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Anaya M, Law W, Montoya HL, Moreira CM. Discharge Interventions for Limited English Proficiency Patients: A Scoping Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02003-2. [PMID: 38639867 DOI: 10.1007/s40615-024-02003-2] [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: 12/31/2023] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Limited English proficiency patients are required under federal law to receive language-concordant care, yet they still receive substandard discharge instructions compared to English-speaking patients. We aimed to summarize the interventions carried out to improve discharge instructions in the limited English proficiency population. METHODS We conducted a scoping review of academic and gray literature from the United States using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols for Scoping Reviews guidelines. We searched PubMed, Embase, and CINAHL for studies to improve discharge communication. RESULTS Of the 3330 studies, 19 studies met the criteria. Core types of interventions included written interventions alone, educational interventions alone, written and educational interventions, audio and visual interventions, and other types of interventions. Even among the same core types of interventions, there were differences in types of interventions, outcomes examined, and results. DISCUSSION The majority of included interventions that studied satisfaction as an outcome measure showed improvement, while the other outcomes were not improved or worsened. More rigorous methodology and community involvement are necessary to further analyze discharge interventions for patients with limited English proficiency (LEP).
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Affiliation(s)
- Melanie Anaya
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA.
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA.
| | - William Law
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
| | - Hannah L Montoya
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
| | - Carla M Moreira
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
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Fazal F, Adil ML, Ijaz T, Ahmad Khan S, Imran Butt A, Abid A, Bashir MN, Ambreen S, Chaudhry TZ, Malik BH. Improving the Quality and Completeness of Discharge Summaries at a Tertiary Care Hospital in Pakistan: A Quality Improvement Project. Cureus 2024; 16:e56134. [PMID: 38487648 PMCID: PMC10938087 DOI: 10.7759/cureus.56134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction Discharge summaries (DS) allow continued patient care after being discharged from the hospital. Only a few quality improvement projects (QIPs) focused on assessing and improving the quality and completeness of DS at tertiary care hospitals have been undertaken in Pakistan. This QIP aimed to evaluate and enhance the quality and completeness of DS at a tertiary care hospital in Pakistan to facilitate seamless healthcare transitions. Methods A QIP was conducted in the medical unit of a tertiary care hospital in Rawalpindi, Pakistan. The DS were assessed using the e-discharge summary self-assessment checklist devised by the Royal College of Physicians (RCP). This QIP was done by the plan, do, study, act (PDSA) cycle. The PDSA cycle comprised two audit cycles and an intervention in between them. The first audit cycle (AC) was conducted on 150 DS. Its duration was from March 2023 to June 2023. An educational workshop was conducted before the re-audit cycle (RAC) to address deficiencies and reinforce the implementation of the guidelines provided by the RCP. The RAC was conducted from June 2023 to August 2023. 100 DS were studied and analyzed to assess for improvement in the completeness of DS. Frequencies and percentages were calculated in each audit cycle. The Chi-squared test was applied to compare the statistical difference between the results of both audit cycles. Results A total of 150 DS were analyzed in the first AC and 100 DS in the RAC. The results of the first AC show that the details of any allergies were recorded only in 3% of the DS; this percentage significantly improved to 51% after the RAC (p-value <0.05). Relevant past medical history was included in 52% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). Secondary diagnoses were written in 54% and 71% of the DS during the first AC and RAC, respectively (p-value <0.05). Details of relevant investigations were included in 60% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). The post-discharge management plan was written in 90% and 98% of the DS during the first AC and RAC, respectively (p-value <0.05). The follow-up plan was written clearly in 65% and 93% of the DS during the first AC and RAC, respectively (p-value <0.05). Conclusion The DS was found to be incomplete after analyzing the results of the first AC. The details related to allergies, medications, operations, and procedures were found to be missing in the majority of the cases. No mention of the patient's concerns or expectations was made in the DS. The results of the RAC showed improvement in the level of completeness of DS. The majority of the weak points observed after the first AC seemed to have improved after the RAC, which shows that intervention proved to be quite effective in improving the completeness and quality of DS. The RAC showed significant improvement in the completeness of the details relating to investigations, allergies, past medical history, secondary diagnoses, and the post-discharge follow-up plan. QIP must be routinely carried out to assess and improve the completeness and quality of DS at hospitals.
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Affiliation(s)
- Faizan Fazal
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Maham L Adil
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Talha Ijaz
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | | | | | - Areesha Abid
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Muhammad N Bashir
- Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Saima Ambreen
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Taha Z Chaudhry
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | - Bilal H Malik
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Gettel CJ, Hastings SN, Biese KJ, Goldberg EM. Emergency Department-to-Community Transitions of Care: Best Practices for the Older Adult Population. Clin Geriatr Med 2023; 39:659-672. [PMID: 37798071 PMCID: PMC10716862 DOI: 10.1016/j.cger.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
This article describes emergency department (ED)-to-community care transitions for older adults and associated challenges, measurement, proven efficacious and effective interventions, and policy considerations. Older adults experiencing social isolation and impairments in functional status or cognition represent unique populations that are particularly at risk during ED-to-community transitions of care and may benefit from targeted intervention implementation. Future efforts should target optimizing screening techniques to identify those at risk, developing and validating patient-centered outcome measures, and using policy and reimbursement levers to include transitional care management services for older adults within the ED setting.
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Affiliation(s)
- Cameron J Gettel
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT 06519, USA.
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Box 3003, Durham, NC 27710, USA; Geriatric Research, Education, Clinical Center, Durham VA Health Care System, Durham, NC, USA; Center for the Study of Human Aging and Development, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kevin J Biese
- Department of Emergency Medicine, University of North Carolina, 170 Manning Drive, CB #7594, Chapel Hill, NC 27599, USA; Department of Medicine, Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth M Goldberg
- Department of Emergency Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 13001 East 17th Place, CB #C290, Aurora, CO 80045, USA
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Doyle TA, Schmidt KK, Halverson CME, Olivera J, Garcia A, Shugg TA, Skaar TC, Schwartz PH. Patient understanding of pharmacogenomic test results in clinical care. PATIENT EDUCATION AND COUNSELING 2023; 115:107904. [PMID: 37531788 PMCID: PMC11058699 DOI: 10.1016/j.pec.2023.107904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/30/2023] [Accepted: 07/15/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Previous research has not objectively assessed patients' comprehension of their pharmacogenomic test results. In this study we assessed understanding of patients who had undergone cytochrome P450 2C19 (CYP2C19) pharmacogenomic testing. METHODS 31 semi-structured interviews with patients who underwent CYP2C19 testing after cardiac catheterization and had been sent a brochure, letter, and wallet card explaining their results. Answers to Likert and binary questions were summarized with descriptive statistics. Qualitative data were analyzed using a grounded theory approach, with particular focus on categorization. RESULTS No participants knew the name of the gene tested or their metabolizer status. Seven participants (23%) knew whether the testing identified any medications that would have lower effectiveness or increased adverse effects for them at standard doses ("Adequate Understanding"). Four participants (13%) read their results from the letter or wallet card they received but had no independent understanding ("Reliant on Written Materials"). Ten participants remembered receiving the written materials (32%). CONCLUSION A majority of participants who had undergone CYP2C19 PGx testing did not understand their results at even a minimal level and would be unable to communicate them to future providers. PRACTICE IMPLICATIONS Further research is necessary to improve patient understanding of PGx testing and their results, potentially through improving patient-provider communication.
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Affiliation(s)
- Tom A Doyle
- Indiana University Center for Bioethics, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karen K Schmidt
- Indiana University Center for Bioethics, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Colin M E Halverson
- Indiana University Center for Bioethics, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jesus Olivera
- Indiana University Center for Bioethics, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Abigail Garcia
- Indiana University Center for Bioethics, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tyler A Shugg
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Todd C Skaar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter H Schwartz
- Indiana University Center for Bioethics, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Philosophy, Indiana University-Purdue University, Indianapolis, IN, USA.
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Mi RZ, Jacobsohn GC, Wu J, Shah MN, Jones CMC, Caprio TV, Cushman JT, Lohmeier M, Kind AJH, Shah DV. Coaching older adults discharged home from the emergency department: The role of competence and emotion in following up with outpatient clinicians. PATIENT EDUCATION AND COUNSELING 2022; 105:3446-3452. [PMID: 36064518 DOI: 10.1016/j.pec.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/31/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Motivating older adults to follow up with an outpatient clinician after discharge from emergency departments (ED) is beneficial yet challenging. We aimed to answer whether psychological needs for motivation and discrete emotions observed by care transition coaches would predict this behavioral outcome. METHODS Community-dwelling older adults following ED discharge were recruited from three EDs in two U.S. states. We examined home visit notes documented by coaches (N = 725). Retrospective chart reviews of medical records tracked participants' health care utilization for 30 days. RESULTS Observed knowledge-based competence predicted higher likelihood of outpatient follow-up within 30 days, while observed sadness predicted a lower likelihood of follow-up within seven days following discharge. Moreover, participants who demonstrated happiness were marginally more likely to have an in-person follow-up within seven days, and those who demonstrated knowledge-based competence were more likely to have an electronic follow-up within 30 days. CONCLUSIONS Knowledge-based competence and emotions, as observed and documented in coach notes, can predict older adults' subsequent outpatient follow-up following their ED-discharge. PRACTICE IMPLICATIONS Intervention programs might encourage coaches to check knowledge-based competence and to observe emotions in addition to delivering the content. Coaches could also customize strategies for patients with different recommended timeframes of follow-up.
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Affiliation(s)
- Ranran Z Mi
- School of Communication, Media and Journalism, Kean University, Union, NJ, USA.
| | - Gwen C Jacobsohn
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jiaxi Wu
- College of Communication, Boston University, Boston, MA, USA
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas V Caprio
- Division of Geriatrics, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Lohmeier
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy J H Kind
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; William S. Middleton Veterans Affairs Geriatrics Research, Education, and Clinical Center, Madison, WI, USA
| | - Dhavan V Shah
- School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, WI, USA; Center for Health Enhancement Systems Studies, University of Wisconsin-Madison, Madison, WI, USA
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Cook JLE, Fioratou E, Davey P, Urquhart L. Improving patient understanding on discharge from the short stay unit: an integrated human factors and quality improvement approach. BMJ Open Qual 2022; 11:bmjoq-2021-001810. [PMID: 35998981 PMCID: PMC9403153 DOI: 10.1136/bmjoq-2021-001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
This intervention used a systems approach to improve patient understanding on discharge from the adult acute medicine short stay unit (SSU). Patient understanding was assessed across five domains: diagnosis, medication changes, follow-up care, return instructions and knowing who their consultant was. The aim of this approach was that at least 90% of patients achieved near-complete understanding (score >4) on questionnaire across all five discharge domains by the end of April 2021. Pre-intervention most patients received verbal instructions and only a minority received written information. Through staff interviews, we identified the electronic discharge document (EDD) as a practical source of written information. However, testing with patients showed that the format required substantial redesign to be written in patient-friendly language, using signposting, spacing information out and avoiding jargon. The effect of this intervention was assessed with a structured telephone questionnaire, which included both a patient self-rated score and a comparative understanding score to assess true patient understanding of the revised EDD. Pre-intervention 29 discharged patients were interviewed across 10 days and post-intervention 10 patients were interviewed in 7 days. Patients consistently over-rated their understanding of discharge information. Only one patient achieved the aim of comparative understanding >4 across all domains post-intervention. Understanding improved across all but one of the domains, the exception being medication changes. An important unanticipated consequence was that interviews identified inconsistencies in EDD information and gaps in patient understanding, which required escalation to the SSU team. In summary, this intervention improved patient understanding across four of the five domains. However, further work is required on process reliability for the redesigned EDD and on improving understanding of medication changes. Furthermore, the interviews revealed clinically important inconsistencies in EDD information and gaps in patient understanding.
