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Penney LS, Nahid M, Leykum LK, Lanham HJ, Noël PH, Finley EP, Pugh J. Interventions to reduce readmissions: can complex adaptive system theory explain the heterogeneity in effectiveness? A systematic review. BMC Health Serv Res 2018; 18:894. [PMID: 30477576 PMCID: PMC6260570 DOI: 10.1186/s12913-018-3712-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
Background Successfully transitioning patients from hospital to home is a complex, often uncertain task. Despite significant efforts to improve the effectiveness of care transitions, they remain a challenge across health care systems. The lens of complex adaptive systems (CAS) provides a theoretical approach for studying care transition interventions, with potential implications for intervention effectiveness. The aim of this study is to examine whether care transition interventions that are congruent with the complexity of the processes and conditions they are trying to improve will have better outcomes. Methods We identified a convenience sample of high-quality care transition intervention studies included in a care transition synthesis report by Kansagara and colleagues. After excluding studies that did not meet our criteria, we scored each study based on (1) the presence or absence of 5 CAS characteristics (learning, interconnections, self-organization, co-evolution, and emergence), as well as system-level interdependencies (resources and processes) in the intervention design, and (2) scored study readmission-related outcomes for effectiveness. Results Forty-four of the 154 reviewed articles met our inclusion criteria; these studies reported on 46 interventions. Nearly all the interventions involved a change in interconnections between people compared with care as usual (96% of interventions), and added resources (98%) and processes (98%). Most contained elements impacting learning (67%) and self-organization (69%). No intervention reflected either co-evolution or emergence. Almost 40% of interventions were rated as effective in terms of impact on hospital readmissions. Chi square testing for an association between outcomes and CAS characteristics was not significant for learning or self-organization, however interventions rated as effective were significantly more likely to have both of these characteristics (78%) than interventions rated as having no effect (32%, p = 0.005). Conclusions Interventions with components that influenced learning and self-organization were associated with a significant improvement in hospital readmissions-related outcomes. Learning alone might be necessary but not be sufficient for improving transitions. However, building self-organization into the intervention might help people effectively respond to problems and adapt in uncertain situations to reduce the likelihood of readmission. Electronic supplementary material The online version of this article (10.1186/s12913-018-3712-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren S Penney
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA. .,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Musarrat Nahid
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Luci K Leykum
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, 2110 Speedway Stop B6500, Austin, TX, 78712-1277, USA
| | - Holly Jordan Lanham
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, 2110 Speedway Stop B6500, Austin, TX, 78712-1277, USA.,Department of Family & Community Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Polly H Noël
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Family & Community Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Erin P Finley
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Psychiatry, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Jacqueline Pugh
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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Prusaczyk B, Kripalani S, Dhand A. Networks of hospital discharge planning teams and readmissions. J Interprof Care 2018; 33:85-92. [DOI: 10.1080/13561820.2018.1515193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Beth Prusaczyk
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amar Dhand
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Network Science Institute, Northeastern University, Boston, MA, USA
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Development and validation of a simplified BRASS index to screen hospital patients needing personalized discharge planning. J Gen Intern Med 2018; 33:1084-1091. [PMID: 29663280 PMCID: PMC6025690 DOI: 10.1007/s11606-018-4405-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/04/2018] [Accepted: 02/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Discharge planning is an important component of hospital care. The Blaylock Risk Assessment Screening Score (BRASS) index is an instrument used to identify patients requiring complex discharge planning. OBJECTIVES (1) Evaluate the ability of the original BRASS index to predict the risk of complex discharge and hospital mortality. (2) Develop and validate a simplified BRASS index by eliminating redundant variables and re-estimating the predictor weights. DESIGN Prospective cohort study. PARTICIPANTS Patients admitted at the general internal medicine wards of tertiary referral hospital in Turin, Italy, and screened within 48 h using the BRASS index. METHODS The first phase of the study assessed the performance of the original BRASS index in predicting the risk of complex discharge and hospital mortality, then a simplified score was developed. In the second phase, temporal validation of the simplified BRASS index was performed. The probability of each discharge modality (discharged at home without complications, complex discharge, and dead in hospital) was modeled using polytomous logistic regression. The AUC was used to compare the performance of the different models. KEY RESULTS Among 6044 patients in the first phase of the study, 63% were discharged at home without complications, 31% had complex discharge, and 6% died during the hospital stay. The AUC of the simplified BRASS index, compared with the original index were 0.71 vs. 0.70 for complex discharge and 0.83 vs. 0.80 for hospital mortality. In the validation set (3325 patients), the simplified BRASS index discriminates the outcome categories with an AUC of 0.69 and 0.81 for complex discharge and hospital mortality, respectively. CONCLUSION The new, simplified BRASS index showed a slightly better performance in predicting the risk of complex discharge and hospital mortality than the original tool and takes less time to be applied. These results were also confirmed in the validation set.
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Naseri C, Haines TP, Etherton-Beer C, McPhail S, Morris ME, Flicker L, Netto J, Francis-Coad J, Lee DCA, Shorr R, Hill AM. Reducing falls in older adults recently discharged from hospital: a systematic review and meta-analysis. Age Ageing 2018; 47:512-519. [PMID: 29584895 PMCID: PMC7206858 DOI: 10.1093/ageing/afy043] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 02/04/2018] [Accepted: 03/01/2018] [Indexed: 12/20/2022] Open
Abstract
Background older adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital. Methods literature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager® Results sixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. We found home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence). Conclusion the recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.
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Affiliation(s)
- Chiara Naseri
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, Western Australia
| | - Terry P Haines
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- Department of Geriatric Medicine, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia
| | - Steven McPhail
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Meg E Morris
- Healthscope & La Trobe Centre for Sport & Exercise Medicine Research, La Trobe University, Victoria, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia
| | - Julie Netto
- School of Occupational Therapy and Social Work, Faculty of Health Science, Curtin University, Perth, Western Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia
| | - Den-Ching A Lee
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Ronald Shorr
- Malcom Randall VA Medical Center, Geriatric Research Education and Clinical Center (GRECC), Florida, USA
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, Western Australia
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Grimsmo A, Løhre A, Røsstad T, Gjerde I, Heiberg I, Steinsbekk A. Disease-specific clinical pathways - are they feasible in primary care? A mixed-methods study. Scand J Prim Health Care 2018; 36:152-160. [PMID: 29644927 PMCID: PMC6066276 DOI: 10.1080/02813432.2018.1459167] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE To explore the feasibility of disease-specific clinical pathways when used in primary care. DESIGN A mixed-method sequential exploratory design was used. First, merging and exploring quality interview data across two cases of collaboration between the specialist care and primary care on the introduction of clinical pathways for four selected chronic diseases. Secondly, using quantitative data covering a population of 214,700 to validate and test hypothesis derived from the qualitative findings. SETTING Primary care and specialist care collaborating to manage care coordination. RESULTS Primary-care representatives expressed that their patients often have complex health and social needs that clinical pathways guidelines seldom consider. The representatives experienced that COPD, heart failure, stroke and hip fracture, frequently seen in hospitals, appear in low numbers in primary care. The quantitative study confirmed the extensive complexity among home healthcare nursing patients and demonstrated that, for each of the four selected diagnoses, a homecare nurse on average is responsible for preparing reception of the patient at home after discharge from hospital, less often than every other year. CONCLUSIONS The feasibility of disease-specific pathways in primary care is limited, both from a clinical and organisational perspective, for patients with complex needs. The low prevalence in primary care of patients with important chronic conditions, needing coordinated care after hospital discharge, constricts transferring tasks from specialist care. Generic clinical pathways are likely to be more feasible and efficient for patients in this setting. Key points Clinical pathways in hospitals apply to single-disease guidelines, while more than 90% of the patients discharged to community health care for follow-up have multimorbidity. Primary care has to manage the health care of the patient holistically, with all his or her complex needs. Patients most frequently admitted to hospitals, i.e. patients with COPD, heart failure, stroke and hip fracture are infrequent in primary care and represent a minority among patients in need of coordinated community health care. In primary care, the low rate of receiving patients discharged from hospitals of major chronic diseases hampers maintenance of required specific skills, thus constricting the transfer of tasks to primary care. Generic clinical pathways are suggested to be more feasible than disease-specific pathways for most patients with complex needs.
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Affiliation(s)
- Anders Grimsmo
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway;
- CONTACT Anders GrimsmoDepartment of Public Health and Nursing, Norwegian University of Science and Technology, P.O. Box 8905, 7491Trondheim, Norway
| | - Audhild Løhre
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway;
| | - Tove Røsstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway;
| | - Ingunn Gjerde
- Faculty of Business Administration and Social Sciences, Molde University College, Specialized University in Logistics, Molde, Norway;
| | - Ina Heiberg
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway;
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Khanbhai Y, Nance M, Smith D. The development and implementation of a discharge checklist for psychiatric inpatients: a pilot study. Australas Psychiatry 2018; 26:259-262. [PMID: 29359578 DOI: 10.1177/1039856217751987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Readmission rates are a routinely used measure of patient and service outcomes, potentially improved by discharge planning. This pilot study aimed to develop a discharge checklist for psychiatric inpatients, exploring its feasibility, applicability, and impact on readmission rates. METHODS The study used a quasi-experimental, pre-post intervention design. The checklist was designed from an evidence-based literature review, and introduced for a three-month period, comparing 28-day readmission rates with the previous three months using interrupted time series analysis. RESULTS Checklists were completed for 80% of patients in the trial period, with 100% completion of checklist items. Demographic and clinical details for pre- and post-intervention groups were closely aligned. There was a small, but statistically non-significant, reduction in readmission rates. CONCLUSIONS There was a high rate of checklist completion. The lack of significant reductions in readmission rates supports more development of the checklist application and design before a longer implementation period and re-evaluation.
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Affiliation(s)
- Yasmin Khanbhai
- Resident Medical Officer, Margaret Tobin Centre, Department of Psychiatry, Flinders Medical Centre, Adelaide, SA, Australia
| | - Michael Nance
- Consultant Psychiatrist, Head of Unit, Margaret Tobin Centre, Flinders Medical Centre, Adelaide, SA, Australia
| | - David Smith
- Senior Research Fellow, Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, SA, Australia
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Measuring the Delivery of Complex Interventions through Electronic Medical Records: Challenges and Lessons Learned. EGEMS 2018; 6:10. [PMID: 30094282 PMCID: PMC6078114 DOI: 10.5334/egems.230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Health services and implementation researchers often seek to capture the implementation process of complex interventions yet explicit guidance on how to capture this process is limited. Medical record review is a commonly used methodology, especially when used as a proxy for provider behavior, with recognized benefits and limitations. The purpose of this study was to test the feasibility of chart review to measure implementation and offer recommendations for future researchers using this method to capture the implementation process. Methods: Grounded in qualitative research methods, we measured the implementation of a transitional care intervention for older adults with dementia being discharged from the hospital. We adapted the operationalization of the intervention’s components to suit chart review methods, sought input from hospital providers before and after data collection, and assessed the agreement between the results of our chart review and provider-report. Findings: We believe chart review can be used effectively as a method for capturing the implementation process and provide future researchers with a list of recommendations based on our experience including understanding the nuance between data extraction versus data abstraction, allowing for large amounts of data not pre-specified in the data collection instrument to be collected, and purposefully and iteratively engaging the providers who are entering data into the chart. Major Themes: Measuring the implementation of complex interventions is a cornerstone in health services research and with the relative convenience and low costs of using chart data, we believe with more use and refinement this methodology could emerge as a valuable and widely used method in the field.
