Project IMPACT Pilot Report: Feasibility of Implementing a Hospital-to-Home Transition Bundle

• Published in: Pediatrics (Evanston) Vol. 139; no. 3
• Main Authors: Mallory, Leah A, Osorio, Snezana Nena, Prato, B Stephen, DiPace, Jennifer, Schmutter, Lisa, Soung, Paula, Rogers, Amanda, Woodall, William J, Burley, Kayla, Gage, Sandra, Cooperberg, David
• Format: Journal Article
• Language: English
• Published: United States 01.03.2017
• Subjects: Adolescent; Child; Child, Preschool; Continuity of Patient Care - organization & administration; Feasibility Studies; Humans; Patient Care Bundles; Patient Discharge; Patient Education as Topic; Patient Handoff; Patient Readmission - statistics & numerical data; Pilot Projects; Telephone; United States
• ISSN: 1098-4275
• DOI: 10.1542/peds.2015-4626

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. 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. 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. 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.