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Davey N, Connolly E, Mc Elwaine P, Kennelly SP. A Systematic Review of Falls Risk of Frail Patients with Dementia in Hospital: Progress, Challenges, and Recommendations. Clin Interv Aging 2024; 19:1127-1139. [PMID: 38948169 PMCID: PMC11214555 DOI: 10.2147/cia.s400582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/15/2024] [Indexed: 07/02/2024] Open
Abstract
This review article assesses the effectiveness and limitations of strategies to reduce falls among hospitalized older adults with frailty and dementia. It explores the efficacy of existing fall prevention strategies for a cohort that is acutely susceptible to falls and fall-related consequences. A systematic literature search was conducted across MEDLINE, Embase, CINAHL, and PsycINFO, employing Medical Subject Headings (MeSH) to identify studies on fall prevention strategies in hospitalized older adults with both dementia and frailty published from 2013 to 2023. The initial 643 records were distilled to eight articles, with Structured Interdisciplinary Bedside Rounds (SIBR) emerging as a notable intervention. SIBR demonstrated a reduction in falls by fostering improved interdisciplinary communication and care planning. However, a decline in family engagement during consecutive sessions suggests a need for strategies to sustain familial involvement. The findings advocate for patient-centered interventions that address the cognitive and functional challenges faced by this cohort of older adults. This review advocates for comprehensive and inclusive research in hospital environments to improve fall prevention strategies for frail older adults with dementia.
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Affiliation(s)
- Naomi Davey
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Eimear Connolly
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Paul Mc Elwaine
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
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Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
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3
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Buchanan CJ, Young E, Mastalerz KA. Engaging resident physicians in the design, implementation, and assessment of bedside interdisciplinary rounds. J Interprof Care 2024; 38:469-475. [PMID: 36814080 DOI: 10.1080/13561820.2023.2176471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/28/2022] [Accepted: 01/07/2023] [Indexed: 02/24/2023]
Abstract
Bedside interdisciplinary rounds (IDR) improve teamwork, communication, and collaborative culture in inpatient settings. Implementation of bedside IDR in academic settings depends on engagement from resident physicians; however, little is known about their knowledge and preferences related to bedside IDR. The goal of this program was to identify medical resident perceptions about bedside IDR and to engage resident physicians in the design, implementation, and assessment of bedside IDR in an academic setting. This is a pre-post mixed methods survey assessing resident physicians' perceptions surrounding a stakeholder-informed bedside IDR quality improvement project. Resident physicians in the University of Colorado Internal Medicine Residency Program (n = 77 pre-implementation survey responses from 179 eligible participants - response rate 43%) were recruited via e-mail to participate in surveys assessing perceptions surrounding the inclusion of interprofessional team members, timing, and preferred structure of bedside IDR. A bedside IDR structure was created based on input from resident and attending physicians, patients, nurses, care coordinators, pharmacists, social workers, and rehabilitation specialists. This rounding structure was implemented on acute care wards in June 2019 at a large academic regional VA hospital in Aurora, CO. Resident physicians were surveyed post implementation (n = 58 post-implementation responses from 141 eligible participants - response rate 41%) about interprofessional input, timing, and satisfaction with bedside IDR. The pre-implementation survey revealed several important resident needs during bedside IDR. Post-implementation survey results revealed high overall satisfaction with bedside IDR among residents, improved perceived efficiency of rounds, preserved quality of education, and value added by interprofessional input. Results also suggested areas for future improvement including timeliness of rounds and enhanced systems-based teaching. This project successfully engaged residents as stakeholders in system-level interprofessional change by incorporating their values and preferences into a bedside IDR framework.
