Prior studies have documented the safety problems that befall patients with complex illnesses at the time of transition from one setting of care to another. In this trial conducted in an integrated delivery system, patients were randomized to receive usual care or the care transitions intervention at the time of hospital discharge. Intervention patients received a personal health record and a "transition coach," who assisted with continuity of care across settings, arranged home visits after discharge, and helped train patients and caregivers in self-care methods. The foci of the intervention were on ensuring accurate medication usage and appropriate follow-up care. The intervention successfully reduced the likelihood of hospital readmission for 3 months after discharge and appeared to be cost effective.
This study found a lower rate of preventable adverse drug events (ADEs) for patients who received medication review, counseling, and telephone follow-up from a hospital pharmacist. Investigators randomized nearly 100 medical patients to receive the pharmacy intervention and found that only 1% of those patients experienced a preventable ADE (11% in the control group). The overall rate of ADEs was similar in both groups. Additional findings included observation of unexplained discrepancies between preadmission and discharge medication regimens in nearly half the patients. This finding supports national interests in medication reconciliation. A past study suggested similar benefits of pharmacy participation in daily rounds in an intensive care unit.
Roy CL, Poon EG, Karson AS, et al. Ann Intern Med. 2005;143:121-128.
This study followed more than 2600 discharged patients from two hospitalist services to capture the number and types of test results that required intervention. Investigators discovered that nearly 40% of patients enrolled had a pending lab or radiology test with 9% requiring action. Discussion also includes survey findings from inpatient providers, which demonstrated poor awareness of pending studies and general dissatisfaction with current systems to manage test follow-up. The authors conclude that future efforts to reduce these preventable errors in discharge follow-up require improved systems for retrieving tests after discharge and better communication between inpatient and outpatient providers.
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