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Wallis JA, Shepperd S, Makela P, Han JX, Tripp EM, Gearon E, Disher G, Buchbinder R, O'Connor D. Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. Cochrane Database Syst Rev 2024; 3:CD014765. [PMID: 38438114 PMCID: PMC10911892 DOI: 10.1002/14651858.cd014765.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Worldwide there is an increasing demand for Hospital at Home as an alternative to hospital admission. Although there is a growing evidence base on the effectiveness and cost-effectiveness of Hospital at Home, health service managers, health professionals and policy makers require evidence on how to implement and sustain these services on a wider scale. OBJECTIVES (1) To identify, appraise and synthesise qualitative research evidence on the factors that influence the implementation of Admission Avoidance Hospital at Home and Early Discharge Hospital at Home, from the perspective of multiple stakeholders, including policy makers, health service managers, health professionals, patients and patients' caregivers. (2) To explore how our synthesis findings relate to, and help to explain, the findings of the Cochrane intervention reviews of Admission Avoidance Hospital at Home and Early Discharge Hospital at Home services. SEARCH METHODS We searched MEDLINE, CINAHL, Global Index Medicus and Scopus until 17 November 2022. We also applied reference checking and citation searching to identify additional studies. We searched for studies in any language. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with qualitative data collection and analysis methods examining the implementation of new or existing Hospital at Home services from the perspective of different stakeholders. DATA COLLECTION AND ANALYSIS Two authors independently selected the studies, extracted study characteristics and intervention components, assessed the methodological limitations using the Critical Appraisal Skills Checklist (CASP) and assessed the confidence in the findings using GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). We applied thematic synthesis to synthesise the data across studies and identify factors that may influence the implementation of Hospital at Home. MAIN RESULTS From 7535 records identified from database searches and one identified from citation tracking, we included 52 qualitative studies exploring the implementation of Hospital at Home services (31 Early Discharge, 16 Admission Avoidance, 5 combined services), across 13 countries and from the perspectives of 662 service-level staff (clinicians, managers), eight systems-level staff (commissioners, insurers), 900 patients and 417 caregivers. Overall, we judged 40 studies as having minor methodological concerns and we judged 12 studies as having major concerns. Main concerns included data collection methods (e.g. not reporting a topic guide), data analysis methods (e.g. insufficient data to support findings) and not reporting ethical approval. Following synthesis, we identified 12 findings graded as high (n = 10) and moderate (n = 2) confidence and classified them into four themes: (1) development of stakeholder relationships and systems prior to implementation, (2) processes, resources and skills required for safe and effective implementation, (3) acceptability and caregiver impacts, and (4) sustainability of services. AUTHORS' CONCLUSIONS Implementing Admission Avoidance and Early Discharge Hospital at Home services requires early development of policies, stakeholder engagement, efficient admission processes, effective communication and a skilled workforce to safely and effectively implement person-centred Hospital at Home, achieve acceptance by staff who refer patients to these services and ensure sustainability. Future research should focus on lower-income country and rural settings, and the perspectives of systems-level stakeholders, and explore the potential negative impact on caregivers, especially for Admission Avoidance Hospital at Home, as this service may become increasingly utilised to manage rising visits to emergency departments.
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Affiliation(s)
- Jason A Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Cabrini Health, Malvern, Australia
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Petra Makela
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jia Xi Han
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Evie M Tripp
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emma Gearon
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gary Disher
- New South Wales Ministry of Health, St Leonards, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise O'Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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O'Neill BJ, Dwyer T, Parkinson L, Reid-Searl K, Jeffrey D. Identifying the core components of a nursing home hospital avoidance programme. Int J Older People Nurs 2023; 18:e12493. [PMID: 35943901 PMCID: PMC10078518 DOI: 10.1111/opn.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 05/23/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Nursing home hospital avoidance programmes have contributed to a reduction in unnecessary emergency transfers but a description of the core components of the programmes has not been forthcoming. A well-operationalised health-care programme requires clarity around core components to evaluate and replicate the programme. Core components are the essential functions and principles that must be implemented to produce expected outcomes. OBJECTIVES To identify the core components of a nursing home hospital avoidance programme by assessing how the core components identified at one nursing home (Site One) translated to a second nursing home (Site Two). METHODS Data collected during the programme's implementation at Site Two were reviewed for evidence of how the core components named at Site One were implemented at Site Two and to determine if any additional core components were evident. The preliminary updated core components were then shared with seven evaluators familiar with the hospital avoidance programme for consensus. RESULTS The updated core components were agreed to include the following: Decision Support Tools, Advanced Clinical Skills Training, Specialist Clinical Support and Collaboration, Facility Policy and Procedures, Family and Care Recipient Education and Engagement, Culture of Staff Readiness, Supportive Executive and Facility Management. CONCLUSION This study launches a discussion on the need to identify hospital avoidance programme core components, while providing valuable insight into how Site One core programme components, such as resources, education and training, clinical and facility support, translated to Site Two, and why modifications and additions, such as incorporating the programme into facility policy, family education and executive support were necessary, and the ramifications of those changes. The next step is to take the eight core component categories and undertake a rigorous fidelity assessment as part of formal process evaluation where the components can be critiqued and measured across multiple nursing home sites. The core components can then be used as evidence-based building blocks for developing, implementing and evaluating nursing home hospital avoidance programmes.
