The impact of a
post-discharge time-out on the quality of hospital discharge notes is known.
Over the last decade, a considerable amount of research has focussed on
documentation improvement and this has included methods for improving the
quality and usefulness of discharge time-outs. During 2021, the authors
examined the impact of a post-discharge time-out on discharge ratings for
patients in general. Using a random sample of general practitioners (nurses,
clinicians and senior nurses), the authors examined two aspects of
post-discharge hospital care: nurses' opinions about time-outs and the impact
of a post-discharge time-in on nurses' reports of physical discharges and
readmissions.
The main outcome was
that nurses who had observed a significant increase in their nurses' opinions
about time outs were those who were also reporting fewer readmissions or
improvements in their capacity to discharge a patient safely. Analysis showed
that nurses' opinions of their capability to discharge a patient accurately were
correlated with a change in their capacity to calculate their discharge time in
real time. Furthermore, analyses showed that nurses' ability to calculate their
real-time discharge time was negatively correlated with their perceived
supervisors' views about their capacity to accurately calculate their capacity.
Analysis also showed
that there was a significant difference between nurses' and physicians' views
about discharge time. The results presented showed that nurses' estimates of
their actual time to discharge far exceeded that of their physicians. This was
particularly apparent in patients with severe and difficult conditions. It was
also found that patients identified by their physicians to require extended
hospital care (e.g. patients diagnosed with cardiogenic shock, invasive
malignancies and infectious diseases) were discharged on average sooner than
those identified by nurses, regardless of their medical history.
An alternative approach
to monitor discharge time and prepare patients for discharge was to use
hospitalized patient databases (dbns). These were established to store
patients' medical history and identify specific concerns and issues that
require closer monitoring. Examples of common dbn types are radiology data,
vital sign databases, electronic health records (EHR), pathology and imaging
data, pharmacy data, and personal data. A major advantage of implementing a
hospital based on the system is the ability to directly communicate between
physicians and medical center staff, which can help to reduce miscommunication
and errors in the process.
To further monitor
patient care and discharge time, many hospitals have developed online tools to
calculate and display the length of time that a patient is in the hospital and
what days they may be released. An example of such tool is the" discharged
by midnight" tool, which is accessible from the "oyer log".
According to one study, a full twenty-nine percent of patients admitted to a
New York City hospital into one of its acute care units reported not being
discharged on their first day of release, despite the hospital's efforts to
promote discharge to a particular evening.
For smaller acute care
settings, such as pharmacies, it is often necessary to use a different system
such as the AART system (Actions and Absence-uated Remote Assessment System) to
calculate the bedside capacity, as it requires no calculation of amortization
or discharge rate. Rather, this system computes the actual capacity needed at
discharge time, which can be compared with an anticipated capacity. This option
should not be used to simply calculate the expected amortization as the
expected number of hours of capacity use is less than the number of hours
actually used, and a lower anticipated discharge time may result in fewer patients
receiving necessary doses of medication. Instead, these systems calculate both
the actual number of units needed and expected units needed at discharge time
to give a more accurate picture of how much capacity is needed.
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