Error Reduction at hospital discharge - Boston University减少错误在出院-波士顿大学.pptVIP

Errors + Hospital Discharge High rates of medical errors at discharge now well documented Readmission by 90-days: 20% of hospitalized patients Can improving the discharge process reduce errors and reduce unplanned rehospitalization? An Etiologic Classification of Errors at Hospital discharge What happens? 60 yo women with Congestive Heart Failure takes the same medicines after discharge as before, plus her new ones; she is readmitted with renal failure requiring long term dialysis. 50 yo Spanish speaking women doesn’t understand how to get to outpatient Stress test, she misses it and next presents with sudden death. Errors at Discharge - Process Evaluation Example of Root Cause Analysis 42 year old man with Abdominal pain with nausea, vomiting, diarrhea Chest pain - sometimes exertional, sometimes at rest 30 admissions in 42 months Can’t something be done? Cumulative Percent of Charges for the 300 Most Frequent Users – Boston CareNET 2003 Factors influencing re-hospitalization Errors at Discharge - Process Evaluation Errors at Discharge - Process Evaluation Re-engineering the Discharge Iterative Group Process Identification of Potential Failures Prioritization Principles of the Newly Re-Engineered Hospital Discharge Re-engineered Discharge must contain: Explicit delineation of roles and responsibilities Patient education throughout the hospitalization Easy Information flow from the PCP among the hospital team back to the PCP Written Discharge Plan Principles of the Newly Re-Engineered Hospital Discharge Written discharge plan: addresses medications dietary and other lifestyle modifications follow-up care patient education instructions about what to do if their condition changes completed before discharge Those at-risk should have the discharge plan reinforced after discharge. All information must be organized and delivered to the PCP. Principles of the Newly Re-Engineered Hospital Discharge Waiting until the discharge o