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Affiliation(s)
- Barbara J O'Neill
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia.,School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Trudy Dwyer
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Lynne Parkinson
- School of Medicine and Public Health, University of New Castle, Callaghan, New South Wales, Australia
| | - Kerry Reid-Searl
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Laging B, Kenny A, Bauer M, Nay R. Recognition and assessment of resident' deterioration in the nursing home setting: A critical ethnography. J Clin Nurs 2018; 27:1452-1463. [PMID: 29396884 DOI: 10.1111/jocn.14292] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the recognition and assessment of resident deterioration in the nursing home setting. BACKGROUND There is a dearth of research exploring how nurses and personal-care-assistants manage a deteriorating nursing home resident. DESIGN Critical ethnography. METHODS Observation and semi-structured interviews with 66 participants (general medical practitioners, nurses, personal-care-assistants, residents and family members) in two Australian nursing homes. The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS The value of nursing assessment is poorly recognised in the nursing home setting. A lack of clarity regarding the importance of nursing assessments associated with resident care has contributed to a decreasing presence of registered nurses and an increasing reliance on personal-care-assistants who had inadequate skills and knowledge to recognise signs of deterioration. Registered nurses experienced limited organisational support for autonomous decision-making and were often expected to undertake protocol-driven decisions that contributed to potentially avoidable hospital transfers. CONCLUSIONS Nurses need to demonstrate the importance of assessment, in association with day-to-day resident care and demand standardised, regulated, educational preparation of an appropriate workforce who are competent in undertaking this role. Workforce structures that enhance familiarity between nursing home staff and residents could result in improved resident outcomes. The value of nursing assessment, in guiding decisions at the point of resident deterioration, warrants further consideration.
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Affiliation(s)
- Bridget Laging
- Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Vic., Australia
| | - Amanda Kenny
- Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
| | - Michael Bauer
- Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
| | - Rhonda Nay
- Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
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O'Neill BJ, Dwyer T, Reid-Searl K, Parkinson L. Nursing staff intentions towards managing deteriorating health in nursing homes: A convergent parallel mixed-methods study using the theory of planned behaviour. J Clin Nurs 2018; 27:e992-e1003. [DOI: 10.1111/jocn.14119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara J. O'Neill
- School of Nursing, Midwifery and Social Sciences; Central Queensland University; Rockhampton Qld Australia
| | - Trudy Dwyer
- School of Nursing, Midwifery and Social Sciences; Central Queensland University; Rockhampton Qld Australia
| | - Kerry Reid-Searl
- School of Nursing, Midwifery and Social Sciences; Central Queensland University; Rockhampton Qld Australia
| | - Lynne Parkinson
- School of Nursing, Midwifery and Social Sciences; Central Queensland University; Rockhampton Qld Australia
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O'Neill BJ, Dwyer T, Reid-Searl K, Parkinson L. Managing the deteriorating nursing home resident after the introduction of a hospital avoidance programme: a nursing perspective. Scand J Caring Sci 2016; 31:312-322. [PMID: 27327142 DOI: 10.1111/scs.12349] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hospital avoidance programmes aim to reduce the number of emergency transfers from nursing homes to hospitals and facilitate early discharge for hospitalised residents. Nursing staff are at the forefront of these efforts, yet little is known about how the programmes affect them and their management of the deteriorating resident. This information is needed to inform hospital avoidance programmes and better understand their work. AIM To examine nursing home nursing staff perceptions regarding their management of the deteriorating resident after the introduction of a hospital avoidance programme. METHODS A thematic analysis was conducted of focus group data collected from nursing staff 14 to 15 months after the introduction of a pilot hospital avoidance programme at an Australian nursing home. FINDINGS The programme was well received and filled a gap in nursing staff management of residents with deteriorating health by providing structure and support. Staff were more confident and focused on this area of their work. Nursing assistants felt more integrated into the system and were supported and learning from nurses. Workload remained heavy and there was a shift in how time was allocated, but nursing staff preferred to keep residents at the facility. CONCLUSION Nursing staff welcomed the programme and benefitted from its implementation. However, strategies must be explored to accommodate the staffing needs associated with providing emergency and subacute care in the nursing home setting.
