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1.
Hosp Pract (1995) ; 49(1): 56-61, 2021 Feb.
Article in English | MEDLINE | ID: mdl-32819172

ABSTRACT

OBJECTIVE: Measure effect of late-afternoon communication and patient planning (CAPP) rounds to increase early electronic discharge orders (EDO). METHODS: We enrolled 4485 patients discharged from six subspecialty medical services. We implemented late-afternoon CAPP rounds to identify patients who could have morning discharge the subsequent day. After an initial successful implementation of the intervention, we identified lack of sustainability. We made changes with sustained implementation of the intervention. This is a before-after study of a quality improvement intervention. PROGRAM EVALUATION: Primary measures of intervention effectiveness were percentage of patients who received EDO by 11 am and patients discharged by noon. Additional measure of effectiveness were percent of patients admitted to the correct ward, emergency department (ED)-to-ward transfer time compared between intervention and nonintervention periods. We compared the overall expected LOS and the average weekly discharges to assess for comparability across the control and intervention time periods. We used the readmission rate as balancing measure to ensure that the intervention was not have unintended negative patients consequences. RESULTS: Expected length of stay based upon discharge diagnosis/comorbidities and readmission rates were similar across the intervention and control time periods. The average weekly discharges were not statistically significant. Percentage of EDO by 11 am was higher in the first intervention period, second intervention period and combined intervention periods (28.9% vs. 21.8%, P < 0.001) compared with the respective control periods. Percent discharged before noon increased in the first intervention period, second intervention period and for the combined intervention periods (17 vs. 11.8%, P < 0.001). There was no difference in the percent admitted to the correct ward and ED-to-ward transfer time. CONCLUSION: Afternoon CAPP rounds to identify early patient discharges the following day led to increase in EDO entered by 11 am and discharges by noon without an adverse change in readmission rates and LOS.


Subject(s)
Patient Care Planning/organization & administration , Patient Care Team/organization & administration , Patient Discharge/statistics & numerical data , Communication , Comorbidity , Efficiency, Organizational , Humans , Length of Stay/statistics & numerical data , Patient Readmission/statistics & numerical data , Quality Improvement/organization & administration , Time Factors
2.
Am J Infect Control ; 43(8): 892-4, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26052100

ABSTRACT

A collaborative effort reduced catheter-associated urinary tract infections in the neuro-spine intensive care unit where the majority of infections occurred at our institution. Our stepwise approach included retrospective data review, daily rounding with clinicians, developing and implementing an action plan, conducting practice audits, and sharing of real-time data outcomes. The catheter-associated urinary tract infection rate was reduced from 8.18 to 0.93 per 1,000 catheter-days and standardized infection ratio decreased from 2.16 to 0.37.


Subject(s)
Catheter-Related Infections/epidemiology , Catheter-Related Infections/prevention & control , Infection Control/methods , Urinary Tract Infections/epidemiology , Urinary Tract Infections/prevention & control , Humans , Incidence , Intensive Care Units , Retrospective Studies
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