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Affiliation(s)
- Cole J Buchanan
- Department of Internal Medicine, University of Colorado Internal Medicine Residency Program, Denver, CO, USA
| | - Eric Young
- Department of Hospital Medicine, Eastern Colorado VA Healthcare System, Aurora, CO, USA
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katarzyna A Mastalerz
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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4
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Schwartz JI, Gonzalez-Colaso R, Gan G, Deng Y, Kaplan MH, Vakos PA, Kenyon K, Ashman A, Sofair AN, Huot SJ, Chaudhry SI. Structured interdisciplinary bedside rounds improve interprofessional communication and workplace efficiency among residents and nurses on an inpatient internal medicine unit. J Interprof Care 2024; 38:427-434. [PMID: 33433262 DOI: 10.1080/13561820.2020.1863932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Structured Interdisciplinary Bedside Rounds (SIBR) is a standardized, team-based intervention for hospitals to deliver high quality interprofessional care. Despite its potential for improving IPC and the workplace environment, relatively little is known about SIBR's effect on these outcomes. Our study aimed to assess the fidelity of SIBR implementation on an inpatient medicine teaching unit and its effects on perceived IPC and workplace efficiency. We conducted a quasi-experimental study with 88 residents and 44 nurses at a large academic medical center and observed 1308 SIBR encounters over 24 weeks. Of these 1308 encounters, the bedside nurse was present for 96.7%, physician for 97.6%, and care manager for 94.7, and 64.7% occurred at the bedside. Following SIBR implementation, perceived IPC improved significantly among residents (93.3% versus 67.9%, p < .024) and nurses (73.7% versus 36.0%, p < .008) compared to before implementation. Moreover, residents perceived greater workplace efficiency operationalized as being paged less frequently with questions by nurses (20.0% versus 49.1%, p = .01). No statistically significant improvements were reported regarding burnout, meaning at work, and workplace satisfaction. Our implementation of SIBR significantly improved perceived IPC and workplace efficiency, which are two important domains of healthcare quality. Future work should examine the impact of SIBR on patient-centered outcomes such as patient experience.
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Affiliation(s)
- Jeremy I Schwartz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Geliang Gan
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Michael H Kaplan
- Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | | | | | | | - Andre N Sofair
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen J Huot
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sarwat I Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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5
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Britton H. Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project. BMJ Open Qual 2023; 12:e002405. [PMID: 37793675 PMCID: PMC10551953 DOI: 10.1136/bmjoq-2023-002405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND NHS staff recruitment and retention have failed to keep pace with service demands and workforce burn-out is of significant concern. This quality improvement project (QIP) aimed to increase staff time for patient facing care through reducing duplication of hospital board rounds within a 36-bedded NHS inpatient geriatric ward. INTERVENTION Thirty-minute board rounds were reduced from twice daily (Monday-Friday) at 08:30 hours and midday to once daily at midday with the aim of freeing up staff time for patient care. A multidisciplinary team (MDT) safety briefing at 08:30 hours lasting 5-10 min was implemented to enable review of shift pressures and identification of patients who are unwell, newly admitted or due for discharge. Safety briefing format was amended to further support staff prioritisation. METHODS This QIP was underpinned by the model for improvement, using Plan-Do-Study-Act cycles. Data were collected through a staff questionnaire alongside calculation of staff time spent at board rounds and safety huddles. Staff verbal feedback and questionnaire results were also used to improve and modify process'. Patient discharge data were collated via trust metrics as a balancing measure. RESULTS Through board round modification, 25 hours of MDT time was saved each week, with all responding staff reporting increased time for patient facing care following QIP implementation. >85% of questionnaire respondents agreed that board round changes resulted in improvement. Balancing measures collected as part of the project also revealed an increase in weekly ward discharges from an average of 15.75-17.5 confirming no negative impact on patient flow following board round amendments. CONCLUSION While significant staffing shortages continue, local innovations focused on staff time may have the potential to support effective use of limited resources.
