Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA.
Department of Pharmacy, Boston Medical Center, Boston, Massachusetts, USA.
Hemodial Int. 2023 Apr;27(2):146-154. doi: 10.1111/hdi.13060. Epub 2023 Jan 25.
Patients with end-stage kidney disease requiring dialysis encounter high hospital readmission rates. One contributor is poor communication between hospitals and outpatient dialysis facilities. We hypothesized that improved communication may reduce 30-day hospital readmissions for patients on dialysis at an urban, safety net hospital.
We created a standardized discharge handoff tool that is easy to use and provides concise data for dialysis centers. The handoff tool is a novel, electronic MACRO template (called a "dot-phrase") to be included in discharge documentation. Instructions for the dot-phrase and electronic facsimile (e-faxing) were sent to Internal Medicine residents immediately prior to their rotation on an inpatient Renal service. We then measured the intervention implementation rate and its impact on hospital readmission metrics.
We compared 3 months of preintervention and 6 months of postintervention data, identifying 82 and 135 index discharges in each respective study period. Patients were predominantly male (56.2%) and receiving hemodialysis (89.8%); a minority (9.2%) were undomiciled at the time of discharge. Mean age was 60.5 years (SD 14.0). Renal discharges followed by 30-day Renal readmission were not statistically lower in the postintervention group for the index discharge alone (26.8% vs. 20.0%, p = 0.12), but were for overall discharges (51.2% vs. 25.7%, p < 0.0001). The dot-phrase was used in 95.4% of discharge summaries, and 74.7% of discharge summaries were e-faxed within 24 h of discharge.
There was high uptake of a standardized discharge handoff tool among Internal Medicine residents on a Renal inpatient service. Using a handoff tool and e-faxing may improve communication with outpatient dialysis centers and may reduce readmissions among some patients but is likely insufficient to fully address high readmission rates. Subsequent intervention iterations would benefit from further collaboration with outpatient dialysis units for customization of the handoff tool to meet local communication needs.
需要透析的终末期肾病患者的住院再入院率较高。造成这种情况的一个原因是医院和门诊透析机构之间沟通不畅。我们假设，改善沟通可能会降低城市医疗保障医院透析患者的 30 天住院再入院率。
我们创建了一个易于使用的标准化交接工具，为透析中心提供简明的数据。交接工具是一种新颖的电子 MACRO 模板（称为“点句”），包含在出院文件中。点句和电子传真（e-fax）的说明在住院肾科服务轮岗前直接发送给内科住院医师。然后，我们测量了干预措施的实施率及其对住院再入院指标的影响。
我们比较了干预前 3 个月和干预后 6 个月的数据，在每个研究期间分别确定了 82 次和 135 次指数出院。患者主要为男性（56.2%），接受血液透析（89.8%）；少数（9.2%）在出院时没有住所。平均年龄为 60.5 岁（标准差 14.0）。仅就索引出院而言，接受 30 天肾脏再入院的肾出院患者在干预后组中的比例并没有统计学上的降低（26.8%比 20.0%，p=0.12），但对于所有出院患者的比例则有所降低（51.2%比 25.7%，p<0.0001）。点句在 95.4%的出院总结中使用，74.7%的出院总结在出院后 24 小时内通过电子传真发送。
肾内科住院医师对标准化交接工具的采用率很高。使用交接工具和电子传真可能会改善与门诊透析中心的沟通，并可能降低部分患者的再入院率，但可能不足以完全解决高再入院率的问题。随后的干预迭代将受益于与门诊透析单位的进一步合作，以定制交接工具以满足当地的沟通需求。
