An Initiative to Improve Performance on a National Transition of Care Measure and to Reduce Readmissions in an Academic Psychiatric Hospital.

BACKGROUND: Inpatient psychiatry discharge planning through careful transition documentation may reduce adverse patient outcomes and decrease hospital readmissions. In 2017 a national psychiatry reporting program instituted a quality metric called the Transition Record with Specified Elements Received by Discharged Patients (TR-1). At Yale New Haven Psychiatric Hospital, the TR-1 metric had 0% provider compliance when the quality metric was instituted. The primary goal of this quality improvement project was to increase the TR-1 metric compliance through use of a structured clinical decision support (CDS) tool and, by extension, reduce the readmission rate. METHODS: This was a quality improvement project conducted in a 118-bed psych hospital from August 1, 2017, to July 31, 2020, and the preintervention period was from January 1 to July 31, 2017. Demographic and clinical diagnosis data were collected pre- and postintervention. A CDS tool composed of 11 discharge elements was developed and implemented. Primary measures were monthly TR-1 compliance rate as a process metric, and 30-day all-cause readmission rate as an outcome metric. RESULTS: The TR-1 compliance rate increased after CDS tool implementation, with a process mean of 48% in year 1, 56% in year 2, and 65% in year 3. The readmission rate was 9.6% for August 2017 to July 2018, 9.9% for August 2018 to July 2019, and 10.3% for August 2019 to July 2020. A slight upward trend in readmissions was observed over the course of the study, but this was not significant (p = 0.95). CONCLUSION: We found that implementing a CDS tool improved care transition documentation, which was sustained over time. However, the change was not associated with a decrease in 30-day readmission.

Child Abuse Response Simulation for Advanced Practice Nursing Students.

PURPOSE: The purpose of this project was for advanced practice nursing students to gain experience taking a history from a parent or caregiver and communicating the treatment plan for an infant in which child abuse is suspected. PROJECT: Fifty-three students participated in a 1:1 simulated encounter with a standardized patient acting as the mother of an infant with a leg injury that reportedly resulted from a fall from the couch. Students received feedback from the standardized patient via an assessment tool and debriefed with faculty immediately after the simulation. OUTCOME: All students demonstrated empathy, acknowledged the mother's emotions, and communicated the concern for abuse. Additionally, all students explained the x-ray findings, need for hospital admission, and referral to investigative agency for further evaluation. CONCLUSION: Simulations designed to provide advanced practice nursing students with experience interviewing a parent and responding in the case of suspected child abuse are an important method of preparing them for initial clinical encounters.