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Affiliation(s)
- Hannah Britton
- Care of the elderly medicine, North Bristol NHS Trust, Westbury on Trym, UK
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6
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Wanko Keutchafo EL, Kerr J, Baloyi OB. A Model for Effective Nonverbal Communication between Nurses and Older Patients: A Grounded Theory Inquiry. Healthcare (Basel) 2022; 10:2119. [PMID: 36360461 PMCID: PMC9690069 DOI: 10.3390/healthcare10112119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 08/24/2023] Open
Abstract
Nonverbal communication is an inevitable art to be effectively mastered by nurses. Nurse nonverbal communication has many benefits when it is effective. For instance, nonverbal communication is important to convey affective and emotional information, and demonstrate respect for and build therapeutic relationships with older patients. As the older population is growing fast worldwide, effective nonverbal communication with older patients is an essential skill for nurses and will improve patients' satisfaction and the quality of care. Therefore, this article presents a model to guide effective nonverbal communication between nurses and older patients. A Grounded Theory approach guided the study. Data were collected between July 2018 and January 2020 through overt participant observations and individual interviews. Purposive and theoretical sampling were used to select 13 clinically experienced nurses, 4 nursing students, and 8 older adults. Data analysis encompassed open coding, axial coding, and selective coding. The results showed that effective nonverbal communication emerged as the co-phenomenon hinged within context and/or environment and is influenced by certain factors. This model, which is in support of person-centered communication and care, advocates for effective nonverbal communication between nurses and older patients.
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Affiliation(s)
- Esther L. Wanko Keutchafo
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa
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Improving Detection of Client Complexity in the Community (Impact): A Study Protocol of a Pragmatic Randomized Controlled Trial. Methods Protoc 2021; 4:mps4040070. [PMID: 34698219 PMCID: PMC8544575 DOI: 10.3390/mps4040070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Community-dwelling older clients are becoming increasingly complex. Detecting this complexity in clinical practice is limited, with greater reliance on community nurses’ clinical judgment and skills. The lack of a consistent approach to complexity impacts the level of care and support for older clients to remain in their homes for longer. Objective: To examine the effectiveness of the Patient Complexity Instrument (PCI) in addition to nurses’ clinical judgment to enhance detection of complexity, and subsequent older clients’ resource allocation compared to usual nursing assessment. Design: A pragmatic randomized controlled trial will be conducted within a community nursing service in regional Victoria, Australia. Clients 65 years and over referred to the service who are eligible for Commonwealth Home Support Programme (CHSP) funding will be randomized into Control group: usual nursing assessment or Intervention group: usual nursing assessment plus the PCI. Nurse participants are Registered Nurses currently employed in the community nursing service. Results: This study will explore whether introducing the PCI in a community nursing service enhances detection of complexity and client care resource allocation compared to nurses’ clinical judgment based on usual nursing assessment. Conclusion: This protocol outlines the study to enhance the detection of complexity by nurses delivering care for community-dwelling older people in the regional Australian context. The findings will inform the use of a standardized tool to detect complexity among community-dwelling older Australians.
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8
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Gomes N, Caroço J, Rijo R, Martinho R, Querido A, Peralta T, Dixe MDA. Evaluation of an e-health platform for informal caregivers and health professionals: the case study of Help2Care. Inform Health Soc Care 2021; 47:144-158. [PMID: 34404326 DOI: 10.1080/17538157.2021.1964509] [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] [Indexed: 10/20/2022]
Abstract
The Help2Care e-Health platform was developed in order to capacitate informal caregivers with digital, multimedia training materials. Health professionals select these materials according to the needs of the homebound patients under the supervision of these caregivers. In turn, caregiver can then use their smartphones to consult and apply the care procedures illustrated by these materials. In this paper, we present the results of performed usability tests for both web and mobile software applications of the Help2Care platform. These indicate an overall positive outcome, revealing less usable aspects such as the navigation flow in the web application and some design elements in the mobile application. Important written feedback was also collected, which we took into consideration to improve the software features of the platform.
