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Ahmadinejad B, Jalali A, Bahramian F, Shabani A, Sherafati M. Implementation of Intrahospital Transfer Strategy During COVID-19 and Identify Success Factors Based on DEMATEL Technique. Qual Manag Health Care 2024:00019514-990000000-00082. [PMID: 39038067 DOI: 10.1097/qmh.0000000000000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic caused a significant strain on world health care systems. The lack of trained and experienced staff was a complicated issue during the pandemic. To overcome insufficient staffing problems, the intrahospital transfer (IHT) strategy was implemented at Milad Hospital in Tehran during COVID-19. We evaluated the effectiveness of the IHT strategy in order to determine whether the strategy should be continued post-COVID. METHODS Six supervisors with experience in COVID-19 wards and the IHT strategy were consulted to identify the advantages of continuing the IHT strategy and to evaluate the success and continuation of IHT factors. Then, the decision-making trial and evaluation laboratory (DEMATEL) method was used to establish a network of influence relationships among IHT strategy factors' success. RESULTS The result showed that all criteria except increasing patient satisfaction (C1) and reducing waste of time (C8) are cause-and-effect criteria that affected other criteria. CONCLUSION The research findings have implications for improving the day-to-day experience of staff navigating transfers of patients between wards and paraclinic units. This study also highlights the theoretical value of the cross-disciplinary integration of medical decision issues and multiple-attribute decision-making methodologies.
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Affiliation(s)
- Bahareh Ahmadinejad
- Author Affiliations: Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran (Ms Ahmadinejad); Health Systems Engineering Research Center, Milad Hospital, Tehran, Iran (Ms Ahmadinejad and Dr Jalali); Griffith Centre of Biomedical and Rehabilitation Engineering, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia (Ms Bahramian); Department of Industrial Engineering, Faculty of Engineering, University of Qom, Qom, Iran (Mr Shabani); and Department of Management and Accounting, Allameh Tabataba'i University, Tehran, Iran (Mr Sherafati)
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Sommer D, Kasbauer J, Jakob D, Schmidt S, Wahl F. Potential of Assistive Robots in Clinical Nursing: An Observational Study of Nurses' Transportation Tasks in Rural Clinics of Bavaria, Germany. NURSING REPORTS 2024; 14:267-286. [PMID: 38391066 PMCID: PMC10885045 DOI: 10.3390/nursrep14010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Transportation tasks in nursing are common, often overlooked, and directly impact patient care time in the context of staff shortages and an aging society. Current studies lack a specific focus on transportation tasks, a gap our research aims to fill. By providing detailed data on transportation needs in nursing, our study establishes a crucial foundation for the development and integration of assistive robots in clinical settings. In July and September 2023, we conducted weekly observations of nurses to assess clinical transportation needs. We aim to understand the economic impact and the methods nurses use for transportation tasks. We conducted a participant observation using a standardized app-based form over a seven-day observation period in two rural clinics. N = 1830 transports were made by nurses and examined by descriptive analysis. Non-medical supplies account for 27.05% (n = 495) of all transports, followed by medical supplies at 17.32% (n = 317), pharmacotherapy at 14.10% (n = 258) and other other categories like meals or drinks contributing 12.68% (n = 232). Most transports had a factual transport time of under a minute, with patient transport and lab samples displaying more variability. In total, 77.15% of all transports were made by hand. Requirements to collect items or connect transports with patient care were included in 5% of all transports. Our economic evaluation highlighted meals as the most costly transport, with 9596.16 € per year in the observed clinics. Budget-friendly robots would amortize these costs over one year by transporting meals. We support understanding nurses' transportation needs via further research on assistive robots to validate our findings and determine the feasibility of transport robots.
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Affiliation(s)
- Domenic Sommer
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Jakob Kasbauer
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Dietmar Jakob
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Sebastian Schmidt
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
| | - Florian Wahl
- Technology Campus Grafenau, Deggendorf Institute of Technology, 94481 Grafenau, Germany
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Benjamin E. Understanding the work and decision-making strategies of bed management nurses: a systematic review. NURSING MANAGEMENT (HARROW, LONDON, ENGLAND : 1994) 2021; 29:25-31. [PMID: 34608774 DOI: 10.7748/nm.2021.e2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/09/2022]
Abstract
The need for hospital-wide solutions to improve patient flow is broadly recognised. Bed management nurses are integral to patient flow processes, and recognition of their strengths and skills is crucial in implementing effective solutions, yet there is limited research describing their role. This article details a systematic review of the literature on bed management nurses. Six themes were identified: complexity in a context of scarcity; dealing with external pressures and conflicting priorities; need for multiple decision-making strategies; uncertainty; need for training; and unrecognised yet important work. The findings could assist nurse managers and hospital leaders to promote communication, teamwork and coordination between hospital staff and bed management nurses.
