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Kummerow Broman K, Phillips S, Hayes RM, Ehrenfeld JM, Holzman MD, Sharp K, Kripalani S, Poulose BK. Insurance status influences emergent designation in surgical transfers. J Surg Res 2015; 200:579-85. [PMID: 26346526 DOI: 10.1016/j.jss.2015.08.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/12/2015] [Accepted: 08/14/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND There is a perception among surgeons that hospitals disproportionately transfer unfavorably insured patients for emergency surgical care. Emergency medical condition (EMC) designation mandates referral center acceptance of patients for whom transfer is requested. We sought to understand whether unfavorably insured patients are more likely to be designated as EMCs. MATERIALS AND METHODS A retrospective cohort study was performed on patient transfers from a large network of acute care facilities to emergency surgery services at a tertiary referral center from 2009-2013. Insurance was categorized as favorable (commercial or Medicare) or unfavorable (Medicaid or uninsured). The primary outcome, transfer designation as EMC or non-EMC, was evaluated using multivariable logistic regression. A secondary analysis evaluated uninsured patients only. RESULTS There were 1295 patient transfers in the study period. Twenty percent had unfavorable insurance. Favorably insured patients were older with fewer nonwhite, more comorbidities, greater illness severity, and more likely transferred for care continuity. More unfavorably insured patients were designated as EMCs (90% versus 84%, P < 0.01). In adjusted models, there was no association between unfavorable insurance and EMC transfer (odds ratio [OR], 1.61; 95% confidence interval [CI], 0.98-2.69). Uninsured patients were more likely to be designated as EMCs (OR, 2.27; CI, 1.08-4.77). CONCLUSIONS The finding that uninsured patients were more likely to be designated as EMCs suggests nonclinical variation that may be mitigated by clearer definitions and increased interfacility coordination to identify patients requiring transfer for EMCs.
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Griffith B. Data leads the way to solving patient throughput problems. an interview with Bill Griffith, MBA, CSSBB, CQA. HEALTH MANAGEMENT TECHNOLOGY 2015; 36:16-17. [PMID: 26357752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Eckstein M, Schlesinger SA, Sanko S. Interfacility Transports Utilizing the 9-1-1 Emergency Medical Services System. PREHOSP EMERG CARE 2015; 19:490-5. [PMID: 25909809 DOI: 10.3109/10903127.2015.1005258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND With the increasing development of regional specialty centers, emergency physicians are often confronted with patients needing definitive care unavailable at their hospital. Interfacility transports (IFTs) may be a useful option to ensure timely, definitive patient care. However, since traditional IFT can be a challenging and time-consuming process, some EMS agencies that have previously limited their service to 9-1-1 emergency responses are now performing emergency IFTs. OBJECTIVE We sought to determine the frequency and nature of transfers provided by a local fire-based 9-1-1 EMS agency that recently began to provide limited IFT for time-critical emergencies. METHODS A retrospective review of paramedic reports for all IFTs between April 2007 and March 2014 in the City of Los Angeles, California. All IFTs initiated by 9-1-1 call from an emergency department (ED) and performed by Los Angeles Fire Department paramedics were included. Reason for transfer, patient demographics, and key time metrics were captured. RESULTS There were 919 IFTs during the study period, out of approximately 1,160,000 total ambulance transports (0.1%). The most frequent reason for IFT request was for transport of patients with ST segment elevation MI (STEMI) to a STEMI receiving center, followed by major trauma to a trauma center, and intracranial hemorrhage to a center with neurosurgical capability. Less common reasons included vascular emergencies, acute stroke, obstetric emergencies, and transfers to pediatric critical care facilities. Median transport time was 8 minutes (IQR 6-13 minutes) and median total time for IFT was 51 minutes (IQR 39-69 minutes). All IFTs involved a potentially life-threatening condition requiring a higher level of care than was available at the referring hospital. CONCLUSIONS Emergent ED-to-ED interfacility transport can provide access to time critical definitive care. EMS agencies that have limited the scope of their response to community 9-1-1 emergencies should have policies in place to assure timely response for emergent IFT requests.
