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Journal Article > Commentary
Transition of care for hospitalized elderly patients—development of a discharge checklist for hospitalists.
The authors describe their experience in developing a discharge checklist to standardize the process at their hospital and provide a model that can be refined for use in other facilities.
Oakbrook Terrace, IL: The Joint Commission; November 2008.
The quality of care delivered at US hospitals continues to improve, according to data gathered by the Joint Commission from nearly 1,500 institutions. Hospitals improved their provision of evidence-based care for patients with heart attacks, congestive heart failure, and pneumonia, and also improved at prevention of health care–associated infections in surgical patients. As in the 2007 report, adherence to the National Patient Safety Goals was more mixed. Although performance improved in some areas (including medication reconciliation and eliminating "do not use" abbreviations), many hospitals do not systematically perform time outs prior to procedures, or have reliable mechanisms for communicating critical test results.
Journal Article > Study
Walker PC, Bernstein SJ, Tucker Jones JN, et al. Arch Intern Med. 2009;169:2003-2010.
Medication errors are a leading contributor to adverse events after hospital discharge, and prior studies have demonstrated a high incidence of inadvertent medication discrepancies at the time of discharge. Pharmacist involvement in inpatient care is a proven strategy to improve safety, and a pharmacist-led medication reconciliation and education process successfully reduced medication errors and hospital readmissions in a prior study. In this trial, while the involvement of a pharmacist in medication teaching, medication reconciliation, communication of medication changes to outpatient physicians, and post-discharge telephone follow-up with patients did appear to reduce medication discrepancies, it had no impact on rates of readmissions and emergency department visits. This finding may indicate that more comprehensive discharge interventions may be necessary in order to reduce the risk of readmission.
Journal Article > Study
Hansen LO, Strater A, Smith L, et al. BMJ Qual Saf. 2011;20:773-778.
Communication between hospital-based and outpatient physicians is often suboptimal, and is thought to play a role in precipitating adverse events after discharge and rehospitalizations. However, this case-control study found that performance of several aspects of discharge communication—including medication reconciliation, discharge summary completion and quality, and patient education—did not decrease the risk of readmission. Other studies of specific discharge interventions, such as arranging outpatient follow-up or pharmacist review of medications, have also not affected readmission rates, meaning that preventable readmissions may only be reduced through more comprehensive (and resource-intensive) programs.