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Affiliation(s)
| | | | - Peter Davey
- University of Dundee School of Medicine, Dundee, UK
| | - Lynn Urquhart
- Infectious Diseases and Acute Medicine, NHS Tayside, Dundee, UK
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Shahid A, Sept B, Kupsch S, Brundin-Mather R, Piskulic D, Soo A, Grant C, Leigh JP, Fiest KM, Stelfox HT. Development and pilot implementation of a patient-oriented discharge summary for critically Ill patients. World J Crit Care Med 2022; 11:255-268. [PMID: 36051938 PMCID: PMC9305680 DOI: 10.5492/wjccm.v11.i4.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 06/18/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication, leaving them vulnerable to increased stress, adverse events, readmission to ICU, and death. To facilitate discharge communication, written summaries have been implemented to provide patients and their families with information on medications, activity and diet restrictions, follow-up appointments, symptoms to expect, and who to call if there are questions. While written discharge summaries for patients and their families are utilized frequently in surgical, rehabilitation, and pediatric settings, few have been utilized in ICU settings.
AIM To develop an ICU specific patient-oriented discharge summary tool (PODS-ICU), and pilot test the tool to determine acceptability and feasibility.
METHODS Patient-partners (i.e., individuals with lived experience as an ICU patient or family member of an ICU patient), ICU clinicians (i.e., physicians, nurses), and researchers met to discuss ICU patients’ specific informational needs and design the PODS-ICU through several cycles of discussion and iterative revisions. Research team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary, Canada. Follow-up surveys on the PODS-ICU and its impact on discharge were administered to patients, family participants, and ICU nurses.
RESULTS Most participants felt that their discharge from the ICU was good or better (n = 13; 87.0%), and some (n = 9; 60.0%) participants reported a good understanding of why the patient was in ICU. Most participants (n = 12; 80.0%) reported that they understood ICU events and impacts on the patient’s health. While many patients and family participants indicated the PODS-ICU was informative and useful, ICU nurses reported that the PODS-ICU was “not reasonable” in their daily clinical workflow due to “time constraint”.
CONCLUSION The PODS-ICU tool provides patients and their families with essential information as they discharge from the ICU. This tool has the potential to engage and empower patients and their families in ensuring continuity of care beyond ICU discharge. However, the PODS-ICU requires pairing with earlier discharge practices and integration with electronic clinical information systems to fit better into the clinical workflow for ICU nurses. Further refinement and testing of the PODS-ICU tool in diverse critical care settings is needed to better assess its feasibility and its effects on patient health outcomes.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Danijela Piskulic
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary T2N 4Z6, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Christopher Grant
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
- School of Health Administration, Dalhousie University, Halifax B3H 4R2, Nova Scotia, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
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Friedemann Smith C, Lunn H, Wong G, Nicholson BD. Optimising GPs' communication of advice to facilitate patients' self-care and prompt follow-up when the diagnosis is uncertain: a realist review of 'safety-netting' in primary care. BMJ Qual Saf 2022; 31:541-554. [PMID: 35354664 PMCID: PMC9234415 DOI: 10.1136/bmjqs-2021-014529] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/19/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Safety-netting has become best practice when dealing with diagnostic uncertainty in primary care. Its use, however, is highly varied and a lack of evidence-based guidance on its communication could be harming its effectiveness and putting patient safety at risk. OBJECTIVE To use a realist review method to produce a programme theory of safety-netting, that is, advice and support provided to patients when diagnosis or prognosis is uncertain, in primary care. METHODS Five electronic databases, web searches, and grey literature were searched for studies assessing outcomes related to understanding and communicating safety-netting advice or risk communication, or the ability of patients to self-care and re-consult when appropriate. Characteristics of included documents were extracted into an Excel spreadsheet, and full texts uploaded into NVivo and coded. A random 10% sample was independently double -extracted and coded. Coded data wasere synthesised and itstheir ability to contribute an explanation for the contexts, mechanisms, or outcomes of effective safety-netting communication considered. Draft context, mechanism and outcome configurations (CMOCs) were written by the authors and reviewed by an expert panel of primary care professionals and patient representatives. RESULTS 95 documents contributed to our CMOCs and programme theory. Effective safety-netting advice should be tailored to the patient and provide practical information for self-care and reconsultation. The importance of ensuring understanding and agreement with advice was highlighted, as was consideration of factors such as previous experiences with healthcare, the patient's personal circumstances and the consultation setting. Safety-netting advice should be documented in sufficient detail to facilitate continuity of care. CONCLUSIONS We present 15 recommendations to enhance communication of safety-netting advice and map these onto established consultation models. Effective safety-netting communication relies on understanding the information needs of the patient, barriers to acceptance and explanation of the reasons why the advice is being given. Reduced continuity of care, increasing multimorbidity and remote consultations represent threats to safety-netting communication.
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Affiliation(s)
| | | | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Coombs NM, Porter JE, Barbagallo M, Plummer V. Public health education by emergency nurses: A scoping review and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2022; 105:1181-1187. [PMID: 34521560 DOI: 10.1016/j.pec.2021.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 08/13/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify the extent, range, and nature of the evidence on public health education provided by emergency nurses. METHODS A scoping review, using the methodological guidance of Joanna Briggs Institute, was conducted to scope and map the literature and research activity. Using predetermined criteria, databases, grey literature, and reference lists were searched for eligible sources. At least two authors reviewed each article. A narrative synthesis methodology was utilised to analyse and report the findings. RESULTS There was significant methodological heterogeneity between sources (n = 6). Three themes were identified: 1) Benefits of the system: An opportunity to inform the public, 2) The barriers: Time pressures and being prepared and 3) The strategies: Plan for structured and created teachable moments CONCLUSION: Limited research is being conducted in this area. Further research is needed to understand emergency nurse's practice and attitudes towards providing public health messages. PRACTICE IMPLICATIONS Emergency nurses need to utilise the 'teachable moment' for every emergency admission, providing opportunistic preventative education to improve health outcomes and reduce demand on the healthcare system.
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Affiliation(s)
- Nicole M Coombs
- School of Health/Nursing, Federation University Australia, PO Box 3191 Gippsland Mail Centre 3841, Victoria, Australia.
| | - Joanne E Porter
- School of Health/Nursing, Federation University Australia, PO Box 3191 Gippsland Mail Centre 3841, Victoria, Australia.
| | - Michael Barbagallo
- School of Health/Nursing, Federation University Australia, PO Box 3191 Gippsland Mail Centre 3841, Victoria, Australia.
| | - Virginia Plummer
- School of Health/Nursing, Federation University Australia, PO Box 3191 Gippsland Mail Centre 3841, Victoria, Australia.
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Isbey S, Badolato G, Kline J. Pediatric Emergency Department Discharge Instructions for Spanish-Speaking Families: Are We Getting It Right? Pediatr Emerg Care 2022; 38:e867-e870. [PMID: 34140448 DOI: 10.1097/pec.0000000000002470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients who speak Spanish are less likely to comply with discharge instructions, adhere to appointments, and take medications than English-speaking patients. However, adherence is improved when discharge instructions are provided in Spanish. This study was designed to assess the frequency of providing written discharge instructions in Spanish to patients who speak Spanish and request interpretation services, and to determine factors associated with receiving written discharge instructions in the preferred language in a pediatric emergency department (ED). METHODS This was a retrospective cross-sectional study of all discharges of Spanish-speaking patients who requested an interpreter in 1 year from a large urban pediatric ED and an associated community ED. Multivariable logistic regression was used to identify patient and visit level characteristics associated with receiving written discharge instructions in Spanish. RESULTS Sixty-one percent of 11,545 patient encounters where a Spanish interpreter was requested received written discharge instructions in Spanish. Patients aged 1 to 3 years (adjusted odds ratio [aOR], 2.87; 95% CI, 2.18-3.77) and aged 4 to 12 years (aOR, 2.06; 95% CI, 1.6-2.65), those seen without a trainee (aOR, 1.37; 95% CI, 1.25-1.5), and those with low acuity triage levels (aOR, 1.6; 95% CI, 1.29-1.97) were more likely to receive discharge instruction in Spanish. Female patients were less likely to receive Spanish discharge instructions (aOR, 0.9; 95% CI, 0.83-0.97). CONCLUSIONS Discharged pediatric ED patients often do not receive written instructions in the preferred language. Patient and provider factors are associated with receiving written instructions in Spanish. Quality improvement efforts are needed to ensure appropriate language discharge education.
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Affiliation(s)
- Sarah Isbey
- From the Department of Emergency Medicine, Children's National Hospital, School of Medicine and Health Sciences, George Washington University
| | - Gia Badolato
- Department of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Jaclyn Kline
- From the Department of Emergency Medicine, Children's National Hospital, School of Medicine and Health Sciences, George Washington University
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Villalona S, Castañeda H, Wilson JW, Romero-Daza N, Yanez Yuncosa M, Jeannot C. Discordance Between Satisfaction and Health Literacy Among Spanish-Speaking Patients with Limited English-Proficiency Seeking Emergency Department Care. HISPANIC HEALTH CARE INTERNATIONAL 2021; 21:60-67. [PMID: 34931564 DOI: 10.1177/15404153211067685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: The emergency department (ED) is one clinical setting where issues pertaining to health communication uniquely manifest themselves on a daily basis. This pilot study sought to understand satisfaction with care, perceptions of medical staff concern, awareness, and comprehension of medical care among Spanish-speaking patients with limited English-language proficiency (LEP). Methods: A two-phase, mixed-methods approach was employed among Spanish-speaking patients with LEP that presented to an ED in West Central Florida. The prospective phase consisted of semistructured interviews (n = 25). The retrospective phase analyzed existing patient satisfaction data collected at the study site (n = 4,940). Results: Content analysis revealed several linguistic barriers among this patient population including limited individual autonomy, self-blame for being unable to effectively articulate concerns, and lack of clarity in understanding follow-up care plans. Retrospective analysis suggested differences between responses from Spanish-speaking patients when compared with their English-speaking counterparts. Conclusions: Our findings suggest discordance between satisfaction and health literacy in this unique patient population. Although high satisfaction was reported, this appeared to be secondary to comprehension of follow-up care instructions.
