Department of Biobehavioral Health Science, College of Nursing, 16100University of Illinois, Chicago, IL, USA.
25815Loyola University Medical Center, Maywood, IL, USA.
Prog Transplant. 2020 Sep;30(3):281-285. doi: 10.1177/1526924820933832. Epub 2020 Jun 18.
Lung transplant recipients have high hospital readmission rates. Readmissions are costly to institutions and associated with higher mortality among patients within the first year of transplant. Strong evidence indicates that in hospitalized patients, the use of discharge bundles results in lower 30-day hospital readmission rates.
A lung transplant team at a Midwest academic medical center performs 40 to 50 lung transplants annually and provides comprehensive, ongoing care for approximately 300 lung transplant recipients. The objective of this quality improvement project was development and implementation of an evidence-based discharge bundle (standardized patient discharge process) to reduce 30-day hospital readmission rates for this patient population.
A gap analysis was performed using focus groups to identify strategies to reduce readmissions. Using that data, a standardized discharge bundle was developed in collaboration with the transplant team.
The discharge bundle included improvements in discharge planning, scripted communication methods between team members, a standardized medication template for patient education, standardized follow-up appointment process, and increased telephone calls to the patient after discharge.
The primary outcome measured was the monthly 30-day hospital readmission rate of facility lung transplant recipients from June through August of 2019 as compared to the same time period in 2018. The readmission rate did not change during the evaluation period. Team members reported improved communication, efficiency, and improved standardization of follow-up care using the discharge bundle.
Implementing a discharge bundle for lung transplant recipients resulted in improved staff satisfaction with the discharge process.
肺移植受者的住院再入院率较高。再入院对医疗机构来说成本高昂，并且与移植后第一年患者的死亡率升高有关。强有力的证据表明，在住院患者中，使用出院套餐可降低 30 天的住院再入院率。
中西部学术医疗中心的肺移植团队每年进行 40 至 50 例肺移植，并为大约 300 名肺移植受者提供全面的持续护理。该质量改进项目的目标是制定和实施基于证据的出院套餐（标准化患者出院流程），以降低该患者群体的 30 天住院再入院率。
使用焦点小组进行差距分析，以确定降低再入院率的策略。根据该数据，与移植团队合作制定了标准化的出院套餐。
出院套餐包括改善出院计划、团队成员之间的脚本式沟通方法、标准化的患者教育用药模板、标准化的随访预约流程，以及增加患者出院后的电话随访。
主要结果是 2019 年 6 月至 8 月与 2018 年同期相比，机构肺移植受者的每月 30 天住院再入院率。在评估期间，再入院率没有变化。团队成员报告说，使用出院套餐改善了沟通、效率，并提高了随访护理的标准化。
为肺移植受者实施出院套餐可提高工作人员对出院流程的满意度。
