Transition of Care for Inpatient Hematology Patients Receiving Chemotherapy: Development of Hospital Discharge Huddle Process and Effects of Implementation

To develop a care model to decrease incidence of preventable errors in the complex multidisciplinary care of hematology inpatients at the time of discharge.An interactive, multidisciplinary, structured discharge process was developed. Multiple focus groups were held to establish the strengths and gaps. A checklist was created for common follow-up needs. Outcomes measured included: dexamethasone received at discharge, antiemetics prescribed, hospital readmissions, number of patient telephone calls received postdischarge, chemotherapy letters created, pegfilgrastim arranged, and peripherally inserted catheter care arranged. Using a pre-post study design, we compared outcomes of patients after the checklist was implemented in June 2014 (n = 41) with a historical cohort of patients admitted to hematology for chemotherapy 1 year earlier in June 2013 (n = 42).Compared with the historical data, improvement was noted for all checklist items except number of hospital readmissions and number of nursing telephone calls. In June 2014, 100% of patients received pegfilgrastim, compared with 88% in June 2013 (P = .02). Antiemetic prescriptions after chemotherapy improved from 40% (June 2013) to 70% (June 2014; P = .004). Two areas did not show improvement: number of readmissions (12 v 21; P = .26) and number of telephone calls after discharge (nine each for June 2013 and 2014; P = 1.0).There was significant decrease in preventable errors demonstrated after implementation of our care model. Developing a systematic approach to hospital discharges can lead to improvements and serve a model for other inpatient wards.