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Affiliation(s)
- Barbara J O'Neill
- School of Nursing and Midwifery, Central Queensland University (CQU), Rockhampton, Qld, Australia
| | - Trudy Dwyer
- School of Nursing and Midwifery, Central Queensland University (CQU), Rockhampton, Qld, Australia
| | - Kerry Reid-Searl
- School of Nursing and Midwifery, Central Queensland University (CQU), Rockhampton, Qld, Australia
| | - Lynne Parkinson
- School of Human Health & Social Sciences, Central Queensland University (CQU), Rockhampton, Qld, Australia
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Fleming A, Bradley C, Cullinan S, Byrne S. Antibiotic prescribing in long-term care facilities: a meta-synthesis of qualitative research. Drugs Aging 2016; 32:295-303. [PMID: 25832969 PMCID: PMC4412731 DOI: 10.1007/s40266-015-0252-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives The objective of this review was to synthesize the findings of qualitative studies investigating the factors influencing antibiotic prescribing in long-term care facilities (LTCFs). These findings will inform the development of future antimicrobial stewardship strategies (AMS) in this setting. Methods We searched Embase, PubMed, PsycInfo, Social Science Citations Index and Google Scholar for all qualitative studies investigating health care professionals’ views on antibiotic prescribing in LTCFs. The quality of the papers was assessed using the Critical Appraisal Skills Programme (CASP) assessment tool for qualitative research. Thematic synthesis was used to integrate the emergent themes into an overall analytical theme. Results The synthesis of eight qualitative studies indicated that health care professionals and administrators have identified factors that influence antibiotic prescribing in LTCFs. These factors include variations in knowledge and practice among health care professionals, and the LTCF context, which is unique given the complex patient population and restricted access to doctors and diagnostic tests. The social factors underpinning the interaction between nurses, residents’ families and doctors also influence decision making around antibiotic prescribing. The study also found that there is an acknowledged need for collaborative, evidence-based AMS specific to LTCFs, as antibiotic prescribing is heavily influenced by factors unique to this setting. Conclusion This review highlighted the key contextual challenges for AMS in LTCFs. The findings provide an in-depth insight into the factors—such as the LTCF context, social factors, variability in knowledge and prescribing practices, and antimicrobial resistance—that impact on antibiotic prescribing and AMS strategies. These factors must be considered in order to ensure the feasibility and applicability of future AMS interventions. Electronic supplementary material The online version of this article (doi:10.1007/s40266-015-0252-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aoife Fleming
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland,
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Lawal AK, Rotter T, Kinsman L, Machotta A, Ronellenfitsch U, Scott SD, Goodridge D, Plishka C, Groot G. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review. BMC Med 2016; 14:35. [PMID: 26904977 PMCID: PMC4765053 DOI: 10.1186/s12916-016-0580-z] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/12/2016] [Indexed: 02/02/2023] Open
Abstract
Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist's criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions' (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement.
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Affiliation(s)
- Adegboyega K Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
| | - Thomas Rotter
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Organisation (North), Launceston, Tasmania, Australia.
| | - Andreas Machotta
- Department of Anesthesiology, Sophia Children's Hospital, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands.
| | - Ulrich Ronellenfitsch
- University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Department of Surgery, Mannheim, Germany.
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
| | - Gary Groot
- College of Medicine, University of Saskatchewan, Saskatoon, Canada.