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Schoell SL, Doud AN, Weaver AA, Barnard RT, Meredith JW, Stitzel JD, Martin RS. Predicting patients that require care at a trauma center: analysis of injuries and other factors. Injury 2015; 46:558-63. [PMID: 25541419 DOI: 10.1016/j.injury.2014.11.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/21/2014] [Accepted: 11/29/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The detection of occult or unpredictable injuries in motor vehicle crashes (MVCs) is crucial in correctly triaging patients and thus reducing fatalities. The purpose of the study was to develop a metric that indicates the likelihood that an injury sustained in a MVC would require management at a Level I/II trauma centre (TC) versus a non-trauma centre (non-TC). METHODS Transfer Scores (TSs) were computed for 240 injuries that comprise the top 95% most frequently occurring injuries in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) with an Abbreviated Injury Scale (AIS) severity of 2 or greater. A TS for each injury was computed using the proportions of patients involved in a MVC from the National Inpatient Sample (NIS) that were transferred to a TC or managed at a non-TC. Similarly, a TSMAIS that excludes patients with higher severity co-injuries was calculated using the proportion of patients with a maximum AIS (MAIS) equal to the AIS severity of a given injury. RESULTS The results indicated for injuries of a given AIS severity, body region, and injury type, there were large variations in the TSMAIS. Overall results demonstrated higher TSMAIS values when injuries were internal, haemorrhagic, intracranial or of moderate severity (AIS 3-5). Specifically, injuries to the head possessed a TSMAIS that ranged from 0.000 to 0.889, with head injuries of AIS 3-5 severities being the most likely to be transferred. DISCUSSION AND CONCLUSIONS The analysis indicated that the TSMAIS is not solely correlated with AIS severity and therefore it captures other important aspects of injury such as predictability and trauma system capabilities. The TS and TSMAIS can be useful in advanced automatic crash notification (AACN) research for the detection of highly unpredictable injuries in MVCs that require direct transport to a TC.
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Weaver LK. Hyperbaric oxygen treatment for the critically ill patient. Diving Hyperb Med 2015; 45:1. [PMID: 25964030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kot J. Staffing and training issues in critical care hyperbaric medicine. Diving Hyperb Med 2015; 45:47-50. [PMID: 25964039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
The integrated chain of treatment of the most severe clinical cases that require hyperbaric oxygen therapy (HBOT) assumes that intensive care is continued while inside the hyperbaric chamber. Such an approach needs to take into account all the risks associated with transportation of the critically ill patient from the ICU to the chamber and back, changing of ventilator circuits and intravascular lines, using different medical devices in a hyperbaric environment, advanced invasive physiological monitoring as well as medical procedures (infusions, drainage, etc) during long or frequently repeated HBOT sessions. Any medical staff who take care of critically ill patients during HBOT should be certified and trained according to both emergency/intensive care and hyperbaric requirements. For any HBOT session, the number of staff needed for any HBOT session depends on both the type of chamber and the patient's status--stable, demanding or critically ill. For a critically ill patient, the standard procedure is a one-to-one patient-staff ratio inside the chamber; however, the final decision whether this is enough is taken after careful risk assessment based on the patient's condition, clinical indication for HBOT, experience of the personnel involved in that treatment and the available equipment.
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Hilligoss B, Mansfield JA, Patterson ES, Moffatt-Bruce SD. Collaborating—or “Selling” Patients? A Conceptual Framework for Emergency Department–to-Inpatient Handoff Negotiations. Jt Comm J Qual Patient Saf 2015; 41:134-43. [PMID: 25977130 DOI: 10.1016/s1553-7250(15)41019-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Improving transitions within the hospital. HOSPITAL PEER REVIEW 2015; 40:7-8. [PMID: 25597141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Velinov G, Jakimovski B, Lesovski D, Ivanova Panova D, Frtunik D, Kon-Popovska M. EHR System MojTermin: Implementation and Initial Data Analysis. Stud Health Technol Inform 2015; 210:872-876. [PMID: 25991280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Healthcare informatics has gained importance over the last several years. E-health systems on a national level have already been implemented in most European countries. Data generated by these systems are used to improve healthcare policies as well as health services. In this paper we present the system MojTermin (MyAppointment), as it evolves from a healthcare appointment engine to a complete national e-health system. We also present preliminary results from data gathered during the implementation of this system. In our analysis, we show how the system aided in the discovery of several specific socio-cultural phenomena, which led to governance changes in order to optimize resourses and raise the quality of the entire national healthcare system.
