New Design for Discharge

With hospitalists playing key roles in improving transitions in care, a new study has tested a low-cost process that shows increases in outpatient follow-up and completed workups soon after hospital discharge.

The improvements potentially could lead to better patient outcomes and lower readmission rates, according to Richard B. Balaban, MD, who as the medical director of Cambridge Health Alliance’s (CHA) Somerville, Mass., primary-care center and a hospitalist at CHA’s Cambridge Hospital has a unique, dual perspective on the discharge process.

Dr. Balaban’s team’s discharge-transfer intervention process, tested in one of the few randomized controlled studies on the subject of transitions of care, is intended to improve communication between hospitalists and primary-care providers, as well as promptly connect inpatients to outpatient providers. It’s also designed to better equip patients to participate in their care and to improve accountability within the medical team.

The study, published in the August 2008 issue of the Journal of General Internal Medicine, garnered praise from Mark Williams, MD, FACP, professor and chief of the Division of Hospital Medicine at Northwestern University’s Feinberg School of Medicine in Chicago and principal investigator of SHM’s Project BOOST study (see “BOOST Sites Chosen,” August 2008, p. 1), which is examining ways to improve transitions of care.1 “This small but well-done study demonstrates how using interventions similar to components in the Project BOOST toolkit resulted in a significant improvement in outpatient follow-up, and a trend toward a reduction in hospitalizations and emergency room visits,” Dr. Williams says.

The four-part process calls for:

• The patient to receive a comprehensive, “user-friendly” discharge instruction form;
• Electronic transfer of the discharge instruction form to RNs at the patient’s primary-care site;
• A primary-care RN to call the patient by the next business day to monitor his or her condition; and
• The review and modification of the discharge plan by the primary-care provider as needed.

The research team, which included Joel S. Weissman, PhD, of Massachusetts General Hospital, Harvard Medical School, and the Harvard School of Public Health; Peter A. Samuel of Harvard Medical School; and Stephanie Woolhandler, MD, of CHA and Harvard Medical School, thinks the discharge process, a key task for hospitalists, should be treated as vital as the admissions process. “Hospitalists need to improve the level of detail in discharge plans; this form and process supports that,” Dr. Balaban says. By providing this quality information to outpatient providers, collaboration is improved, making hospitalists more effective, he says.