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Affiliation(s)
- N Gomes
- School of Technology and Management, Polytechnic Institute of Leiria, Leiria, Portugal
| | - J Caroço
- School of Technology and Management, Polytechnic Institute of Leiria, Leiria, Portugal
| | - R Rijo
- School of Technology and Management, Polytechnic Institute of Leiria, Leiria, Portugal.,Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal.,Institute for Systems Engineering and Computers at Coimbra (INESC Coimbra), University of Coimbra, Coimbra, Portugal.,Faculty of Medicine of the University of São Paulo, Health Intelligence Laboratory, Ribeirão Preto/São Paulo, Brazi
| | - R Martinho
- School of Technology and Management, Polytechnic Institute of Leiria, Leiria, Portugal.,Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal
| | - A Querido
- Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal.,School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal.,Center for Innovative Care and Health Technology (Citechcare), Leiria, Portugal
| | - T Peralta
- Center for Innovative Care and Health Technology (Citechcare), Leiria, Portugal.,Emergency department, Hospital Center of Leiria, Leiria, Portugal
| | - Maria Dos Anjos Dixe
- School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal.,Center for Innovative Care and Health Technology (Citechcare), Leiria, Portugal
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9
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Trivedi SP, Kopp Z, Williams PN, Hupp D, Gowen N, Horwitz LI, Schwartz MD. Who is Responsible for Discharge Education of Patients? A Multi-Institutional Survey of Internal Medicine Residents. J Gen Intern Med 2021; 36:1568-1575. [PMID: 33532957 PMCID: PMC8175511 DOI: 10.1007/s11606-020-06508-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Safely and effectively discharging a patient from the hospital requires working within a multidisciplinary team. However, little is known about how perceptions of responsibility among the team impact discharge communication practices. OBJECTIVE Our study attempts to understand residents' perceptions of who is primarily responsible for discharge education, how these perceptions affect their own reported communication with patients, and how residents envision improving multidisciplinary communication around discharges. DESIGN A multi-institutional cross-sectional survey. PARTICIPANTS Internal medicine (IM) residents from seven US residency programs at academic medical centers were invited to participate between March and May 2019, via email of an electronic link to the survey. MAIN MEASURES Data collected included resident perception of who on the multidisciplinary team is primarily responsible for discharge communication, their own reported discharge communication practices, and open-ended comments on ways discharge multidisciplinary team communication could be improved. KEY RESULTS Of the 613 resident responses (63% response rate), 35% reported they were unsure which member of the multidisciplinary team is primarily responsible for discharge education. Residents who believed it was either the intern's or the resident's primary responsibility had 4.28 (95% CI, 2.51-7.30) and 3.01 (95% CI, 1.66-5.71) times the odds, respectively, of reporting doing discharge communication practices frequently compared to those who were not sure who was primarily responsible. To improve multidisciplinary discharge communication, residents called for the following among team members: (1) clarifying roles and responsibilities for communication with patients, (2) setting expectations for communication among multidisciplinary team members, and (3) redefining culture around discharges. CONCLUSIONS Residents report a lack of understanding of who is responsible for discharge education. This diffusion of ownership impacts how much residents invest in patient education, with more perceived responsibility associated with more frequent discharge communication.
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Affiliation(s)
- Shreya P Trivedi
- Department of Population Health, New York University School of Medicine, New York, NY, USA.
- Department of Medicine, Beth Israel Deaconess Medical Center, 550 Brookline Avenue, Boston, MA, 02215, USA.
| | - Zoe Kopp
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Paul N Williams
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Derek Hupp
- Department of Medicine, University of Iowa, Iowa, IA, USA
| | - Nick Gowen
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Leora I Horwitz
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Mark D Schwartz
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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10
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Redley B, Campbell D, Stockman K, Barnes S. Mixed methods quality evaluation of structured interprofessional medical ward rounds. Intern Med J 2021; 50:222-231. [PMID: 31069904 DOI: 10.1111/imj.14330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/31/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Standardised structure and content of interdisciplinary medical ward rounds can promote patient safety and patient-centred teamwork. AIMS To evaluate interdisciplinary ward rounds using a Structured Interdisciplinary Bedside Rounding (SIBR) intervention. METHODS The study involved multi-method, repeat measures with a non-equivalent control group. Non-participant observations were collected at: 1 and 6 months, on an intervention ward that introduced SIBR; and a control ward that continued traditional rounds. Focus group and survey data were also collected on the intervention ward. Participants were clinicians (medicine, nursing and allied health) working in two general medicine wards at a tertiary hospital in Melbourne, Australia. RESULTS Seventy-eight patient rounds were observed at Time 1, and 239 at Time 2. The SIBR ward rounds had all clinician disciplines represented, whereas allied health and nurses were present for less than 20% of non-SIBR rounds. Interdisciplinary participation and frequency of desired clinician behaviours increased, and variability in duration of time per patient decreased, on the SIBR rounds. Longitudinal data reflected decreased performance of some SIBR behaviours in the intervention ward, while some desired behaviours increased in the control ward. Qualitative survey and focus group data indicated many positive views, but fit with broader ward routines impacted SIBR implementation. CONCLUSIONS The overall recommendation by staff was that SIBR should continue. The results provide insights into the adoption of SIBR behaviours and illustrated diffusion of behaviours across wards. Highlighting successes and identifying barriers can help meet challenges for ongoing improvement.