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Hägglund M, Bolin P, Koch S. Experiences as input to eHealth design - a hip surgery patient journey case. Stud Health Technol Inform 2015; 210:672-674. [PMID: 25991235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of the study is to describe the planned hip-surgery care process as experienced by patients and healthcare professionals, as well as a qualitative analysis of problems. Data was collected through 3 focus group meetings with patients and healthcare professionals. We present the results in form of a patient journey model, examples of problems as expressed by patients and examples of proposed eHealth services by both patients and care professionals. The results indicate that although the patient journey is similar for most patients, their experiences are highly individual and designing eHealth to improve the patient journey will require flexibility and adaptability to the individual's needs.
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Haque W, Derksen BA, Calado D, Foster L. Using business intelligence for efficient inter-facility patient transfer. Stud Health Technol Inform 2015; 208:170-176. [PMID: 25676968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the context of inter-facility patient transfer, a transfer operator must be able to objectively identify a destination which meets the needs of a patient, while keeping in mind each facility's limitations. We propose a solution which uses Business Intelligence (BI) techniques to analyze data related to healthcare infrastructure and services, and provides a web based system to identify optimal destination(s). The proposed inter-facility transfer system uses a single data warehouse with an Online Analytical Processing (OLAP) cube built on top that supplies analytical data to multiple reports embedded in web pages. The data visualization tool includes map based navigation of the health authority as well as an interactive filtering mechanism which finds facilities meeting the selected criteria. The data visualization is backed by an intuitive data entry web form which safely constrains the data, ensuring consistency and a single version of truth. The overall time required to identify the destination for inter-facility transfers is reduced from hours to a few minutes with this interactive solution.
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Dotseth M. Teaching patients to protect themselves during care transitions: a patient safety campaign. MINNESOTA MEDICINE 2014; 97:41-43. [PMID: 25226653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patient safety can be compromised at any time, but a disproportionate number of problems occur when patients are transitioning between care settings and care providers. Therefore, those trying to improve patient safety need to focus particular attention on times of transition. This article describes a public education campaign to change patients' behaviors during those periods.
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Sussman T, Dupuis S. Supporting residents moving into long-term care: multiple layers shape residents' experiences. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:438-59. [PMID: 24372420 DOI: 10.1080/01634372.2013.875971] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This interpretive grounded theory study explores 10 residents' retrospective accounts of the relocation process, including the decision to move into a long-term care home, the pre-move preparations, the moving day circumstances, and the initial adjustment period following the move. Analysis of the data revealed a complex intersection of conditions at multiple layers that shaped residents' experiences of the transitional process. Recommendations to enhance circumstances at individual, interpersonal, and systemic layers, for each temporal stage of the relocation process are proposed. Implications for social work practice across the continuum of care are also discussed.
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Scott J, Waring J, Heavey E, Dawson P. Patient Reporting of Safety experiences in Organisational Care Transfers (PRoSOCT): a feasibility study of a patient reporting tool as a proactive approach to identifying latent conditions within healthcare systems. BMJ Open 2014; 4:e005416. [PMID: 24833698 PMCID: PMC4024601 DOI: 10.1136/bmjopen-2014-005416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/17/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is increasingly recognised that patients can play a role in reporting safety incidents. Studies have tended to focus on patients within hospital settings, and on the reporting of patient safety incidents as defined within a medical model of safety. This study aims to determine the feasibility of collecting and using patient experiences of safety as a proactive approach to identifying latent conditions of safety as patients undergo organisational care transfers. METHODS AND ANALYSIS The study comprises three components: (1) patients' experiences of safety relating to a care transfer, (2) patients' receptiveness to reporting experiences of safety, (3) quality improvement using patient experiences of safety. (1) A safety survey and evaluation form will be distributed to patients discharged from 15 wards across four clinical areas (cardiac, care of older people, orthopaedics and stroke) over 1 year. Healthcare professionals involved in the care transfer will be provided with a regular summary of patient feedback. (2) Patients (n=36) who return an evaluation form will be sampled representatively based on the four clinical areas and interviewed about their experiences of healthcare and safety and completing the survey. (3) Healthcare professionals (n=75) will be invited to participate in semistructured interviews and focus groups to discuss their experiences with and perceptions of receiving and using patient feedback. Data analysis will explore the relationship between patient experiences of safety and other indicators and measures of quality and safety. Interview and focus group data will be thematically analysed and triangulated with all other data sources using a convergence coding matrix. ETHICS AND DISSEMINATION The study has been granted National Health Service (NHS) Research Ethics Committee approval. Patient experiences of safety will be disseminated to healthcare teams for the purpose of organisational development and quality improvement. Results will be disseminated to study participants as well as through peer-reviewed outputs.
