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Coordinating the transition to outpatient care is an important part of discharging hospitalized patients. In this study, researchers at a community hospital near Boston tested an intervention designed to improve this transition.
Researchers randomized 96 hospitalized patients to a special discharge intervention or to usual care. All patients had previously established relationships with primary care providers (PCPs) at outpatient facilities affiliated with this hospital. Each intervention began with a specially designed patient discharge form (reviewed with the patient) that captured key elements of the hospitalization and proposed follow-up. The form was transmitted electronically to a nurse at the patient’s outpatient provider site; this nurse phoned the patient the next day to review follow-up plans. The patient’s PCP then reviewed the form and nurse’s notes and modified the plan as necessary.
The proportion of patients who had one or more “undesirable outcomes” (i.e., no outpatient appointment within 3 weeks, readmission or emergency department visit within 1 month, or failure to complete an outpatient work-up recommended at discharge) was significantly lower in the intervention group (26%) than in the randomized control group (55%) or in a historical control group (55%).
Balaban RB et al. Redefining and redesigning hospital discharge to enhance patient care: A randomized controlled study. J Gen Intern Med 2008 Aug; 23:1228.
Comment
This relatively simple intervention improved several aspects of outpatient follow-up after hospitalization. The intervention’s generalizability is limited somewhat, given that all these patients already had outpatient medical providers within the same hospital system. Nevertheless, elements of this intervention could be duplicated in many clinical settings.