One important difference is that persons being discharged from a private psychiatric hospital are not always entitled to services from the Local Mental Health Authority (LMHA). Within the first 6 months, readmission occurs for between 20 and 40% of patients (Reference Caton, Koh and FleissCaton et al, 1985; Reference Boydell, Malcolmson and SikerbolBoydell et … This study provided preliminary evidence of an association between commonly required discharge planning practices (contacting a current or prior mental health outpatient provider, scheduling an aftercare appointment, and forwarding a discharge summary to the outpatient provider) and the likelihood and timeliness of the first outpatient appointment following a psychiatric hospitalization for individuals with Medicaid. Electronic versus dictated hospital discharge summaries: a randomized controlled trial. Summary of Proposed Changes CMS proposes the following: • Adoption of the Medication Continuation Following Inpatient Psychiatric Discharge measure - National Quality Forum (NQF) #3205 • Request for public comment o Current measure set o Possible new measures or new measure topics 05/02/2019. Figure 1 displays the results of a survival analysis comparing the time to first follow-up visit among all discharges, grouped by number of discharge planning activities (none, one, any two, or all three). Significant increase was observed in inclusion of date of dictation of discharge summaries which will be a useful component for future audits. The road map for e-discharge summary implementation, including related parall el projects is set out in diagram 1. A significant reduction in spelling/typing errors is also seen. inpatient setting to their next level of care. 10 - Inpatient Psychiatric Facility Services (Rev. It contracted with five managed behavioral health care organizations (MBHOs) to review psychiatric admissions in defined geographic regions in 2012–2013. J Hosp Med 2009; 4:219-225. III. This checklist is intended to provide Healthcare providers with a reference to use when responding to Medical Documentation Requests for Inpatient Psychiatric Admission services. Check. Furthermore, key decisions on patient care can be made by follow-up health professionals, at the earliest and with the help of appropriate information. Providing appropriate instruction and training to junior doctors has been found to be useful in improving the quality of discharge summaries.12 Therefore, it might be beneficial to include instructions or guidelines for appropriate discharge summaries at local Trust or departmental inductions. Table 2: The time taken between discharge of patient and dictation of letter is analysed. However, for 45% of discharges involving adults and 35% of discharges involving youths, the patient did not attend an initial aftercare appointment within 30 days of discharge. Am J Med Quality 1999; 14:160-169. Quality of psychiatric discharge summaries: a service evaluation following the introduction of an electronic discharge summary system. 2020 May 1;58(5):25-31. doi: 10.3928/02793695-20200221-01. This in turn helps in making invaluable decisions to patient care in the community. DISCHARGE SUMMARY FOR PATIENTS AT THE FORENSIC MENTAL HEALTH FACILITY Effective Date: February 1, ... (typically no longer in need of inpatient level of care, no longer a danger to self or others, can be safely and effectively treated within the community, etc.) This study examined discharge planning practices by hospital providers for 17,053 psychiatric discharges in New York’s statewide Medicaid program. Audit of psychiatric discharge summaries: completing the cycle. In summary, individuals who are discharged from an inpatient mental health unit may be unaware of their future risk for suicide. Patient confidentiality and anonymity was maintained. Information model - Mental health inpatient discharge View the standard as a detailed mindmap. It was used for all patients discharged from the acute psychiatric ward in Hither Green Hospital over a 10 month period. It is often the primary mode of communication between the hospital care team and aftercare providers. A search of electronic databases was conducted. The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. CMS L33624/A56865 Connecticut Illinois MBHOs documented hospital providers’ reports of the presence of three discharge planning practices for each discharge: communicating with an outpatient provider prior to discharge, scheduling an aftercare appointment, and forwarding a discharge summary. JAMA 297:831–841, 2007Crossref, Medline, Google Scholar, 9 Coleman EA, Parry C, Chalmers S, et al. A Discharge Summary is created when a patient’s case is closed and referred to another provider either by discharge from an inpatient or outpatient program. Can Fam Phy 1999; 45:2893-2899. Checklist: Inpatient Psychiatric Admission Documentation. The primary outcome was a continuous measure of time to first psychiatric outpatient treatment follow-up during the first 45 days after hospital discharge. 2. This finding has face validity; one would not expect routine discharge planning practices to influence treatment trajectories over longer periods following discharge, when other clinical factors (such as substance use and lack of awareness of need for treatment) and social and environmental factors (such as lack of transportation) are more likely to influence health-seeking behavior. This audit looks at the content and timing of discharge summaries from The Mount, Old Age Psychiatry hospital as to whether it adheres to the local Trust guidelines. Future research should control for important confounding factors that may affect the likelihood that highly vulnerable individuals will access outpatient treatment soon after discharge from hospital psychiatric care. Communication by hospital staff with outpatient providers and timely scheduling of initial outpatient visits following discharge have been associated with improved attendance at outpatient psychiatric services (5,6). To calculate rates of follow-up, we also categorized the outcome by whether the visit occurred within the first seven or 30 days following discharge. However, one study of standardized discharge planning contacts pre- and postdischarge for individuals with multiple readmissions found no impact on readmissions or engagement in outpatient services (7). Raise awareness amongst senior house officers (SHO’s) and other doctors in the Trust regarding recording of pre-morbid history, occupational history, name of keyworker as this was only done in 52%, 62%, 56% cases respectively. 