ABSTRACT
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. RESULTS: In Study Period 1, 75.9% of the patients had discharge assignments, compared with 90.8% in Period 2 (p < .001). The overall 11 A.M. discharge rate improved from 10.4% to 21.2% from 2007 to 2011. "Green" patients were more likely to be discharged before 11 A.M. than "yellow" or "red" patients (p < .001). Patients with RYG assignments discharged by 11 A.M. had a lower length of stay than those without assignments and did not have an associated increased risk of readmission. Discharge prediction accuracy worsened after the change in placement, decreasing from 75.1% to 59.1% for "green" patients (p < .001), and from 34.5% to 29.2% (p < .001) for "yellow" patients. In both periods, hospitalists were more accurate than house staff in discharge predictions, suggesting that education and/or experience may contribute to discharge assignment. CONCLUSIONS: The RYG Discharge Tool helped facilitate earlier discharges, but accuracy depends on placement in daily work flow and experience.
Subject(s)
Communication , Efficiency, Organizational , Patient Discharge , Quality of Health Care/organization & administration , Aged , Aged, 80 and over , Female , Humans , Interprofessional Relations , Length of Stay , Male , Middle Aged , Time FactorsABSTRACT
Napoleon Bonaparte (1769 to 1821) is one of the most studied historical figures in European history. Not surprisingly, amongst the many mysteries still surrounding his person is the cause of his death, and particularly the suspicion that he was poisoned, continue to intrigue medical historians. After the defeat of the Napoleonic Army at the battle of Waterloo in 1815, Napoleon was exiled to the small island of Saint Helena in the South Atlantic, where he died 6 years later. Although his personal physician, Dr François Carlo Antommarchi, stated in his autopsy report that stomach cancer was the cause of death, this diagnosis was challenged in 1961 by the finding of an elevated arsenic concentration in one of Napoleon's hair samples. At that time it was suggested that Napoleon had been poisoned by one of his companions in exile who was allegedly supported by the British Government. Since then Napoleon's cause of death continues to be a topic of debate. The aim of this review is to use a multidisciplinary approach to provide a systematic and critical assessment of Napoleon's cause of death.
