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Project IMPACT Pilot Report: Feasibility of Implementing a Hospital-to-Home Transition Bundle
Leah A Mallory1, Snezana Nena Osorio2, B Stephen Prato1
1Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
Insights
A pediatric patient-centered transition bundle improved caregiver home management skills after hospital discharge. This study demonstrated the bundle
Area of Science:
- Pediatric Healthcare
- Patient Transition Management
- Quality Improvement
Background:
- Hospital to home transitions are critical for pediatric patient outcomes.
- A 4-element patient-centered transition bundle was developed to improve care.
- The bundle includes a checklist, teach-back education, provider handoff, and postdischarge calls.
Purpose of the Study:
- To assess the feasibility of implementing a pediatric patient-centered transition bundle.
- To report initial outcomes of the bundle at four pilot sites.
- To measure caregiver ability to teach-back information and 30-day readmission rates.
Main Methods:
- A multisite, observational time series design was employed.
- Sequential interventions were used to implement bundle components.
- Data collected via electronic health records and postdischarge calls; analyzed using statistical process control charts.
Main Results:
- Bundle implemented across four sites for 2601 patients.
- Caregiver ability to teach-back improved significantly from 18% to 82%.
- Phone contact rates were 69%; readmission rates showed no improvement and varied by technology support.
Conclusions:
- The pediatric care transition bundle was successfully implemented, improving process measures and caregiver skills.
- Key factors for success include local context, EHR integration, and subgroup analysis for technology-supported patients.
- Further research should focus on optimizing technology integration for improved readmission rates.
Background And Objectives:
To improve hospital to home transitions, a 4-element pediatric patient-centered transition bundle was developed, including: a transition readiness checklist; predischarge teach-back education; timely and complete written handoff to the primary care provider; and a postdischarge phone call. The objective of this study was to demonstrate the feasibility of bundle implementation and report initial outcomes at 4 pilot sites. Outcome measures included postdischarge caregiver ability to teach-back key home management information and 30-day reuse rates.
Methods:
A multisite, observational time series using multiple planned sequential interventions to implement bundle components with non-technology-supported and technology-supported patients. Data were collected via electronic health record reviews and during postdischarge phone calls. Statistical process control charts were used to assess outcomes.
Results:
Four pilot sites implemented the bundle between January 2014 and May 2015 for 2601 patients, of whom 1394 had postdischarge telephone encounters. Improvement was noted in the implementation of all bundle elements with the transitions readiness checklist posing the greatest feasibility challenge. Phone contact connection rates were 69%. Caregiver ability to teach-back essential home management information postdischarge improved from 18% to 82%. No improvement was noted in reuse rates, which differed dramatically between technology-supported and non-technology-supported patients.
Conclusions:
A pediatric care transition bundle was successfully tested and implemented, as demonstrated by improvement in all process measures, as well as caregiver home management skills. Important considerations for successful implementation and evaluation of the discharge bundle include the role of local context, electronic health record integration, and subgroup analysis for technology-supported patients.
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