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Socwell CP, Bucci L, Patchell S, Kotowicz E, Edbrooke L, Pope R. Utility of Mayo Clinic's early screen for discharge planning tool for predicting patient length of stay, discharge destination, and readmission risk in an inpatient oncology cohort. Support Care Cancer 2018; 26:3843-3849. [PMID: 29777381 DOI: 10.1007/s00520-018-4252-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/06/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE To examine the feasibility of using the Mayo Clinic's Early Screen for Discharge Planning (ESDP) tool in determining its predictive ability in an inpatient oncology hospital setting for variables including length of stay (LOS), discharge destination, and readmission risk. METHODS A prospective observational study was conducted at a metropolitan tertiary cancer centre in Melbourne, Australia. The ESDP score, along with patient outcomes and characteristics, were collected to examine the relationships between positive and negative ESDP scores and patient outcomes. RESULTS A total of 136 participants met inclusion criteria for this study. The proportion with positive ESDP scores was greater in those with unplanned hospital admissions compared with planned admissions (χ2(1, n = 136) = 3.94, p = 0.047). The ESDP status was not a significant predictor of oncology hospital LOS (rpb = 0.116, p = 0.178); however, the ESDP scores did predict discharge destination (χ2(2, n = 136) = 20.22, p < .001). Those re-admitted within 14 days were more likely to have negative ESDP scores than those not readmitted within this time period (χ2(1, n = 136) = 5.22, p = 0.022). Those with positive ESDP scores received a greater number of hospital services whilst admitted than those with negative scores (rpb = 0.388, p < .001) and were more likely to receive particular types of services. CONCLUSION The findings from this study suggest that the ESDP tool could be useful in an adult inpatient oncology population in a hospital with defined specialised hospital discharge planning services (SHDCPS). The ESDP may be beneficial for early identification of service types likely to be required in care and likely discharge destination, both of which can assist discharge planning (DP); however, the ESDP was not useful for predicting LOS or readmission risk in the adult inpatient oncology population without a SHDCPS model in place.
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Affiliation(s)
- Caitlyn P Socwell
- Doctor of Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4226, Australia.
| | - Lucy Bucci
- Physiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Sharni Patchell
- Physiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Erika Kotowicz
- Physiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Lara Edbrooke
- Physiotherapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
| | - Rodney Pope
- Doctor of Physiotherapy Program, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4226, Australia.,School of Community Health, Charles Sturt University, Albury, NSW, 2640, Australia
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Naseri C, McPhail SM, Netto J, Haines TP, Morris ME, Etherton-Beer C, Flicker L, Lee DCA, Francis-Coad J, Hill AM. Impact of tailored falls prevention education for older adults at hospital discharge on engagement in falls prevention strategies postdischarge: protocol for a process evaluation. BMJ Open 2018; 8:e020726. [PMID: 29678985 PMCID: PMC5914781 DOI: 10.1136/bmjopen-2017-020726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Older adults recently discharged from hospital have greater incidence of adverse events, functional decline, falls and subsequent readmission. Providing education to hospitalised patients on how to prevent falls at home could reduce postdischarge falls. There has been limited research investigating how older adults respond to tailored falls prevention education provided at hospital discharge. The aim of this study is to evaluate how providing tailored falls prevention education to older patients at the point of, and immediately after hospital discharge in addition to usual care, affects engagement in falls prevention strategies in the 6-months postdischarge period, including their capability and motivation to engage in falls prevention strategies. METHODS AND ANALYSES This prospective observational cohort study is a process evaluation of a randomised controlled trial, using an embedded mixed-method design. Participants (n=390) who have been enrolled in the trial are over the age of 60 years, scoring greater than 7/10 on the Abbreviated Mental Test Score. Participants are being discharged from hospital rehabilitation wards in Perth, Western Australia, and followed up for 6 months postdischarge. Primary outcome measures for the process evaluation are engagement in falls prevention strategies, including exercise, home modifications and receiving assistance with activities of daily living. Secondary outcomes will measure capability, motivation and opportunity to engage in falls prevention strategies, based on the constructs of the Capability Opportunity Motivation Behaviour system. Quantitative data are collected at baseline, then at 6 months postdischarge using structured phone interviews. Qualitative data are collected from a purposive sample of the cohort, using semistructured in-depth phone interviews. Quantitative data will be analysed using regression modelling and qualitative data will be analysed using interpretive phenomenological analysis. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed journals and at conferences worldwide. This study is approved by hospital and university Human Research Ethics Committees.
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Affiliation(s)
- Chiara Naseri
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | - Steven M McPhail
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Woolloongabba, Queensland, Australia
| | - Julie Netto
- School of Occupational Therapy and Social Work, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | - Terrence P Haines
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Meg E Morris
- Healthscope & La Trobe Centre for Sport & Exercise Medicine Research, La Trobe University, Melbourne, Victoria, Australia
| | - Christopher Etherton-Beer
- Department of Geriatric Medicine, School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia
| | - Den-Ching A Lee
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
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Lin LE, Lo SC, Liu CY, Chen SC, Wu WC, Liu WI. Effectiveness of Needs-oriented Hospital Discharge Planning for Caregivers of Patients With Schizophrenia. Arch Psychiatr Nurs 2018; 32:180-187. [PMID: 29579510 DOI: 10.1016/j.apnu.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 11/26/2022]
Abstract
Hospital discharge planning for clients with schizophrenia reduces client rehospitalization rates and improves their medication adherence. The effectiveness of caregiver participation in hospital discharge planning has seldom been explored. The purpose of this study was to examine the effectiveness of caregiver participation in hospital discharge planning for clients with schizophrenia in reducing caregiver burden and improving health status. A quasi-experimental research design was adopted. The research location was in a psychiatric hospital in Northern Taiwan. The target population was caregivers of inpatients with schizophrenia. Nurses served as care coordinators and provided six-step hospital discharge planning services to caregivers. Structured questionnaires were employed to measure caregiver burden and health status. Intervention effect was tested using analysis of covariance in which outcome measure at pretest and selected demographic variables were treated as covariates. A total of 114 caregivers completed pretest and posttest evaluations, with 57 people in each group. A significant difference was found between the experimental and the control group regarding the caregiver burden and health status (P<0.001) The caregiver burden and health status of the experimental group improved more significantly compared with the control group. The caregiver-involved discharge planning process developed in this study effectively reduced the burden placed on caregivers and improved their health status. Mental health nurses can serve as the main care coordinators for assessment, planning, referral and provision of the required services. Caregiver-involved hospital discharge planning should become part of the routine care process.
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Affiliation(s)
- Li-En Lin
- Department of Nursing, Bali Psychiatric Center, No.33, Huafushan, Bali Dist., New Taipei City 249, Taiwan, ROC
| | - Su-Chen Lo
- Department of Nursing, Bali Psychiatric Center, No.33, Huafushan, Bali Dist., New Taipei City 249, Taiwan, ROC
| | - Chieh-Yu Liu
- National Taipei University of Nursing and Health Sciences
| | - Shing-Chia Chen
- School of Nursing, College of Medicine, National Taiwan University, Department of Nursing, National Taiwan University Hospital, No.1, Sec. 1, Ren Ai Rd., Zhongzheng Dist., Taipei City 10052, Taiwan, ROC
| | - Wen-Cheng Wu
- Tao Yuan General Hospital, Ministry of Health and Welfare; School of Law, Fu Jen Catholic University
| | - Wen-I Liu
- National Taipei University of Nursing and Health Sciences.
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Baky V, Moran D, Warwick T, George A, Williams T, McWilliams E, Marine JE. Obtaining a follow-up appointment before discharge protects against readmission for patients with acute coronary syndrome and heart failure: A quality improvement project. Int J Cardiol 2018; 257:12-15. [DOI: 10.1016/j.ijcard.2017.10.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/01/2017] [Accepted: 10/09/2017] [Indexed: 11/28/2022]
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Xiang X, Robinson-Lane SG, Rosenberg W, Alvarez R. Implementing and sustaining evidence-based practice in health care: The Bridge Model experience. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:280-294. [PMID: 29488854 PMCID: PMC5880696 DOI: 10.1080/01634372.2018.1445154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This qualitative study analyzed the experience of community-based organizations (CBOs) implementing and sustaining the Bridge Model of Transitional Care, a social work-based health service intervention for reducing hospital readmissions. We conducted semi-structured interviews with clinical supervisors from 13 CBOs that received Bridge Model training between 2012 and 2015. CBOs faced significant challenges implementing and sustaining transitional care programs, particularly related to building effective and sustainable partnerships with hospitals. Additional barriers to program implementation and sustainability included financial barriers and staff turnover. Facilitators to implementation and sustainability included organizational champions, organizational culture, and value of evidence. Recommendations for CBOs to implement health service interventions include gaining early buy-in from hospital partners, creating a contractual arrangement with the hospital partner, understanding changes in health-care payment models, diversifying funding sources, developing an evaluation plan, and nurturing organizational champions.