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Affiliation(s)
- Ellen Benjamin
- University of Massachusetts Amherst College of Nursing, Amherst MA, US
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Tobiano G, Ryan C, Jenkinson K, Scott L, Marshall AP. Handover From the Emergency Department to Inpatient Units: A Quality Improvement Study. J Nurs Care Qual 2021; 36:339-345. [PMID: 33079819 DOI: 10.1097/ncq.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intrahospital handovers are high risk. Standardization of content and process is recommended. LOCAL PROBLEM Emergency department to inpatient unit handovers were inefficient. INTERVENTIONS The intervention was a standardized operating protocol, including checklist and procedures. METHODS The intervention was coproduced and prototyped. Handovers were observed for intervention adherence, and the Handover Evaluation Scale was used to measure nurses' perceived quality of handover. RESULTS The handover had 3 steps. Step 1 had more content, prompting by the receiver, and family participation postintervention. Step 3 was shorter in duration, had less content, and occurred at the bedside more postintervention. Receiving nurses were able to ask questions and found that information provided was timely, current, and easy to follow. Sending nurses perceived that handover was less succinct postimplementation, despite decreases in handover duration and repetition of information. CONCLUSIONS This project has triggered ongoing improvement initiatives, necessary to keep accommodating the needs of nurses that work across boundaries.
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Affiliation(s)
- Georgia Tobiano
- Gold Coast Health, Gold Coast, Queensland, Australia (Dr Tobiano, Mss Ryan, Jenkinson, and Scott and Dr Marshall); and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia (Drs Tobiano and Marshall)
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Bristol AA, Martin-Plank L, Crist JD. Health Care Professionals' Experiences as Family Caregivers During Intra-Hospital Transitions. J Gerontol Nurs 2021; 47:31-36. [PMID: 33497448 DOI: 10.3928/00989134-20210113-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
Abstract
Family caregivers are often perceived as inexperienced family members assuming caregiving duties. However, health care professionals may also find themselves in an informal caregiving role as older adult relatives or friends are hospitalized and experience intra-hospital transitions. The purpose of the current study was to describe the experiences of health care professionals assuming the role of informal caregiver during intra-hospital transitions. As part of a larger study, a separate analysis of six semi-structured interviews from family caregivers with health care backgrounds was considered. Health care professionals as family caregivers (HCP-FCs) reported they sought inclusion in the care provided, they had unique insider perspectives, and experienced role struggle between health care professional and new informal caregiver. Moreover, HCP-FCs reported increased role struggle during interactions with colleagues and fellow health care professionals. Understanding of the role of HCP-FCs during transitions in care is necessary to develop interventions supportive of patient- and family-centered care. [Journal of Gerontological Nursing, 47(2), 31-36.].
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Trovó SA, Cucolo DF, Perroca MG. Transfer of patients in hospital units: impacts on nursing workload. Rev Esc Enferm USP 2021; 55:e0327. [PMID: 34161440 DOI: 10.1590/s1980-220x2020024903727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/06/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To measure the average time spent by the nursing team in transferring patients; to compare the activities observed during the performance of this intervention with those described by the Nursing Interventions Classification and to investigate the intensity of its influence on the workload. METHOD Observational study using timekeeping software conducted in two hospitals in the northwest region of the State of São Paulo. 200 patient transfers were monitored by the team using two validated instruments. RESULTS The average time spent by nurses on transfers ranged from 9.3 (standard deviation = 3.5) to 12.2 (standard deviation = 2.5) minutes and by assistants/ technicians between 7.1 (standard deviation = 2,8) and 11.0 (standard deviation = 2.2) minutes. 63 transfers made by nurses and 87 by assistants/technicians were considered qualified (>70% of the score). The team expended 19.3 to 29% of the working day time in this intervention. CONCLUSION The transfer of patients has an impact on the workload of the team and needs to be considered in the measurement of nursing activities for the calculation and distribution of personnel to improve the quality and continuity of care.
