are few reports of institution-wide efforts to improve handoffs.

Defining impact of a rapid response team: qualitative study with nurses, physicians and hospital administrators.

Objective: The objective of this study was to qualitatively describe the impact of a Rapid Response Team (RRT) at a 944-bed, university-affiliated hospital.

Methods: We analysed 49 open-ended interviews with administrators, primary team attending physicians, trainees, RRT attending hospitalists, staff nurses, nurses and respiratory technicians.

Results: Themes elicited were categorised into the domains of (1) morale and teamwork, (2) education, (3) workload, (4) patient care, and (5) hospital administration.

When a patient refuses life-saving care: issues raised when treating a Jehovah's Witness.

Patients who are Jehovah's Witnesses frequently cross the path of nephrologists when they are acutely ill in the intensive care unit and stable in the long-term setting. It is important that we as a group have a rudimentary understanding of their philosophy about blood transfusion so that we can be proactive in their management. We use a case as a launching point to discuss the origins of the faith and the decision to refuse blood, as well as potential therapeutic strategies that can be used to improve the care of these patients.

Evaluation of an asynchronous physician voicemail sign-out for emergency department admissions.

Study Objective: Communication failures contribute to errors in the transfer of patients from the emergency department (ED) to inpatient medicine units. Oral (synchronous) communication has numerous benefits but is costly and time consuming. Taped (asynchronous) communication may be more reliable and efficient but lacks interaction.

Dropping the baton: a qualitative analysis of failures during the transition from emergency department to inpatient care.

Study Objective: We identify, describe, and categorize vulnerabilities in emergency department (ED) to internal medicine patient transfers.

Methods: We surveyed all emergency medicine house staff, emergency physician assistants, internal medicine house staff and hospitalists at an urban, academic medical center. Respondents were asked to describe any adverse events occurring because of inadequate communication between emergency medicine and the admitting physician.

Timing in the communication of pain among nursing home residents, nursing staff, and clinicians.

Background: The management of nursing home (NH) residents' pain requires adequate nursing assessment and clinician knowledge of pain therapies. However, the timely communication of pain from residents to nurses and from nurses to clinicians is equally necessary. Using a 4-step model (nursing assessment of pain, notification of clinicians regarding pain assessment, clinicians' assessment of pain and intervention), and nursing reassessment following an intervention, we describe the timing with which each of these steps occur.