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Affiliation(s)
- Seiichi Villalona
- 12287Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Heide Castañeda
- Department of Anthropology, University of South Florida, Tampa, FL, USA
| | - Jason W Wilson
- Emergency Department, 7829Tampa General Hospital, Tampa, FL, USA.,Department of Internal Medicine, Morsani College of Medicine at the University of South Florida, Tampa, FL, USA
| | - Nancy Romero-Daza
- Department of Anthropology, University of South Florida, Tampa, FL, USA
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12
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Winokur EJ. Optimizing Discharge Knowledge and Behaviors. J Emerg Nurs 2021; 47:839-842. [PMID: 34776092 DOI: 10.1016/j.jen.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/19/2022]
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13
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DeSai C, Janowiak K, Secheli B, Phelps E, McDonald S, Reed G, Blomkalns A. Empowering patients: simplifying discharge instructions. BMJ Open Qual 2021; 10:bmjoq-2021-001419. [PMID: 34521621 PMCID: PMC8442096 DOI: 10.1136/bmjoq-2021-001419] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/28/2021] [Indexed: 11/06/2022] Open
Abstract
Patients who do not have enough information about their discharge plans have decreased treatment compliance, decreased patient safety, increased emergency department (ED) recidivism, and poor satisfaction. This project aimed to develop and implement a method to assess and improve patient understanding of treatment and discharge plan in the ED. The authors developed a questionnaire to assess patient knowledge using Centers for Medicare and Medicaid Services and Joint Commission recommendations, areas of communication deficits reported in other manuscripts, and ED staff and provider input. Responses from patient interviews were then scored against the medical record. Three trained scorers graded all responses, and inter-rater reliability was calculated using the kappa statistic. Baseline observations found that written discharge instructions were long and tedious, and important information was difficult to find. Based on initial patient scores, stakeholder interviews, and fishbone diagrams, the team developed a one-page simplified information page (SIP) targeted to inform patients their most relevant discharge instructions. Next, the SIP was tested on 118 patients to measure its effect on patient understanding. At the baseline study, no patients had complete understanding of their discharge instructions. The areas of lowest scores were medication instructions and indications to return to the ED. Implementation of the SIP resulted in statistically significant changes in score distribution across all questions assessed with the Wilcoxon signed-rank test. Interrater reliability between scorers was high (kappa=0.84). We incorporated the concept of the SIP to the cover page of our standard discharge instructions. Healthcare providers often spend valuable time educating their patients, and it is important to assess the effectiveness of this teaching to identify areas in which we may improve health literacy and patient understanding. This project has shown that a simple, easy-to-read, concise page developed with patient input significantly improved ED discharge instruction knowledge.
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Affiliation(s)
- Charisma DeSai
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Keri Janowiak
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Beatrice Secheli
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Eleanor Phelps
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sam McDonald
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gary Reed
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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14
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Wallin D, Vezzetti R, Young A, Wilkinson M. Do Parents of Discharged Pediatric Emergency Department Patients Read Discharge Instructions? Pediatr Emerg Care 2021; 37:e468-e473. [PMID: 30346364 DOI: 10.1097/pec.0000000000001647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The percentage of discharged emergency department (ED) patients who read discharge instructions (DCIs) is unknown. In this study of parents of pediatric ED patients, we attempt to quantify the DCI readership rate and identify variables associated with readership. We hypothesized that few families would read their child's DCIs. METHODS We conducted a prospective, randomized study of parents of pediatric patients who were discharged home from the ED. We randomized participants to receive a study invitation as either the second or the second to last page of their DCIs. We incentivized study participation with a $10 gift card and then used the invitation response rate as a proxy for DCI readership. We utilized logistic regression to identify predictor variables showing significant association with readership. RESULTS One thousand patients were randomized; 963 were included in the final analysis. Eighty-four subjects, 8.8% (95% confidence interval, 7.0%-10.7%), responded to investigators. In the final regression model, private insurance (adjusted odds ratio, 1.76; P = 0.036), placement of the study invitation early within DCIs (adjusted odds ratio, 1.93; P = 0.011), and laceration diagnosis (adjusted odds ratio, 2.97; P = 0.012) predicted readership, whereas parents of Hispanic children were less likely to respond, even after adjustment for language spoken (adjusted odds ratio, 0.57; P = 0.028). CONCLUSIONS A minority of parents of patients discharged from the pediatric ED appear to read through their child's DCIs, with Hispanic families and those without private insurance least likely to read. Future research can explore how best to reach these particularly vulnerable families.
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Affiliation(s)
- Dina Wallin
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of California, San Francisco, CA
| | - Robert Vezzetti
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX
| | - Andrew Young
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX
| | - Matthew Wilkinson
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX
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15
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Dahm MR, Li J, Thomas J, Smith P, Georgiou A. How is test-related information communicated in Australian Emergency Departments? - ED clinicians' and patients' perspectives. PATIENT EDUCATION AND COUNSELING 2021; 104:1970-1977. [PMID: 33500178 DOI: 10.1016/j.pec.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/13/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the communication processes involving test-related information in Australian Emergency Departments (EDs); specifically what and how ED clinicians communicate test-related information to patients, what patients know and understand about the provided information, and how patients view the potential to access their test-results electronically. METHODS We conducted face-to-face semi-structured interviews with clinicians (n = 26) and patients (n = 32) across three Australian EDs. Interviews were transcribed and analysed iteratively, following principles of qualitative content analysis and grounded theory. RESULTS Depending on various contextual (e.g. time pressures) and patient factors (e.g. perceived health literacy), ED clinicians provided, and patients recalled receiving, test-related information along a continuum, ranging from "no or limited" information to "specific" information. Many patients were confused about how to access their test-results. Patients welcomed the potential for future electronic access to results but viewed their individual health and/or computer literacy skills and knowledge as potential barriers. CONCLUSIONS EDs are highly dynamic environments where contextual forces impinge on the amount and quality of test-related information that clinicians communicate to ED patients. PRACTICE IMPLICATIONS Systemic and patient factors need to be addressed to optimise the provision of test-related information in ED settings, improve patient understanding and foster patient empowerment.
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Affiliation(s)
- Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 6, 75 Talavera Rd, Macquarie University, NSW, 2109, Australia; Institute for Communication in Health Care (ICH), College of Arts and Social Science, Australian National University, 110 Ellery Crescent, Canberra, ACT, 2601, Australia.
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 6, 75 Talavera Rd, Macquarie University, NSW, 2109, Australia.
| | - Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 6, 75 Talavera Rd, Macquarie University, NSW, 2109, Australia.
| | - Peter Smith
- Graduate School of Medicine, Building 28, University of Wollongong, Keiraville, NSW, 2522, Australia.
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Level 6, 75 Talavera Rd, Macquarie University, NSW, 2109, Australia.
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Hodges R, Stepien S, Kim LY. Quality Improvement: Using Teach-Back to Improve Patient Satisfaction during Discharge in the Emergency Department. J Emerg Nurs 2021; 47:870-878. [PMID: 34215436 DOI: 10.1016/j.jen.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients discharged in the emergency department often have poor understanding of their discharge instructions. Teach-back is a communication method that involves asking patients to explain in their own words what a health care provider just told them. The purpose of this project was to determine whether nurse-led teach-back at discharge could improve patient satisfaction with discharge information. METHODS A teach-back method was used to educate patients on what to do if they do not feel better after leaving, using a single site quality improvement design. Patient satisfaction was measured using a standardized benchmark question on whether providers explained what to do if they did not feel better after leaving. The department goal for this question was established as achieving a response of "Yes, definitely" for 64.4% or more of the satisfaction surveys. Patient satisfaction data were collected before and after intervention through a survey given to patients within 24 hours after their visit. A statistical process chart was used to analyze whether the observed improvements coincided with implementation of the teach-back intervention. RESULTS Although there was an overall increase in post-intervention scores (61%) from baseline scores (59%), there were no special cause variations signaling that the intervention had a significant impact. DISCUSSION Teach-back may improve patient satisfaction with discharge information. Future implementation with measures of intervention adoption, fidelity, accountability, and sustainability are needed.
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van Loon-van Gaalen M, van der Linden MC, Gussekloo J, van der Mast RC. Telephone follow-up to reduce unplanned hospital returns for older emergency department patients: A randomized trial. J Am Geriatr Soc 2021; 69:3157-3166. [PMID: 34173229 PMCID: PMC9290482 DOI: 10.1111/jgs.17336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/10/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
Background/Objectives Telephone follow‐up calls could optimize the transition from the emergency department (ED) to home for older patients. However, the effects on hospital return rates are not clear. We investigated whether telephone follow‐up reduces unplanned hospitalizations and/or unplanned ED return visits within 30 days of ED discharge. Design Pragmatic randomized controlled trial with allocation by month; odd months intervention group, even months control group. Setting Two ED locations of a non‐academic teaching hospital in The Netherlands. Participants Community‐dwelling adults aged ≥70 years, discharged home from the ED were randomized to the intervention group (N = 4732) or control group (N = 5104). Intervention Intervention group patients: semi‐scripted telephone call from an ED nurse within 24 h after discharge to identify post‐discharge problems and review discharge instructions. Control group patients: scripted satisfaction survey telephone call. Measurements Primary outcome: total number of unplanned hospitalizations and/or ED return visits within 30 days of ED discharge. Secondary outcomes: separate numbers of unplanned hospitalizations and ED return visits. Subgroup analysis by age, sex, living condition, and degree of crowding in the ED at discharge. Results Overall, 42% were males, and median age was 78 years. In the intervention group, 1516 of 4732 patients (32%) consented, and in the control group 1659 of 5104 (33%) patients. Unplanned 30‐day hospitalization and/or ED return visit was found in 16% of intervention group patients and 14% of control group patients (odds ratio 1.16; 95% confidence interval: 0.96–1.42). Also, no statistically significant differences were found in secondary outcome measures. Within the subgroups, the intervention did not have beneficial effects for the intervention group. Conclusion Telephone follow‐up after ED discharge in older patients did not result in reduction of unplanned hospital admissions and/or ED return visits within 30 days. These results raise the question of whether other outcomes could be improved by post‐discharge ED telephone follow‐up.