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Affiliation(s)
- Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | - Walter Rosenberg
- Social Work and Community Health, Rush University Medical Center, Chicago, IL, USA
| | - Renae Alvarez
- Center for Long Term Care Reform, Health & Medicine Policy Research Group, Chicago, IL, USA
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Cammilletti V, Forino F, Palombi M, Donati D, Tartaglini D, Di Muzio M. BRASS score and complex discharge: a pilot study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:414-425. [PMID: 29350655 PMCID: PMC6166170 DOI: 10.23750/abm.v88i4.6191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 11/23/2022]
Abstract
Aims: A highly functional continuity of patient care, which is linked to the reduction of the risk of long-term hospitalization, above all for ‘at-risk’ patients. Research into an objective, reliable instrument for redirecting individual results to organizational aims to extend the entire country, is a fundamental step to move from a reactive assistance approach to a pro-active one. Methods: An observational and descriptive retrospective study was carried out July - November 2014 in two Italian state hospitals, completing the BRASS Index within 48/72 hours of admission. Results: The study group consisted of 122 inpatients. A correlation presented itself, albeit low (ρ=0.05191), between age and the number of ‘revolving door’ admissions; a medium correlation (ρ=0.485131) between age and risk band (according to BRASS). Conclusions: The BRASS Index is straightforward and swift, and can prove a valuable tool in directing nurses’ attention to those patients most at risk of prolonged hospitalization. (www.actabiomedica.it)
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Affiliation(s)
| | - Fortunata Forino
- Policlinico Umberto I of Rome, Sapienza University of Rome, Italy.
| | - Marina Palombi
- Policlinico Umberto I of Rome, Sapienza University of Rome, Italy.
| | | | | | - Marco Di Muzio
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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Seyedfarajollah S, Nayeri F, Kalhori SRN, Ghazisaeedi M, Keikha L. The Framework of NICU-discharge Plan System for Preterm Infants in Iran: Duties, Components and Capabilities. Acta Inform Med 2018; 26:46-50. [PMID: 29719313 PMCID: PMC5869233 DOI: 10.5455/aim.2018.26.46-50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: The development of comprehensive discharge plan system Not only, will facilitate the discharge process, increase staff and parent satisfaction, improve the care of preterm infants, also reduce the human error. Aim: to determine duties, components and capabilities of NICU discharge plan system as a multidimensional tool for facilitating the complex process of transition preterm infants to the home and support parents for post-discharge care. Method: The descriptive and qualitative study conducted in 2017. Firstly by literature review, components of framework were determined in 38 statements under 3 major themes: duties, components, and capabilities and then related questionnaire was provided. Cronbach’s alpha test was used to assess the reliability of the questionnaire. The result was more than 0.82 for all statements of questionnaire. The validity of the instrument was determined based on concepts in the valid scientific texts and comments of experts. The analysis was performed using SPSS software. Result: In overall, 29 experts participated in the consensus process. In the duties section, all of the statements reach more than 50% consensus. Among statements of the components and capabilities consensus was achieved in 12 out of 17, 12 out of 16 statements respectively. Conclusion: according to survey, checkout infant readiness determined as the main duty of the system. Alarm message for special examination before discharge and parent readiness checklist considered as the most important components. The ability to send alarm message, register and log in system were the key capabilities of the discharge system.
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Affiliation(s)
- Sedigheh Seyedfarajollah
- Department of Health Information Management, School Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatameh Nayeri
- Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Keikha
- Department of Health Information Management, School Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Boodaie BD, Bui AH, Feldman DL, Brodman M, Shamamian P, Kaleya R, Rosenblatt M, Somerville D, Kischak P, Leitman IM. A perioperative care map improves outcomes in patients with morbid obesity undergoing major surgery. Surgery 2017; 163:450-456. [PMID: 29195738 DOI: 10.1016/j.surg.2017.09.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 09/05/2017] [Accepted: 09/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The surgical management of patients with morbid obesity (body mass index ≥ 40) is notable for a relatively high risk of complications. To address this problem, a perioperative care map was developed using precautions and best practices commonly employed in bariatric surgery. It requires additional medical assessments, sleep apnea surveillance, more stringent guidelines for anesthetic management, and readily available bariatric operating room equipment, among other items. This care map was implemented in 2013 at 4 major urban teaching hospitals for use in patients undergoing all types of nonambulatory surgery with a body mass index greater than 40 kg/m2. The impact on patient outcomes was evaluated. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was used to compare 30-day outcomes of morbidly obese patients before the year 2013 and after the years 2015 care-map implementation. In addition, trends in 30-day outcomes for morbidly obese patients were compared with those for non-obese patients. RESULTS Morbidly obese patients, between 2013 and 2015, saw an adjusted decrease in the rate of unplanned return to the operating room (OR = 0.49; P = .039), unplanned readmission (OR = 0.57; P = .006), total duration of stay (-0.87 days; P = .009), and postoperative duration of stay (-0.69 days; P = .007). Of these, total duration of stay (-0.86 days; P = .015), and postoperative duration of stay (-0.69 days; P = .012) improved significantly more for morbidly obese patients than for nonmorbidly obese patients. CONCLUSION Outcomes in morbidly obese patients improved from 2013 to 2015. Implementation of a perioperative care map may have contributed to these improvements. The care map should be further investigated and considered for more widespread use.
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Affiliation(s)
| | - Anthony H Bui
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - David L Feldman
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY; Hospitals Insurance Company, New York, NY
| | - Michael Brodman
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - Peter Shamamian
- Montefiore Medical Center Albert Einstein College of Medicine, Surgery, Bronx, NY
| | - Ronald Kaleya
- Maimonides Medical Center, Department of Surgery, Brooklyn, NY
| | - Meg Rosenblatt
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
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66
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Allen J, Hutchinson AM, Brown R, Livingston PM. User experience and care for older people transitioning from hospital to home: Patients' and carers' perspectives. Health Expect 2017; 21:518-527. [PMID: 29120529 PMCID: PMC5867324 DOI: 10.1111/hex.12646] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2017] [Indexed: 11/29/2022] Open
Abstract
Background Transitioning from hospital to home is challenging for many older people living with chronic health conditions. Transitional care facilitates safe and timely transfer of patients between levels of care and across care settings and includes communication between practitioners, assessment and planning, preparation, medication reconciliation, follow‐up care and self‐management education. To date, there is limited understanding of how to actively involve care recipient service users in transitional care. Objective This study was part of a larger research project. The objective of this article was to report the first study phase, in which we aimed to describe user experience pertaining to patients and carers. Design, setting and participants The study design was qualitative descriptive using interviews. Patients (n = 19) and carers (n = 7) participated in semi‐structured interviews about their experience of transition from hospital to home in an urban Australian health‐care setting. Interview data were analysed using thematic analysis. Findings All participants reported that they needed to become independent in transition. Participants perceived a range of social processes supported their independence at home: supportive relationships with carers, caring relationships with health‐care practitioners, seeking information, discussing and negotiating the transitional care plan and learning to self‐care. Discussion Findings contribute to our understanding that quality transitional care should focus on patients’ need to regain independence. Social processes supporting the capacities of patients and carers should be emphasized in future initiatives. Conclusion Future transitional care interventions should emphasize strategies to enable negotiation for suitable supports and assist care recipients to overcome barriers identified in this study.
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Affiliation(s)
- Jacqueline Allen
- School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia.,Centre for Quality and Patient Safety, Monash Health Partnership, Monash Health, Burwood, Vic., Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia
| | - Patricia M Livingston
- Faculty of Health & School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia
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67
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Dizon ML, Reinking C. Reducing Readmissions: Nurse-Driven Interventions in the Transition of Care From the Hospital. Worldviews Evid Based Nurs 2017; 14:432-439. [PMID: 29024460 DOI: 10.1111/wvn.12260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transitions of care (TOC) from hospitals is a continuing focus for quality improvement to reduce readmissions. Sufficient resources to offer interventions remain an issue for hospitals, leading to efforts to target high-risk patients and identify effective interventions. OBJECTIVES Describe and measure effects, hospital-wide and among high-risk patients, of a multifaceted TOC program on 30-day readmissions in a 441-bed acute care community hospital. METHODS Pre-post TOC intervention examining 30-day readmission rates during planning, implementation, and intervention years compared to baseline. Patient characteristics and services received by patients targeted for TOC individualized interventions during hospitalization and after discharge were retrieved from medical records and compared over 4 years during which the intervention was planned and implemented. RESULTS Summary hospital-wide readmission rates reduced from 11.8% during planning (2011), 12.0% during implementation (2012), to 11.4% during intervention (2013) compared to 13.7% at prestudy baseline (2010; p < .001). TOC program patients were mostly identified by clinician referral (66.7%) rather than computer-generated risk at admission (32.3%), and nearly one-third (30.6%) were readmitted within 30 days of release. LINKING EVIDENCE TO ACTION Reductions in readmissions were achieved using a multifaceted approach with efforts at admission, predischarge, and postdischarge in a community hospital. Having clinical staff involved in TOC program is important in both patient identification and interventions to reduce readmissions.
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Affiliation(s)
- Mae L Dizon
- Nurse Practitioner, NICHE Program, El Camino Hospital, San Jose, CA, USA
| | - Cheryl Reinking
- Chief Nursing Officer, El Camino Hospital, Los Altos, CA, USA
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68
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Rushton M, Howarth M, Grant MJ, Astin F. Person-centred discharge education following coronary artery bypass graft: A critical review. J Clin Nurs 2017; 26:5206-5215. [PMID: 28881069 DOI: 10.1111/jocn.14071] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To examine the extent that individualised education helps reduce depression and anxiety and improves self-care for people who have undergone coronary artery bypass graft surgery. BACKGROUND Individualised discharge planning is increasingly important following cardiac surgery due to recurrent admissions as well as the issue of anxiety and depression, often due to lack of preparation. The hospital to home transition is fundamental in the recovery process. Individualised education and person-centred care ensure that patients' educational needs are met. This empowers patients, increasing self-efficacy or confidence, resulting in autonomy, a smoother discharge process and avoiding postdischarge problems and rehospitalisation. DESIGN A critical review of published peer-reviewed literature was conducted. METHODS Electronic databases searched included MEDLINE, CINAHL, the Cochrane Library and PsychInfo 2009-2015. RESULTS Eight articles were identified for review, and a Critical Appraisal Skills Programme framework was used to determine the quality of the papers, all of the papers focussed on coronary artery bypass graft. The designs were typically experimental or quasi-experimental with two reviews. CONCLUSION A greater understanding of the patients' needs allows tailored education to be provided, which promotes self-care management. This level of patient empowerment increases confidence and ultimately minimise anxiety and depression. Despite the varying teaching and learning methods associated with individualised education, patient-centred education has the potential to assist cardiac nurses in adequately preparing patients for discharge following their coronary artery bypass graft. RELEVANCE TO CLINICAL PRACTICE Development of individualised education programmes is crucial in preparing patients for discharge. The reduction in readmission to hospital has a significant effect on already stretched resources, and the reduction in postoperative complications during the recovery period linked with depression and anxiety will have a positive effect on the individuals' ability to self-care, health and well-being.