8. There was a slight drop in the time between dictation and typing (from 84% to 73%), which could possibly due to availability of administrative staff, dictation tapes or medical notes and proof reading by medical staff. PSYCHIATRIC HOSPITAL 2121 Main Street Anywhere, USA Date of Exam: 5/5/2015 Time of Exam: 11:21:19 AM Patient Name: Jones, January Patient Number: 1000010659260 PHYSICIAN DISCHARGE SUMMARY Date Admitted: 4/30/2015 Date Discharged: 5/5/2015 This discharge summary consists of : 1. Summary of Proposed Changes CMS proposes the following: • Adoption of the Medication Continuation Following Inpatient Psychiatric Discharge measure - National Quality Forum (NQF) #3205 • Request for public comment o Current measure set o Possible new measures or new measure topics 05/02/2019. 103, No. Acta Psychiatrica Scandinavica 120:1–9, 2009Crossref, Medline, Google Scholar, 7 Puschner B, Steffen S, Völker KA, et al. 2020 May 1;58(5):25-31. doi: 10.3928/02793695-20200221-01. The percentage adherence in cycle 1 is compared with findings from cycle 2. Quality of Electronic Discharge Summaries at Newham University Hospital: An Audit. There was also a significant increase in inclusion of date of dictation of discharge summaries (p<0.001). Therefore, timely audit and feedback can be very useful in improvement of discharge summaries and patient care. Despite ease of diagnosis, monitoring is often poor across psychiatric populations. The authors report no financial relationships with commercial interests. A total of 103 patient discharge summaries were therefore analysed in Cycle 1 of the study. JAMA. Table 1: The presence of information mentioned in the Trust guidelines is analysed. Disposition and treatment … DATE OF DISCHARGE: MM/DD/YYYY. For many individuals, routine discharge planning practices may be necessary and sufficient to ensure successful care transitions. 2013; 23: doi:10.1093/eurpub/ckt126.042. The MHHO care manager documented whether the hospital provider contacted a current or prior mental health outpatient provider, scheduled an aftercare appointment, and forwarded a discharge summary to the outpatient provider. The source for all administrative data was the BH MCOs’ transactional claims systems. NYS wished to collect baseline data regarding discharge planning practices by hospital providers prior to the managed care transition. The workshop’s second panel was structured with one presentation and three reactions to that presentation. In cycle 1 of the audit, adherence to local Trust guidelines in relation to the content, accuracy and timing of discharge summaries were studied. The road map for e-discharge summary implementation, including related parall el projects is set out in diagram 1. Aim. Remove number of pages from the list of sub-headings needed in discharge summary as this is dependent on typing and not necessarily possible to estimate while dictating discharge summary. Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Individuals who received all three discharge planning practices had a higher likelihood of follow-up and kept their first outpatient follow-up visit at almost twice the speed compared with individuals who received none of the practices (hazard ratio=1.96, p<.001). It contracted with five managed behavioral health care organizations (MBHOs) to review psychiatric admissions in defined geographic regions in 2012–2013. 5, 8 October 2019 | Psychiatric Services, Vol. A significant decrease in spelling/typing errors in diagnosis or medical jargon was observed (p<0.001). Accessible summary. Dr. Smith, Dr. Essock, Dr. Olfson, and Dr. Wall are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York (e-mail: 25 August 2020 | Psychiatric Services, Vol. Psychiatric Discharge Summary Medical Transcription Sample Report. Date of Admission/Transfer: Date of Discharge/Transfer: Admitting Diagnosis: This should be your working diagnosis at the time of admission (not the chief complaint/presenting symptoms). aThe survival rate is the percentage of discharges involving individuals who have not attended an initial outpatient visit since being discharged. Data were collected using the data collection tool (appendix 1). INITIAL PSYCHIATRIC ASSESSMENT 3/12/2012 Complete Evaluation History: Anna is a divorced Canadian 59 year old woman. However, it is an important part of discharge summary. Routine discharge planning practices include communicating with outpatient providers regarding treatment plans, scheduling timely appointments for outpatient follow-up care, and forwarding discharge summaries to outpatient providers. CMS Manual System. For cycle 2, the audit sample comprised of patients admitted and discharged from Ward 3 & 4 of The Mount, between 01.04.2012 to 31.10.2012. Hand-written summaries have been found to be well-accepted by primary care physicians although involve the factor of legibility.8 A randomised-controlled trial found no difference between electronic and dictated discharge summaries for primary care physician satisfaction.9 Although the use of electronic discharge summaries has significantly improved both the content and timing of discharge summaries reaching follow-up physician or healthcare staff,10 they have been found to contain higher number of errors in patient