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Affiliation(s)
| | | | - Jacobijn Gussekloo
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Department of Psychiatry, CAPRI-University Antwerp, Antwerp, Belgium
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18
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Omaki E, Castillo R, McDonald E, Eden K, Davis S, Frattaroli S, Rothman R, Shields W, Gielen A. A patient decision aid for prescribing pain medication: Results from a pilot test in two emergency departments. PATIENT EDUCATION AND COUNSELING 2021; 104:1304-1311. [PMID: 33280968 DOI: 10.1016/j.pec.2020.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study piloted a patient education and decision aid tool about prescription pain relievers to determine potential impact on: comfort receiving an opioid prescription; knowledge about opioids; decisional conflict about whether to take an opioid; and shared decision making with the prescribing physician. METHODS Patients with acute pain were recruited from two emergency departments (ED), and randomized to complete the tool (N = 65) or a time-matched control (N = 59) on a tablet. Data collection involved: a baseline survey; a post-test immediately following the assigned program; a discharge survey after seeing the physician; and a 6-week follow-up survey. RESULTS Knowledge increased and comfort receiving an opioid decreased as hypothesized, but did not reach statistical significance. Despite the lack of knowledge differences, the tool had significant positive impact on patients feeling more informed and experiencing less decisional conflict. Shared decision making with the prescribing physician was not impacted. CONCLUSION A patient decision aid can help ED patients feel more informed and less conflicted about prescription pain relievers but did not impact shared decision-making. PRACTICE IMPLICATIONS Patient education programs implemented in the ED should consider engaging physicians in the program to help to promote patient-centered approaches in the treatment of acute pain.
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Affiliation(s)
- Elise Omaki
- Johns Hopkins Center for Injury Research and Policy, Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, MD, 21205, United States.
| | - Renan Castillo
- Johns Hopkins Center for Injury Research and Policy, Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, MD, 21205, United States
| | - Eileen McDonald
- Johns Hopkins Center for Injury Research and Policy, Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, MD, 21205, United States
| | - Karen Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, 97239, United States
| | - Stephen Davis
- WVU Injury Control and Research Center, West Virginia University, Morgantown, WV, 26506, United States
| | - Shannon Frattaroli
- Johns Hopkins Center for Injury Research and Policy, Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, MD, 21205, United States
| | - Richard Rothman
- Johns Hopkins Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21287, United States
| | - Wendy Shields
- Johns Hopkins Center for Injury Research and Policy, Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, MD, 21205, United States
| | - Andrea Gielen
- Johns Hopkins Center for Injury Research and Policy, Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, MD, 21205, United States
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Farrell M. Dealing with fracture repair complications in cats and dogs. IN PRACTICE 2021. [DOI: 10.1002/inpr.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Steel PAD, Bodnar D, Bonito M, Torres-Lavoro J, Eid DB, Jacobowitz A, Shemesh A, Tanouye R, Rumble P, DiCello D, Sharma R, Farmer B, Pomerantz S, Zhang Y. MyEDCare: Evaluation of a Smartphone-Based Emergency Department Discharge Process. Appl Clin Inform 2021; 12:362-371. [PMID: 33910262 DOI: 10.1055/s-0041-1729165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Poor comprehension and low compliance with post-ED (emergency department) care plans increase the risk of unscheduled ED return visits and adverse outcomes. Despite the growth of personal health records to support transitions of care, technological innovation's focus on the ED discharge process has been limited. Recent literature suggests that digital communication incorporated into post-ED care can improve patient satisfaction and care quality. OBJECTIVES We evaluated the feasibility of utilizing MyEDCare, a text message and smartphone-based electronic ED discharge process at two urban EDs. METHODS MyEDCare sends text messages to patients' smartphones at the time of discharge, containing a hyperlink to a Health Insurance Portability and Accountability Act (HIPAA)-compliant website, to deliver patient-specific ED discharge instructions. Content includes information on therapeutics, new medications, outpatient care scheduling, return precautions, as well as results of laboratory and radiological diagnostic testing performed in the ED. Three text messages are sent to patients: at the time of ED discharge with the nurse assistance for initial access of content, as well as 2 and 29 days after ED discharge. MyEDCare was piloted in a 9-month pilot period in 2019 at two urban EDs in an academic medical center. We evaluated ED return visits, ED staff satisfaction, and patient satisfaction using ED Consumer Assessment of Healthcare Providers and Systems (ED-CAHPS) patient satisfaction scores. RESULTS MyEDCare enrolled 27,713 patients discharged from the two EDs, accounting for 43% of treat-and-release ED patients. Of the treat-and-release patients, 27% completed MyEDCare discharge process, accessing the online content at the time of ED discharge. Patients discharged via MyEDCare had fewer 72-hour, 9-day, and 30-day unscheduled return ED visits and reported higher satisfaction related to nursing care. CONCLUSION EDs and urgent care facilities may consider developing a HIPAA-compliant, text message, and smartphone-based discharge process, including the transmission of test results, to improve patient-centered outcomes.
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Affiliation(s)
- Peter A D Steel
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - David Bodnar
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Maryellen Bonito
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Jane Torres-Lavoro
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Dona Bou Eid
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Andrew Jacobowitz
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Amos Shemesh
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Robert Tanouye
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Patrick Rumble
- NewYork-Presbyterian Hospital, New York, New York, United States
| | - Daniel DiCello
- NewYork-Presbyterian Hospital, New York, New York, United States
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Brenna Farmer
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Sandra Pomerantz
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Yiye Zhang
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States.,Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
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Bilazarian A, Hovsepian V, Kueakomoldej S, Poghosyan L. A Systematic Review of Primary Care and Payment Models on Emergency Department Use in Patients Classified as High Need, High Cost. J Emerg Nurs 2021; 47:761-777.e3. [PMID: 33744017 DOI: 10.1016/j.jen.2021.01.012] [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: 11/08/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Reducing costly and harmful ED use by patients classified as high need, high cost is a priority across health care systems. The purpose of this systematic review was to evaluate the impact of various primary care and payment models on ED use and overall costs in patients classified as high need, high cost. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search was performed from January 2000 to March 2020 in 3 databases. Two reviewers independently appraised articles for quality. Studies were eligible if they evaluated models implemented in the primary care setting and in patients classified as high need, high cost in the United States. Outcomes included all-cause and preventable ED use and overall health care costs. RESULTS In the 21 articles included, 4 models were evaluated: care coordination (n = 8), care management (n = 7), intensive primary care (n = 4), and alternative payment models (n = 2). Statistically significant reductions in all-cause ED use were reported in 10 studies through care coordination, alternative payment models, and intensive primary care. Significant reductions in overall costs were reported in 5 studies, and 1 reported a significant increase. Care management and care coordination models had mixed effects on ED use and overall costs. DISCUSSION Studies that significantly reduced ED use had shared features, including frequent follow-up, multidisciplinary team-based care, enhanced access, and care coordination. Identifying primary care models that effectively enhance access to care and improve ongoing chronic disease management is imperative to reduce costly and harmful ED use in patients classified as high need, high cost.
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22
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Hoek AE, Joosten M, Dippel DWJ, van Beeck EF, van den Hengel L, Dijkstra B, Papathanasiou D, van Rijssel D, van den Hamer M, Schuit SCE, Burdorf A, Haagsma JA, Rood PPM. Effect of Video Discharge Instructions for Patients With Mild Traumatic Brain Injury in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med 2021; 77:327-337. [PMID: 33618811 DOI: 10.1016/j.annemergmed.2020.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 10/09/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE We measure the effect of video discharge instructions on postconcussion symptoms in patients with mild traumatic brain injury in the emergency department. METHODS A multicenter randomized controlled trial was conducted in which patients with mild traumatic brain injury were randomly assigned to either intervention (verbal, written, and video discharge information) or control (verbal and written discharge information only). All patients were interviewed 1 week and 3 months from randomization. Primary outcome measure was the Rivermead Post-Concussion Symptoms Questionnaire at 3 months. Secondary outcomes were correct recall, Hospital Anxiety and Depression Scale score, health-related quality of life (12-Item Short Form Health Survey), return visits, and patient satisfaction. RESULTS A total of 2,883 patients were assessed for eligibility, of whom 381 were included in the control group and 390 in the video intervention group. Difference in mean total Rivermead Post-Concussion Symptoms Questionnaire score between the 2 groups was 0.2 at 1 week and 0.3 at 3 months after traumatic brain injury (estimated effect -0.7; 95% confidence interval -2.1 to 0.7). There was also no difference in Hospital Anxiety and Depression Scale score, recall, 12-Item Short Form Health Survey score, return visits, and patient satisfaction between the control and intervention group. CONCLUSION Severity of postconcussion symptoms in patients with mild traumatic brain injury did not improve by adding video information to standard care. Also, there was no difference in recall, health-related quality of life, return visits, and patient satisfaction between the control and intervention groups.
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Affiliation(s)
- Amber E Hoek
- Department of Emergency Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marieke Joosten
- Department of Emergency Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ed F van Beeck
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Björn Dijkstra
- Department of Emergency Medicine, Dijklanderziekenhuis, Hoorn, the Netherlands
| | - Dafni Papathanasiou
- Department of Emergency Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - Daphne van Rijssel
- Department of Emergency Medicine, Reinier de Graaf, Delft, the Netherlands
| | - Maaike van den Hamer
- Department of Emergency Medicine, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | - Stephanie C E Schuit
- Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Juanita A Haagsma
- Department of Emergency Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Pleunie P M Rood
- Department of Emergency Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Dwan RL, Raymond BL, Richardson MG. Unanticipated Consequences of Switching to Sugammadex: Anesthesia Provider Survey on the Hormone Contraceptive Drug Interaction. Anesth Analg 2021; 133:958-966. [PMID: 33684087 DOI: 10.1213/ane.0000000000005465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sugammadex binds progesterone with high affinity and may interfere with hormonal contraceptive effectiveness. The clinical, economical, and ethical implications of unintended pregnancy should prompt anesthesiologists to actively consider and manage this pharmacologic interaction. We surveyed anesthesiology providers at our institution about knowledge of this potential adverse drug interaction, how they manage it clinically, and the extent to which they involve patients in shared decision-making regarding choice of neuromuscular blocker antagonist. METHODS A survey instrument was distributed to anesthesiology providers at a large, tertiary-care medical center. The survey explored prior experience using neostigmine and sugammadex, knowledge about potential sugammadex interference with hormonal contraception, pre-/postoperative counseling practices, clinical management, and shared decision-making regarding potential use of neostigmine in lieu of sugammadex to avoid this drug-drug interaction. RESULTS Of 259 surveys distributed, 155 were fully completed, and 10 were partially completed. Overall response rate was 60% (residents 85%, student nurse anesthetists 53%, certified registered nurse anesthetists 58%, attendings 48%). All but 1 respondent recognized the potential for sugammadex interference with oral hormonal contraception. Far fewer accurately identified potential interference with hormonal intrauterine devices (44%) and hormonal contraceptive implants (55%). The manufacturer's recommended 7-day duration of alternative contraception was correctly identified by 72% of respondents; others (22%) reported longer durations (range 10-30 days). Most (78% overall) agreed/strongly agreed that potential interference with contraceptive effectiveness should be discussed with patients preoperatively. Despite the majority (86% overall) that endorsed shared decision-making and inviting patient input regarding choice between sugammadex and neostigmine, many respondents reported "rarely/never" having discussed this drug interaction with patients in actual clinical practice, either preoperatively (67%) or postoperatively (80%). Furthermore, most respondents (79%) reported "rarely/never" administering neostigmine to intentionally avoid this drug interaction. CONCLUSIONS Two years after designating sugammadex as antagonist of choice, physician and nurse anesthesia providers reported seldom inquiring about contraceptive use among women of childbearing potential and rarely discussing potential risk of contraceptive failure from sugammadex exposure. Most lack accurate knowledge of sugammadex interference with hormonal intrauterine and subcutaneous contraceptive devices. Although most endorse preoperative counseling and support patient autonomy or shared decision-making regarding choice of reversal agent, the same respondents report rarely, if ever, actualizing these positions in clinical practice. These conflicting findings highlight the need for education regarding residual neuromuscular block versus adverse drug interactions, collaboration among providers involved in patient counseling, and intentional mindfulness of reproductive justice when caring for women of childbearing potential.
