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

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

Kathleen Huth, Arda Hotz, Norah Emara  1 , Bryanna Robertson  1 , Marissa Leaversuch  1 , Alexandra N Mercer  1 , Alisa Khan, Maria-Lucia Campos  1 , Isabella Liss  1 , Phillip D Hahn  2 , Dionne A Graham, Laura Rossi  3 , Margaret V Thomas  4 , Nahel Elias  4 , Marie Morris  1 , Laurie Glader  5 , Amy Pinkham  1 , Kristin M Bardsley  1 , Sarah Wells  1 , Jayne Rogers  1 , Jay G Berry, Sangeeta Mauskar, Amy J Starmer
Affiliations

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

Kathleen Huth et al. J Patient Saf. .

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.

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Conflict of interest statement

A.J.S. holds equity in and has consulted with the I-PASS Patient Safety Institute. The I-PASS Patient Safety Institute is a company that seeks to train institutions in best handoff practices and aid in their implementation. The I-PASS Patient Safety Institute was in no way involved in this study. Moreover, to ensure objectivity, all data were analyzed via a statistical team who do not have any involvement with the I-PASS Patient Safety Institute. All analyses were conducted by this statistical team. A.J.S. has received monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for teaching and consulting on physician performance and handoffs. The other authors disclose no conflict of interest.

References

    1. The Joint Commission. Sentinel event alert: Inadequate handoff communication. Jt Comm . 2017;58:1–6 Available at: https://www.jointcommission.org/sentinel_event_alert_58_inadequate_hando... . Accessed February 21, 2018.
    1. Starmer AJ, Spector ND, West DC, et al. Integrating research, quality improvement, and medical education for better handoffs and safer care: disseminating, adapting, and implementing the I-PASS program. Jt Comm J Qual Patient Saf . 2017;43:319–329.
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    1. Tsilimingras D, Bates DW. Addressing postdischarge adverse events: a neglected area. Jt Comm J Qual Patient Saf . 2008;34:85–97.

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