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Showing results for tags 'Readmission'.
Found 26 results
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Content ArticleThe aim of this study from Hutchinson et al. was to explore the reasons for and experiences of patients who make an unplanned return visit to the emergency department. Interviews from 13 participants generated findings related to experiences at and following their initial visit that contributed to their decision to return to the emergency department. Four themes were developed: (1) Patients experience barriers to feeling heard and having their concerns addressed; (2) Patients have little choice but to place their trust in clinicians; (3) Patients unexpectedly experience persistent symptoms which cannot be managed at home; and (4) Patients develop a sense of urgency about having their condition treated. The study concluded that a negative experience at the initial ED visit may have dual conflicting impacts. It can contribute to patients' perceived need for a return visit because they are ill-equipped to manage their condition at home, and it can also contribute to their initial reluctance to return to the ED when symptoms persist. Nurses and other clinicians working in ED need to actively build patient's experiential trust through clear communication, timely consultation and shared decision-making at discharge, which in turn can increase patient's confidence and capability to self-manage their condition.
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Content ArticleStandard operating procedures (SOPs) should improve safety in the operating theatre, but controlled studies evaluating the effect of staff-led implementation are needed. Morgan et al. evaluated three team process measures (compliance with WHO surgical safety checklist, non-technical skills and technical performance) and three clinical outcome measures (length of hospital stay, complications and readmissions) before and after a 3-month staff-led development of SOPs. They found that SOPs when developed and introduced by frontline staff do not necessarily improve operative processes or outcomes. The inherent tension in improvement work between giving staff ownership of improvement and maintaining control of direction needs to be managed, to ensure staff are engaged but invest energy in appropriate change.
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News Article
Virtual ward costs twice that of inpatient care, study finds
Patient Safety Learning posted a news article in News
Researchers have found the costs of treating patients in a 40-bed virtual ward were double that of traditional inpatient care. The study’s authors said the findings should raise concerns over a flagship NHS England policy, which has driven the establishment of 10,000 virtual ward beds. Virtual wards, sometimes described as “hospital at home”, are cited as a safe way to reduce pressure on hospitals, by reducing length of stay and enabling quicker recovery. The study at Wrightington Wigan and Leigh Teaching Hospitals, in Greater Manchester, found a clear reduction in length of stay but also found higher rates of readmission. The authors said this led to additional costs, with the cost of a bed day in the virtual ward estimated at £1,077, compared to £536 in a general inpatient hospital bed. “This raises concerns [over] the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management. This evidence should be taken into consideration by [the] NHS in planning the next large deployment of virtual wards within the UK… “Virtual wards must be cost effective if they are to replace traditional inpatient care, the costs must be comparable or lower than the costs of hospital stay to be economically sustainable in the medium to long terms.” To break even, the paper said the virtual ward would need to double its throughput, but warned this would risk lowering the standard of care. Read full story (paywalled) Source: HSJ, 25 January 2024 -
News Article
Thousands of mental health patients readmitted within a month in England
Patient Safety Learning posted a news article in News
Thousands of patients are being readmitted to NHS mental health units in England every year soon after being discharged, raising concerns about poor care, bed shortages and increased risk of suicide. Experts say being discharged prematurely can be upsetting, set back the patient’s chances of making a full recovery and be “disastrous” for their health. Figures from NHS mental health trusts in England show that last year almost 5,000 people – children and adults – were readmitted to a mental health facility within a month of leaving. The Labour MP Dr Rosena Allin-Khan said the “alarming” data, which she obtained under freedom of information laws, showed too many patients were not receiving enough help to recover. Allin-Khan said: “With record waiting lists and mental health beds in short supply, it is alarming that many patients are being discharged only to be readmitted within days. Every patient expects to receive full and appropriate mental health support, so it is concerning that in many cases patients are being discharged prematurely. “Being discharged too soon can have a disastrous impact, stunting progress towards a full recovery, ultimately causing further damage to a patient’s mental health.” Read full story Source: The Guardian, 12 January 2024 -