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Lomi A, Mascia D, Vu DQ, Pallotti F, Conaldi G, Iwashyna TJ. Quality of care and interhospital collaboration: a study of patient transfers in Italy. Med Care 2014; 52:407-14. [PMID: 24714579 PMCID: PMC4036796 DOI: 10.1097/mlr.0000000000000107] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We examine the dynamics of patient-sharing relations within an Italian regional community of 35 hospitals serving approximately 1,300,000 people. We test whether interorganizational relations provide individual patients access to higher quality providers of care. RESEARCH DESIGN AND METHODS We reconstruct the complete temporal sequence of the 3461 consecutive interhospital patient-sharing events observed between each pair of hospitals in the community during 2005-2008. We distinguish between transfers occurring between and within different medical specialties. We estimate newly derived models for relational event sequences that allow us to control for the most common forms of network-like dependencies that are known to characterize collaborative relations between hospitals. We use 45-day risk-adjusted readmission rate as a proxy for hospital quality. RESULTS After controls (eg, geographical distance, size, and the existence of prior collaborative relations), we find that patients flow from less to more capable hospitals. We show that this result holds for patient being shared both between as well as within medical specialties. Nonetheless there are strong and persistent other organizational and relational effects driving transfers. CONCLUSIONS Decentralized patient-sharing decisions taken by the 35 hospitals give rise to a system of collaborative interorganizational arrangements that allow the patient to access hospitals delivering a higher quality of care. This result is relevant for health care policy because it suggests that collaborative relations between hospitals may produce desirable outcomes both for individual patients, and for regional health care systems.
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Laing IA. Where should extreme preterm babies be delivered? Crucial data from EPICure. Arch Dis Child Fetal Neonatal Ed 2014; 99:F177-8. [PMID: 24723697 DOI: 10.1136/archdischild-2014-306020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Micklos L. Transition and interprofessional collaboration in moving from pediatric to adult renal care. Nephrol Nurs J 2014; 41:311-317. [PMID: 25065064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Gonzalo JD, Yang JJ, Stuckey HL, Fischer CM, Sanchez LD, Herzig SJ. Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool. Int J Qual Health Care 2014; 26:337-47. [PMID: 24737836 DOI: 10.1093/intqhc/mzu040] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a new electronic handoff tool for emergency department to medicine ward patient transfers over a 1-year period. DESIGN Prospective mixed-methods analysis of data submitted by medicine residents following admitting shifts before and after eSignout implementation. SETTING University-based, tertiary-care hospital. PARTICIPANTS Internal medicine resident physicians admitting patients from the emergency department. INTERVENTION An electronic handoff tool (eSignout) utilizing automated paging communication and responsibility acceptance without mandatory verbal communication between emergency department and medicine ward providers. MAIN OUTCOME MEASURES (i) Incidence of reported near misses/adverse events, (ii) communication of key clinical information and quality of verbal communication and (iii) characterization of near misses/adverse events. RESULTS Seventy-eight of 80 surveys (98%) and 1058 of 1388 surveys (76%) were completed before and after eSignout implementation. Compared with pre-intervention, residents in the post-intervention period reported similar number of shifts with a near miss/adverse event (10.3 vs. 7.8%; P = 0.27), similar communication of key clinical information, and improved verbal signout quality, when it occurred. Compared with the former process requiring mandatory verbal communication, 93% believed the eSignout was more efficient and 61% preferred the eSignout. Patient safety issues related to perceived sufficiency/accuracy of diagnosis, treatment or disposition, and information quality. CONCLUSIONS The eSignout was perceived as more efficient and preferred over the mandatory verbal signout process. Rates of reported adverse events were similar before and after the intervention. Our experience suggests electronic platforms with optional verbal communication can be used to standardize and improve the perceived efficiency of patient handoffs.