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Affiliation(s)
- Robyn L Dwan
- From the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Seegan PL, Tangella K, Seivert NP, Reynolds E, Young A, Ziegfeld S, Garcia A, Hodgman E, Parrish C. Factors Associated with Pediatric Burn Clinic Follow-up after Emergency Department Discharge. J Burn Care Res 2021; 43:207-213. [PMID: 33693681 DOI: 10.1093/jbcr/irab046] [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: 11/14/2022]
Abstract
Attrition between emergency department discharge and outpatient follow-up is well documented across a variety of pediatric ailments. Given the importance of outpatient medical care and the lack of related research in pediatric burn populations, we examined sociodemographic factors and burn characteristics associated with outpatient follow-up adherence among pediatric burn patients. A retrospective review of medical records was conducted on patient data extracted from a burn registry database at an urban academic children's hospital over a 2-year period (January 2018-December 2019). All patients were treated in the emergency department and discharged with instructions to follow-up in an outpatient burn clinic within one week. A total of 196 patients (Mage=5.5 years; 54% male) were included in analyses. Average percent total body surface area was 1.9 (SD=1.5%). One-third of pediatric burn patients (33%) did not attend outpatient follow-up as instructed. Older patients (OR=1.00; 95% CI: [.99-1.00], p=.045), patients with superficial burns (OR=9.37; 95% CI: [2.50-35.16], p=.001), patients with smaller percent total body surface area (OR=1.37; 95% CI: [1.07-1.76], p=.014), and patients with Medicaid insurance (OR=.22; 95% CI: [.09-.57], p=.002) or uninsured/unknown insurance (OR=.07; 95% CI: [.02-.26], p=.000) were less likely to follow up, respectively. Patient gender, race, ethnicity, and distance to clinic were not associated with follow-up. Follow-up attrition in our sample suggests a need for additional research identifying factors associated with adherence to follow-up care. Identifying factors associated with follow-up adherence is an essential step in developing targeted interventions to improve health outcomes in this at-risk population.
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Affiliation(s)
- Paige L Seegan
- Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry
| | - Kavya Tangella
- Johns Hopkins University, Department of Psychological and Behavioral Sciences
| | - Nicholas P Seivert
- Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences
| | - Elizabeth Reynolds
- Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry
| | - Andrea Young
- Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry
| | - Susan Ziegfeld
- Johns Hopkins University School of Medicine, Department of Surgery
| | - Alejandro Garcia
- Johns Hopkins University School of Medicine, Department of Surgery
| | - Erica Hodgman
- Johns Hopkins University School of Medicine, Department of Surgery
| | - Carisa Parrish
- Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry
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Benjenk I, DuGoff EH, Jacobsohn GC, Cayenne N, Jones CMC, Caprio TV, Cushman JT, Green RK, Kind AJH, Lohmeier M, Mi R, Shah MN. Predictors of Older Adult Adherence With Emergency Department Discharge Instructions. Acad Emerg Med 2021; 28:215-225. [PMID: 32767696 DOI: 10.1111/acem.14105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients. METHODS We performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age ≥ 60 years) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient-reported medication adherence, provider follow-up visit adherence, and knowledge of "red flags" (signs of worsening health requiring further medical attention). RESULTS A total 824 patients were potentially eligible, and 699 had data in at least one pillar. A total of 35% adhered to medication instructions, 76% adhered to follow-up instructions, and 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio [AOR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.98) were less likely to adhere to follow-up instructions. Participants who were older (AORs trended downward as age category increased) or depressed (AOR = 0.39, 95% CI = 0.17 to 0.85) or had one or more functional limitations (AOR = 0.62, 95% CI = 0.41 to 0.94) were less likely to recall red flags. CONCLUSION Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED-to-home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED.
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Affiliation(s)
- Ivy Benjenk
- From the Department of Health Policy and Management School of Public Health University of Maryland College Park MDUSA
| | - Eva H. DuGoff
- From the Department of Health Policy and Management School of Public Health University of Maryland College Park MDUSA
- the Department of Population Health Sciences School of Medicine and Public HealthUniversity of Wisconsin MadisonWIUSA
- the Berkeley Research Group Washington DCUSA
| | - Gwen C. Jacobsohn
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Nia Cayenne
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Courtney M. C. Jones
- the Department of Emergency MedicineUniversity of Rochester Medical Center RochesterNYUSA
| | - Thomas V. Caprio
- the Department of Public Health SciencesUniversity of Rochester Medical Center RochesterNYUSA
- the Department of Medicine Division of Geriatrics University of Rochester Medical Center Rochester NYUSA
| | - Jeremy T. Cushman
- the Department of Emergency MedicineUniversity of Rochester Medical Center RochesterNYUSA
- the Department of Public Health SciencesUniversity of Rochester Medical Center RochesterNYUSA
| | - Rebecca K. Green
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Amy J. H. Kind
- the Division of Geriatrics and Gerontology Department of Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
- and the William S. Middleton Veterans Affairs Geriatrics Research, Education, and Clinical Center Madison WIUSA
| | - Michael Lohmeier
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Ranran Mi
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Manish N. Shah
- the Department of Population Health Sciences School of Medicine and Public HealthUniversity of Wisconsin MadisonWIUSA
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
- the Division of Geriatrics and Gerontology Department of Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
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Pacella‐LaBarbara ML, Suffoletto BP, Kuhn E, Germain A, Jaramillo S, Repine M, Callaway CW. A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash-related Injury. Acad Emerg Med 2020; 27:1126-1139. [PMID: 32339359 DOI: 10.1111/acem.14000] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/27/2020] [Accepted: 04/22/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) symptoms (PTSS) are common after minor injuries and can impair recovery. We sought to understand whether an evidence-based mobile phone application with self-help tools (PTSD Coach) could be useful to improve recovery after acute trauma among injured emergency department (ED) patients. This pilot study examined the feasibility, acceptability, and potential benefit of using PTSD Coach among acutely injured motor vehicle crash (MVC) patients. METHODS From September 2017 to September 2018, we recruited adult patients within 24 hours post-MVC from the EDs of two Level I trauma centers in the United States. We randomly assigned 64 injured adults to either the PTSD Coach (n = 33) or treatment as usual (TAU; n = 31) condition. We assessed PTSS and associated symptoms at 1 month (83% retained) and 3 months (73% retained) postenrollment. RESULTS Enrollment was feasible (74% of eligible subjects participated) but usability and engagement were low (67% used PTSD Coach at least once, primarily in week 1); 76% of those who used it rated the app as moderately to extremely helpful. No differences emerged between groups in PTSS outcomes. Exploratory analyses among black subjects (n = 21) indicated that those in the PTSD Coach condition (vs. TAU) reported marginally lower PTSS (95% CI = -0.30 to 37.77) and higher PTSS coping self-efficacy (95% CI = -58.20 to -3.61) at 3 months. CONCLUSIONS We demonstrated feasibility to recruit acutely injured ED patients into an app-based intervention study, yet mixed evidence emerged for the usability and benefit of PTSD Coach. Most patients used the app once and rated it favorably in regard to satisfaction with and helpfulness, but longitudinal engagement was low. This latter finding may explain the lack of overall effects on PTSS. Additional research is warranted regarding whether targeting more symptomatic patients and the addition of engagement and support features can improve efficacy.
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Affiliation(s)
| | - Brian P. Suffoletto
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
| | - Eric Kuhn
- the Dissemination and Training Division National Center for PTSD Palo Alto CA
- the Department of Psychiatry and Behavioral Sciences School of Medicine Stanford University Stanford CA
| | - Anne Germain
- and the Department of Psychiatry School of Medicine University of Pittsburgh Pittsburgh PA
| | - Stephany Jaramillo
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
| | - Melissa Repine
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
| | - Clifton W. Callaway
- From the Department of Emergency Medicine School of Medicine University of Pittsburgh Pittsburgh PA
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Cosic F, Porter T, Norsworthy C, Price R, Bedi H. Comparison of health literacy in privately insured and public hospital orthopaedic patients. AUST HEALTH REV 2020; 43:399-403. [PMID: 29754593 DOI: 10.1071/ah17209] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/25/2018] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to quantify and compare patient health literacy between privately insured and public orthopaedic patients. Methods As part of the present cross-sectional study, elective postoperative orthopaedic patients across two sites were recruited and asked to complete a questionnaire at the first postoperative out-patient review. Patients were divided into three groups: (1) a public group (Public); (2) a private group (Private-pre); and (3) a private group that completed the questionnaire immediately after the out-patient review (Private-post). The questionnaire consisted of six questions regarding surgical management, expected recovery time and postoperative instructions. Patients were further asked to grade their satisfaction regarding information received throughout their management. Results In all, 150 patients completed the questionnaire, 50 in each of the three groups. Patients in the Public, Private-pre and Private-post groups answered a mean 2.74, 3.24 and 4.70 of 6 questions correctly respectively. The Private-pre group was 1.46-fold more likely to demonstrate correct health literacy than the Public group, whereas the Private-post group was 2.44-fold more likely to demonstrate improved health literacy than the Private-pre group. Patient satisfaction with information received was not associated with health literacy. Conclusion Limited health literacy in orthopaedic patients continues to be an area of concern. Both private and public orthopaedic patients demonstrated poor health literacy, but private patients demonstrated significant improvement after the out-patient review. What is known about the topic? Limited health literacy is a growing public health issue worldwide, with previous literature demonstrating a prevalence of low health literacy of 26% and marginal health literacy of 20% among all patient populations. Of concern, limited health literacy has been shown to result in a range of adverse health outcomes, including increased mortality and chronic disease morbidity. It has also been associated with an increased rate of hospitalisation and use of healthcare resources. Previous work in the orthopaedic trauma setting has found poor levels of health literacy and poor understanding of diagnosis, management and prognosis in the Australian public health system. Promisingly, it has been shown that simple, targeted interventions can improve patient health literacy. What does this paper add? This study further highlights that health literacy exhibited by orthopaedic patients is poor, particularly among patients in the public healthcare system. The present study is the first to have demonstrated that health literacy is poor among patients in both the public and private healthcare systems, despite these patients having distinctly different demographics. Promisingly, the present study shows that, unlike public orthopaedic out-patient review, private orthopaedic out-patient review appears to be effective in increasing patient health literacy regarding their orthopaedic condition and its management. What are the implications for practitioners? Health literacy is essential for patients to effectively communicate with doctors and achieve good health outcomes. Healthcare professionals need to be aware that a large proportion of patients have poor health literacy and difficulty understanding health-related information, particularly pertaining to that surrounding diagnosis, management and prognosis. This study highlights the need for healthcare professionals to ensure that they communicate with patients at an appropriate level to ensure patient understanding during the pre-, peri- and postoperative stages of management. Further, healthcare professionals should be aware that there is potential to improve patient health literacy at routine out-patient review, provided that this opportunity is used as an educational resource.