News ArticleNearly a third of people who were discharged from hospitals in England after being treated for COVID-19 were readmitted within five months – and almost one in eight died, a study suggests. The research, which is still to be peer-reviewed, also found a higher risk of problems developing in a range of organs after hospital discharge in those younger than 70 and ethnic minority individuals. “There’s been so much talk about all these people dying from Covid … but death is not the only outcome that matters,” said Dr Charlotte Summers, a lecturer in intensive care medicine at the University of Cambridge who was not involved in this study. “The idea that we have that level of increased risk in people – particularly young people – it means we’ve got a lot of work to do.” There is no consensus on the scale and impact of “long Covid”, but scientists have described emerging evidence as concerning. According to recent figures provided by the Office for National Statistics (ONS), a fifth of people in England still have coronavirus symptoms five weeks after being infected, half of whom continue to experience problems for at least 12 weeks. Read full story Source: The Guardian, 18 January 2021
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News Article
Recovering COVID-19 patients given devices to spot dips in oxygen levels
Patient Safety Learning posted a news article in News
Those recovering from Covid-19 are to be given devices which can help spot dips in their blood oxygen-levels while they recover at home. The NHS is trialling the use of oximeters, combined with an app, which will make it easier to spot whether people need to be re-admitted to hospital. The new oximeter service is being tested with more than 150 patients in sites on Watford, Hertfordshire and north London. Clinicians in ‘virtual wards’ are able to track patients’ vital signs – including temperature, heart rate and blood oxygen saturation – in near real-time, receiving alerts if they suggest a patient is deteriorating so that further assessments and care can be arranged. Health and Social Care Secretary, Matt Hancock, said: “While we restore face to face NHS services too, new innovations will ensure patients can benefit from the comfort of home, with the reassurance that they can be fast tracked to support from the NHS should they need. NHS at Home will help keep people safe and out of hospital while providing the best possible care.” Read full story Source: Digital Health, 5 June 2020 -
News Article
New pharmacy referral service to help patients avoid hospital readmission
Patient Safety Learning posted a news article in News
From July, hospitals will be able to refer patients who would benefit from extra guidance around new prescribed medicines to their community pharmacy. Patients will be digitally referred to their pharmacy after discharge from hospital. The NHS Discharge Medicines Service will help patients get the maximum benefits from new medicines they’ve been prescribed by giving them the opportunity to ask questions to pharmacists and ensuring any concerns are identified as early as possible. This is part of the Health Secretary’s ‘Pharmacy First’ approach to ease wider pressures on A&Es and general practice. Read full story Source: Department of Health and Social Care, 23 February 2020 -
News Article
Cornwall hospital to discharge patients early despite saying it may be harmful
Patient Safety Learning posted a news article in News
A major NHS hospital is under such pressure that it has decided to discharge people early even though it admits that patients may be harmed and doctors think the policy is unwise. The Royal Cornwall Hospitals NHS trust has told staff to help it reduce the severe overcrowding it has been facing in recent weeks by discharging patients despite the risks involved. In a memo sent on 8 January, three trust bosses said the Royal Cornwall hospital in Truro, which is also known as Treliske hospital and has the county’s only A&E department, “has been under significant pressure for the last two weeks and it is vital that we are able to see and admit our acutely unwell patients through our emergency department and on to our wards”. The memo added: “One of these mitigations was to look at the level of risk that clinicians are taking when discharging patients from Treliske hospital either to home or to community services, recognising that this may be earlier than some clinicians would like and may cause a level of concern. “It was agreed, however, that this would be a proportionate risk that we as a health community were prepared to take on the understanding that there is a possibility that some of these patients will be readmitted or possibly come to harm.” Read full story Source: 14 January 2020 -
Content ArticleThe Re-Engineered Discharge (Project RED) programme is a nationally recognised best practice centered on delivering a patient-tailored hospital discharge plan demonstrated to reduce all-cause 30-day readmissions and improve safety during care transitions. In this study, Mitchell et al. implemented the RED in 10 hospitals to study the implementation process. Key findings: Wide variability in the fidelity of the RED intervention. Engaged leadership and multidisciplinary implementation teams were keys to success. Common challenges included obtaining timely follow-up appointments, transmitting discharge summaries to outpatient clinicians, and leveraging information technology. Eight out of 10 hospitals reported improvement in 30-day readmission rates after RED implementation. The authors concluded that a supportive hospital culture is essential for successful RED implementation. A flexible implementation strategy can be used to implement RED and reduce readmissions.
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Content ArticleReadmissions to hospital are increasingly being used as an indicator of quality of care. However, this approach is valid only when we know what proportion of readmissions are avoidable. The authors conducted a systematic review of studies that measured the proportion of readmissions deemed avoidable. This study, published in Canadian Medical Association Journal, examined how such readmissions were measured and estimated their prevalence.
