Improving a Discharge Process to Decrease Readmission Rates

PURPOSE: The purpose of this quality improvement (QI) project was to improve the case management discharge instructions for patients in an inpatient psychiatric and medical unit. It utilized very specific directions on how to address disease progression symptoms outside of the acute care setting in an effort to achieve readmission rates below the 10th percentile (the unit desired). The current case management discharge process was modified in three ways, including: 1) modification of the case management discharge instructions into a user-friendly, one-page format written on a fifth-grade reading level, 2) dividing the discharge instructions section of warning signs into three categories: mild, moderate, and severe symptoms, and 3) the inclusion of a treatment sheet into the new discharge instructions which was given to the patient at discharge. Chart audits, interviews, observation, and pre- and post-intervention surveys were methods used to collect data regarding patient and nurse perceptions of the usefulness of the discharge instructions, as well as compliance with the new discharge process. OUTCOMES: User-friendliness of the discharge instruction was improved significantly from 20% to 87%. Post implementation, all nurses instructed patients about the warning symptoms on the new discharge form. The completion of the discharge compliance summary improved from 75% to 100%. IMPACT: The nurses and QI team reported satisfaction with the new form’s content and user-friendliness, increasing the likelihood that it will be used and potentially reduce readmission rates

An Object-Oriented Approach to Knowledge Representation in a Biomedical Domain

An object-oriented approach has been applied to the different stages involved in developing a knowledge base about insulin metabolism. At an early stage the separation of terminological and assertional knowledge was made. The terminological component was developed by medical experts and represented in CORE. An object-oriented knowledge acquisition process was applied to the assertional knowledge. A frame description is proposed which includes features like states and events, inheritance and collaboration. States and events are formalized with qualitative calculus. The terminological knowledge was very useful in the development of the assertional component. It assisteed in understanding the problem domain, and in the implementation stage, it assisted in building good inheritance hierarchies

Evaluating the microbial experience influence on anti-tumor immune response

Despite the steady increase of hygienic standards, the CDC continues to report an increase of immune-mediated diseases such as allergies and asthma. Human avoidance of microbial exposure and subsequently less experienced immune systems may be the cause for this increase. We investigated if increased microbial exposure results in increased immunity to cancer (B16 melanoma) by measuring activated lymphocytes between two groups of C57Bl/6 mice: specific pathogen free (SPF) mice (which had little microbial exposure) and cohoused (COH) mice (which were exposed to numerous microbes). Previous research shows that the CoH mouse model mimics a human adult’s immune system, while the SPF mouse model mimics that of a human infant’s. Activated lymphocyte levels were quantified with weekly bleeds using antibody staining flow cytometry. Anti-tumor response was evaluated through multiple harvests in which blood, lymph nodes, spleens, and tumors were collected and analyzed with flow cytometry. CoH mice were expected to have heightened levels of activated lymphocytes and an anti-tumor response superior to the SPF mice. The CoH mice did gain microbial experience and showed in a higher quantity of activated CD8+ T cells. Preliminary results suggest that this may have resulted in an increased anti-tumor response and slowed cancer proliferation