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Affiliation(s)
- Bernice Redley
- Centre for Quality and Patient Safety Research - Monash Health Partnership School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
| | - Don Campbell
- Department of General Medicine, Monash Health Department of Medicine, Monash University, Monash Health, Melbourne, Victoria, Australia
| | - Keith Stockman
- Health Operations Research Unit, Monash Health Community, Melbourne, Victoria, Australia
| | - Sara Barnes
- Department of General Medicine, Monash Health Department of Medicine, Monash University, Melbourne, Victoria, Australia
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11
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Basic D, Huynh ET, Gonzales R, Shanley CG. Twice-Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients. J Am Geriatr Soc 2021; 69:779-784. [PMID: 33395498 DOI: 10.1111/jgs.17007] [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: 07/14/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVE Ineffective interdisciplinary communication has negative impacts on patient outcomes. The use of regular structured interdisciplinary bedside rounds (SIBR), where each patient interaction lasts 3-5 minutes, is a model of care that improves interdisciplinary communication. We evaluated the impact of SIBR on in-hospital falls. DESIGN Prospective before-after study of older people hospitalized with acute illness. SETTING Two side-by-side aged care wards in a university hospital in Sydney, Australia. PARTICIPANTS A total of 3,673 consecutive inpatients of mean age 83.8 ± 7.7 years, with 1,703 before SIBR compared with 1,970 after SIBR. No patients were excluded from potential participation. INTERVENTION Twice-weekly SIBR. MEASUREMENTS Falls data were manually extracted from a mandatory institutional incident reporting database. Medical diagnoses were based on the Australian Refined Diagnosis Related Groups classification system. Injuries due to falls were corroborated using the institutional electronic medical record (Cerner PowerChart). Generalized estimating equations were used to evaluate the incidence rate ratio (IRR) of falls and fall-related injuries. A negative binomial distribution and a logarithmic link function were used to linearize regression equations. RESULTS After SIBR, there were 7.4 falls per 1,000 occupied bed days (OBD), compared with 10.6 falls per 1,000 OBD before SIBR (P < .001). The implementation of SIBR reduced falls (IRR = 0.67, 95% CI = 0.52-0.85), after adjusting for age, gender, cognitive impairment, behavioral and psychological symptoms of dementia, deconditioning and frailty, but not fall-related injuries (IRR = 0.79, 95% CI = 0.52-1.20). CONCLUSION This study is the first to investigate the effect of SIBR on in-hospital falls. It provides evidence that a sustainable, twice-weekly intervention is associated with a reduction in falls. It has the potential to be used in other settings where falls are frequent.
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Affiliation(s)
- David Basic
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Elizabeth T Huynh
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Rinaldo Gonzales
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
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12
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Beaird G, Baernholdt M, White KR. Perceptions of interdisciplinary rounding practices. J Clin Nurs 2020; 29:1141-1150. [PMID: 31889345 DOI: 10.1111/jocn.15161] [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: 04/25/2019] [Revised: 12/05/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore practitioner perspectives on the facilitators, barriers and outcomes associated with interdisciplinary rounding practices (IDR). BACKGROUND Interdisciplinary rounding practices is frequently used intervention to promote collaboration and patient-centred care in hospital units. Previous research supports that having IDR in place can lead to greater perceptions of collaboration and practitioner satisfaction; however, the practice does not always lead to better outcomes for patients. For IDR to be successful, unit leadership needs a greater understanding of facilitators and barriers as perceived by team members. At both the individual and organisational levels, there is limited understanding on what influences the success of IDR. This study seeks to explore factors influencing interdisciplinary rounding and perceived outcomes by team members. DESIGN A quasi-qualitative design was used to address the aim of this study. Four open-ended questions were emailed to practitioners across fifteen units in two academic health centres. All units identified as having IDR in place. METHODS A directed content analysis of practitioner responses was used to identify key themes. The Standards for Reporting Qualitative Research checklist was consulted for reporting of the results. RESULTS A total of 141 practitioners responded to the open-ended questions. Three themes emerged from the data: (a) setting the stage; (b) the work of the team; and 3) benefits to patient care. CONCLUSIONS The study provides a nuanced perspective of facilitators, barriers and potential outcomes associated with IDR. Future research is needed to gain additional perspective on the role the organisation plays in promoting a healthy workplace environment as well as providing patient-centred care. RELEVANCE TO CLINICAL PRACTICE This study provides insight into facilitators and barriers to conducting interdisciplinary rounding practices in the inpatient setting. Results can be useful to unit leaders and staff that advocate for more collaborative and patient-centred rounding practices.