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Content ArticleInterventions information related to the patient’s medication and hospital stay is provided to the community pharmacists on discharge from hospital, who undertake a two-part service involving medicines reconciliation and a medicine use review. To investigate the association of this discharge medicines review (DMR) service with hospital readmission, a data linking process was undertaken across six national databases. The objective of this research, published by BMJ Open, was to evaluate the association of the DMR community pharmacy service with hospital readmissions through linking National Health Service data sets.
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Content ArticleBuilding on published patient safety research literature, this paper from the OECD, aims to broaden the existing knowledge base on safety lapses occurring in primary and ambulatory care settings. The findings of this paper show that safety lapses in primary and ambulatory care are common. About half of the global burden of patient harm originates in primary and ambulatory care, and estimates suggest that nearly four out of ten patients experience safety issue(s) in their interaction with this setting. Safety lapses in primary and ambulatory care most often result in an increased need for care or hospitalisations. Available evidence estimates the direct costs of safety lapses – the additional tests, treatments and health care – in primary and ambulatory care to be around 2.5% of total health expenditure. Safety lapses resulting in hospitalisations each year may count 6% of total hospital bed days and more than 7 million admissions in the OECD.
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Content ArticleThis study assesses the association of increased bed occupancy with changes in the percentage of overnight patients discharged from hospital on a given day and their subsequent 30-day readmission rate. Longitudinal panel data methods are used to analyse secondary care records (n = 4,193,590) for 136 non-specialist Trusts between April 2014 and February 2016.
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Content Article
ECRI - Top 10 Patient Safety Concerns 2020
Claire Cox posted an article in International patient safety
ECRI Institute's Top 10 Patient Safety Concerns for 2020 features new topics, with an emphasis on concerns that have the biggest potential impact on patient health across all care settings. However, the number one topic on this year's list is one revisited from 2019: missed and delayed diagnoses. ECRI’s list of patient safety concerns for 2020: 1. Missed and delayed diagnoses—Diagnostic errors are very common. Missed and delayed diagnoses can result in patient suffering, adverse outcomes, and death. 2. Maternal health across the continuum—Approximately 700 women die from childbirth-related complications each year in the U.S. More than half of these deaths are preventable. 3. Early recognition of behavioural health needs—Stigmatisation, fear, and inadequate resources can lead to negative outcomes when working with behavioural health patients. 4. Responding to and learning from device problems—Incidents involving medical devices or equipment can occur in any setting where they might be found, including ageing services, physician and dental practices, and ambulatory surgery. 5. Device cleaning, disinfection, and sterilisation—Sterile processing failures can lead to surgical site infections, which have a 3% mortality rate and an associated annual cost of $3.3 billion. 6. Standardising safety across the system—Policies and education must align across care settings to ensure patient safety. 7. Patient matching in the EHR—Organisations should consistently use standard patient identifier conventions, attributes, and formats in all patient encounters. 8. Antimicrobial stewardship—Over prescribing of antibiotics throughout all care settings contributes to antimicrobial resistance. 9. Overrides of Automated Dispensing Cabinets (ADC)—Overrides to remove medications before pharmacist review and approval lead to dangerous and deadly consequences for patients. 10. Fragmentation across care settings—Communication breakdowns result in readmissions, missed diagnoses, medication errors, delayed treatment, duplicative testing and procedures, and dissatisfaction. -
Content ArticleThe Agency for Healthcare Research and Quality (AHRQ) created On-Time Preventable Hospital and Emergency Department Visits to help nursing homes with electronic medical records identify residents at risk for events that could lead to a hospital visit. The tools are designed to help a multidisciplinary nursing home team prevent hospital and emergency department visits that can be avoided with good preventive care.
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Content ArticleThis guide published by the Agency for Healthcare Research & Quality (AHRQ) is a tested, evidence-based resource to help hospitals in the United States work as partners with patients and families to improve quality and safety. The guide includes: How to select, implement and evaluate the guide’s strategies. How patient and family engagement can benefit your hospital. How senior hospital leadership can promote patient and family engagement. Strategy 1: Working with patients and families as advisors shows how hospitals can work with patients and family members as advisors at the organisational level. Strategy 2: Communicating to improve quality helps improve communication among patients, family members, clinicians and hospital staff from the point of admission. Strategy 3: Nurse bedside shift report supports the safe handoff of care between nurses by involving the patient and family in the change of shift report for nurses. Strategy 4: IDEAL discharge planning helps reduce preventable readmissions by engaging patients and family members in the transition from hospital to home.
