Project RED Impacts Patient Experience.

BACKGROUND: Hospitalized patients are frequently unprepared to care for themselves after discharge often leading to unplanned hospital readmission. One strategy to reduce readmission rates is improving the quality of patient education and preparation before hospital discharge. The ReEngineered Discharge (RED) is a standardized hospital-based program designed to provide patients and caregivers the information they need to continue care at home. OBJECTIVES: We sought to study the impact of the RED intervention on posthospitalization adult patient experience scores in an urban academic safety-net hospital. METHODS: We conducted a descriptive study of a pilot program that compared posthospitalization survey responses to the Press Ganey survey item "Instructions were given about how to care for yourself at home." We compared the survey results for 3 groups of adult patients: those receiving the RED program, those receiving a standard discharge on the same hospital unit, and those receiving a standard discharge on other hospital units. RESULTS: A greater percentage of adult patients who received the RED discharge program rated the quality of their discharge as "very good" as compared to those receiving a standard discharge on the same hospital unit and those receiving a standard discharge on other hospital units (61%, 35%, and 41%, respectively, P = .0001). CONCLUSION: Delivery of a standardized hospital discharge program resulted in a larger proportion of top-box "very good" responses on a Press Ganey posthospitalization survey. Future research should examine whether hospital-based transition programs can sustain improvement in patient experience measures and whether these improvements can be observed in other patient populations.

School Referral Patterns among Adolescents with Serious Emotional Disturbance Enrolled in Systems of Care.

School staff play a critical role in referring adolescents with serious emotional disturbance (SED) to mental health services; however, the mechanisms underlying this referral process are poorly understood. We used data from adolescents (N=4,365) enrolled in SAMHSA's Children's Mental Health Initiative Systems of Care (SOC) and participating in a national evaluation to compare the profiles of youth referred for SOC services by school staff with youth referred for those services by professionals at other agencies. We sought to identify whether school staff referred a unique set of adolescents by examining indicators of global impairment and impairment in school functioning (i.e., absences, suspensions, failures). Using multilevel regression models, we estimated the association of global impairment and school functioning with referral source (i.e., school vs. other) and controlled for SOC community characteristics and individual-level socio-demographics. Findings indicated that adolescents referred from schools had significantly lower levels of global impairment than adolescents referred from mental health settings. However, they had considerable school-related impairment, with rates of absences, suspensions, and failures that were equivalent to youth referred from most other agencies. This study is the first to examine school-related impairment among youth receiving SOC services as a function of referral source. By identifying adolescents with more mild global impairment, who nonetheless experienced significant impairment in school functioning, schools can be key contributors to effectively identifying a unique set of adolescents for SOC services. Further, schools might meaningfully inform the provision of comprehensive services to this population by educating community agencies about school functioning among youth with SED.

School- and Classroom-Based Supports for Children Following the 2013 Boston Marathon Attack and Manhunt.

School staff provide key mental health services following mass crisis events and teachers, in particular, can provide important supports within their classrooms. This study examines Boston-area teachers' perception of classroom-wide psychiatric distress and the types of supports that schools and teachers provided following the 2013 Boston Marathon bombing and subsequent manhunt. Boston-area K-12 teachers (N = 147) in communities with varying levels of exposure to the bombing and manhunt completed an anonymous web-based survey 2-5 months after the attack. Teachers reported on students' exposure to the bombings and manhunt, classroom-wide psychiatric distress, and the types of supports they and their schools provided students. Teacher reports of student exposure to the bombings and manhunt were significantly associated with their perceptions of greater classroom-wide psychiatric distress. Almost half indicated that their school had no formal policy for responding to the crisis, half reported no training to address events, and even the most common classroom-based support strategy-reassuring students of their safety-was provided by only 76 % of teachers. Teacher perceptions of student exposure to the manhunt, but not the bombing, were significantly associated with greater provision of these supports. In the aftermath of the Boston Marathon bombings and manhunt, teachers and schools provided supports; however, the extent and types of supports varied considerably. Working with teachers to most effectively and consistently serve in this complex role has the potential to improve school-based crisis response plans, as well as student outcomes.

The role of tissue plasminogen activator use and systemic hypercoagulability in central line-associated bloodstream infections.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) impact patient outcomes and increase cost of hospitalization. In situ thrombus is known to promote microbial adhesion and colonization and potentially lead to CLABSI. Clinical validation of this theory, adjusting for presence of systemic hypercoagulability, is needed. METHODS: This study is a retrospective review of all adult and pediatric patients with peripherally inserted central catheter placement over a 4-year period at our tertiary care center. Tissue plasminogen activator (TPA) use was utilized as indicator for line site thrombus. CLABSIs rates were compared in patients with or without TPA use, adjusting for the presence of hypercoagulable conditions, age, and severity of illness. RESULTS: A total of 3,723 patients with peripherally inserted central catheter lines was evaluated, 40% of whom received TPA. The adjusted odds of developing a CLABSI was 3.59 times greater in those patients who received TPA compared with those who did not (95% confidence interval [CI]: 1.86-6.94). Neither severity of illness (odds ratio [OR], 1.00; 95% CI: 0.51-1.96) nor primary (OR, 3.41; 95% CI: 0.43-26.7) or secondary hypercoagulability (OR, 0.91; 95% CI: 0.44-1.88) were statistically associated with a higher risk of infection. CONCLUSION: The use of TPA, as a possible indicator in situ thrombus, was associated with a higher risk of developing CLABSI. Neither primary nor secondary hypercoagulability was correlated with risk of developing CLABSI.