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13
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Manges K, Groves PS, Farag A, Peterson R, Harton J, Greysen SR. A mixed methods study examining teamwork shared mental models of interprofessional teams during hospital discharge. BMJ Qual Saf 2019; 29:499-508. [PMID: 31776201 DOI: 10.1136/bmjqs-2019-009716] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/02/2019] [Accepted: 11/10/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Little is known about how team processes impact providers' abilities to prepare patients for a safe hospital discharge. Teamwork Shared Mental Models (teamwork-SMMs) are the teams' organised understanding of individual member's roles, interactions and behaviours needed to perform a task like hospital discharge. Teamwork-SMMs are linked to team effectiveness in other fields, but have not been readily investigated in healthcare. This study examines teamwork-SMMs to understand how interprofessional teams coordinate care when discharging patients. METHODS This mixed methods study examined teamwork-SMMs of inpatient interprofessional discharge teams at a single hospital. For each discharge event, we collected data from the patient and their discharge team (nurse, physician and coordinator) using interviews and questionnaires. We quantitatively determined the discharge teams' teamwork-SMM components of quality and convergence using the Shared Mental Model Scale, and then explored their relationships to patient-reported preparation for posthospital care. We used qualitative thematic analysis of narrative cases to examine the contextual differences of discharge teams with higher versus lower teamwork-SMMs. RESULTS The sample included a total of 106 structured patient interviews, 192 provider day-of-discharge questionnaires and 430 observation hours to examine 64 discharge events. We found that inpatient teams with better teamwork-SMMs (ie, higher perceptions of teamwork quality or greater convergence) were more effective at preparing patients for post-hospital care. Additionally, teams with high and low teamwork-SMMs had different experiences with team cohesion, communication openness and alignment on the patient situation. CONCLUSIONS Examining the quality and agreement of teamwork-SMMs among teams provides a better understanding of how teams coordinate care and may facilitate the development of specific team-based interventions to improve patient care at hospital discharge.
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Affiliation(s)
- Kirstin Manges
- National Clinician Scholar, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA .,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Amany Farag
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Ryan Peterson
- Department of Biostatistics & Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Joanna Harton
- Department of Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - S Ryan Greysen
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Holmes TR, Cumming BD, Sideris AW, Lee JW, Briggs NE, Havas TE. Multidisciplinary Tracheotomy Teams: An Analysis of Patient Outcomes and Resource Allocation. EAR, NOSE & THROAT JOURNAL 2019; 98:232-237. [PMID: 30939910 DOI: 10.1177/0145561319840103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We sought to establish the effect of introducing a multidisciplinary tracheotomy management team (MDT). Tracheotomies are high-cost interventions with potentially devastating complications. Multidisciplinary teams have been introduced in many hospitals with the aim of reducing complications, however, data supporting them are lacking. There is currently insufficient evidence to conclude MDTs reduce length of hospital or intensive care unit (ICU) stay, and there is little information on cost analysis. A chart review identified patients who had a tracheotomy inserted at a major metropolitan teaching hospital with an acute spinal medicine service 2 years before and after the MDT was implemented. The primary outcome was time to decannulation. Other outcomes included tracheotomy complications, the proportion of patients decannulated, length of ICU and hospital stay, and admission cost. Our search identified 174 (78 prior and 96 post-MDT) patients. Baseline demographics were similar between groups. There was no difference in time to decannulation, the decannulation rate, or the length of hospital or ICU stay. Complication rates were low in both groups. There was an increase in the proportion of patients who received speaking valves and a reduction in cost of admission in a subgroup of patients who did not undergo head and neck surgery. There is insufficient evidence to support the widespread introduction of tracheotomy MDTs. Institutions considering introducing a tracheotomy team should carefully consider their case-mix, volume, and available resources as well as the structure and responsibilities of the team, and the timing of its activities within the working week. The potential benefits of MDTs including teaching of staff, and collaboration of teams should be acknowledged. Given the potentially significant implications for cost to the health system, a randomized trial is needed to guide policy in this area.