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Affiliation(s)
- Melanie Rushton
- School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, Salford, UK
| | - Michelle Howarth
- School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, Salford, UK
| | - Maria J Grant
- School of Nursing, Midwifery, Social Work and Social Sciences, University of Salford, Salford, UK
| | - Felicity Astin
- University of Huddersfield/Calderdale & Huddersfield NHS Foundation Trust, Huddersfield, UK
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69
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Validating Performance of a Hospital Discharge Planning Decision Tool in Community Hospitals. Prof Case Manag 2017; 22:204-213. [PMID: 28777233 DOI: 10.1097/ncm.0000000000000233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY The Early Screen for Discharge Planning (ESDP) is a decision support tool developed in an urban academic medical center. High ESDP scores identify patients with nonroutine discharge plans who would benefit from early discharge planning intervention. We aimed to determine the predictive performance of the ESDP in a different practice setting. PRIMARY PRACTICE SETTING Rural regional community hospital. METHODOLOGY AND SAMPLE We designed a comparative, descriptive survey study and enrolled a convenience sample of 222 patients (identified at admission) who provided informed consent. Sample characteristics and ESDP scores were collected during enrollment. The Problems After Discharge Questionnaire, EuroQoL-5Dimensions quality-of-life measure, length of stay, and use of post-acute care services were recorded after discharge. We compared outcomes between patients with low and high ESDP scores. RESULTS More than half of the sample (51.8%) had a high ESDP score. Patients with high ESDP scores reported more problems after discharge (p = .02), reported lower quality of life (p < .001), had longer length of stays (p = .04), and used post-acute care services (p = .006) more than patients with low ESDP scores. The difference in the average percentage of unmet needs was not statistically significant (p = .12), but patients with high ESDP scores reported more unmet needs than patients with low ESDP scores. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The value of systematically proactive approaches to discharge planning is increasingly recognized, but establishing the performance capacity of support tools is critical for optimizing benefit. These study findings support use of the ESDP in regional community hospitals, making it a useful, open-source decision support tool for various health care delivery systems.
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70
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Towne SD, Fair K, Smith ML, Dowdy DM, Ahn S, Nwaiwu O, Ory MG. Multilevel Comparisons of Hospital Discharge among Older Adults with a Fall-Related Hospitalization. Health Serv Res 2017; 53:2227-2248. [PMID: 28857156 DOI: 10.1111/1475-6773.12763] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We examined multilevel factors associated with hospital discharge status among older adults suffering a fall-related hospitalization. DATA SOURCES The 2011-2013 (n = 131,978) Texas Inpatient Hospital Discharge Public-Use File was used. STUDY DESIGN/METHODS Multilevel logistic regression analyses estimated the likelihood of being discharged to institutional settings versus home. PRINCIPAL FINDINGS Factors associated with a greater likelihood of being discharged to institutional settings versus home/self-care included being female, white, older, having greater risk of mortality, receiving care in a non-teaching hospital, having Medicare (versus Private) coverage, and being admitted from a non-health care facility (versus clinical referral). CONCLUSIONS Understanding risk factors for costly discharges to institutional settings enables targeted fall-prevention interventions with identification of at-risk groups and allows for identifying policy-related factors associated with discharge status.
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Affiliation(s)
- Samuel D Towne
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX
| | - Kayla Fair
- Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew Lee Smith
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX.,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA
| | - Diane M Dowdy
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX
| | - SangNam Ahn
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX.,Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN
| | - Obioma Nwaiwu
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, School of Public Health, College Station, TX
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71
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Wang J, Boehm L, Mion LC. Intrinsic capacity in older hospitalized adults: Implications for nursing practice. Geriatr Nurs 2017; 38:359-361. [PMID: 28778277 DOI: 10.1016/j.gerinurse.2017.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Jinjiao Wang
- University of Rochester School of Nursing, Rochester, NY, USA
| | - Leanne Boehm
- University of Rochester School of Nursing, Rochester, NY, USA; VA Quality Scholars Program, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Lorraine C Mion
- Ohio State University College of Nursing, Columbus, OH, USA.
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72
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Bångsbo A, Dunér A, Dahlin-Ivanoff S, Lidén E. Collaboration in discharge planning in relation to an implicit framework. Appl Nurs Res 2017; 36:57-62. [PMID: 28720240 DOI: 10.1016/j.apnr.2017.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/31/2017] [Accepted: 05/27/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Angela Bångsbo
- Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Arvid Wallgrens Backe hus 2, Box 455, 405 30 Göteborg, Sweden; Sahlgrenska Academy, Centre of Ageing and Health, University of Gothenburg, 405 30 Göteborg, Sweden; R & D Sjuhärad Välfärd, University of Borås, 501 90 Borås, Sweden.
| | - Anna Dunér
- Department of Social Work, University of Gothenburg, Sprängkullsgat. 23, Box 720, 405 30 Göteborg, Sweden; Sahlgrenska Academy, Centre of Ageing and Health, University of Gothenburg, 405 30 Göteborg, Sweden
| | - Synneve Dahlin-Ivanoff
- Sahlgrenska Academy, University of Gothenburg, Institute of Neuroscience and Physiology, Arvid Wallgrens Backe hus 2, Box 455, 405 30 Göteborg, Sweden; Sahlgrenska Academy, Centre of Ageing and Health, University of Gothenburg, 405 30 Göteborg, Sweden
| | - Eva Lidén
- Sahlgrenska Academy, Centre of Ageing and Health, University of Gothenburg, 405 30 Göteborg, Sweden; Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Arvid Wallgrens Backe hus 1, Box 457, 405 30 Göteborg, Sweden
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73
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Hare MP, Teasdale TL, Crilly J. Implementation of a clinical pharmacy service in the Transfer Unit of a tertiary hospital: a clinical quality audit. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Monique P. Hare
- Department of Pharmacy; Gold Coast University Hospital; Gold Coast Health; Southport Australia
| | - Trudy L. Teasdale
- Department of Pharmacy; Gold Coast University Hospital; Gold Coast Health; Southport Australia
| | - Julia Crilly
- Department of Emergency Medicine; Gold Coast Health; Southport Australia
- Menzies Health Institute; Griffith University; Southport Australia
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Correa-Casado M, Granero-Molina J, Hernández-Padilla JM, Fernández-Sola C. [Transferring palliative-care patients from hospital to community care: A qualitative study]. Aten Primaria 2017; 49:326-334. [PMID: 27842728 PMCID: PMC6876029 DOI: 10.1016/j.aprim.2016.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/14/2016] [Accepted: 09/02/2016] [Indexed: 11/05/2022] Open
Abstract
AIM To know the experience of case-manager nurses with regard to transferring palliative-care patients from the hospital to their homes. DESIGN Qualitative phenomenological study carried out in 2014-2015. SETTING Poniente and Almería health districts, which referral hospitals are Poniente Hospital and Torrecárdenas Hospital, respectively. PARTICIPANTS A purposive sample comprised of 12 case-manager nurses was recruited from the aforementioned setting. METHOD Theoretical data saturation was achieved after performing 7 in-depth individual interviews and 1 focus group. Data analysis was performed following Colaizzi's method. RESULTS Three themes emerged: (1) 'Case-management nursing as a quality, patient-centred service' (2) 'Failures of the information systems', with the subthemes "patients" insufficient and inadequate previous information" and "ineffective between-levels communication channels for advanced nursing"; (3) 'Deficiencies in discharge planning', with the subthemes "deficient management of resources on admission", "uncertainty about discharge" and "insufficient human resources to coordinate the transfer". CONCLUSIONS Case-manager nurses consider themselves a good-quality service. However, they think there are issues with coordination, information and discharge planning of palliative patients from hospital. It would be useful to review the communication pathways of both care and discharge reports, so that resources needed by palliative patients are effectively managed at the point of being transferred home.
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Affiliation(s)
- Matías Correa-Casado
- Agencia Pública Empresarial Sanitaria Hospital de Poniente, El Ejido, Almería, España
| | - José Granero-Molina
- Departamento de Enfermería, Fisioterapia y Medicina, Universidad de Almería, Investigador asociado, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile
| | | | - Cayetano Fernández-Sola
- Departamento de Enfermería, Fisioterapia y Medicina, Universidad de Almería, Investigador asociado, Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Temuco, Chile.
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Briggs R, O'Shea E, de Siún A, O'Neill D, Gallagher P, Timmons S, Kennelly S. Does admission to a specialist geriatric medicine ward lead to improvements in aspects of acute medical care for older patients with dementia? Int J Geriatr Psychiatry 2017; 32:624-632. [PMID: 27198080 DOI: 10.1002/gps.4501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/30/2016] [Accepted: 04/19/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study is to clarify if admission to a specialist geriatric medicine ward leads to improvements in aspects of acute medical care for patients with dementia. METHODS We analysed combined data involving 900 patients from the Irish and Northern Irish audits of dementia care. Data on baseline demographics, admission outcomes, clinical aspects of care, multidisciplinary assessment and discharge planning processes were collected. RESULTS Less than one-fifth of patients received their inpatient care on a specialist geriatric medicine ward. Patients admitted to a geriatric medicine ward were less likely to undergo a formal assessment of mobility compared with those in non-geriatric wards (119/143 (83%) vs 635/708 (90%), odds ratio (OR) = 0.57 (0.35 to 0.94)) and were more likely to receive newly prescribed antipsychotic medication during the admission (27/54 (50%) vs 95/2809 (36%), OR = 1.95 (1.08 to 3.51)). Patients admitted to a geriatric medicine ward were more likely to have certain aspects of discharge planning initiated, including completion of a single plan for discharge (78/118 (66%) vs 275/611 (45%), OR = 2.38 (1.58 to 3.60)). Surgical wards performed more poorly on certain aspects including having a named discharge co-ordinator (32/71, 45%) and documentation of decisions regarding resuscitation status (18/95, 19%). CONCLUSION Relatively low numbers of patients with dementia received care on a specialist geriatric medicine ward. There appears to be a more streamlined discharge planning process in place on these wards, but they did not perform as well as one would expect in certain areas, such as compliance with multidisciplinary assessment and antipsychotic prescribing. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Robert Briggs
- Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland
| | - Emma O'Shea
- Irish National Audit of Dementia Care in Acute Hospitals, National Audit of Dementia Care, Cork, Ireland
| | - Ana de Siún
- Irish National Audit of Dementia Care in Acute Hospitals, National Audit of Dementia Care, Cork, Ireland
| | - Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland.,Irish National Audit of Dementia Care in Acute Hospitals, National Audit of Dementia Care, Cork, Ireland
| | - Paul Gallagher
- Irish National Audit of Dementia Care in Acute Hospitals, National Audit of Dementia Care, Cork, Ireland.,Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Irish National Audit of Dementia Care in Acute Hospitals, National Audit of Dementia Care, Cork, Ireland.,Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Sean Kennelly
- Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland.,Irish National Audit of Dementia Care in Acute Hospitals, National Audit of Dementia Care, Cork, Ireland
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Mennuni M, Gulizia MM, Alunni G, Francesco Amico A, Maria Bovenzi F, Caporale R, Colivicchi F, Di Lenarda A, Di Tano G, Egman S, Fattirolli F, Gabrielli D, Geraci G, Gregorio G, Francesco Mureddu G, Nardi F, Radini D, Riccio C, Rigo F, Sicuro M, Urbinati S, Zuin G. ANMCO Position Paper: hospital discharge planning: recommendations and standards. Eur Heart J Suppl 2017; 19:D244-D255. [PMID: 28751845 PMCID: PMC5526471 DOI: 10.1093/eurheartj/sux011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The hospital discharge is often poorly standardized and affected by discontinuity and fragmentation of care, putting patients at high risk of both post-discharge adverse events and early readmission. The present ANMCO document reviews the modifiable components of the hospital discharge process related to adverse events or re-hospitalizations and suggests the optimal methods for redesigning the whole discharge process. The key principles for proper hospital discharge or transfer of care acknowledge that the hospital discharge: • is not an isolated event, but a process that has to be planned as soon as possible after the admission, ensuring that the patient and the caregiver understand and contribute to the planned decisions, as equal partners; • is facilitated by a comprehensive systemic approach that begins with a multidimensional evaluation process; • must be organized by an operator who is responsible for the coordination of all phases of the hospital patient journey, involving afterward the general practitioner and transferring to them the information and responsibility at discharge; • is the result of an integrated multidisciplinary team approach; • appropriately uses the transitional and intermediate care services; • is carried out in an organized system of care and continuum of services; and • programs the passage of information to after-discharge services.
