Transitional Care Services: A Quality and Safety Process Improvement Programme in Neurosurgery
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 入组人数
- 242
- 试验地点
- 1
- 主要终点
- Length of Hospital Stay
研究概览
简要总结
Readmissions increasingly serve as a metric of hospital performance, inviting quality improvement initiatives in both medicine and surgery. Recently, a readmission reduction program in the United States was associated with significantly shorter length of stay, earlier discharge, and reduced 30-day readmission after elective neurosurgery. These results underscore the importance of patient education and surveillance after hospital discharge, and it would be beneficial to test whether the same approach yields beneficial results in a different health system, the NHS. In this study, the investigators will replicate the Transitional Care Program (TCP) with the goal of decreasing length of stay, improving discharge efficiency, and reducing readmissions in neurosurgical patients by optimizing patient education and post-discharge surveillance.
详细描述
Discharge Program Process Abbreviations: AA: administrative assistant; MRN: medical record number; OT: occupational therapy; PT: physical therapy; and TCT = Transitional Care Team.
CLINIC (pre-enrolment)
- Patient has clinic visit with surgeon and is identified for surgery
- Surgeon identifies that the patient is eligible to participate in the program and consents the patient for enrolment.
- Patients will be given a written information sheet on the program, and will have the opportunity to receive the information via email as well.
- Their consent will be obtained in clinic; the use of interpreters will be used for individuals with special communication needs.
AFTER CLINIC
- Once individuals consent to be randomised into the study, their MRN will be given to the TCP nurse, who will randomise the patient into the control or intervention group using a random number generator.
- Patients randomised to the TCP will be given a pre-determined discharge date when they are called to schedule their operation. The anticipated discharge date will be determined by each surgeon's expected length of stay per procedure.
- AA provides brief intro to patient about the discharge pilot, including need for family member to be present to take patient home after appointment is complete. The surgery and discharge appointments are then booked.
- AA sends surgical letter (with anticipated length of stay and discharge appointment date/time) and discharge pilot postcard to patient via email or mail
- AA enters case and discharge information into NSU Discharge Calendar
- Transitional Care Team (TCT) checks NSU Discharge Calendar daily for scheduled cases and discharge appointments
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
盲法说明
All eligible patients will be consented to participate in the study. If they consent, a non-clinician study team member will randomise the patient into the control or intervention arm. Thereafter, all members of the care team will be notified of the patient's allocation in order to deliver the TCP.
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients are eligible for the TCP if scheduled for elective neurological surgery (including spinal surgery performed by an orthopedic surgeon) and were expected to have a discharge disposition to home.
排除标准
- •Patients with an anticipated discharge to a facility other than home
- •Patients with an anticipated discharge to home who are then discharged to a facility other than home will be excluded from the statistical analysis
研究组 & 干预措施
Transitional Care Programme
The primary intervention of the Transitional Care Programme (TCP) will be additional patient education, framing of expectations for the hospital course and length of stay, coordinated team preparation for discharge, a dedicated discharge appointment, and a follow up phone call.
干预措施: Transitional Care Programme (Other)
Standard of Care
Patients are admitted without a pre-determined discharge date. They do not receive a dedicated discharge appointment, and will not receive a follow up phone call 48 hours after discharge.
结局指标
主要结局
Length of Hospital Stay
时间窗: From time of hospital admission until the time of first hospital discharge or time of death from any cause, whichever came first. Assessed up to 4 months post-admission.
Time from admission until discharge (reported in hours)
次要结局
- Discharge before 12:00pm(This is assessed on the date of discharge from time 00:00 to time 23:59. The actual time of discharge or time of death from any cause, whichever came first, will be noted. Assessed up to 4 months post-admission.)
- Patient Satisfaction scores based on a single survey provided to the patient at the time of discharge.(From the time of hospital discharge from the original admission up until 2 weeks after discharge)
- Hospital Readmission(From the time of hospital discharge from the original admission until 30 days after hospital discharge)
- Cost(The cost of the hospital admission will be calculated for the time frame from the initial hospital admission until 30 days after hospital discharge, or time of death from any cause.)