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Laging B, Ford R, Bauer M, Nay R. A meta-synthesis of factors influencing nursing home staff decisions to transfer residents to hospital. J Adv Nurs 2015; 71:2224-36. [DOI: 10.1111/jan.12652] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Bridget Laging
- School of Nursing, Midwifery and Paramedicine; Australian Catholic University; Melbourne Victoria Australia
- Australian Centre for Evidence Based Aged Care (ACEBAC); La Trobe University; Melbourne Victoria Australia
| | - Rosemary Ford
- School of Nursing, Midwifery and Paramedicine; Australian Catholic University; Melbourne Victoria Australia
| | - Michael Bauer
- Australian Centre for Evidence Based Aged Care (ACEBAC); La Trobe University; Melbourne Victoria Australia
| | - Rhonda Nay
- La Trobe University; Melbourne Victoria Australia
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Ayaz SI, Haque N, Pearson C, Medado P, Robinson D, Wahl R, Zervos M, O'Neil BJ. Nursing home-acquired pneumonia: course and management in the emergency department. Int J Emerg Med 2014; 7:19. [PMID: 24899929 PMCID: PMC4029805 DOI: 10.1186/1865-1380-7-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/20/2014] [Indexed: 01/06/2023] Open
Abstract
Background Pneumonia is among the foremost causes of hospitalization and mortality in patients residing in extended care facilities. Despite its prevalence, there is currently little literature focusing on the course and management of nursing home-acquired pneumonia (NHAP) in the emergency department (ED). Our objective was to investigate the ED presentation, course, management and outcomes in patients admitted through the ED with NHAP. Methods A retrospective chart review of nursing home patients with a presumptive or final diagnosis of pneumonia admitted through the ED was performed at two large hospitals in Detroit, Michigan. Results A total of 296 patients were included in the study from 2002 to 2007 with a mean age of 81.1 years (SD ± 10.95) and 55.4% females. Blood cultures were performed on 90.8% of patients in the ED; 17.8% of these revealed growths, but half of these were considered contaminants. Initial chest x-ray in the ED was read as possible pneumonia in 18.2% of patients; 73.9% were started on antibiotics (ABX) in the ED. Mean hospital length of stay (LOS) was 10.75 days (SD ± 9.35) and in-hospital mortality was 16.2%. Time until first ABX in univariate analysis was nearly significant (p = 0.053) for mortality prediction, and the appropriate versus inappropriate ABX (per the Infectious Diseases Society of America and American Thoracic Society guidelines) did not affect mortality. Patients treated with a single ABX had significantly increased LOS (p = 0.0089). There was poor correlation between LOS and time until first ABX as well as LOS and time until appropriate ABX with a correlation coefficient of -0.048 (p = 0.42) and -0.08 (p = 0.43), respectively. Conclusions In this data set of NHAP patients admitted through the ED, we found a surprisingly low prevalence of true-positive blood cultures, high incidence of antibiotic pre-treatment at nursing homes prior to admission, high hospital mortality and low immunization rates. There was a wide spectrum of pathogens grown in blood culture. Only two thirds of the patients had dyspnea at presentation, and less than half had either cough or fever. On physical examination, about one fourth had no clinical findings consistent with pneumonia. Further, less than one fifth of chest x-rays were interpreted as possible pneumonia.
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Affiliation(s)
- Syed Imran Ayaz
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, 6G-UHC, Detroit, MI 48201, USA
| | - Nadia Haque
- Division of Infectious Diseases, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, 6G-UHC, Detroit, MI 48201, USA
| | - Patrick Medado
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, 6G-UHC, Detroit, MI 48201, USA
| | - Duane Robinson
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, 6G-UHC, Detroit, MI 48201, USA
| | - Robert Wahl
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, 6G-UHC, Detroit, MI 48201, USA
| | - Marcus Zervos
- Division of Infectious Diseases, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, 6G-UHC, Detroit, MI 48201, USA
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Laging B, Bauer M, Ford R, Nay R. Decision to transfer to hospital from the residential aged care setting: a systematic review of qualitative evidence exploring residential aged care staff experiences. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Rotter T, Kinsman L, Machotta A, Zhao FL, van der Weijden T, Ronellenfitsch U, Scott SD. Clinical pathways for primary care: effects on professional practice, patient outcomes, and costs. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas Rotter
- University of Saskatchewan; College of Pharmacy and Nutrition; 110 Science Place Saskatoon Saskatchewan Canada S7N 5C9
| | - Leigh Kinsman
- Monash University; School of Rural Health; Rowan Street Bendigo VIC 3550 Australia
| | - Andreas Machotta
- Erasmus MC - Sophia Children's Hospital; Department of Anesthesiology; PO Box 2060 Rotterdam Netherlands 3000 CB
| | - Fei-Li Zhao
- University of Newcastle; School of Medicine and Public Health; Newcastle Australia 2308
| | - Trudy van der Weijden
- School for Public Health and Primary Care; Department of General Practice; Maastricht University Maastricht Netherlands 6200 MD
| | - Ulrich Ronellenfitsch
- University Medical Centre Mannheim, University of Heidelberg; Department of Surgery; Theodor-Kutzer-Ufer 1-3 Mannheim Germany 68167 Mannheim
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Arendts G, Quine S, Howard K. Decision to transfer to an emergency department from residential aged care: A systematic review of qualitative research. Geriatr Gerontol Int 2013; 13:825-33. [DOI: 10.1111/ggi.12053] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Susan Quine
- School of Public Health; University of Sydney; Sydney; New South Wales; Australia
| | - Kirsten Howard
- School of Public Health; University of Sydney; Sydney; New South Wales; Australia
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Jamshed N, Woods C, Desai S, Dhanani S, Taler G. Pneumonia in the long-term resident. Clin Geriatr Med 2011; 27:117-33. [PMID: 21641501 DOI: 10.1016/j.cger.2011.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pneumonia in the long-term resident is common. It is associated with high morbidity and mortality. However, diagnosis and management of pneumonia in long-term care residents is challenging. This article provides an overview of the epidemiology, pathophysiology, diagnostic challenges, and management recommendations for pneumonia in this setting.
