hospital discharge

Complications

• 20% of older adults experience an adverse drug event after hospital discharge*
  • 1/3 considered preventable
  • 17% involve drugs on Beer's list
  • benzodiazepines, proton pump inhibitors & celecoxib most common
• intensifying antihypertensives at hospital discharge associated with harm without reduction of cardiovascular events
• hypoglycemia in diabetics the last day of hospitalization associated with higher readmission rates & postdischarge mortality
• 10% of inpatients with diabetes receive intensification of their treatment at a VAMC before discharge, usually with insulin; half deemed unnecessary
• hospital readmission

* < 50% of patients can list their diagnoses, their medications or their purpose at hospital discharge

* see transition of care for patient risk factors for poor outcomes

Management

• patients should receive a list of medications at the time of discharge & be informed of previous medications that have been discontinued or changed
• discharge medication education program for high-risk patients, including scheduling a post-hospital discharge telephone follow-up within 2-3 days of discharge reduces hospital readmission rate (RR=0.57)
• transitional care management after hospital discharge
  • associated with reduced mortality & lower cost among Medicare beneficiaries
  • first became reimbursable by Medicare in 2013
  • covers the first 30 days after discharge
  • includes non-face-to-face follow-up (telephone) within 2-3 days after discharge, plus an office visit within 7-14 days
  • rarely used
• successful hospital-to-home transitional care programs all center around interprofessional care coordination teams
  • a transition care provider (hospitalist transitions coach) is a component of an interprofessional care coordination team
  • explicit communication with the primary care physician is fundamental to a successful transition of care after hospitalization
• virtual postdischarge ward teams did not prevent hospital readmissions among high-risk medical patients
• a nurse-led, in-hospital discharge intervention among high-risk elderly failed to prevent readmissions or emergency department visits
• ~60% of automated notifications of actionable tests pending at hospital discharge with documented follow-up in the medical record
• hospital discharge summary*
• follow-up in 1 week for heart failure hospitalization
• physical therapy & occupational therapy

* 1% increase in 30-day readmissions for every 3-day delay in hospital discharge summary

• mean time to hospital discharge summary completion is 8 days
• 43% of hospital readmissions occur before hospital discharge summary available

Notes

• patients who cannot be discharge to home may be discharged to
  • skilled nursing facility (SNF)
  • long-term acute care hospital (LTAC)
• discharge to home with home health care associated with higher rates of hospital readmission, with differences in mortality or functional outcomes, but with lower Medicare payments
• priotitizing hospital discharge before noon does not result in earlier discharge or diminished length of hospital stay

More general terms

• inpatient discharge (includes hospital discharge)

Additional terms

• hospital
• hospitalization
• Kohlman Evaluation of Living Skills (KELS)
• length of stay (LOS)
• transition of care; health care transition