Head and neck cancer readmission reduction (HANCARRE) project : Reducing 30-day readmissions
© 2022 The Authors. World Journal of Otorhinolaryngology ‐ Head and Neck Surgery published by John Wiley & Sons Ltd on behalf of Chinese Medical Association..
Objective: Unplanned 30-day readmissions result in increased costs and decreased patient satisfaction. The objective of this study was to compare readmission rates before and after a multidisciplinary quality improvement initiative that focuses on patient and staff education, use of targeted skilled nursing facilities, and appropriate use of patient observation status.
Methods: This was a quality improvement study of all unplanned admissions to the Head and Neck Oncology service at a tertiary care facility during a 3-year period between October 2015 and September 2018. In October 2016, when the Head and Neck Oncology service revised its discharge practices for patients undergoing extirpative and/or reconstructive surgery. These changes included enhancing patient education, increasing the use of a skilled nursing facility with directed staff education and patient handoffs by advanced practice nurses, and appropriate utilization of 23-h observation status for returning patients. The readmission rate from the pre-intervention era (October 2015 through September 2016) was compared to the readmission rate from the post-intervention era (October 2016 through September 2018). Secondary outcomes were the rates of 23-h observation within 30 days of the discharge as well as emergency room visits within 30 days of discharge.
Results: In this sample of 449 patients, 161 (35.9%) were observed before the change-in-practice (before October 2016), and 288 (64.1%) were observed following the change-in-practice (after September 2016). On univariable analysis, the risk of readmission declined by approximately 41.4% from the pre-intervention era, though this conclusion was not statistically significant (P = 0.06). On multivariable analysis, patients at moderate or high risk of death were 2.31 times more likely than those at minor risk of death to readmit within 30 days (P = 0.03). Similarly, those with recurrent or persistent cancer were 3.33 times more likely than those undergoing initial curative surgical management of cancer to readmit within 30 days (P = 0.001). No patient characteristics were associated with a 23-h observation following discharge (all P > 0.05). Conclusions were similar for emergency room visits following discharge.
Conclusions: A three-part quality improvement strategy resulted in a clinically important decrease in 30-day readmissions, though the decline was not statistically significant. There were no significant changes in 23-h observation within 30 days of discharge or emergency room visits within 30 days of discharge.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
World journal of otorhinolaryngology - head and neck surgery - 8(2022), 2 vom: 13. Juni, Seite 158-166 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Yang, Sara [VerfasserIn] |
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| Links: |
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| Themen: |
30‐day readmissions |
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| Anmerkungen: |
Date Revised 16.07.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1002/wjo2.56 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM343031426 |
|---|
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| 520 | |a © 2022 The Authors. World Journal of Otorhinolaryngology ‐ Head and Neck Surgery published by John Wiley & Sons Ltd on behalf of Chinese Medical Association. | ||
| 520 | |a Objective: Unplanned 30-day readmissions result in increased costs and decreased patient satisfaction. The objective of this study was to compare readmission rates before and after a multidisciplinary quality improvement initiative that focuses on patient and staff education, use of targeted skilled nursing facilities, and appropriate use of patient observation status | ||
| 520 | |a Methods: This was a quality improvement study of all unplanned admissions to the Head and Neck Oncology service at a tertiary care facility during a 3-year period between October 2015 and September 2018. In October 2016, when the Head and Neck Oncology service revised its discharge practices for patients undergoing extirpative and/or reconstructive surgery. These changes included enhancing patient education, increasing the use of a skilled nursing facility with directed staff education and patient handoffs by advanced practice nurses, and appropriate utilization of 23-h observation status for returning patients. The readmission rate from the pre-intervention era (October 2015 through September 2016) was compared to the readmission rate from the post-intervention era (October 2016 through September 2018). Secondary outcomes were the rates of 23-h observation within 30 days of the discharge as well as emergency room visits within 30 days of discharge | ||
| 520 | |a Results: In this sample of 449 patients, 161 (35.9%) were observed before the change-in-practice (before October 2016), and 288 (64.1%) were observed following the change-in-practice (after September 2016). On univariable analysis, the risk of readmission declined by approximately 41.4% from the pre-intervention era, though this conclusion was not statistically significant (P = 0.06). On multivariable analysis, patients at moderate or high risk of death were 2.31 times more likely than those at minor risk of death to readmit within 30 days (P = 0.03). Similarly, those with recurrent or persistent cancer were 3.33 times more likely than those undergoing initial curative surgical management of cancer to readmit within 30 days (P = 0.001). No patient characteristics were associated with a 23-h observation following discharge (all P > 0.05). Conclusions were similar for emergency room visits following discharge | ||
| 520 | |a Conclusions: A three-part quality improvement strategy resulted in a clinically important decrease in 30-day readmissions, though the decline was not statistically significant. There were no significant changes in 23-h observation within 30 days of discharge or emergency room visits within 30 days of discharge | ||
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| 700 | 1 | |a Bier-Laning, Carol |e verfasserin |4 aut | |
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