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Content ArticleCataract removal and implantation of an artificial lens is the most common surgical procedure undertaken by the NHS. Insertion of an incorrect intraocular lens was the most commonly reported never event in England between April 2016 and March 2017. A never event is a serious incident that is entirely preventable. Read the Healthcare Safety Investigation Branch's report on the insertion of an incorrect intraocular lens.
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Content ArticleLittle is known as to whether the effects of physician sex on patients’ clinical outcomes vary by patient sex. This study examined whether the association between physician sex and hospital outcomes varied between female and male patients hospitalised with medical conditions. The findings indicate that patients have lower mortality and readmission rates when treated by female physicians, and the benefit of receiving treatments from female physicians is larger for female patients than for male patients.
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Content ArticleHospitals with high mortality and readmission rates for patients with heart failure (HF) might also perform poorly in other quality concepts. Wang et al. sought to evaluate the association between hospital performance on mortality and readmission with hospital performance rates of safety adverse events. They found that patients admitted with HF to hospitals with high 30-day all-cause mortality and readmission rates had a higher risk of in-hospital adverse events. There may be common quality issues among these 3 measure concepts in these hospitals that produce poor performance for patients with HF.
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Content ArticleThis study from Jalilian et al., published in the BMJ, evaluated the length of stay difference and its economic implications between hospital patients and virtual ward patients. It found that the use of a 40-bed virtual ward was clinically effective in terms of survival for patients not needing readmission and allowed for the freeing of three hospital beds per day. However, the cost for each day freed from hospital stay was three-quarters larger than the one for a single-day hospital bed. This raises concerns about the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management.
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Content ArticleThis report from the National Asthma and Chronic Obstructive Pulmonary Disease Audit Programme (NACAP) shows what happened after people were admitted to hospital with an asthma attack or COPD exacerbation between 2018 and 2020. The data show that many people are being readmitted to hospital within three months of going home and that some, particularly with COPD, are dying within three months of their exacerbation. Key findings Adult asthma: 0.4% died within 30 days of admission to hospital, 0.8% within 90 days COPD: 6.1% died within 30 days of admission, 11.9% within 90 days.
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Content ArticleOut-of-hours discharge from the intensive care unit (ICU) to the ward is associated with increased in-hospital mortality and ICU readmission. This study in the journal Critical Care Medicine was part of the REcovery FoLlowing intensive CarE Treatment mixed methods study. It aimed to map the discharge process and describe the consequences of out-of-hours discharge to inform practice changes to reduce the impact of discharge at night. The study identified significant limitations in out-of-hours care provision following overnight discharge from ICU. The authors recommend changes to help make daytime discharge more likely, and new systems to ensure patient safety where night time discharge is unavoidable.
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News ArticleExtra beds squeezed into hospitals as part of winter planning are crowding out space for rehab, pushing up length of stay and knock-on costs, and increasing the chance of readmission, NHS leaders have been warned. Systems and trusts were encouraged to staff thousands of additional ward beds in the run-up to last winter to try to ease emergency care pressures, and government and NHS England have since asked for many of them to be kept open through the year. However, many of the additional beds are not in proper ward spaces, instead being located in gyms and other areas used for physiotherapy and other rehab. This followed on from some rehab areas already being lost during the pandemic, to be used for beds or storage. NHSE has sent out a warning about the issue, following a commitment by ministers earlier this year. However, senior figures in physio and older people’s care remain concerned the spaces will not be restored without checks and enforcement, especially as acute trusts remain under pressure to increase general bed space.
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Content ArticleThis cross-sectional study in JAMA Network Open looked at patients in the USA with pneumonia who are admitted to hospitals with higher risk-standardised readmission rates. It aimed to assess whether these patients have higher rates of adverse events. The authors found that patients with pneumonia admitted to hospitals with high all-cause readmission rates were more likely to develop adverse events during hospitalisation. This strengthens the evidence that readmission rates reflect the quality of hospital care for pneumonia.
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Content ArticleThis report from the Queen's Nursing Institute’s International Community Nursing Observatory (ICNO) describes the role of district nursing in ensuring continuity of care and preventing unnecessary hospital admissions. It highlights the advanced skills in assessment, diagnosis and patient management of District Nurse Team Leaders - skills that could be used to provide safe and effective care for people at home. The report argues that the NHS is failing to capitalise on the skills, knowledge and experience of District Nurses and instead is investing in new specialist teams of staff in the community, which may impact negatively on continuity of care. At the same time, the number of District Nurses has fallen dramatically. It calls on the government of each country in the UK to develop and publish a robust workforce plan for community nursing which reverses the decline in staffing and transforms the workforce to meet current and future healthcare challenges.