progress, additional diagnosis and free-text components.11. The final study cohort included 17,053 discharges. What this paper adds to existing knowledge? Course of Treatment, 3. Aim: The discharge summary is a vital component of patient care. A significant increase is observed in the early typing of discharge letter from the date of discharge of patient. Inpatient Discharge Summary: This is the same format as an interim summary or off-service note This is usually a dictated report (at least in the Children’s hospital), but the format is the same whether dictated or written. Although the MBHOs conducted telephonic concurrent review, they were unable to independently confirm that hospital providers completed each activity. : Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. Discharge records missing a Medicaid identification number or for persons who did not have continuous Medicaid eligibility for at least 45 days postdischarge were excluded (N=4,068). The sample included only Medicaid recipients; measurement of the discharge planning practices was based on provider report, yet providers received no standardized guidance as to what constituted the contacts and communications called for in these practices; and we were unable to document timeliness of the specific practices relative to the discharge date. This could be included in the discharge summary. : Discharge planning in mental health care: a systematic review of the recent literature. A summary of the indicator is provided in Table 2. Significant increase in inclusion of family history, social history, follow-up arrangements and date of dictation is observed. van Walraven C, Seth R, Austin PC, et al. Discharge records for a one-year period (July 2012–June 2013) were selected (N=24,034). The New York State (NYS) Medicaid program transferred management of behavioral health benefits for individuals receiving federal Supplemental Security Income benefits to managed care plans beginning in 2015. Conclusions: This study adds to importance of accuracy and timing of discharge summaries to ensure good medical practice and continuity of care. Further research that determines the best time to use intensive care transition interventions and how to tailor the use of specific interventions for individual patients will allow providers to better align scarce resources. Hence, it is worth spending time on doing a good discharge letter which includes relevant information. This certainly needs improving as these are the relevant areas to facilitate smooth transition of care in the community and follow-up arrangement. However, there was significant decrease in inclusion of follow-up arrangements (p=0.007) as well as a decrease in inclusion of name of key-worker assigned to patient (from 64% in cycle 1 to 56% in cycle 2; p=0.0225). Methods. DATE OF ADMISSION: MM/DD/YYYY. premature discharge from treatment, and the inability to cope with life circumstances are significant factors leading to recurring inpatient hospitalizations (Kanamüller et al., 2014; Noyola, Sorgi, Alday, & Reidler, 2014). O’Leary KJ, Liebovitz DM, Feinglass J, et al. Discharge planning activities included contacting a current or prior mental health outpatient provider, scheduling an aftercare appointment, and forwarding a discharge summary to the outpatient provider. I. He was given a referral to different psychiatrists for his bipolar disorder and also a referral to a facility for his drug abuse history. Discharge Summary . A literature review noted that outpatient primary care providers receive a continuing care plan within one week for only 15% of discharged patients, and up to 25% of continuing care plans never reach outpatient providers (8). By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies. Identify the note as a discharge summary. Author information: (1)Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research Stockholm, Box 4044, 141 04 Stockholm, Sweden. Haglund A(1)(2), Lysell H(2), Larsson H(3)(4), Lichtenstein P(3), Runeson B(2). Compliance with each point from the above categories is shown in the following series of tables and comparison is made between the studies in Cycles 1 and 2 (Table 1-4). There is widespread acceptance of basic discharge planning practices as a standard of care. A systematic review of research on discharge summaries in Europe. 2. Course of Treatment, 3. Aim. It is considered a legal document and it has the potential to jeopardize the patient’s care if errors are made. The four groups appeared to separate by day 3 following discharge and to diverge between days 3 and 8, with individuals who received more discharge planning activities showing more rapid connections with aftercare. Background. Abhishek Shastri, Santosh Bangar, Shoshanah Waldman, Elham Esfahani and Nick Brindle. Individuals with serious mental illnesses who receive inpatient psychiatric treatment are at high risk of experiencing adverse events and poor outcomes during the period immediately following discharge (1). A total of 97 patient discharge summaries were therefore analysed in this part of the study. A follow-on audit was conducted to study the impact of recommendations that had been put forward at the end of Cycle 1 of the audit. The HBIPS measure set is unique in that there are two distinct Initial Patient Populations within the measure set, one for the discharge measures (HBIPS-1, HBIPS-4, HBIPS-5, HBIPS-6, and HBIPS-7) and the other for event measures (HBIPS-2 and HBIPS-3). Predictors included dichotomous (yes/no) indicators for each of the discharge planning practices and a separate variable created to reflect the total number of practices that were implemented (range 0–3). : Predictors of timely follow-up care among Medicaid-enrolled adults after psychiatric hospitalization. Outpatient mental health service use following hospital discharge was documented from Medicaid claims data. 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