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Affiliation(s)
- Simone Aparecida Trovó
- Faculdade de Medicina de São José do Rio Preto, Programa de Pós-Graduação em Enfermagem, São José do Rio Preto, SP, Brazil
| | - Danielle Fabiana Cucolo
- Universidade Federal de São Carlos, Programa de Pós Graduação em Enfermagem, São Carlos, SP, Brazil.,Pontifícia Universidade Católica de Campinas, Programa de Pós Graduação de Residência Multiprofissinal em Saúde, Campinas, SP, Brazil
| | - Márcia Galan Perroca
- Faculdade de Medicina de São José do Rio Preto, Programa de Pós-Graduação em Enfermagem, São José do Rio Preto, SP, Brazil
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Fekieta R, Rosenberg A, Jenq GY, Emerson BL. A New Tool to Assess Clinician Experience With Patient Care Transitions. Qual Manag Health Care 2021; 30:87-96. [PMID: 33783422 DOI: 10.1097/qmh.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Clinician experience of intrahospital patient care transfers can drive transfer success and safe patient care. Measuring clinician experience can provide insights into opportunities to improve transfer processes that impact patient care. As part of a quality improvement project, we developed a brief survey to gauge clinician experience with patient care transfers that occur within a hospital. METHODS The survey framework was built upon a previously identified taxonomy of intrahospital transfers that includes categories of transfer activities: disposition, notification, preparation, communication, and coordination. The survey tool was administered twice to physicians, nurses, and other health professionals across a single hospital. Data were analyzed comparing providers sending patients, and those receiving patients. RESULTS The survey response rate was 33% to 34% across both years. While helpful in demonstrating improving trends in provider experience and engagement with transfer processes, the survey also allowed for differences between the experiences of sending and receiving providers to be revealed. Nurses reported improved preparedness to receive patients and receivers overall reported improved teamwork. Senders' perceptions showed improved trends in all transfer categories. Preliminary data also suggest acceptable reliability across respondent type, item category, and time. Specifically, reliability across sending and receiving clinicians was demonstrated in the categories of timeliness (α = 0.85) and culture (α = 0.72). Responses of sending clinicians were internally consistent within culture (α = 0.82), while responses of receiving clinicians were internally consistent within culture (α = 0.86), timeliness (α = 0.76), notification (α = 0.77), communication (α = 0.73), and teamwork (α = 0.73). CONCLUSIONS Overall, the survey was feasible to implement and built to optimize content, construct, and response process validity. Survey results drove practical improvement work, such as informing a verbal transfer protocol to improve nursing preparedness to receive patients on general medicine units. As a practical tool, the survey and its results can help hospital administrators to focus on categories of transfer activities that are most problematic for clinicians and to track trends for quality improvement.
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Affiliation(s)
- Renee Fekieta
- Yale University School of Medicine, New Haven, Connecticut (Drs Fekieta and Emerson); Yale University School of Public Health, New Haven, Connecticut (Ms Rosenberg); and University of Michigan Medicine, Ann Arbor (Dr Jenq)
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Gu X, Itoh K. Organizational climate for safe and effective inter-unit handoffs in Japanese hospitals. Int J Health Plann Manage 2021; 36:1153-1165. [PMID: 33797114 DOI: 10.1002/hpm.3162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/17/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To extract the organizational climate factors that contribute to safe and effective inter-unit patient handoffs, as well as to capture their crucial characteristics in the context of current Japanese hospitals. METHODS A questionnaire survey was conducted among nursing staff in 31 general hospitals, collecting a total of 5117 valid responses (69% response rate). RESULTS A five-factor model was established to determine the inter-unit handoff climate within hospitals. This comprised information and responsibility-related risk, role understanding, communication, handoff environment, and guidelines and process. Based on nursing staff perceptions, the inter-unit handoff climate in Japanese hospitals were generally found to be moderate or moderate-to-high levels across all five of the factors. Nursing staff's perceptions of all five climate factors differed significantly across hospitals and work units, rather than working conditions (full-time vs. part-time) or professions (nurse vs. nurse assistant). All five handoff factors were verified their significant impacts on patient safety awareness and handoff quality. Furthermore, in hospitals where staff perceptions of handoff climate were more positive, information was transferred more effectively. CONCLUSIONS An inter-unit handoff climate structure was extracted and verified its impact on handoff quality and safety. Due to moderate climate levels in Japanese hospitals, as well as background factors such as low risk awareness among staff and busy situations, promoting a more positive organizational culture is suggested for creating safer and more effective inter-unit handoffs. Improving the current handoff guidelines and processes in hospitals and using non-licensed assistive staff more effectively are also recommended.