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Affiliation(s)
- Namirah Jamshed
- Georgetown University School of Medicine, Washington, DC, USA.
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Lohfeld L, Loeb M, Brazil K. Evidence-based clinical pathways to manage urinary tract infections in long-term care facilities: a qualitative case study describing administrator and nursing staff views. J Am Med Dir Assoc 2007; 8:477-84. [PMID: 17845952 DOI: 10.1016/j.jamda.2007.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Revised: 05/12/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This article examines the views of nursing staff and administrators in long-term care facilities (LTCFs) regarding a clinical pathway for managing urinary tract infections (UTIs) in LTCF residents. DESIGN A qualitative (case study) design was used. SETTING Data were collected from 8 LTCFs in southern Ontario and 2 in Iowa enrolled in a larger randomized controlled trial of clinical pathway for managing UTIs in LTCF residents, conducted between September 2001 and March 2003. The clinical pathway, designed to more effectively identify, diagnose, and treat UTIs, and reduce inappropriate antibiotics use for asymptomatic UTIs, introduced 2 decision tools to determine when to order a urine culture and initiate antibiotic treatment for suspected UTIs. PARTICIPANTS We conducted 19 individual interviews with administrators and 10 focus groups with 52 nurses. FINDINGS Nurses generally thought that the pathways were well developed and easy to use, and administrators believed they were an important educational resource. Barriers to their use varied by group-initial lack of buy-in from nurses (medical directors), additional work (directors of nursing), and the need to change the protocol to exclude certain residents based on prior health conditions and/or pressure from physicians or families (nurses). CONCLUSIONS Both administrators and staff, once familiar with a new clinical protocol to improve UTI management in LTCFs, generally supported its use.
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Affiliation(s)
- Lynne Lohfeld
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
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Carusone SC, Loeb M, Lohfeld L. A clinical pathway for treating pneumonia in the nursing home: part II: the administrators' perspective and how it differs from nurses' views. J Am Med Dir Assoc 2006; 7:279-86. [PMID: 16765863 DOI: 10.1016/j.jamda.2005.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This paper examines the utility and sustainability of a clinical pathway for treating nursing home residents with pneumonia from the perspective of nursing administrators and medical directors in Ontario, Canada. The discussion includes a comparison of the perspectives of the administrators and the nursing staff (reported in part I of this article). DESIGN A qualitative case study design was used. SETTING Data were collected from 6 nursing homes in Southern Ontario that were drawn from a larger randomized controlled trial of a clinical pathway to help identify, diagnose, and manage cases of nursing home-acquired pneumonia. PARTICIPANTS Six interviews were conducted with nursing administrators and 2 with medical directors (1 per facility). Key themes were identified in the interview data using the template style of analysis described by Miller and Crabtree. FINDINGS Administrators were in favor of using a clinical pathway for identifying and treating pneumonia in nursing home residents. Participants thought that during the study residents with pneumonia received better and more timely care, and that nurses' clinical skills, knowledge, and confidence had improved. In comparison with views expressed by nurses and medical directors in the same facilities, nursing administrators tended to report less clinical training and staff support were required to successfully implement the pathway. CONCLUSIONS Even though nurses and administrators strongly support the use of a pneumonia clinical pathway in nursing homes, implementation plans should be tailored to individual facilities and be informed by the perspectives of both administrators and staff.
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Affiliation(s)
- Soo Chan Carusone
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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