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Affiliation(s)
- Filip Cosic
- School of Medicine Monash University, Wellington Rd, Clayton, Vic. 3800, Australia
| | - Tabitha Porter
- OrthoSport Victoria, The Epworth, 89 Bridge Road, Richmond, Vic. 3121, Australia. ;
| | - Cameron Norsworthy
- OrthoSport Victoria, The Epworth, 89 Bridge Road, Richmond, Vic. 3121, Australia. ;
| | - Rohan Price
- OrthoSport Victoria, The Epworth, 89 Bridge Road, Richmond, Vic. 3121, Australia. ;
| | - Harvinder Bedi
- OrthoSport Victoria, The Epworth, 89 Bridge Road, Richmond, Vic. 3121, Australia. ;
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Mahajan M, Hogewoning JA, Zewald JJA, Kerkmeer M, Feitsma M, van Rijssel DA. The impact of teach-back on patient recall and understanding of discharge information in the emergency department: the Emergency Teach-Back (EM-TeBa) study. Int J Emerg Med 2020; 13:49. [PMID: 32972361 PMCID: PMC7513274 DOI: 10.1186/s12245-020-00306-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/09/2020] [Indexed: 11/21/2022] Open
Abstract
Background Previous research has demonstrated that patients leaving the emergency department (ED) have poor recall and understanding of their discharge information. The teach-back method is an easy technique that can be used to check, and if necessary correct, inaccurate recall. In our study, we aimed to determine the direct and short-term impact of teach-back as well as feasibility for routine use in the ED. Methods A prospective cohort study in an urban, non-academic ED was performed which included adult patients who were discharged from the ED with a new medical problem. The control group with the standard discharge was compared to the intervention group using the teach-back method. Recall and comprehension scores were assessed immediately after discharge and 2–4 days afterward by phone, using four standardized questions concerning their diagnosis, treatment, follow-up care, and return precautions. Results Four hundred eighty-three patients were included in the study, 239 in the control group, and 244 in the intervention group. Patients receiving teach-back had higher scores on all domains immediately after discharge and on three domains after 2–4 days (6.3% versus 4.5%). After teach-back, the proportion of patients that left the ED with a comprehension deficit declined from 49 to 11.9%. Deficits were most common for return precautions in both groups (41.3% versus 8.1%). Teach-back conversation took 1:39 min, versus an average of 3:11 min for a regular discharge interview. Conclusion Teach-back is an efficient and non-time-consuming method to improve patients’ immediate and short-term recall and comprehension of discharge information in the ED.
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Affiliation(s)
- Mandhkani Mahajan
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands.
| | - Janine Alida Hogewoning
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | | | - Margreet Kerkmeer
- Science Department, Reinier de Graaf Hospital, Reinier Academy, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Mathilde Feitsma
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands
| | - Daphne Annika van Rijssel
- Department of Emergency Medicine, Reinier de Graaf Hospital, P.O. Box 5011, 2600, GA, Delft, The Netherlands
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Dermody S, Hughes M, Smith V. The Effectiveness of Pictorial Discharge Advice Versus Standard Advice Following Discharge From the Emergency Department: A Systematic Review and Meta-Analysis. J Emerg Nurs 2020; 47:66-75.e1. [PMID: 32962841 DOI: 10.1016/j.jen.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Failure to provide adequate discharge advice to patients on leaving the emergency department can lead to poor understanding of and noncompliance with discharge instructions and consequently postdischarge complications or hospital readmissions. The use of pictographs to complement discharge advice has the potential to enhance patient recall and comprehension. The purpose of this paper was to determine the effectiveness of pictorial discharge advice compared with standard discharge advice in the emergency department. METHODS A systematic review and meta-analysis was conducted. CINAHL, MEDLINE, ASSIA, and EMBASE were searched from inception to March 1, 2020, combining terms related to the emergency room, pictogram, and randomized trials as appropriate. Randomized trials reporting on the use of pictorial discharge advice in the emergency department were eligible for inclusion. Outcome measures were comprehension, compliance with advice, satisfaction with advice and the ED visit, and reattendance rates. The Cochrane risk of bias tool was used to assess bias in the included studies. RESULTS Four studies were identified as eligible and included in the review. Pictorial discharge advice improved comprehension, compliance, and patient satisfaction with the advice, but not satisfaction with the ED visit when compared with standard discharge advice. None of the included studies measured reattendance rates. DISCUSSION The results of this systematic review support the use of pictorial discharge advice. However, few studies exist; none had a low risk of bias overall, and 3 were published over 12 years ago. This finding highlights a need for further research to inform evidence-based best practices on optimal methods for providing quality discharge advice in the emergency department.
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Gleason K, McDonald KM. In response to Ledford and colleagues Toward a Model of Shared Meaningful Diagnosis: How to capture a shared, meaningful diagnosis? PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30461-4. [PMID: 32891469 PMCID: PMC7914276 DOI: 10.1016/j.pec.2020.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 05/11/2023]
Affiliation(s)
- Kelly Gleason
- School of Nursing, Johns Hopkins University, Baltimore, MD USA.
| | - Kathryn M McDonald
- School of Nursing, Johns Hopkins University, Baltimore, MD USA; School of Medicine (General Internal Medicine), Bloomberg School of Public Health, and Carey School of Business Johns Hopkins University, Baltimore, MD USA
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Naureckas Li C, Camargo CA, Faridi M, Espinola JA, Hayes BD, Porter S, Cohen A, Samuels-Kalow M. Medication Education for Dosing Safety: A Randomized Controlled Trial. Ann Emerg Med 2020; 76:637-645. [PMID: 32807539 DOI: 10.1016/j.annemergmed.2020.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/01/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE This study sought to determine whether a brief intervention at the time of emergency department (ED) discharge can improve safe dosing of liquid acetaminophen and ibuprofen by parents or guardians. METHODS We performed a randomized controlled trial in the ED of parents and guardians of children 90 days to 11.9 years of age who were discharged with acetaminophen or ibuprofen, or both. Families were randomized to standard care or a teaching intervention combining lay language, simplified handouts, provision of an unmarked dosing syringe, and teach-back to confirm correct dosing. Participants were called 48 to 72 hours and 5 to 7 days after ED discharge to assess understanding of correct dosing. The primary outcome was defined as parent or guardian report of safe dosing at the time of first follow-up call. Our primary hypothesis was that the intervention would decrease the rate of error from 30% to 10% at 48- to 72-hour follow-up. RESULTS We enrolled 149 of 259 (58%) eligible subjects; 97 of 149 (65%) were reached at first follow-up call, of whom 35 of 97 (36%) received the intervention. Among those participants receiving the intervention, 25 of 35 (71%) were able to identify a safe dose for their child at the time of the first call compared with 28 of 62 (45%) of those in the control arm. The difference in proportions was 26% (95% confidence interval [CI] 7% to 46%). There was a 58% increase in reporting safe dosing in the intervention group compared with the control roup (relative risk 1.58; 95% CI 1.12 to 2.24), and it remained significant after adjustment for health literacy and language (adjusted relative risk 1.50; 95% CI 1.06 to 2.13). CONCLUSIONS A multifaceted intervention at the time of ED discharge-consisting of a simplified dosing handout, a teaching session, teach-back, and provision of a standardized dosing device-can improve parents' knowledge of safe dosing of liquid medications at 48 to 72 hours.
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Affiliation(s)
- Caitlin Naureckas Li
- Division of Pediatric Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Mohammad Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Janice A Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Bryan D Hayes
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Department of Pharmacy, Massachusetts General Hospital, Boston, MA
| | - Stephen Porter
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH
| | - Ari Cohen
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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Abdul Rahman N'I, Nurumal MS, Awang MS, Mohd Shah ANS. Emergency department discharge instruction for mild traumatic brain injury: Evaluation on readability, understandability, actionability and content. Australas Emerg Care 2020; 23:240-246. [PMID: 32713770 DOI: 10.1016/j.auec.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/31/2020] [Accepted: 06/20/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Emergency departments (EDs) routinely provide discharge instructions due to a large number of patients with mild traumatic brain injury (mTBI) being discharged home directly from ED. This study aims to evaluate the quality of available mTBI discharge instructions provided by EDs of Malaysia government hospitals. METHODS All 132 EDs were requested for a copy of written discharge instruction given to the patients. The mTBI discharge instructions were evaluated using the Patient Education Materials Assessment-Printable Tool (PEMAT-P) for understandability and actionability. Readability was measured using an online readability tool of Malay text. The content was compared against the discharge instructions recommended by established guidelines. RESULTS 49 articles were eligible for the study. 26 of the articles met the criteria of understandability, and 3 met the criteria for actionability. The average readability level met the ability of average adult. Most of the discharge instructions focused on emergency symptoms, and none contained post-concussion features. CONCLUSION Majority of the discharge instructions provided were appropriate for average people to read but difficult to understand and act upon. Important information was neglected in most discharge instructions. Thus, revision and future development of mTBI discharge instruction should consider health literacy demand and cognitive ability to process such information.
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Affiliation(s)
- Nurul 'Inayati Abdul Rahman
- Department of Critical Care Nursing, Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia.
| | - Mohd Said Nurumal
- Department of Critical Care Nursing, Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Mohamed Saufi Awang
- Neurosurgery Unit, Department of Surgery, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Aida Nur Sharini Mohd Shah
- Department of Internal Medicine, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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Rising KL, Powell RE, Cameron KA, Salzman DH, Papanagnou D, Doty AM, Latimer L, Piserchia K, McGaghie WC, McCarthy DM. Development of the Uncertainty Communication Checklist: A Patient-Centered Approach to Patient Discharge From the Emergency Department. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1026-1034. [PMID: 32101919 PMCID: PMC7302334 DOI: 10.1097/acm.0000000000003231] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Clear communication with patients upon emergency department (ED) discharge is important for patient safety during the transition to outpatient care. Over one-third of patients are discharged from the ED with diagnostic uncertainty, yet there is no established approach for effective discharge communication in this scenario. From 2017 to 2019, the authors developed the Uncertainty Communication Checklist for use in simulation-based training and assessment of emergency physician communication skills when discharging patients with diagnostic uncertainty. This development process followed the established 12-step Checklist Development Checklist framework and integrated patient feedback into 6 of the 12 steps. Patient input was included as it has potential to improve patient-centeredness of checklists related to assessment of clinical performance. Focus group patient participants from 2 clinical sites were included: Thomas Jefferson University Hospital, Philadelphia, PA, and Northwestern University Hospital, Chicago, Illinois.The authors developed a preliminary instrument based on existing checklists, clinical experience, literature review, and input from an expert panel comprising health care professionals and patient advocates. They then refined the instrument based on feedback from 2 waves of patient focus groups, resulting in a final 21-item checklist. The checklist items assess if uncertainty was addressed in each step of the discharge communication, including the following major categories: introduction, test results/ED summary, no/uncertain diagnosis, next steps/follow-up, home care, reasons to return, and general communication skills. Patient input influenced both what items were included and the wording of items in the final checklist. This patient-centered, systematic approach to checklist development is built upon the rigor of the Checklist Development Checklist and provides an illustration of how to integrate patient feedback into the design of assessment tools when appropriate.
