Improving patient prioritization during hospital-homecare transition: A pilot study of a clinical decision support tool.

Patient admission to homecare is a complex process. Medicare policy requires that all patients receive a first home visit within 48hr after the referral is received at the homecare agency. For unstable or high risk patients, waiting 48hr to be seen by homecare nurses may not be safe. In this pilot study we tested an innovative clinical decision support tool (called PREVENT), designed to identify patients who may need to be prioritized for early homecare visits. The study was conducted in 2016 at a large homecare agency in the Northeastern US with 176 patients admitted to homecare from the hospital. In the control phase (n=90 patients), we calculated the PREVENT priority score (indicative of high or medium/low first nursing visit priority) but did not share the score with the homecare intake nurses who influence visit scheduling. In the experimental phase, the PREVENT score was shared with the homecare intake nurses (n=86 patients). During the experimental phase, high-risk patients received their first homecare nursing visit about one-half a day sooner than in the control phase (1.8 days vs. 2.2 days). Rehospitalizations from homecare decreased by 9.4% between the control (21.1%) and experimental phases (11.7%). This pilot study of patient prioritization showed promising results: high priority patients received their first homecare visit sooner and overall rehospitalization rates were lower.