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Affiliation(s)
- Xiuzhu Gu
- Department of Industrial Engineering and Economics, School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Kenji Itoh
- Department of Industrial Engineering and Economics, School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
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Appelbaum R, Martin S, Tinkoff G, Pascual JL, Gandhi RR. Eastern association for the surgery of trauma - quality, patient safety, and outcomes committee - transitions of care: healthcare handoffs in trauma. Am J Surg 2021; 222:521-528. [PMID: 33558061 DOI: 10.1016/j.amjsurg.2021.01.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/16/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Handoffs are defined as the transfer of patient information, professional responsibility, and accountability between caregivers. This work aims to clarify the current state of transitions of care related to the management of trauma patients. METHODS A PubMed database and web search were performed for articles published between 2000 and 2020 related to handoffs and transitions of care. The key search terms used were: handoff(s), handoff(s) AND healthcare, and handoff(s) AND trauma. A total of 55 studies were included in qualitative synthesis. RESULTS This systematic review explores the current state of healthcare handoffs for trauma patients. Factors found to impact successful handoffs included process standardization, team member accountability, effective communication, and the incorporation of culture. This review was limited by the small number of prospective randomized studies available on the topic. CONCLUSION Handoffs in trauma care have been studied and should be utilized in the context of published experience and practice. Standardization when applied with accountability has proven benefit to reduce communication errors during these transfers of care.
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Affiliation(s)
- Rachel Appelbaum
- Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
| | - Shayn Martin
- Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA.
| | - Glen Tinkoff
- Department of Surgery, University Hospitals, Cleveland, OH, USA.
| | - Jose L Pascual
- Surgery/Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Rajesh R Gandhi
- Department of Surgery, JPS Health Network, Medical Education, TCU/UNTHSC School of Medicine, Fort Worth, TX, USA.
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Abstract
Previous transitional care research has focused on transitions occurring between community and hospital settings. Little is known regarding intrahospital transitions and how they affect care quality. A systematic review was therefore conducted to synthesize the literature regarding clinical outcomes associated with intrahospital transitions. Literature published between January 2003 and December 2018 and indexed in Medline/PubMed, CINAHL, and PsychINFO were reviewed using PRISMA guidelines. Articles were limited to English language and peer-reviewed. Articles were excluded if they focused on transitions occurring from or to the hospital, discharge/discharge planning, or postdischarge follow-up. Data abstraction included study characteristics, sample characteristics, and reported clinical outcomes. Fourteen studies met inclusion criteria, primarily using cross-sectional, cohort, or retrospective chart review quantitative designs. Data were analyzed and synthesized based on outcomes reported. Major outcomes emerging from the articles included delirium, hospital length of stay, mortality, and adverse events. Delirium, hospital length of stay, and morbidity and mortality rates were associated with delayed transfers and transfers to inappropriate units. In addition, increased fall risk and infection rates were associated with higher rates of transfer. Intrahospital transitions represent critical periods of time where the quality of care being provided may be diminished, negatively affecting patient safety and outcomes.
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11
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Gu X, Itoh K. Inter‐shift handoff: Changes over a 6‐year interval. J Adv Nurs 2020; 76:3418-3428. [DOI: 10.1111/jan.14537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/29/2020] [Accepted: 07/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Xiuzhu Gu
- Department of Industrial Engineering and Economics School of Engineering Tokyo Institute of Technology Meguro‐ku Tokyo Japan
| | - Kenji Itoh
- Department of Industrial Engineering and Economics School of Engineering Tokyo Institute of Technology Meguro‐ku Tokyo Japan
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Hervé MEW, Zucatti PB, Lima MADDS. Transition of care at discharge from the Intensive Care Unit: a scoping review. Rev Lat Am Enfermagem 2020; 28:e3325. [PMID: 32696919 PMCID: PMC7365613 DOI: 10.1590/1518-8345.4008.3325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/07/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE to map the available evidence on the components of the transition of care, practices, strategies, and tools used in the discharge from the Intensive Care Unit (ICU) to the Inpatient Unit (IU) and its impact on the outcomes of adult patients. METHOD a scoping review using search strategies in six relevant health databases. RESULTS 37 articles were included, in which 30 practices, strategies or tools were identified for organizing and executing the transfer process, with positive or negative impacts, related to factors intrinsic to the Intensive Care Unit and the Inpatient Unit and cross-sectional factors regarding the staff. The analysis of hospital readmission and mortality outcomes was prevalent in the included studies, in which trends and potential protective actions for a successful care transition are found; however, they still lack more robust evidence and consensus in the literature. CONCLUSION transition of care components and practices were identified, in addition to factors intrinsic to the patient, associated with worse outcomes after discharge from the Intensive Care Unit. Discharges at night or on weekends were associated with increased rates of readmission and mortality; however, the association of other practices with the patient's outcome is still inconclusive.