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Affiliation(s)
- Kristin L. Rising
- K.L. Rising is associate professor and director of acute care transitions, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rhea E. Powell
- R.E. Powell is associate professor, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, and senior researcher, Mathematica, Princeton, New Jersey
| | - Kenzie A. Cameron
- K.A. Cameron is research professor, Department of Medical Education and Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David H. Salzman
- D.H. Salzman is associate professor, Department of Emergency Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dimitrios Papanagnou
- D. Papanagnou is associate professor and vice chair for education, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda M.B. Doty
- A.M.B. Doty is a research coordinator, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lori Latimer
- L. Latimer is a research coordinator, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine Piserchia
- K. Piserchia is a clinical research coordinator, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William C. McGaghie
- W.C. McGaghie is professor, Department of Medical Education, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Danielle M. McCarthy
- D.M. McCarthy is associate professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Quantifying the Crisis: Opioid-Related Adverse Events in Outpatient Ambulatory Plastic Surgery. Plast Reconstr Surg 2020; 145:687-695. [PMID: 32097308 DOI: 10.1097/prs.0000000000006570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The United States is currently in the midst of an opioid epidemic precipitated, in part, by the excessive outpatient supply of opioid pain medications. Accordingly, this epidemic has necessitated evaluation of practice and prescription patterns among surgical specialties. The purpose of this study was to quantify opioid-related adverse events in ambulatory plastic surgery. METHODS A retrospective review of 43,074 patient profiles captured from 2001 to 2018 within an American Association for Accreditation of Ambulatory Surgery Facilities quality improvement database was conducted. Free-text search terms related to opioids and overdose were used to identify opioid-related adverse events. Extracted profiles included information submitted by accredited ambulatory surgery facilities and their respective surgeons. Descriptive statistics were used to quantify opioid-related adverse events. RESULTS Among our cohort, 28 plastic surgery patients were identified as having an opioid-related adverse event. Overall, there were three fatal and 12 nonfatal opioid-related overdoses, nine perioperative opioid-related adverse events, and four cases of opioid-related hypersensitivities or complications secondary to opioid tolerance. Of the nonfatal cases evaluated in the hospital (n = 17), 16 patients required admission, with an average 3.3 ± 1.7 days' hospital length of stay. CONCLUSIONS Opioid-related adverse events are notable occurrences in ambulatory plastic surgery. Several adverse events may have been prevented had different diligent medication prescription practices been performed. Currently, there is more advocacy supporting sparing opioid medications when possible through multimodal anesthetic techniques, education of patients on the risks and harms of opioid use and misuse, and the development of societal guidance regarding ambulatory surgery prescription practices.
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Pétré B, Margat A, Servotte JC, Guillaume M, Gagnayre R, Ghuysen A. Patient education in the emergency department: take advantage of the teachable moment. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:511-517. [PMID: 31028515 DOI: 10.1007/s10459-019-09893-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/20/2019] [Indexed: 06/09/2023]
Abstract
Several recent works have highlighted hospital discharge as a good opportunity to deliver patient education (PE). Despite its constraints (overcrowding and unpredictable workload, in particular), the emergency department (ED) should be viewed as an opportune place for improving patient satisfaction and adherence to recommendations, and thus for preventing complications and early readmission, suggesting that better PE and health information could be one way to enhance patient safety. Building evidence on how best to organise and deliver effective PE poses many challenges, however. This paper gives an overview of the main issues (what we already know and prospects for research/clinical approaches) concerning PE in the ED: improving provider skills, ensuring PE continuity, developing educational materials, interprofessional collaboration, identifying specific educational needs for certain subgroups of patients, evaluating PE delivery, and identifying the most effective interventions. Future research will be needed to develop evidence-based guidelines for a comprehensive approach to PE.
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Affiliation(s)
- Benoit Pétré
- Public Health Department, University of Liege, Quartier Hôpital, Avenue Hippocrate 13 (B23), 4000, Liège, Belgium.
| | - Aurore Margat
- Educations and Health Practices Laboratory (LEPS), (EA 3412), UFR SMBH, Paris 13 University, Sorbonne Paris Cite, Bobigny, France
| | - Jean-Christophe Servotte
- Public Health Department, University of Liege, Quartier Hôpital, Avenue Hippocrate 13 (B23), 4000, Liège, Belgium
| | - Michèle Guillaume
- Public Health Department, University of Liege, Quartier Hôpital, Avenue Hippocrate 13 (B23), 4000, Liège, Belgium
| | - Rémi Gagnayre
- Educations and Health Practices Laboratory (LEPS), (EA 3412), UFR SMBH, Paris 13 University, Sorbonne Paris Cite, Bobigny, France
| | - Alexandre Ghuysen
- Public Health Department, University of Liege, Quartier Hôpital, Avenue Hippocrate 13 (B23), 4000, Liège, Belgium
- Emergency Department, University Hospital Center of Liege, Liège, Belgium
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Strudwick K, Russell T, Bell AJ, Chatfield MD, Martin-Khan M. Musculoskeletal injury quality outcome indicators for the emergency department. Intern Emerg Med 2020; 15:501-514. [PMID: 31773561 DOI: 10.1007/s11739-019-02234-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/09/2019] [Indexed: 12/26/2022]
Abstract
High standards of care for musculoskeletal injuries presenting to emergency departments (ED) must be maintained despite financial constraints, the model of care in place, or the pressure to reach time-based performance measures. Outcome quality indicators (QIs) provide a tangible way of assessing and improving the outcomes of health-care delivery. This study aimed to develop a set of outcome QIs for musculoskeletal injuries in the ED that are meaningful, valid, feasible to collect, simple to use for clinical quality improvement and chosen by experts in the field. The study used a multi-phase mixed methods design, commencing with a systematic review of available outcome QIs. An expert panel then developed a set of preliminary QIs based on the available scientific evidence. Prospective observational data collection was undertaken across eight EDs with subsequent retrospective chart audits, follow-up phone calls and audit of administrative databases. After statistical analysis, validated results were presented to the expert panel who discussed, refined and formally voted on a final outcome QI set. A total of 41 preliminary outcome QIs were field tested in EDs, with data collected on 633 patients. Using the field study results, the expert panel voted 11 outcome QIs into the final set. These covered effectiveness of pain management, timeliness to discharge, re-presentations to the ED and unplanned visits to health professionals in the community, missed injuries, opioids side effects and the patient experience. An evidence-based set of outcome quality indicators is now available to support clinical quality improvement of musculoskeletal injury care in the ED setting.
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Affiliation(s)
- Kirsten Strudwick
- Emergency and Physiotherapy Departments, QEII Jubilee Hospital, Metro South Health, Brisbane, QLD, Australia.
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Trevor Russell
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Anthony J Bell
- Uniting Care Health, The Wesley Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Mark D Chatfield
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Fares M, Khachman D, Salameh P, Lahoud N. Evaluation of discharge instructions among hospitalized Lebanese patients. Pharm Pract (Granada) 2020; 18:1-9. [PMID: 32206139 PMCID: PMC7075427 DOI: 10.18549/pharmpract.2020.1.1686] [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: 09/18/2019] [Accepted: 02/09/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Hospital readmissions are considered as the primary indicator of insufficient quality of care and are responsible of increasing annual medical costs by billions of dollars. Different factors tend to reduce readmissions, particularly instructions at discharge. Objectives: Our study objective was to evaluate discharge instructions given to hospitalized Lebanese patients and associated factors. Methods: Two hundred patients, aged between 21 and 79 years and admitted to the emergency department, were recruited from a Lebanese university hospital. Discharge instructions were evaluated by a face-to-face interview to fill a questionnaire with the patients immediately after their final contact with the physician or nurse in charge. We mainly focused on medications instructions and created two scores related to “instructions given” and “instructions appropriate” to later conduct bivariate analysis. Results: We found that discharge instructions were not completely given to all our study population. The degree of appropriateness fluctuated between 25% and 100%. The instructor in charge of giving discharge instructions had its significant influence on medication instructions given (p=0.014). In addition, the instructor and his experience influenced the degree of “appropriate instructions”. In fact, our study showed that despite being capable of giving good medication advice, nurses’ instructions were significantly less effective in comparison with physicians, fellows and residents. However, nurses gave 52% of the instructions, which questions the quality of those instructions. Conclusions: In conclusion, our observational study showed that in a Lebanese university hospital, patients’ understanding of discharge instructions is poor. Careful attention should be drawn to other hospitals as well and interventions should be considered to improve instructions quality and limit later complications and readmissions. The intervention of clinical pharmacists and their medication-related advice might be crucial in order to improve instructions’ quality.
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Affiliation(s)
- Mirella Fares
- PharmD. Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadat (Lebanon).
| | - Dalia Khachman
- PharmD, PhD. Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadat (Lebanon).
| | - Pascale Salameh
- PharmD, PhD. National Institute of Public Health, Clinical Epidemiology & Toxicology (INSPECT-LB), Faculty of Public Health, Lebanese University, Fanar (Lebanon).
| | - Nathalie Lahoud
- PharmD, PhD. National Institute of Public Health, Clinical Epidemiology & Toxicology (INSPECT-LB), Faculty of Public Health, Lebanese University, Fanar (Lebanon).