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Street M, Considine J, Livingston P, Ottmann G, Kent B. In-reach nursing services improve older patient outcomes and access to emergency care. Australas J Ageing 2014; 34:115-20. [PMID: 24571401 DOI: 10.1111/ajag.12137] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. METHODS Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services. RESULTS Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P < 0.001) and admission rates decreased by 23% (68 vs 45%, P < 0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P = 0.007). CONCLUSIONS There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.
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Aizen E, Hindawi E, Shahla H, Elyounes AA. [The effect of an intervention on rates of nursing home residents transfers to emergency departments]. HAREFUAH 2014; 153:83-127. [PMID: 24716424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Transfers of nursing home residents to emergency departments can result in iatrogenic complications, morbidity, and excess health care expenditure. Some of these transfers are potentially avoidable. OBJECTIVES To determine the rate of emergency department transfers of nursing home residents, prior to and following an intervention program that includes a set of tools and strategies designed to reduce these transfers. METHODS The present study was conducted in four departments at the Shfaram Geriatric Center (Beet Alenaya). The rate of emergency department transfers was determined in 118 residents of the nursing home during the 12 months prior to and during the 12 months following implementation and initiation of the intervention. RESULTS Following the intervention, a significant reduction in the rate of emergency department transfers was observed in the study population from 2.61 to 1.28 transfers per 1,000 stay days, with a 50.1% transfer reduction (P < 0.005). The most significant reduction was observed among residents staying in the Complex Nursing Care Department (54.7%)(P < 0.05). The reduction rate among long term nursing care residents was modest (20.3%) and did not reach statistical significance. CONCLUSION The implementation of such an intervention can reduce the rate of transfers of nursing home residents to emergency departments. Such interventions might lead to quality improvement in nursing homes and should be further evaluated in larger randomized controlled trials.
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Griffiths D, Morphet J, Jones T, Williams A, Innes K, Crawford K, Morey J. Management of aged care residents in the emergency department. AUSTRALIAN NURSING & MIDWIFERY JOURNAL 2014; 21:39. [PMID: 24673024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Embedded crisis workers help to decompress ED, connect mental health and addiction medicine patients with needed resources. ED MANAGEMENT : THE MONTHLY UPDATE ON EMERGENCY DEPARTMENT MANAGEMENT 2014; 26:13-17. [PMID: 24505862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To manage a big spike in demand from patients seeking emergency care for mental health (MH) and addiction medicine concerns, staff from the University of Pittsburgh Medical Center-Mercy and Western Psychiatric Institute and Clinic of UPMC have devised a series of interventions aimed at quickly linking these patients with the care and resources they need. The most visible intervention is the addition of embedded crisis workers in the ED who help patients with MH or social needs navigate to more appropriate community resources. In just one year, the time it takes for a detox patient to be seen in the ED has decreased from one hour to less than 15 minutes, and the time it takes for a patient to be admitted to a detox unit has gone from about 20 hours to six hours. The percentage of patients admitted for MH or addiction medicine concerns has declined as staff have been able to apply inpatient resources more appropriately. Administrators say the hospital's clinical decision unit, which had been serving as a holding tank for the crush of MH and addiction medicine patients awaiting inpatient beds, can now be used for its intended purpose, for medical issues related to patients evaluated and treatment in the ED.
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Johnson SR. Managing care between home and hospice. MODERN HEALTHCARE 2014; 44:26. [PMID: 24640397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Flemming D, Paul M, Hübner U. Building a common ground on the clinical case: design, implementation and evaluation of an information model for a Handover EHR. Stud Health Technol Inform 2014; 201:167-174. [PMID: 24943540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Handovers need a common ground on the clinical cases between the members of the successive shifts to establish continuity of care. Conventional electronic patient record systems (EHR) proved to be only insufficiently suitable for supporting the grounding process. Against this background we proposed a basic concept for a handover EHR that extends general EHRs in particular openEHR based systems. The resulting handover information model was implemented in a database and evaluated based on 120 clinical cases. The information items of these cases could be mapped successfully to the model, however, the new class "anticipatory guidance" needed to be introduced. The evaluation also demonstrated the importance of highly aggregated information on the clinical case, opinions and meta-information such as the relevance of an item during handovers. Based on these findings, in particular the handover database, handover EHR applications are currently developed to support the grounding process.
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McKinlay JAC. Diploma in Retrieval and Transfer Medicine. JOURNAL OF THE ROYAL NAVAL MEDICAL SERVICE 2014; 100:97. [PMID: 24881436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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