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Affiliation(s)
- Mauro Mennuni
- Cardiology Department - UTIC, Ospedale L. Parodi Delfino, Piazza Aldo Moro, 00034 Colleferro (RM), Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima – Azienda Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Gianfranco Alunni
- Integrated Heart Failure Unit, Ospedale di Assisi, Assisi (PG), Italy
| | | | | | - Roberto Caporale
- Interventional Cardiology Department, Ospedale Santissima Annunziata, Cosenza, Italy
| | - Furio Colivicchi
- CCU-Cardiology Department, Ospedale San Filippo Neri, Roma, Italy
| | | | | | | | | | | | - Giovanna Geraci
- Cardiology Unit, AOR Villa Sofia-Cervello, P.O. Cervello, Palermo, Italy
| | - Giovanni Gregorio
- CCU-Cardiology Department, Ospedale San Luca, Vallo della Lucania (SA), Italy
| | - Gian Francesco Mureddu
- Cardiology and Cardiac Rehabilitation Department, AO San Giovanni Addolorata, Roma, Italy
| | - Federico Nardi
- Cardiology Department, Ospedale Castelli, Verbania, Italy
| | | | - Carmine Riccio
- Azienda Ospedaliera S. Anna e S. Sebastiano, Caserta, Italy
| | - Fausto Rigo
- Cardiology Unit, Ospedale dell'Angelo, Mestre (VE), Italy
| | - Marco Sicuro
- Cardiology and Cardiac Care Unit, Ospedale Generale Regionale-PO U. Parini, Aosta, Italy
| | | | - Guerrino Zuin
- Cardiology Unit, Ospedale dell'Angelo, Mestre (VE), Italy
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77
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Nyborg I, Danbolt LJ, Kirkevold M. User participation is a family matter: A multiple case study of the experiences of older, hospitalised people and their relatives. J Clin Nurs 2017; 26:4353-4363. [DOI: 10.1111/jocn.13765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Ingrid Nyborg
- Institute of Health and Society; University of Oslo; Oslo Norway
- Innlandet Hospital Trust; Gjøvik Norway
| | - Lars J Danbolt
- Norwegian School of Theology; Oslo Norway
- The Center for the Psychology of Religion; Innlandet Hospital Trust; Ottestad Norway
| | - Marit Kirkevold
- Institute of Health and Society; University of Oslo; Oslo Norway
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78
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Gerrie S, Sim J, Winstone T, Milne D, Modahl L, Bagnall C, Curin R, Metcalfe J, O'Carroll N. Auckland district health board radiology service improvement: An after hours ultrasound service pilot study. SONOGRAPHY 2017. [DOI: 10.1002/sono.12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Samantha Gerrie
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Jenny Sim
- Department of Anatomy and Medical Imaging, School of Medical Sciences, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Tim Winstone
- Auckland DHB Performance and Improvement Team; Auckland City Hospital; Auckland New Zealand
| | - David Milne
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Lucy Modahl
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Carol Bagnall
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Raewyn Curin
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Julia Metcalfe
- Radiology Department; Auckland City Hospital; Auckland New Zealand
| | - Nicola O'Carroll
- Radiology Department; Auckland City Hospital; Auckland New Zealand
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79
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Abstract
BACKGROUND The Re-Engineered Discharge (RED) program is a hospital-based initiative shown to decrease hospital reutilization. We implemented the RED in 10 hospitals to study the implementation process. DESIGN We recruited 10 hospitals from different regions of the United States to implement the RED and provided training for participating hospital leaders and implementation staff using the RED Toolkit as the basis of the curriculum followed by monthly telephone-based technical assistance for up to 1 year. METHODS Two team members interviewed key informants from each hospital before RED implementation and then 1 year later. Interview data were analyzed according to common and comparative themes identified across institutions. Readmission outcomes were collected on participating hospitals and compared pre- versus post-RED implementation. RESULTS Key findings included (1) wide variability in the fidelity of the RED intervention; (2) engaged leadership and multidisciplinary implementation teams were keys to success; (3) common challenges included obtaining timely follow-up appointments, transmitting discharge summaries to outpatient clinicians, and leveraging information technology. Eight out of 10 hospitals reported improvement in 30-day readmission rates after RED implementation. CONCLUSIONS A supportive hospital culture is essential for successful RED implementation. A flexible implementation strategy can be used to implement RED and reduce readmissions.
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80
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Wu CJJ, Atherton JJ, MacIsaac RJ, Courtney M, Chang AM, Thompson DR, Kostner K, MacIsaac AI, d'Emden M, Graves N, McPhail SM. Effectiveness of the cardiac-diabetes transcare program: protocol for a randomised controlled trial. BMC Health Serv Res 2017; 17:109. [PMID: 28153000 PMCID: PMC5290652 DOI: 10.1186/s12913-017-2043-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/20/2017] [Indexed: 12/03/2022] Open
Abstract
Background This paper presents a protocol for a randomised controlled trial of the Cardiac-Diabetes Transcare program which is a transitional care, multi-modal self-management program for patients with acute coronary syndrome comorbid with type 2 diabetes. Prior research has indicated people hospitalised with dual cardiac and diabetes diagnoses are at an elevated risk of hospital readmissions, morbidity and mortality. The primary aim of this study is to evaluate the effectiveness (and cost-effectiveness) of a Cardiac-Diabetes Transcare intervention program on 6-month readmission rate in comparison to usual care. Methods/Design A two-armed, randomised controlled trial with blinded outcome assessment will be conducted to evaluate the comparative effectiveness of two modes of care, including a Usual Care Group and a Cardiac-Diabetes Transcare Intervention (in addition to usual care) Group. The primary outcome is 6-month readmission rate, although a range of secondary outcomes will be collected (including self-efficacy) at baseline, 1, 3 and 6 month reassessments. The intervention group will receive in-hospital education tailored for people recovering from an acute coronary syndrome-related hospital admission who have comorbid diabetes, and they will also receive home visits and telephone follow-up by a trained Research Nurse to reinforce and facilitate disease-management-related behaviour change. Both groups will receive usual care interventions offered or referred from participating hospital facilities. A sample size of 432 participants from participating hospitals in the Australian states of Queensland and Victoria will be recruited for 90% power based on the most conservative scenarios modelled for sample size estimates. Discussion The study outlined in this protocol will provide valuable insight into the effectiveness of a transitional care intervention targeted for people admitted to hospital with cardiac-related presentations commencing in the inpatient hospital setting and transition to the home environment. The purpose of theory-based intervention comprising face-to-face sessions and telephone follow up for patients with acute coronary syndrome and type 2 diabetes is to increase self-efficacy to enhance self-management behaviours and thus improve health outcomes and reduce hospital readmissions. Trial registration This study has been registered with the Australian New Zealand Clinical Trials Registry dated 16/12/2014: ACTRN12614001317684.
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Affiliation(s)
- Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Rd, Banyo, Qld, 4014, Australia. .,School of Nursing, Queensland University of Technology, Brisbane, Australia. .,Royal Brisbane and Women's Hospital, (RBWH), Brisbane, Australia. .,Mater Medical Research Institute-University of Queensland (MRI-UQ), Brisbane, Australia.
| | - John J Atherton
- Royal Brisbane and Women's Hospital, (RBWH), Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia
| | - Richard J MacIsaac
- Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,St Vincent's Institute of Medical Research, Melbourne, Australia
| | - Mary Courtney
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Rd, Banyo, Qld, 4014, Australia
| | - Anne M Chang
- School of Nursing, Director of Centre for Evidence Based Healthy Ageing, Queensland University of Technology, Brisbane, Australia
| | - David R Thompson
- Director of Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karam Kostner
- Mater Medical Research Institute-University of Queensland (MRI-UQ), Brisbane, Australia.,Department of Cardiology, Mater Health Services, University of Queensland, Brisbane, Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St Vincent's Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Michael d'Emden
- Royal Brisbane and Women's Hospital, (RBWH), Brisbane, Australia
| | - Nick Graves
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia.,Australian Centre for Health Services Innovation, Brisbane, Australia
| | - Steven M McPhail
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
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81
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Prusaczyk B, Cherney SM, Carpenter CR, DuBois JM. Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities. Clin Gerontol 2017; 40:63-73. [PMID: 28452628 PMCID: PMC5911394 DOI: 10.1080/07317115.2016.1201714] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Due to issues related to informed research consent, older adults with cognitive impairments are often excluded from high-quality studies that are not directly related to cognitive impairment, which has led to a dearth of evidence for this population. The challenges to including cognitively impaired older adults in research and the implications of their exclusion are a transdisciplinary issue. The ethical challenges and logistical barriers to conducting research with cognitively impaired older adults are addressed from the perspectives of three different fields-social work, emergency medicine, and orthopaedic surgery. Issues related to funding, study design, intervention components, and outcomes are discussed through the unique experiences of three different providers. A fourth perspective-medical research ethics-provides alternatives to exclusion when conducting research with cognitively impaired older adults such as timing, corrective feedback and plain language, and capacity assessment and proxy appointments. Given the increasing aging population and the lack of evidence on cognitively impaired older adults, it is critical that researchers, funders, and institutional review boards not be dissuaded from including this population in research studies.
