RESUMO
PURPOSE: To develop a care model to decrease incidence of preventable errors in the complex multidisciplinary care of hematology inpatients at the time of discharge. METHODS: An interactive, multidisciplinary, structured discharge process was developed. Multiple focus groups were held to establish the strengths and gaps. A checklist was created for common follow-up needs. Outcomes measured included: dexamethasone received at discharge, antiemetics prescribed, hospital readmissions, number of patient telephone calls received postdischarge, chemotherapy letters created, pegfilgrastim arranged, and peripherally inserted catheter care arranged. Using a pre-post study design, we compared outcomes of patients after the checklist was implemented in June 2014 (n = 41) with a historical cohort of patients admitted to hematology for chemotherapy 1 year earlier in June 2013 (n = 42). RESULTS: Compared with the historical data, improvement was noted for all checklist items except number of hospital readmissions and number of nursing telephone calls. In June 2014, 100% of patients received pegfilgrastim, compared with 88% in June 2013 (P = .02). Antiemetic prescriptions after chemotherapy improved from 40% (June 2013) to 70% (June 2014; P = .004). Two areas did not show improvement: number of readmissions (12 v 21; P = .26) and number of telephone calls after discharge (nine each for June 2013 and 2014; P = 1.0). CONCLUSION: There was significant decrease in preventable errors demonstrated after implementation of our care model. Developing a systematic approach to hospital discharges can lead to improvements and serve a model for other inpatient wards.
