实施针对医疗复杂性儿童的医院-家庭过渡干预后，减少了出院后事件。

Reduced Postdischarge Incidents After Implementation of a Hospital-to-Home Transition Intervention for Children With Medical Complexity.

机构信息

From the Department of Pediatrics, Boston Children's Hospital.

Program for Patient Safety and Quality, Boston Children's Hospital.

出版信息

J Patient Saf. 2023 Oct 1;19(7):493-500. doi: 10.1097/PTS.0000000000001155. Epub 2023 Sep 5.

DOI:10.1097/PTS.0000000000001155

PMID:37729645

Abstract

OBJECTIVES

Prior research suggests that errors occur frequently for patients with medical complexity during the hospital-to-home transition. Less is known about effective postdischarge communication strategies for this population. We aimed to assess rates of 30-day (1) postdischarge incidents and (2) readmissions and emergency department (ED) visits before and after implementing a hospital-to-home intervention.

METHODS

We conducted a prospective intervention study of children with medical complexity discharged at a children's hospital from April 2018 to March 2020. A multistakeholder team developed a bundled intervention incorporating the I-PASS handoff framework including a postdischarge telephone call, restructured discharge summary, and handoff communication to outpatient providers. The primary outcome measure was rate of postdischarge incidents collected via electronic medical record review and family surveys. Secondary outcomes were 30-day readmissions and ED visits.

RESULTS

There were 199 total incidents and the most common were medication related (60%), equipment issues (15%), and delays in scheduling/provision of services (11%). The I-PASS intervention was associated with a 36.4% decrease in the rate of incidents per discharge (1.51 versus 0.95, P = 0.003). There were fewer nonharmful errors and quality issues after intervention (1.27 versus 0.85 per discharge, P = 0.02). The 30-day ED visit rate was significantly lower after intervention (12.6% versus 3.4%, per 100 discharges, P = 0.05). Thirty-day readmissions were 15.8% versus 10.2% postintervention (P = 0.32).

CONCLUSIONS

A postdischarge communication intervention for patients with medical complexity was associated with fewer postdischarge incidents and reduced 30-day ED visits. Standardized postdischarge communication may play an important role in improving quality and safety in the transition from hospital-to-home for vulnerable populations.

摘要

目的

先前的研究表明，在患者从医院出院回家的过程中，患有复杂疾病的患者经常会出现错误。对于该人群，有效的出院后沟通策略知之甚少。我们旨在评估实施医院到家庭干预前后 30 天（1）出院后事件和（2）再入院和急诊部（ED）就诊的发生率。

方法

我们对 2018 年 4 月至 2020 年 3 月期间从儿童医院出院的患有复杂疾病的儿童进行了前瞻性干预研究。一个由多利益相关者组成的团队制定了一项捆绑干预措施，该措施结合了 I-PASS 交接框架，包括出院后电话、改组的出院小结以及与门诊提供者的交接沟通。主要结局指标是通过电子病历审查和家庭调查收集的出院后事件发生率。次要结局是 30 天再入院和 ED 就诊。

结果

共有 199 起总事件，最常见的是与药物相关的事件（60%）、设备问题（15%）和服务安排/提供的延误（11%）。I-PASS 干预与出院时事件发生率降低了 36.4%（每出院 1.51 次与 0.95 次，P = 0.003）相关。干预后非危害性错误和质量问题减少（每出院 1.27 次与 0.85 次，P = 0.02）。干预后 30 天 ED 就诊率显著降低（每 100 出院 12.6%与 3.4%，P = 0.05）。30 天再入院率为 15.8%与 10.2%，干预后（P = 0.32）。