Hospital discharge: testing the "Blaylock Risk Assessment Screening Score" in a surgical department.

Background and aim of the work Standardizing patients' assessment to identify individuals at greater risk in encountering difficulties at discharge may help to assist healthcare professionals in clinical decision making and address the gaps in quality that negatively affect continuity of care. We analyzed the predictive validity and the test-retest reliability of the BRASS index in surgical inpatients. Moreover, we evaluated the association between other variables and length of stay or location at discharge. Methods A prospective observational study was conducted. Four hundred twenty-eight patients (≥18 years old) hospitalized in the surgical department of Vimercate hospital were recruited. Data were collected using BRASS index within 48 hours from admission and before discharge. Results We found a high specificity for BRASS in identifying patients discharged to their home with assistance or to residential care. The hospital stay for medium and high-risk patients was significantly longer than those in the low-risk group. There was no statistically significant difference of the BRASS scores during hospitalization. Type of admission, pressure ulcers, ASA score, multidrug-resistant bacterial infections, medical complications and Intensive Unit Care stay showed a significant correlation with longer hospitalization and increased probability to be discharged to their home with assistance or to residential care. Conclusions The BRASS Index may support healthcare professionals to identify surgical inpatients requiring a discharge planning and needs to be completed just once at admission. The inclusion of other patient-specific factors in the assessment process could be valuable for targeting the at-risk population.

[The assessment of planned discharges: agreement between BRASS index and clinical judgement]. / Valutazione delle dimissioni pianificate: concordanza tra indice di BRASS e giudizio clinico.

. The assessment of planned discharges: agreement between BRASS index and clinical judgement. INTRODUCTION: The BRASS (Blaylock Risk Assessment Screening Score) index is a risk screening tool for identification of patients at risk of difficult discharge. OBJECTIVE: To assess the agreement of discharge options between the BRASS classification and the nurses' clinical judgement. METHODS: Consecutive patients admitted to surgical wards of a large Italian hospital from November 2016 to June 2017 were assessed with the BRASS index within 48 hours from admission and 24 hours before discharge. After discharge a group of expert nurses, blind to the BRASS score and patient effective destination, planned the patients' discharge reviewing the clinical records. Patients were classified as needing ordinary discharge, with support or to hospital. RESULTS: The 90% of the 428 included patients remained in the same BRASS risk class; the agreement between BRASS score (K Cohen) at admission and clinical judgement was 0.474 and 0.533 at discharge. Of the 96 subject at need of discharge with support or to hospital, 60 were classified in the same class by the BRASS Index. Factors that impacted on the different classification were patients' age, presence of devices and availability and appropriateness of social support. CONCLUSIONS: Most patients remained in the same BRASS class. There is moderate agreement between BRASS index and clinical judgement, specifically for patients at medium/high risk of difficult discharge. Our data confirm the need for including new items in the Brass scale.

Enhanced Recovery After Surgery (ERAS) multimodal programme as experienced by pancreatic surgery patients: Findings from an Italian qualitative study.

BACKGROUND: ERAS has recently been implemented in pancreatic surgery settings, but there is little evidence regarding the effects as perceived by patients. Given the lack of the knowledge in the field, the aim of this study was to capture the experience of patients undergoing pancreatic surgery who received perioperative care based on the ERAS programme. METHODS: We designed a qualitative study undertaken in the pancreatic surgery unit of San Raffaele Hospital in Milan, Italy. Twenty-two consecutive patients were invited to participate in the study and 13 patients were interviewed. Data was collected between March and December 2012 either through face-to-face or semi-structured telephone follow-up from three to six weeks after discharge. Data was analysed using the interpretative phenomenological approach. RESULTS: Patients who underwent surgical pancreatic procedures and treated with ERAS programme reported experiences based on four themes: (1) Feeling prepared to face surgery, (2) Being actively "inside" or "outside" the programme, (3) Healing at home: the best setting, and (4) "Perceiving the ordinary as extraordinary": reaching independence, once at home. CONCLUSION: According to the findings, uncomplicated pancreatic surgery patients may benefit from the ERAS programme. Preadmission counselling should help patients to assume an active role. Once the patient returns home, the availability of a caregiver should be thoroughly assessed to guarantee the support needed by patients to successfully complete the ERAS(programme. Surgery and nursing staff should carefully monitor patients and suggest whether they continue, interrupt, or individualise the scheduled ERAS interventions in accordance with a patient's clinical condition and preferred personal timing.