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Fekieta R, Rosenberg A, Hodshon B, Feder S, Chaudhry SI, Emerson BL. Organisational factors underpinning intra-hospital transfers: a guide for evaluating context in quality improvement. Health Syst (Basingstoke) 2020; 10:239-248. [PMID: 34745587 DOI: 10.1080/20476965.2020.1768807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
During intra-hospital transfers, multiple clinicians perform coordinated tasks that leave patients vulnerable to undesirable outcomes. Communication has been established as a challenge to care transitions, but less is known about the organisational complexities within which transfers take place. We performed a qualitative assessment that included various professions to capture a multi-faceted understanding of intra-hospital transfers. Ethnographic observations and semi-structured interviews were conducted with clinicians and staff from the Medical Intensive Care Unit, Emergency Department, and general medicine units at a large, urban, academic, tertiary medical centre. Results highlight the organisational factors that stakeholders view as important for successful transfers: the development, dissemination, and application of protocols; robustness of technology; degree of teamwork; hospital capacity; and the ways in which competing hospital priorities are managed. These factors broaden our understanding of the organisational context of intra-hospital transfers and informed the development of a practical guide that can be used prior to embarking on quality improvement efforts around transitions of care.
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Affiliation(s)
- Renee Fekieta
- Center for Healthcare Innovation, Redesign & Learning, Yale University School of Medicine, New Haven, CT, USA
| | | | - Beth Hodshon
- Center for Healthcare Innovation, Redesign & Learning, Yale University School of Medicine, New Haven, CT, USA
| | - Shelli Feder
- Yale University School of Nursing, New Haven, CT, USA
| | - Sarwat I Chaudhry
- Center for Healthcare Innovation, Redesign & Learning, Yale University School of Medicine, New Haven, CT, USA
| | - Beth L Emerson
- Center for Healthcare Innovation, Redesign & Learning, Yale University School of Medicine, New Haven, CT, USA
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Germack HD, Fekieta R, Campbell Britton M, Feder SL, Rosenberg A, Chaudhry SI. Cooperation and conflict in intra-hospital transfers: A qualitative analysis. Nurs Open 2020; 7:634-641. [PMID: 32089862 PMCID: PMC7024622 DOI: 10.1002/nop2.434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/15/2019] [Accepted: 11/27/2019] [Indexed: 11/26/2022] Open
Abstract
Aim The purpose of this study was to explore the latent conditions of cooperation and conflict in intra-hospital patient transfers (i.e. transfers of patients between units in a hospital). Design Secondary qualitative analysis of 28 interviews conducted with 29 hospital staff, including physicians (N = 13), nurses (N = 10) and support staff (N = 6) from a single, large academic tertiary hospital in the Northeastern United States. Methods A two-member multidisciplinary team applied a directed content analysis approach to data collected from semi-structured interviews. Results Three recurrent themes were generated: (a) patient flow policies created imbalances of power; (b) relationships were helpful to facilitate safe transfers; and (c) method of admission order communication was a source of disagreement. Hospital quality improvement efforts could benefit from a teaming approach to minimize unintentional power imbalances and optimize communicative relationships between units.
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Affiliation(s)
- Hayley D. Germack
- National Clinician Scholars ProgramYale University School of MedicineNew HavenCTUSA
- Present address:
School of Nursing Department of Acute and Tertiary CareUniversity of PittsburghPittsburghPAUSA
| | - Renee Fekieta
- Department of Population HealthYale University School of MedicineNew HavenCTUSA
| | | | | | | | - Sarwat I. Chaudhry
- Department of Internal MedicineYale University School of MedicineNew HavenCTUSA
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Abstract
Geriatric nurses are skilled in the special needs of hospitalized older adults. While significant focus has been placed on improving care transitions upon discharge, less attention has been placed on intra-hospital transitions. Intra-hospital transitions represent transfers occurring between hospital units or rooms. Intra-hospital transitions challenge normal nursing workflow and require careful consideration of care coordination to prevent adverse events for older adults. Frequent changes in environment and a lack of consistency in care may support the development or prolongation of delirium as older adults are transferred between units and rooms. Additional adverse event risks include infections and falls, which also increases with each transfer. Geriatric nurse involvement can enhance communication between units as well as ensuring appropriate geriatric assessments occur. Geriatric nurses are thus well positioned to act as leaders during intra-hospital transitions, potentially reducing these and adverse events.
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Affiliation(s)
- Alycia A Bristol
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, 433 1st Avenue, New York, NY 10010, United States.
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