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Affiliation(s)
- Beth Prusaczyk
- a Washington University School of Medicine , St. Louis , Missouri , USA
| | - Steven M Cherney
- a Washington University School of Medicine , St. Louis , Missouri , USA
| | | | - James M DuBois
- a Washington University School of Medicine , St. Louis , Missouri , USA
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82
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Lindegaard Pedersen J, Pedersen PU, Damsgaard EM. Nutritional Follow-Up after Discharge Prevents Readmission to Hospital - A Randomized Clinical Trial. J Nutr Health Aging 2017; 21:75-82. [PMID: 27999853 DOI: 10.1007/s12603-016-0745-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To compare the effects of two individualized nutritional follow-up intervention strategies (home visit or telephone consultation) with no follow-up, with regard to acute readmissions to hospital at two points in time, 30 and 90 days after discharge from hospital. DESIGN Randomized clinical trial with two intervention groups and one control group, and monitoring on readmission at 30 and 90 days after discharge. SETTING Intervention in the participants' homes after discharge from hospital. PARTICIPANTS Inclusion: Malnourished geriatric patients and patients at risk of malnutrition (MNA<24), aged 75 years and older, living at home and alone. Exclusion: Nursing home residents and patients with terminal illnesses or cognitive impairment. Randomization: Upon discharge, the patients were stratified according to nutritional status (MNA), and assigned to one of three groups: 'home visit', 'telephone', or 'control' group. INTERVENTION Individualized nutritional counselling of the patient and the patient's daily home carer by a clinical dietician one, two, and four weeks after discharge from hospital. The counselling was either in-person at the patient's homes, or over the telephone. All patients received a diet plan on discharge. The control group received standard care, but no follow-up after discharge. MEASUREMENTS Information on readmissions to hospital and mortality at 30 and 90 days after discharge was obtained from electronic patient records. Intention-to-treat (ITT) and per-protocol (PP) analyses were carried out. RESULTS Two-hundred and eight participants were randomized, 73 to home visits, 68 to the telephone consultation group, and 67 to the control group. The mean age of the participants was 86.1 years. Home visit participants had a lower risk of readmission to hospital compared to control participants at 30 days after discharge (HR=0.4; 95% CI: 0.2-0.9, p=0.03) and 90 days after discharge (HR=0.4; 95% CI: 0.2-0.8, p<0.01). No significant difference was detected between the telephone consultation group and the control group, at either 30 days (HR=0.6, 95% CI: 0.3-1.3, p=0.18) or 90 days after discharge (HR=0.7, 95% CI: 0.4-1.3, p=0.23). The PP analysis revealed that the risk of readmission was significantly lower in the home visit group compared to the control group and the telephone consultation group compared to the control group, and this was evident at 30 days as well as at 90 days after discharge. CONCLUSION An individualized nutritional follow-up performed as home visits seems to reduce readmission to hospital 30 and 90 days after discharge. Intervention by telephone consultations may also prevent readmission, but only among participants who receive the full intervention.
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Affiliation(s)
- J Lindegaard Pedersen
- Jette Lindegaard Pedersen, Clinical research nurse, Aarhus University Hospital, Geriatrics, P.P. Oerumsgade 11, Aarhus, 8000, Denmark, 0045 40256721,
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83
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Abstract
Background Discharge from hospital presents significant risks to patient safety, with up to one in five patients experiencing adverse events within 3 weeks of leaving hospital. Aim To describe the frequency and types of patient safety incidents associated with discharge from secondary to primary care, and commonly described contributory factors to identify recommendations for practice. Design and setting A mixed methods analysis of 598 patient safety incident reports in England and Wales related to ‘Discharge’ from the National Reporting and Learning System. Method Detailed data coding (with 20% double-coding), data summaries generated using descriptive statistical analysis, and thematic analysis of special-case sample of reports. Incident type, contributory factors, type, and level of harm were described, informing recommendations for future practice. Results A total of 598 eligible reports were analysed. The four main themes were: errors in discharge communication (n = 151; 54% causing harm); errors in referrals to community care (n = 136; 73% causing harm); errors in medication (n = 97; 87% causing harm); and lack of provision of care adjuncts such as dressings (n = 62; 94% causing harm). Common contributory factors were staff factors (not following referral protocols); and organisational factors (lack of clear guidelines or inefficient processes). Improvement opportunities include developing and testing electronic discharge methods with agreed minimum information requirements and unified referrals systems to community care providers; and promoting a safety culture with ‘safe discharge’ checklists, discharge coordinators, and family involvement. Conclusion Significant harm was evident due to deficits in the discharge process. Interventions in this area need to be evaluated and learning shared widely.
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84
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Couturier B, Carrat F, Hejblum G. A systematic review on the effect of the organisation of hospital discharge on patient health outcomes. BMJ Open 2016; 6:e012287. [PMID: 28003282 PMCID: PMC5223668 DOI: 10.1136/bmjopen-2016-012287] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The transition from hospital to home represents a key step in the management of patients and several problems related to this transition may arise, with potential adverse effects on patient health after discharge. The purpose of our study was to explore the association between components of the hospital discharge process including subsequent continuity of care and patient outcomes in the post-discharge period. DESIGN Systematic review of observational and interventional studies. SETTING We conducted a combined search in the Medline and Web of Science databases. Additional studies were identified by screening the bibliographies of the included studies. The data collection process was conducted using a standardised predefined grid that included quality criteria. PARTICIPANTS A standard patient population returning home after hospitalisation. PRIMARY AND SECONDARY OUTCOMES Adverse health outcomes occurring after hospital discharge. RESULTS In the 20 studies fulfilling our eligibility criteria, the main discharge-process components explored were: discharge summary (n=2), discharge instructions (n=2), drug-related problems at discharge (n=4), transition from hospital to home (n=5) and continuity of care after hospital discharge (n=7). The major subsequent patient health outcomes measured were: rehospitalisations (n=18), emergency department visits (n=8) and mortality (n=5). Eight of the 18 studies exploring rehospitalisations and two of the eight studies examining emergency department visits reported at least one significant association between the discharge process and these outcomes. None of the studies investigating patient mortality reported any significant such associations between the discharge process and these outcomes. CONCLUSIONS Irrespective of the component of the discharge process explored, the outcome considered (composite or not), the sample size and the study design, no consistent statistical association between hospital discharge and patient health outcome was identified. This systematic review highlights a wide heterogeneity between studies, especially in terms of the component(s) of the hospital discharge process investigated, study designs, outcomes and follow-up durations.
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Affiliation(s)
- Bérengère Couturier
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
- AP–HP, Hôpital St-Antoine, Unité de Santé Publique, Paris, France
| | - Fabrice Carrat
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
- AP–HP, Hôpital St-Antoine, Unité de Santé Publique, Paris, France
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
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85
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Panikar V, Sosale A, Agarwal S, Unnikrishnan A, Kalra S, Bhattacharya A, Chawla M, Anjana RM, Bhatt A, Jaggi S, Sosale B, Hasnani D, Vadgama J. RSSDI clinical practice recommendations for management of In-hospital hyperglycaemia—2016. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0528-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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86
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Waring J, Marshall F, Bishop S. Understanding the occupational and organizational boundaries to safe hospital discharge. J Health Serv Res Policy 2016; 20:35-44. [PMID: 25472988 DOI: 10.1177/1355819614552512] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Safe hospital discharge relies upon communication and coordination across multiple occupational and organizational boundaries. Our aim was to understand how these boundaries can exacerbate health system complexity and represent latent sociocultural threats to safe discharge. METHODS An ethnographic study was conducted in two local health and social care systems (health economies) in England, focusing on two clinical areas: stroke and hip fracture patients. Data collection involved 345 hours of observations and 220 semi-structured interviews with health and social care professionals, patients and their lay carers. RESULTS Hospital discharge involves a dynamic network of interactions between heterogeneous health and social care actors, each characterized by divergent ways of organizing discharge activities; cultures of collaboration and interaction and understanding of what discharge involves and how it contributes to patient recovery. These interrelated dimensions elaborate the occupational and organisational boundaries that can influence communication and coordination in hospital discharge. CONCLUSIONS Hospital discharge relies upon the coordination of multiple actors working across occupational and organizational boundaries. Attention to the sociocultural boundaries that influence communication and coordination can help inform interventions that might support enhanced discharge safety.
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Affiliation(s)
- Justin Waring
- Professor of Organizational Sociology, Centre for Health Innovation Leadership & Learning, Nottingham University Business School, Jubilee Campus University of Nottingham, Nottingham, UK
| | - Fiona Marshall
- Research Fellow, Centre for Health Innovation Leadership & Learning, Nottingham University Business School, Jubilee Campus University of Nottingham, Nottingham, UK
| | - Simon Bishop
- Lecturer, Centre for Health Innovation Leadership & Learning, Nottingham University Business School, Jubilee Campus University of Nottingham, Nottingham, UK
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87
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Abstract
The objective was to determine whether the Elders Risk Assessment Index can predict multi-disciplinary team referral of older patients (≥ 65 years) in Emergency Department same-day discharges. The study identified 1,376 qualifying individuals from a regional New Zealand hospital database. Of these, 12.7 % were referred to the multi-disciplinary team. Univariate and multivariate analyses were used to explore associations between the Index, its components, and other demographic factors with referral. With every unit increase in the Index there was a 9% increase in the odds of being referred. When the components of the Index were analysed separately, an increased likelihood of being referred was associated with not being married, having had a previous hospital admission of more than five days, having chronic obstructive pulmonary disease, and being older. Conversely, a decreased likelihood was associated with having diabetes. When non-Index items were analysed it was found that females were more likely to be referred than males and that Māori were less likely to be referred than New Zealand Europeans. With adaptation, the Elders Risk Assessment Index may provide a simple, cost-effective, and timely tool to assist in determining the need for multi-disciplinary team referral for older people who present to the Emergency Department.
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88
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Wong C, Hogan DB. Care Transitions: Using Narratives to Assess Continuity of Care Provided to Older Patients after Hospital Discharge. Can Geriatr J 2016; 19:97-102. [PMID: 27729948 PMCID: PMC5038931 DOI: 10.5770/cgj.19.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A common scenario that may pose challenges to primary care providers is when an older patient has been discharged from hospital. The aim of this pilot project is to examine the experiences of patients' admission to hospital through to discharge back home, using analysis of patient narratives to inform the strengths and weaknesses of the process. METHODS For this qualitative study, we interviewed eight subjects from the Sheldon M. Chumir Central Teaching Clinic (CTC). Interviews were analyzed for recurring themes and phenomena. Two physicians and two resident learners employed at the CTC were recruited as a focus group to review the narrative transcripts. RESULTS Narratives generally demonstrated moderate satisfaction among interviewees with respect to their hospitalization and follow-up care in the community. However, the residual effects of their hospitalization surprised five patients, and five were uncertain about their post-discharge management plan. CONCLUSION Both secondary and primary care providers can improve on communicating the likely course of recovery and follow-up plans to patients at the time of hospital discharge. Our findings add to the growing body of research advocating for the implementation of quality improvement measures to standardize the discharge process.
