Hemali P Patel, MD*;Essey Yirdaw, MPH;Amy Yu, MD;Connie Amaro, RN, BSN Case Manager;Mario Rubio;Lisa Slater, PharmD;Katharine Perica, PharmD, BCPS;Kaycee Shiskowsky, RN-BC, MBA;Read G. Pierce, MD and Christine D. Jones, MD, MS, University of Colorado Anschutz Medical Campus, Aurora, CO

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 200

Categories: Innovations Abstracts, Quality Improvement

Background: Collaboration between multidisciplinary teams during the discharge process can optimize the safety of discharge planning. At our tertiary academic medical center, case managers (CM) and pharmacists have historically been assigned to patients by unit rather than medicine teams. As a result, medicine teams often need to interact with several unit-based CMs and pharmacists due to lack of geographical cohorting, leading to inefficiency and fragmentation in discharge planning.

Purpose: To institute new multidisciplinary, team-based discharge planning rounds for general medicine patients.

Description: In July 2015, we began a new multidisciplinary rounds (MDR) team pilot on two of four medicine resident ward teams. The MDR team included a CM, pharmacist, charge nurse, the medicine team, and a patient resident liaison (who makes patient appointments). The CM led MDR with a script to: 1) identify patients for early discharge the next day, 2) identify high risk patients using readmission risk scores, 3) identify common barriers to discharge, and 4) evaluate avoidable delays in discharge.

Early PDSAs included the addition of an afternoon check point between the medicine team and CM to review next day discharges.  In November, we completed a PDSA to lengthen resident rotations on pilot teams to 28-days to improve continuity, and to ensure that attendings were primarily hospitalists.  In comparison, control team residents had 14-day rotations and attending physicians included hospitalists, primary care physicians and physician scientists. Finally, in November, transitions of care pharmacy residents began providing discharge medication counseling and follow up phone calls to patients on pilot teams.  

In November, we began comparing outcome data from patients discharged from MDR pilot teams to control teams. During the MDR pilot (11/1/15-4/30/16), we saw a 5 hour decrease in length of stay (LOS) – 93 hours vs. 98 hours for pilot versus control teams. The proportion of patients with discharge orders before noon was 41% on pilot teams versus 30% of patients on control teams and the 30-day readmission rate was 16% on pilot teams compared to 18% for control teams.

After the team-based MDR pilot concluded (5/1/16-9/30/16), we continued to have resident continuity on the pilot teams but returned to the unit-based CM model.  During this time, LOS was 2 hours shorter on pilot vs control teams (95 vs 97 hours), and the proportion of discharge orders before noon was similar between pilot and control teams (27% vs 25%). The 30-day readmission rate was 12% compared to 19% for pilot vs control teams.

Conclusions: Team-based MDR pilot supports development of comprehensive individual discharge plans, resulting in shorter LOS, earlier discharge times, and lower 30-day readmissions. After a team-based MDR pilot concluded, readmission rates continue to be low on pilot teams in the presence of ongoing physician continuity, suggesting that continuity may positively impact 30-day readmission rates.

To cite this abstract:

Patel, HP; Yirdaw, E; Yu, A; Amaro, C; Rubio, M; Slater, L; Perica, K; Shiskowsky, K; Pierce, RG; Jones, CD . TEAM-BASED STRUCTURE OF DISCHARGE MULTIDISCIPLINARY ROUNDS LEADS TO EARLIER DISCHARGE. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 200. Journal of Hospital Medicine. 2017; 12 (suppl 2). Accessed April 1, 2020.

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