Safe STEP Program Effective for Getting Older Hospitalized Patients Home

Norra MacReady

April 07, 2008

April 7, 2008 (San Diego) — An innovative program helps elderly patients avoid the pitfalls associated with making the transition from hospital to home, Param Dedhia, MD, instructor in the Collaborative Internal Medicine Service, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, reported here at Hospital Medicine 2008, the Society of Hospital Medicine annual meeting.

Nearly half of all older patients experience at least 1 medical error, and almost one quarter experience an adverse event related to peridischarge. For these individuals, "hospitals are dangerous places," said Dr. Dedhia.

Called the Safe and Successful Transition of Elderly Patients (Safe STEP), the new program includes a predischarge history and physical tailored to the special needs of geriatric patients, emphasis on communication and teamwork among providers from different disciplines, a detailed medication review with a pharmacist, and a predischarge meeting among the patient, the patient's caregiver, and a clinician.

The program was tested in general medicine wards run by hospitalists at 3 hospital centers in different states. Postdischarge outcomes for patients who participated in Safe STEP were compared with those of patients who underwent the usual discharge process. All of the patients were at least 65 years old, with home being their planned discharge destination.

The study included 185 Safe STEP patients and 237 control patients. The average age in both groups was about 77 years. At 3 days postdischarge, 88% of the study group described their health as better than it was before their hospital stay compared with 79% of the control group (P = .003). At 30 days, 87% of the study group still considered their health better than before, compared with 70% of the control group (P = .001).

Emergency department (ED) visits and hospital readmission rates reflected the self-assessments: 10% of the control group required ED visits or hospital readmission within 3 days of discharge compared with 3% of the Safe STEP group (P < .003). At 30 days, the rate of ED visits was 21% among the control group and 14% among the intervention group (P = .046), and the rates of hospital readmission were 22% and 14%, respectively (P = .029). Participants in the Safe STEP protocol also reported significantly higher rates of satisfaction with their transitions (P < .001).

Going from hospital to home "is all about handoffs and communications," said Bryan Huang, MD, associate clinical professor of medicine at the University of California, San Diego, who was not involved in this research. These findings show that "if we can improve transitions, we can improve quality of care."

Dr. Dedhia receives research funding from the Society of Hospital Medicine and the John A. Hartford Foundation.

Hospital Medicine 2008: Abstract 16. Presented April 5, 2008.

J Hosp Med. 2008;3(suppl 1):9.


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