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Affiliation(s)
- Carolyn Wong
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary
| | - David B Hogan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
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89
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Houghton JSM, Urriza Rodriguez D, Weale AR, Brooks MJ, Mitchell DC. Delayed discharges at a major arterial centre: a 4-month cross-sectional study at a single specialist vascular surgery ward. BMJ Open 2016; 6:e011193. [PMID: 27687896 PMCID: PMC5051326 DOI: 10.1136/bmjopen-2016-011193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Delayed discharges are a significant problem for the National Health Service. The objectives of this study were to determine the prevalence and impact of delayed discharge at a single specialist vascular surgery ward. DESIGN A cross-sectional observational study. SETTING A single specialist vascular unit in the UK during a 4-month study period (01/09/2014-31/12/2014). PARTICIPANTS All patients admitted to the ward during the study period were included. Patients spending ≥1 night on the ward once declared medically fit for discharge (MFFD) were prospectively identified and data prospectively collected. All other patients were identified retrospectively with data collected retrospectively from electronic records. OUTCOME MEASURES Primary outcome was number of patients experiencing delayed discharge. Secondary outcome measures were length of stay, length of delay and cost of delay. RESULTS There were 268 admissions with a total length of stay (LoS) of 2776 days. 57 admissions (21.3%) experienced delayed discharges with a total 535 excess bed days (19.3% total LoS) once MFFD. Unplanned admission (relative risk 7.3 (95% CI 2.7 to 20.0; p<0.001)) and index amputation (relative risk 9.2 (95% CI 3.8 to 22.0; p<0.001)) were associated with increased risk of delayed discharge. There were significant differences in the length of delay by the reason for the delay (p=0.01). Delay due to the provision of social services and inpatient rehabilitation were associated with longer length of delay (post hoc analysis). Age was not independently associated with either increased risk of delayed discharge or length of delay.The total estimated cost of delayed discharges during the study period was £146 055. CONCLUSIONS A significant number of vascular patients experience delayed discharge. MFFD vascular patients occupy a high proportion of vascular beds at considerable financial cost. Unplanned admissions, amputees and those delayed due to social services contributed most to delays. Closer integration with community health and social care providers may reduce delays.
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Affiliation(s)
- J S M Houghton
- Major Arterial Centre, Bristol Bath Weston Vascular Network, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D Urriza Rodriguez
- Major Arterial Centre, Bristol Bath Weston Vascular Network, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - A R Weale
- Major Arterial Centre, Bristol Bath Weston Vascular Network, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - M J Brooks
- Major Arterial Centre, Bristol Bath Weston Vascular Network, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - D C Mitchell
- Major Arterial Centre, Bristol Bath Weston Vascular Network, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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90
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Zegers M, Hesselink G, Geense W, Vincent C, Wollersheim H. Evidence-based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews. BMJ Open 2016; 6:e012555. [PMID: 27687901 PMCID: PMC5051502 DOI: 10.1136/bmjopen-2016-012555] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To provide an overview of effective interventions aimed at reducing rates of adverse events in hospitals. DESIGN Systematic review of systematic reviews. DATA SOURCES PubMed, CINAHL, PsycINFO, the Cochrane Library and EMBASE were searched for systematic reviews published until October 2015. STUDY SELECTION English-language systematic reviews of interventions aimed at reducing adverse events in hospitals, including studies with an experimental design and reporting adverse event rates, were included. Two reviewers independently assessed each study's quality and extracted data on the study population, study design, intervention characteristics and adverse patient outcomes. RESULTS Sixty systematic reviews with moderate to high quality were included. Statistically significant pooled effect sizes were found for 14 types of interventions, including: (1) multicomponent interventions to prevent delirium; (2) rapid response teams to reduce cardiopulmonary arrest and mortality rates; (3) pharmacist interventions to reduce adverse drug events; (4) exercises and multicomponent interventions to prevent falls; and (5) care bundle interventions, checklists and reminders to reduce infections. Most (82%) of the significant effect sizes were based on 5 or fewer primary studies with an experimental study design. CONCLUSIONS The evidence for patient-safety interventions implemented in hospitals worldwide is weak. The findings address the need to invest in high-quality research standards in order to identify interventions that have a real impact on patient safety. Interventions to prevent delirium, cardiopulmonary arrest and mortality, adverse drug events, infections and falls are most effective and should therefore be prioritised by clinicians.
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Affiliation(s)
- Marieke Zegers
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Gijs Hesselink
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Wytske Geense
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Hub Wollersheim
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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91
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Blom MC, Erwander K, Gustafsson L, Landin-Olsson M, Jonsson F, Ivarsson K. Primary triage nurses do not divert patients away from the emergency department at times of high in-hospital bed occupancy - a retrospective cohort study. BMC Emerg Med 2016; 16:39. [PMID: 27658706 PMCID: PMC5034663 DOI: 10.1186/s12873-016-0102-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency department (ED) overcrowding is frequently described in terms of input- throughput and output. In order to reduce ED input, a concept called primary triage has been introduced in several Swedish EDs. In short, primary triage means that a nurse separately evaluates patients who present in the Emergency Department (ED) and either refers them to primary care or discharges them home, if their complaints are perceived as being of low acuity. The aim of the present study is to elucidate whether high levels of in-hospital bed occupancy are associated with decreased permeability in primary triage. The appropriateness of discharges from primary triage is assessed by 72-h revisits to the ED. METHODS The study is a retrospective cohort study on administrative data from the ED at a 420-bed hospital in southern Sweden from 2011-2012. In addition to crude comparisons of proportions experiencing each outcome across strata of in-hospital bed occupancy, multivariate models are constructed in order to adjust for age, sex and other factors. RESULTS A total of 37,129 visits to primary triage were included in the study. 53.4 % of these were admitted to the ED. Among the cases referred to another level of care, 8.8 % made an unplanned revisit to the ED within 72 h. The permeability of primary triage was not decreased at higher levels of in-hospital bed occupancy. Rather, the permeability was slightly higher at occupancy of 100-105 % compared to <95 % (OR 1.09 95 % CI 1.02-1.16). No significant association between in-hospital bed occupancy and the probability of 72-h revisits was observed. CONCLUSIONS The absence of a decreased permeability of primary triage at times of high in-hospital bed occupancy is reassuring, as the opposite would have implied that patients might be denied entry not only to the hospital, but also to the ED, when in-hospital beds are scarce.
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Affiliation(s)
- Mathias C Blom
- IKVL/Avd för medicin, Universitetssjukhuset, Hs 32, EA-blocket, plan 2, 221 85 Lund, Sweden
| | - Karin Erwander
- IKVL/Avd för medicin, Universitetssjukhuset, Hs 32, EA-blocket, plan 2, 221 85 Lund, Sweden
| | - Lars Gustafsson
- Helsingborgs lasarett, IK-enheten, S Vallgatan 5, 251 87 Helsingborg, Sweden
| | - Mona Landin-Olsson
- IKVL/Avd för medicin, Universitetssjukhuset, Hs 32, EA-blocket, plan 2, 221 85 Lund, Sweden
| | - Fredrik Jonsson
- Pre- och intrahospital akutsjukvård, Helsingborgs lasarett, S Vallgatan 5, 251 87 Helsingborg, Sweden
| | - Kjell Ivarsson
- IKVL/Avd för medicin, Universitetssjukhuset, Hs 32, EA-blocket, plan 2, 221 85 Lund, Sweden
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92
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Toye C, Parsons R, Slatyer S, Aoun SM, Moorin R, Osseiran-Moisson R, Hill KD. Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial. Int J Nurs Stud 2016; 64:32-41. [PMID: 27684320 DOI: 10.1016/j.ijnurstu.2016.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/07/2016] [Accepted: 09/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hospital discharge of older people receiving care at home offers a salient opportunity to identify and address their family caregivers' self-identified support needs. OBJECTIVES This study tested the hypothesis that the extent to which family caregivers of older people discharged home from hospital felt prepared to provide care at home would be positively influenced by their inclusion in the new Further Enabling Care at Home program. DESIGN This single-blind randomised controlled trial compared outcomes from usual care alone with those from usual care plus the new program. The program, delivered by a specially trained nurse over the telephone, included: support to facilitate understanding of the patient's discharge letter; caregiver support needs assessment; caregiver prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports. SETTING AND PARTICIPANTS Dyads were recruited from the medical assessment unit of a Western Australian metropolitan public hospital. Each dyad comprised a patient aged 70 years or older plus an English speaking family caregiver. METHODS The primary outcome was the caregiver's self-reported preparedness to provide care for the patient. Data collection time points were designated as: Time 1, within four days of discharge; Time 2, 15-21days after discharge; Time 3, six weeks after discharge. Other measures included caregivers' ratings of: their health, patients' symptoms and independence, caregiver strain, family well-being, caregiver stress, and positive appraisals of caregiving. Data were collected by telephone. RESULTS Complete data sets were obtained from 62 intervention group caregivers and 79 controls. Groups were equivalent at baseline. Needs prioritised most often by caregivers were: to know whom to contact and what to expect in the future and to access practical help at home. Support guidance included how to: access help, information, and resources; develop crisis plans; obtain referrals and services; and organise legal requirements. Compared to controls, preparedness to care improved in the intervention group from Time 1 to Time 2 (effect size=0.52; p=0.006) and from Time 1 to Time 3 (effect size=0.43; p=0.019). These improvements corresponded to a change of approximately 2 points on the Preparedness for Caregiving instrument. Small but significant positive impacts were also observed in other outcomes, including caregiver strain. CONCLUSIONS These unequivocal findings provide a basis for considering the Furthering Enabling Care at Home program's implementation in this and other similar settings. Further testing is required to determine the generalisability of results.
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Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, The Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia, 6009, Australia.
| | - Richard Parsons
- School of Pharmacy, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia.
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, The Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia, 6009, Australia.
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, GPO Box U1987 Perth, Western Australia, 6845, Australia.
| | - Rebecca Osseiran-Moisson
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia.
