Distinct Approaches to Perioperative Management of Anticoagulation and Antiplatelet Therapy among Providers Performing Cutaneous Surgery.

BACKGROUND: Despite increasing cross-collaboration between providers who perform cutaneous surgery, a disparity still exists in the current practices regarding perioperative management. This could lead to treatment delays, patient confusion, and increased morbidity, such as clotting, infection, and discomfort of patients. OBJECTIVE: To characterize the management practices of different providers in regards to perioperative anticoagulation and antiplatelet therapy for cutaneous surgery. METHODS AND MATERIALS: This study used an electronic survey to assess current perioperative management practices of dermatologic surgeons and plastic and reconstructive surgeons. RESULTS: 177 physicians (115 dermatologic surgeons and 62 plastic and reconstructive surgeons) responded to the survey. For all therapeutic agents, dermatologic surgeons were significantly more likely than their plastic and reconstructive surgery colleagues to continue all anticoagulant and antiplatelet agents perioperatively for cutaneous surgery (vitamin K antagonists, antiplatelets, LMWH, direct Xa inhibitors, direct thrombin inhibitors, NSAIDS: P<0.001; fish oil, vitamin E: P<0.01). CONCLUSION: Our data highlight the significant practice gaps that exist between dermatologic surgeons and plastic and reconstructive surgeons. Reducing this disparity will facilitate improved continuity of care, especially when patients are referred from dermatologic surgeons to plastic and reconstructive surgeons for more complex repairs, and potentially reduce morbidity and mortality associated with medication discontinuation. J Drugs Dermatol. 2022;21(7):766-772. doi:10.36849/JDD.6726.

Discharge documentation of patients discharged to subacute facilities: a three-year quality improvement process across an integrated health care system.

BACKGROUND: Effective communication among physicians during hospital discharge is critical to patient care. Partners Healthcare (Boston) has been engaged in a multi-year process to measure and improve the quality of documentation of all patients discharged from its five acute care hospitals to subacute facilities. METHODS: Partners first engaged stakeholders to develop a consensus set of 12 required data elements for all discharges to subacute facilities. A measurement process was established and later refined. Quality improvement interventions were then initiated to address measured deficiencies and included education of physicians and nurses, improvements in information technology, creation of or improvements in discharge documentation templates, training of hospitalists to serve as role models, feedback to physicians and their service chiefs regarding reviewed cases, and case manager review of documentation before discharge. To measure improvement in quality as a result of these efforts, rates of simultaneous inclusion of all 12 applicable data elements ("defect-free rate") were analyzed over time. RESULTS: Some 3,101 discharge documentation packets of patients discharged to subacute facilities from January 1, 2006, through September 2008 were retrospectively studied. During the 11 monitored quarters, the defect-free rate increased from 65% to 96% (p < .001 for trend). The largest improvements were seen in documentation of preadmission medication lists, allergies, follow-up, and warfarin information. CONCLUSIONS: Institution of rigorous measurement, feedback, and multidisciplinary, multimodal quality improvement processes improved the inclusion of data elements in discharge documentation required for safe hospital discharge across a large integrated health care system.

Communication and information deficits in patients discharged to rehabilitation facilities: an evaluation of five acute care hospitals.

BACKGROUND: The quality of discharge documentation in patients discharged to rehabilitation centers and other subacute facilities is less well studied than that of patients discharged home. OBJECTIVE: To evaluate the quality of information transfer among patients discharged from acute hospitals to subacute facilities across an integrated healthcare delivery system. DESIGN: Retrospective evaluation of discharge documentation packets of selected patients. SETTING: Five acute care hospitals of the Partners Healthcare System. MEASUREMENTS: We measured the presence of specific data elements required to safely care for patients after discharge, including all data elements required by the Joint Commission on Accreditation of Healthcare Organizations (TJC). RESULTS: A total of 1501 discharge documentation packets were reviewed from March 2005 through June 2007. Only 1055 (70.3%) discharge summaries had all the information required by TJC, with physical examination at admission and condition at discharge most often missing (in 11.4% and 14.2% of cases, respectively). Other deficiencies not mandated by TJC included a list of preadmission medications (missing in 20.3%) and reasons for changes in these medications at discharge (35.3%), mention of pending test results (47.2%), and postdischarge management and follow-up plans (11.1%). CONCLUSIONS: We found room for improvement in the inclusion of data elements required for the safe transfer of patients from acute hospitals to subacute facilities, especially in areas such as medication reconciliation, pending test results, and adequate follow-up plans.