Effects of Implementing a Health Team Communication Redesign on Hospital Readmissions Within 30 Days

Background and Rationale Poor communication between health team members can interfere with timely, coordinated preparation for hospital discharge. Research on daily bedside interprofessional health team rounds and nursing bedside shift handoff reports provides evidence that these strategies can improve communication. Aims To improve health team communication and collaboration about hospital discharge; improve patient experience of discharge measured by patient‐reported quality of discharge teaching, readiness for discharge, and postdischarge coping difficulty; and reduce readmissions and emergency department (ED) visits postdischarge. Methods A two‐sample pre‐ and postintervention design provided baseline data for redesign of health team communication processes and comparison data for evaluation of the new process’ impact. Health team members (n = 105 [pre], n = 95 [post]) from two surgical units of an academic medical center in the midwestern United States provided data on discharge‐related communication and collaboration. Patients (n = 413 [pre], n = 191 [post]) provided data on their discharge experience (quality of discharge teaching, readiness for discharge, postdischarge coping difficulty) and outcomes (readmissions, ED visits). Chi‐square and t tests were used for unadjusted pre‐ and postintervention comparisons. Logistic regression of readmissions with a matched pre‐ and postintervention sample included adjustments for patient characteristics and hospitalization factors. Results Readmissions decreased from 18% to 12% (p \u3c .001); ED visits decreased from 4.4% to 1.5% (p \u3c .001). Changes in health team communication and collaboration and patients’ experience of discharge were minimal. Discussion The targeted outcomes of readmission and ED visits improved after the health team communication process redesign. The process indicators did not improve; potential explanations include unmeasured hospital and unit discharge, and other care process changes during the study timeframe. Linking Evidence to Practice Evidence from daily interprofessional team bedside rounding and bedside shift report studies was translated into a redesign of health team communication for discharge. These strategies support readmission reduction efforts

Interprofessional Health Team Communication About Hospital Discharge: An Implementation Science Evaluation Study

The Consolidated Framework for Implementation Research guided formative evaluation of the implementation of a redesigned interprofessional team rounding process. The purpose of the redesigned process was to improve health team communication about hospital discharge. Themes emerging from interviews of patients, nurses, and providers revealed the inherent value and positive characteristics of the new process, but also workflow, team hierarchy, and process challenges to successful implementation. The evaluation identified actionable recommendations for modifying the implementation process

Statistical mechanics of the multi-constraint continuous knapsack problem

We apply the replica analysis established by Gardner to the multi-constraint continuous knapsack problem,which is one of the linear programming problems and a most fundamental problem in the field of operations research (OR). For a large problem size, we analyse the space of solution and its volume, and estimate the optimal number of items to go into the knapsack as a function of the number of constraints. We study the stability of the replica symmetric (RS) solution and find that the RS calculation cannot estimate the optimal number of items in knapsack correctly if many constraints are required.In order to obtain a consistent solution in the RS region,we try the zero entropy approximation for this continuous solution space and get a stable solution within the RS ansatz.On the other hand, in replica symmetry breaking (RSB) region, the one step RSB solution is found by Parisi's scheme. It turns out that this problem is closely related to the problem of optimal storage capacity and of generalization by maximum stability rule of a spherical perceptron.Comment: Latex 13 pages using IOP style file, 5 figure

Storage of correlated patterns in a perceptron

We calculate the storage capacity of a perceptron for correlated gaussian patterns. We find that the storage capacity $\alpha_c$ can be less than 2 if similar patterns are mapped onto different outputs and vice versa. As long as the patterns are in general position we obtain, in contrast to previous works, that $\alpha_c \geq 1$ in agreement with Cover's theorem. Numerical simulations confirm the results.Comment: 9 pages LaTeX ioplppt style, figures included using eps

Secure exchange of information by synchronization of neural networks

A connection between the theory of neural networks and cryptography is presented. A new phenomenon, namely synchronization of neural networks is leading to a new method of exchange of secret messages. Numerical simulations show that two artificial networks being trained by Hebbian learning rule on their mutual outputs develop an antiparallel state of their synaptic weights. The synchronized weights are used to construct an ephemeral key exchange protocol for a secure transmission of secret data. It is shown that an opponent who knows the protocol and all details of any transmission of the data has no chance to decrypt the secret message, since tracking the weights is a hard problem compared to synchronization. The complexity of the generation of the secure channel is linear with the size of the network.Comment: 11 pages, 5 figure

Learning from Minimum Entropy Queries in a Large Committee Machine

In supervised learning, the redundancy contained in random examples can be avoided by learning from queries. Using statistical mechanics, we study learning from minimum entropy queries in a large tree-committee machine. The generalization error decreases exponentially with the number of training examples, providing a significant improvement over the algebraic decay for random examples. The connection between entropy and generalization error in multi-layer networks is discussed, and a computationally cheap algorithm for constructing queries is suggested and analysed.Comment: 4 pages, REVTeX, multicol, epsf, two postscript figures. To appear in Physical Review E (Rapid Communications

Inferring hidden states in Langevin dynamics on large networks: Average case performance

We present average performance results for dynamical inference problems in large networks, where a set of nodes is hidden while the time trajectories of the others are observed. Examples of this scenario can occur in signal transduction and gene regulation networks. We focus on the linear stochastic dynamics of continuous variables interacting via random Gaussian couplings of generic symmetry. We analyze the inference error, given by the variance of the posterior distribution over hidden paths, in the thermodynamic limit and as a function of the system parameters and the ratio {\alpha} between the number of hidden and observed nodes. By applying Kalman filter recursions we find that the posterior dynamics is governed by an "effective" drift that incorporates the effect of the observations. We present two approaches for characterizing the posterior variance that allow us to tackle, respectively, equilibrium and nonequilibrium dynamics. The first appeals to Random Matrix Theory and reveals average spectral properties of the inference error and typical posterior relaxation times, the second is based on dynamical functionals and yields the inference error as the solution of an algebraic equation.Comment: 20 pages, 5 figure

Statistical Mechanics of Learning: A Variational Approach for Real Data

Using a variational technique, we generalize the statistical physics approach of learning from random examples to make it applicable to real data. We demonstrate the validity and relevance of our method by computing approximate estimators for generalization errors that are based on training data alone.Comment: 4 pages, 2 figure