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Coordinated Discharge Package in Medical Assessment Units

Coffs Harbour Base Hospital
Project Added:
8 October 2015
Last updated:
22 October 2015

Coordinated Discharge Package in Medical Assessment Units

Summary

This project provided a Coordinated Discharge Package (CDP), including a discharge summary and follow-up call, to patients discharged from Medical Assessment Units (MAUs) at Coffs Harbour Health Campus (CHHC). 

Aim

To provide a comprehensive yet efficient discharge tool that improves patient care and collaboration between community care providers and hospital health professionals, while meeting the prescribed 10% readmission target.

Benefits

  • Improves patient outcomes and satisfaction.
  • Reduces readmission rates.
  • Improves patient understanding of their illness and medications required.
  • Improves coordination with community care.
  • Provides emotional support for patients and carers.

Project status

Dates

Start: December 2013.

Status 

Sustained - The project has been implemented, is sustained in standard business.

Background

NSW Health reports that the majority of local health districts regularly breach the recommended 10% readmission targets for MAUs. Readmission rates within a 28-day period suggest that not all issues were addressed in full on the first admission.

Readmission rates are one of five key performance indicators used to monitor MAUs across NSW. Monthly reports suggest there is an epidemic challenge at hand, with the majority of MAU services exceeding the 10% readmission target. Both rural and urban hospitals have been equally affected, with no obvious association between the type or size of the centre and their readmission performance.

One of the major concerns with high readmission rates is the increased cost of healthcare for issues which have already been addressed in previous admissions.  A study by Boston University Medical Centre (Project RED [Re-Engineered Discharge]) found that the cost of rehospitalisation at the current standard of care was 33% higher than with an intentional discharge toolkit similar to the CDP. Given the extent of readmissions in NSW, significant savings in health expenditure could be achieved with appropriate implementation of a CDP.

It has been suggested that a major contributing factor to high readmission rates is the level of patient understanding of their pathology, investigations, inpatient and outpatient management, which can lead to reduced compliance with medications and follow up. Project RED proposed a 12-step discharge process, coupled with a 48-hour follow-up call to bridge the gap in patient understanding of their condition and increase compliance with medications and attendance to follow-up appointments.

The study showed considerable benefits in improving patient understanding and providing a sense of empowerment and control over managing their condition. There was also a significant reduction in rehospitalisation and subsequent healthcare spending.

CHHC has only achieved a readmission rate to its MAU below 10% twice. Given the healthcare and financial implications of high readmissions, this was a significant issue for Mid North Coast Local Health District. It implemented an adaptation of Project RED in December 2013, with a strong emphasis on reviewing management plans upon discharge.

Implementation

  • Creation of standardised CDP process tailored to the needs of the local population.
  • Face-to-face consultations at the time of discharge by a junior medical officer (JMO), with a follow-up call one week post-discharge. The consultation uses a standardised set of questions to highlight changes to medication and follow-up appointments.
  • Development of a CDP registry to monitor consultations and measure readmission rates.
  • Development of patient feedback forms to quantify data and improve the patient’s consultation experience.
  • Discharge advocates may be introduced in the future, particularly with large patient loads and numerous daily discharges.

Results

To examine the efficacy of this intervention, the CDP was trialled for one month, with a 28-day follow-up period. Results for the trial group were compared against a retrospective group where no intervention was undertaken. Results for the trial group showed:

  • reduced readmission rates from 9.5% in March 2013 to 5.3% in December 2013
  • it is anticipated that the follow-up call will improve patient understanding of their condition, compliance with medication and attendance at follow-up appointments
  • improved communication and planning with community care providers and support for patients and carers through post-discharge follow-up call.
  • the average time taken to deliver face-to-face consultation and follow-up call was 17 minutes per patient, which was a feasible achievement for the JMO to accomplish without needing to allocate additional hours.

Lessons learnt

  • Incorporating the CDP into the JMO handover ensures the ongoing use of this process, despite the constant rotation of medical professionals.
  • While a standardised consultation form has been developed to address the current needs of the patient, flexibility to adapt and revise this is equally essential for this intervention to remain sustainable and relevant.
  • A multidisciplinary approach can be taken to the discharge process, by involving various allied health teams in the implementation of the CDP.
  • The CDP has the potential to be customised to suit the needs of the local population and applied across many different communities.
  • Broader application of the CDP to units outside the MAU that have higher patient loads may require further planning and a dedicated discharge advocate to achieve the same results.
  • The sample size of this project was too small to statistically confirm the perceived outcomes. However the pilot project showed tremendous promise and further experimentation of its use will be invaluable.

Further reading

  • NSW Health. Key Performance Indicators: Medical Assessment Unit. 2009.
  • NSW Health. Medical Assessment Unit: Operational Guide. 2009.
  • Jack, BW, Chetty VK, Anthony D. A Reengineered Hospital Discharge Program to Decrease Rehospitalization. Annals of Internal Medicine 2009; 150: 178-187.
  • Agency for Clinical Innovation (ACI). Medical Assessment Units in NSW; 2009. Web. 7 March 2014.
  • Boston University Medical Center. Project RED. 2014.

Contact

Dr Christiaan Mostert
Staff Specialist, General Medicine & MAU
Coffs Harbour Health Campus
Mid North Coast Local Health District
Phone: 02 6656 7074
christiaan.mostert@ncahs.health.nsw.gov.au

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