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Affiliation(s)
- Timothy R Holmes
- 1 Department of Otolaryngology-Head and Neck Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Benjamin D Cumming
- 1 Department of Otolaryngology-Head and Neck Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Anders W Sideris
- 1 Department of Otolaryngology-Head and Neck Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jennifer W Lee
- 1 Department of Otolaryngology-Head and Neck Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Nancy E Briggs
- 2 Mark Wainwright Analytical Centre, University on New South Wales, Sydney, New South Wales, Australia
| | - Thomas E Havas
- 1 Department of Otolaryngology-Head and Neck Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia
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15
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Caroço J, Gomes N, Martinho R, Rijo R, Peralta T, Carvalho D, Querido A, Anjos Dixe MD. Challenges on the usability of digital platforms for informal caregivers and health professionals: the case study of Help2Care. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.procs.2019.12.241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Basic D, Huynh E, Gonzales R, Shanley C. Structured interdisciplinary bedside rounds, in-hospital deaths, and new nursing home placements among older inpatients. Clin Interv Aging 2018; 13:2289-2294. [PMID: 30519010 PMCID: PMC6233858 DOI: 10.2147/cia.s171508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Ineffective interdisciplinary communication is linked to many adverse consequences of hospitalization. This study evaluated the effect of SIBR, a model of care that encourages interdisciplinary communication and patient and family participations, on in-hospital deaths and new nursing home (NH) placements. Materials and methods This before-after study included 3,673 consecutive inpatients of mean age 83.8 years, of whom 93.2% were admitted through the emergency department. After each twice-weekly SIBR session, an interdisciplinary care plan was implemented and recorded on a datasheet attached to the bedside record. Staff unable to participate in SIBR were asked to view the datasheet and to follow the care plan. Logistic regression models were computed for in-hospital deaths and new NH placements. Results Although SIBR implementation had no effect on in-hospital deaths (OR, 1.00; 95% CI, 0.77–1.29), SIBR increased NH placements among those who survived the hospitalization (n=3,346) in both unadjusted (14.6% vs 9.1%; P<0.001) and adjusted (OR, 1.75; 95% CI, 1.38–2.23) analyses. Conclusion Although the mechanisms between SIBR implementation and NH placement remain uncertain, SIBR may encourage patients and families to make decisions on placement earlier than they would have otherwise. Models of care aiming to improve communication should be evaluated across diverse services and settings to determine effectiveness and to monitor for adverse findings.
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Affiliation(s)
- David Basic
- Department of Geriatric Medicine, Aged Care Research Unit, Liverpool Hospital, Liverpool BC, NSW 1871, Australia,
| | - Elizabeth Huynh
- Department of Geriatric Medicine, Aged Care Research Unit, Liverpool Hospital, University of NSW, Liverpool BC, NSW 1871, Australia
| | - Rinaldo Gonzales
- Department of Geriatric Medicine, Aged Care Research Unit, Liverpool Hospital, Liverpool BC, NSW 1871, Australia,
| | - Chris Shanley
- Department of Geriatric Medicine, Centre for Applied Nursing Research, Western Sydney University and Ingham Institute of Applied Medical Research, Aged Care Research Unit, Liverpool Hospital, Liverpool BC, NSW 1871, Australia
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