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93
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Al-Sughayir MA. Effect of accreditation on length of stay in psychiatric inpatients: pre-post accreditation medical record comparison. Int J Ment Health Syst 2016; 10:55. [PMID: 27606002 PMCID: PMC5013634 DOI: 10.1186/s13033-016-0090-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/29/2016] [Indexed: 12/04/2022] Open
Abstract
Background An interest in hospital accreditation is growing rapidly among many countries to enhance the quality of health care services. The literature showed a positive association between accreditation and some processes of health care. One of the main factors that influence bed availability is the length of hospital stay (LOS), which is considered as an important indicator of the quality of inpatient psychiatric hospitalization. We aimed to investigate whether hospital accreditation drives improvements for the length of stay in psychiatric inpatients. Methods The study reviewed medical records of consecutive hospital admissions for pre- and post-accreditation comparisons of LOS in two acute mental health wards at a teaching general hospital in Riyadh, Saudi Arabia. Data obtained from the 12-month-post-accreditation period (July 2011 to June 2012) were compared with those from the 12-month-pre-accreditation period (July 2009 to June 2010). The adoption of accreditation program occurred over a 12-month period in the middle of the study (July 2010 to June 2011). Compiled information included demographics, diagnosis, assessment, and LOS. All identified charts were reviewed; there were no exclusion criteria. Patients were not contacted. Results Post-accreditation, the mean (SD) length of stay was 35.3 ± 18.5 days and the range was 3–113 days. Whereas in the pre-accreditation period the mean (SD) length of stay was 41.1 ± 29.5 days and the range was 1–167 days. The difference was statistically significant (P = 0.026). Conclusion Accreditation reduces excess LOS and contributes to improving the quality of psychiatric inpatient care and access to psychiatric beds.
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Affiliation(s)
- Mohammed Abdullah Al-Sughayir
- Psychiatry Department, College of Medicine, King Saud University, PO Box 21525, Riyadh, 11485 Kingdom of Saudi Arabia
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94
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Cookson R, Asaria M, Ali S, Ferguson B, Fleetcroft R, Goddard M, Goldblatt P, Laudicella M, Raine R. Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundInequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them.ObjectivesThe objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format.DesignLongitudinal whole-population study at the small-area level.SettingEngland from 2001/2 to 2011/12.ParticipantsA total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people.Main outcome measuresSlope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality.Data sourcesPractice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8).ResultsBetween 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark.LimitationsGeneral practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible.ConclusionsNHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any administrative geography comprising ≥ 100,000 people.Future workExploration of quality improvement lessons from local areas performing well and badly on health-care equity, improved methods including better measures of need and risk and measures of health-care inequality over the life-course, and monitoring of other dimensions of equity. These indicators can also be used to evaluate the health-care equity impacts of interventions and make international health-care equity comparisons.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Miqdad Asaria
- Centre for Health Economics, University of York, York, UK
| | - Shehzad Ali
- Centre for Health Economics, University of York, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Brian Ferguson
- Knowledge and Intelligence, Public Health England, York, UK
| | | | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Peter Goldblatt
- Institute of Health Equity, University College London, London, UK
| | | | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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95
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Conroy SP, Turpin S. New horizons: urgent care for older people with frailty. Age Ageing 2016; 45:577-84. [PMID: 27496917 DOI: 10.1093/ageing/afw135] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/13/2016] [Indexed: 11/13/2022] Open
Abstract
Urgent care for older people is a major public health issue and attracts much policy attention. Despite many efforts to curb demand, many older people with frailty and urgent care needs to access acute hospital services. The predominant model of care delivered in acute hospitals tends to be medically focussed, yet the evidence-based approaches that appear to be effective invoke a holistic model of care, delivered by interdisciplinary teams embedding geriatric competencies into their service. This article reviews the role for holistic care-termed Comprehensive Geriatric Assessment in the research literature-and how it can be used as an organising framework to guide future iterations of acute services to be better able to meet the multifaceted needs of older people.
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Affiliation(s)
- Simon P Conroy
- University of Leicester School of Medicine, Department of Health Sciences, Room 3.37, Centre for Medicine, University of Leicester, Lancaster Road, Leicester LE1 7HA, UK
| | - Sarah Turpin
- Fellow in Geriatric Emergency Medicine, Leicester Royal Infirmary , Leicester, UK
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96
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Statile AM, Schondelmeyer AC, Thomson JE, Brower LH, Davis B, Redel J, Hausfeld J, Tucker K, White DL, White CM. Improving Discharge Efficiency in Medically Complex Pediatric Patients. Pediatrics 2016; 138:peds.2015-3832. [PMID: 27412640 DOI: 10.1542/peds.2015-3832] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%. METHODS We used quality improvement methods to identify key drivers and inform interventions. Medical discharge goals were defined on admission for each patient. Interventions included implementation of a complex care inpatient team with electronic admission order set, weekly care coordination rounds, needs assessment tool, and medication pathway. The primary measure, percentage of patients discharged within 2 hours of meeting medical discharge goals, was followed on a run chart. The secondary measures, pre- and post-intervention length of stay and 30-day readmission rate, were compared by using Wilcoxon rank-sum and χ(2) tests, respectively. RESULTS The percentage of medically complex patients discharged within 2 hours of meeting medical discharge goals improved from 50% to 88% over 17 months and sustained for 6 months. In preintervention-postintervention comparison, median length of stay did not change (3.1 days [interquartile range, 1.8-7.0] vs 2.9 days [interquartile range, 1.7-6.1]; P = .67) and 30-day readmission rate was not impacted (30.7% vs 26.4%; P = .51). CONCLUSIONS Efficient discharge for medically complex patients requires support of a multidisciplinary team to proactively address discharge needs, ensuring patients are ready for discharge when medical goals are met.
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Affiliation(s)
- Angela M Statile
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence
| | - Joanna E Thomson
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence
| | - Laura H Brower
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Blair Davis
- James M. Anderson Center for Health Systems Excellence
| | | | - Julie Hausfeld
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Karen Tucker
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Denise L White
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence
| | - Christine M White
- Division of Hospital Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio James M. Anderson Center for Health Systems Excellence
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97
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Durocher E, Gibson BE, Rappolt S. Rehabilitation as "destination triage": a critical examination of discharge planning. Disabil Rehabil 2016; 39:1271-1278. [PMID: 27411290 DOI: 10.1080/09638288.2016.1193232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE In this paper we examine how the intersection of various social and political influences shapes discharge planning and rehabilitation practices in ways that may not meet the espoused aims of rehabilitation programs or the preferences of older adults and their families. METHODS Taking a critical bioethics perspective, we used microethnographic case study methods to examine discharge-planning processes in a well-established older adult inpatient rehabilitation setting in Canada. The data included observations of discharge-planning family conferences and semi-structured interviews conducted with older adults facing discharge, their family members and rehabilitation professionals involved in discharge planning. RESULTS From the time of admission, a contextual push to focus on discharge superseded program aims of providing interventions to increase older adults' functional capabilities. Professionals' primary commitment to safety limited consideration of discharge options and resulted in costly and potentially unnecessary recommendations for 24-hour care. The resulting "rehabilitation" stay was more akin to an extended process of "destination triage" biased towards the promotion of physical safety than optimizing functioning. CONCLUSIONS The resulting reduction of rehabilitation into "destination triage" has significant social, financial and occupational implications for older adults and their families, and broader implications for healthcare services and overarching healthcare systems. Implications for Rehabilitation Current trends promoting consideration of discharge planning from the point of admission and prioritizing physical safety are shifting the focus of rehabilitation away from interventions to maximize recovery of function, which are the stated aims of rehabilitation. Such practices furthermore promote assessments to determine prognosis early in the rehabilitation stay when accurate prognosis is difficult, which can lead to overly conservative recommendations for discharge from rehabilitation services, thus further negating the impact of rehabilitation. Further work is required to examine the social, occupational and functional implications of superseding rehabilitation interventions to maximize capabilities with practices that prioritize safety over quality of life for older adults and their family members.
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Affiliation(s)
- Evelyne Durocher
- a School of Occupational Therapy Occupational Science Field, Faculty of Health Sciences , Western University , London , Canada
| | - Barbara E Gibson
- b Department of Physiotherapy, Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada
| | - Susan Rappolt
- c Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute , University of Toronto , Toronto , Canada
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98
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Connolly MJ. Avoidable readmission: an avoidable failure of discharge planning. Lancet Haematol 2016; 3:e258-e259. [PMID: 27264032 DOI: 10.1016/s2352-3026(16)30039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/15/2016] [Indexed: 06/05/2023]
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99
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Pollack AH, Backonja U, Miller AD, Mishra SR, Khelifi M, Kendall L, Pratt W. Closing the Gap: Supporting Patients' Transition to Self-Management after Hospitalization. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2016; 2016:5324-5336. [PMID: 27500285 DOI: 10.1145/2858036.2858240] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients going home after a hospitalization face many challenges. This transition period exposes patients to unnecessary risks related to inadequate preparation prior to leaving the hospital, potentially leading to errors and patient harm. Although patients engaging in self-management have better health outcomes and increased self-efficacy, little is known about the processes in place to support and develop these skills for patients leaving the hospital. Through qualitative interviews and observations of 28 patients during and after their hospitalizations, we explore the challenges they face transitioning from hospital care to self-management. We identify three key elements in this process: knowledge, resources, and self-efficacy. We describe how both system and individual factors contribute to breakdowns leading to ineffective patient management. This work expands our understanding of the unique challenges faced by patients during this difficult transition and uncovers important design opportunities for supporting crucial yet unmet patient needs.
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Affiliation(s)
- Ari H Pollack
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA; Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Uba Backonja
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Andrew D Miller
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Sonali R Mishra
- The Information School, University of Washington, Seattle, WA, USA
| | - Maher Khelifi
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Logan Kendall
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, WA, USA
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Wann-Hansson C, Wennick A. How do patients with peripheral arterial disease communicate their knowledge about their illness and treatments? A qualitative descriptive study. BMC Nurs 2016; 15:29. [PMID: 27147906 PMCID: PMC4855438 DOI: 10.1186/s12912-016-0151-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peripheral arterial disease is a chronic illness, and patients with peripheral arterial disease should receive advice about lifestyle changes and medical therapies to reduce further atherosclerotic complications. Previous research has indicated that patients with peripheral arterial disease lack information about their disease and secondary prevention measures. The aim was to elucidate how patients with peripheral arterial disease communicate their knowledge about their illness and treatments. METHODS During 2009, seven focus group interviews were conducted with twenty-one patients (50-81 years old) with peripheral arterial disease and were analysed using content analysis. RESULTS When respondents with PAD communicate their knowledge about the illness and its treatments they "Navigate through uncertainty, believes and facts about PAD, displaying an active or passive information-seeking behaviour". After discharge, they felt a feeling of relief at first, which was later exchanged into uncertainty from their restricted knowledge about the illness and how to behave following revascularisation. For example, during the discussions about risk factors, smoking was noted as a major risk factor, that triggered feelings of guilt. Thus, the respondents needed to consult other sources of information to manage their everyday lives. CONCLUSIONS Following endovascular treatment, the short amount of time spent with peripheral arterial disease patients requires innovative guidance in clinical practice to meet individuals' needs regardless of whether the patient actively or passively understands and manages their peripheral arterial disease.
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Affiliation(s)
- Christine Wann-Hansson
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25, 20506 Malmö, Sweden ; Vascular department, Skane University Hospital, Malmö, Sweden
| | - Anne Wennick
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25, 20506 Malmö, Sweden
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