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Hoek AE, Anker SC, van Beeck EF, Burdorf A, Rood PP, Haagsma JA. Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis. Ann Emerg Med 2020; 75:435-444. [DOI: 10.1016/j.annemergmed.2019.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/10/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
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Stevens L, Fry M, Jacques M, Barnes A. Perceptions and experience of emergency discharge as reported by nurses and medical officers. Australas Emerg Care 2020; 23:55-61. [DOI: 10.1016/j.auec.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/27/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
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McCarthy DM, Powell RE, Cameron KA, Salzman DH, Papanagnou D, Doty AM, Leiby BE, Piserchia K, Klein MR, Zhang XC, McGaghie WC, Rising KL. Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial. BMC MEDICAL EDUCATION 2020; 20:49. [PMID: 32070353 PMCID: PMC7029572 DOI: 10.1186/s12909-020-1926-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications. METHODS The trial is a multicenter, two-arm randomized controlled trial designed to teach communication skills using simulation-based mastery learning (SBML). Resident emergency physicians from two training programs will be randomly assigned to immediate or delayed receipt of the two-part UCEM intervention after completing a baseline standardized patient encounter. The two UCEM components are: 1) a web-based interactive module, and 2) a smart-phone-based game. Both formats teach and reinforce communication skills for patient cases involving diagnostic uncertainty. Following baseline testing, participants in the immediate intervention arm will complete a remote deliberate practice session via a video platform and subsequently return for a second study visit to assess if they have achieved mastery. Participants in the delayed intervention arm will receive access to UCEM and remote deliberate practice after the second study visit. The primary outcome of interest is the proportion of residents in the immediate intervention arm who achieve mastery at the second study visit. DISCUSSION Patients' understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. Although use of SBML is a resource intensive educational approach, this trial has been deliberately designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake. TRIAL REGISTRATION The trial was registered at clinicaltrials.gov (NCT04021771). Registration date: July 16, 2019.
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Affiliation(s)
- Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario, Suite 200, Chicago, IL, 60611, USA.
| | - Rhea E Powell
- Division of General Internal Medicine and Geriatrics, Northwestern University, Philadelphia, PA, USA
| | - Kenzie A Cameron
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David H Salzman
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario, Suite 200, Chicago, IL, 60611, USA
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dimitrios Papanagnou
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amanda Mb Doty
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Katherine Piserchia
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario, Suite 200, Chicago, IL, 60611, USA
| | - Matthew R Klein
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario, Suite 200, Chicago, IL, 60611, USA
| | - Xiao C Zhang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - William C McGaghie
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Moore MD, Gray KD, Panjwani S, Finnerty B, Ciecerega T, Afaneh C, Fahey TJ, Crawford CV, Zarnegar R. Impact of procedural multimedia instructions for pH BRAVO testing on patient comprehension: a prospective randomized study. Dis Esophagus 2020; 33:5532834. [PMID: 31313807 DOI: 10.1093/dote/doz068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/12/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
The positive impact on patient comprehension and improved procedural outcomes when multimedia is utilized to convey instructions preprocedurally has been previously shown for gastrointestinal procedures such as colonoscopy. However, in gastroesophageal reflux testing (GERD), we continue to utilize verbal and written instructions to establish this diagnosis when we use BRAVO pH testing. This is arguably a more complex procedure involving stopping medications, placement of a device, and maintaining an accurate diary for the duration of the testing. We hypothesize that by utilizing multimedia to relay complex textual information, patients will have improved comprehension of periprocedural instructions thereby improving data entry and satisfaction of expectations during the procedure. Prospective randomized study of 120 patients undergoing endoscopic placement of the BRAVO pH monitoring capsule for evaluation of GERD receive either written preoperative instructions (control) or written plus video instructions (video group). A composite comprehension score was calculated using procedure-specific parameters of data entry over the 48-hour monitoring period. Patient satisfaction was evaluated on the basis of a five-point Likert scale. Extent of patient satisfaction was defined by the fulfillment of patient expectations. Exclusion criteria included patients who did not have access to the video or did not complete follow-up. Seventy-eight patients completed all follow-up evaluations. The video group (n = 44) had a significantly higher mean comprehension score when compared to the control group (n = 34) (9.6 ± 1.4 vs. 7.4 ± 2.0, P = 0.01). Overall satisfaction with instructions was significantly higher in the intervention group (91% vs. 47%, p 0.01). We detected no significant difference in comprehension or satisfaction scores in subgroup analyses of the video group comparing patients <65 and ≥65 years of age and by education level. Compared to standard written instructions, video instructions improved patient comprehension based on data evaluation, and satisfaction. Therefore, clinicians should consider incorporation of multimedia instructions to enhance patient periprocedural expectations and understanding of reflux pH testing using the BRAVO procedure.
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Affiliation(s)
- M D Moore
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - K D Gray
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - S Panjwani
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - B Finnerty
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - T Ciecerega
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - C Afaneh
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - T J Fahey
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - C V Crawford
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
| | - R Zarnegar
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
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Phonpruk K, Flowers K, Naughton G, Fulbrook P. Analysis of written resources for parents of children discharged from a paediatric emergency department. J Child Health Care 2019; 23:652-662. [PMID: 31154813 DOI: 10.1177/1367493519852460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to profile the information and readability of parent-focused resources to support care at home following a child's discharge from a paediatric emergency department (ED). Analysis included recording the scope, source, readability scores and benchmarking the contents against previous recommendations for discharge information. Information from 46 resources (on 41 conditions) from three separate sources was analysed. Overall, a wide range of resources was available. Inconsistency was evident in the framework and design of resources available. Approximately two-thirds of resources provided information about referral to community resources, and most had links to community health providers. Assessment of readability levels showed a predominant pitch towards a relatively high level of schooling. Existing written resources available for parents to use in caring for their child following discharge from an ED could improve with more streamlined designs as well as consistent references to community resources and additional health providers. Parents with low reading capacity may not be able to make the most of existing resources to care for their child at home following ED discharge. This framework was developed for reviewing the resources that could be useful for quality assessment of other parent-focused discharge information.
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Affiliation(s)
| | - Karen Flowers
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
| | - Geraldine Naughton
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Paul Fulbrook
- Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.,The Prince Charles Hospital, Brisbane, Australia.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Awareness of diagnosis and follow up care after discharge from the Emergency Department. Australas Emerg Care 2019; 22:221-226. [PMID: 31624010 DOI: 10.1016/j.auec.2019.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/26/2019] [Accepted: 08/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients currently receive discharge summaries including investigation results, medical assessment and follow up requirements with health professionals on discharge from the emergency department (ED). This study aimed to evaluate if a simplified discharge information card in addition to current care improved patients' awareness of their discharge diagnosis and requirements for follow-up appointment. METHODS A prospective pre-post design interventional study was conducted. The pre-intervention phase collected data from patients who did not receive the discharge card. The post-intervention phase occurred after implementing the discharge card. Participants underwent brief interviews to assess awareness of diagnosis and follow-up appointment requirements after discharge. Responses were compared to the plan in the medical notes and concordance determined. RESULTS There were 112 patients in the pre-intervention group and 117 in the post-intervention group. Awareness of discharge diagnosis improved from 73.2% (95% CI: 64.3-80.5) of pre-interventions participants to 89.7% (95% CI: 82.9-94.0) for participants receiving the discharge card (p<0.001; NNT 6.1 patients). Statistically significant improvements were observed regarding knowledge of follow-up destination and timing. CONCLUSION A short discharge information card improved awareness of discharge diagnoses and follow-up requirements. Such interventions that empower patients with knowledge about their health, should be considered prior to discharge from EDs.
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Adherence of older emergency department patients to community-based specialized geriatric services. CAN J EMERG MED 2019; 21:659-666. [DOI: 10.1017/cem.2019.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjectivesOur objective was to determine emergency department (ED) patient adherence to outpatient specialized geriatric services (SGS) following ED evaluation by the geriatric emergency management (GEM) nurse, and identify barriers and facilitators to attendance.MethodsWe conducted a prospective cohort study at two academic EDs between July and December 2016, enrolling a convenience sample of patients ≥ 65 years, seen by a GEM nurse, referred to outpatient SGS, and consented to study participation. We completed a chart review and a structured telephone follow-up at 6 weeks. Descriptive statistics were used.ResultsWe enrolled 103/285 eligible patients (86 eligible but not enrolled, 86 declined specialized geriatric referrals, and 10 declined study participation). Patients were mean age of 83.1 years, 59.2% female, and 73.2% cognitively impaired. Reasons for referral included mobility (86.4%), cognition (56.3%), pain (38.8%), mood (35.0%), medications (33.0%), and nutrition (31.1%). Referrals were to Geriatric Day Hospital (GDH) programs (50.5%), geriatric outreach (26.2%), falls clinic (12.6%), and geriatric psychiatry (8.7%). Adherence with follow-up was 59.2%. Barriers to attendance included patient did not feel SGS were needed (52.1%), inability to recall GEM consultation (53.4%), and dependence on family for transportation (72.6%). Home-based assessments had the highest adherence (81.5%).ConclusionAdherence of older ED patients referred by the GEM team to SGS is suboptimal, and a large proportion of patients decline these referrals in the ED. Future work should examine the efficacy of home-based assessments in a larger confirmatory setting and focus on interventions to increase referral acceptance and address barriers to attendance.
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A Picture Is Worth a Thousand Words: Pictographs to Improve Understanding of Discharge Instructions. J Emerg Nurs 2019; 45:531-537. [DOI: 10.1016/j.jen.2019.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/18/2018] [Accepted: 01/15/2019] [Indexed: 11/23/2022]
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Lisby M, Klingenberg M, Ahrensberg JM, Hoeyem PH, Kirkegaard H. Clinical impact of a comprehensive nurse-led discharge intervention on patients being discharged home from an acute medical unit: Randomised controlled trial. Int J Nurs Stud 2019; 100:103411. [PMID: 31629207 DOI: 10.1016/j.ijnurstu.2019.103411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute medical units have increasingly been implemented in modern healthcare to ensure a fast track for treatment and care, thus increasing the number of patients being discharged. To avoid early readmissions, new approaches to discharging patients from these settings are needed. OBJECTIVE To investigate the clinical impact of a comprehensive nurse-led discharge intervention on patients being discharged home from an acute medical unit. OUTCOMES The primary outcome was 30-days hospital readmission. Secondary outcomes were utilisation of healthcare, including contacting emergency departments, the general practitioner or after-hours physicians; patient experience; and health-related quality of life. DESIGN This study was a non-blinded randomised clinical controlled trial with a 1 year enrolment period from November 2014 to 2015. Group assignment was performed by computer generated codes. SETTING The setting was a 34-bed acute medical unit at a Danish University Hospital. PARTICIPANTS Non-surgical patients aged 18+ with more than one contact to hospitals during the last 12 months were eligible for inclusion. Furthermore, patients had to have been discharged home and had a follow-up appointment after discharge. METHODS The intervention consisted of (1) an assessment of the patient's overall situation, (2) an assessment of their comprehension of discharge recommendations, (3) a simple discharge letter targeting the individual patient's health literacy and (4) a follow-up telephone call 2 days post-discharge. The study was carried out by a research nurse and the 1st author. Data was collected from medical records, registers and questionnaires. Intention-to-treat and per protocol analysis were performed. RESULTS In all, 200 participants were enrolled (101 intervention; 99 control). Of these, 17 were excluded due to transfer to another hospital department and 4 did not receive the full intervention, resulting in 86 in the intervention group and 93 in the control group. At 30 days post-discharge, 22/101 (22%) in the intervention group had at least one readmission vs. 19/99 (19%) in the control group. The total number of all-cause readmissions in the follow-up period was 0.28 (SD: 0.67) in the intervention group vs. 0.26 (SD: 0.63) in the control group. There were no statistically significant differences in baseline characteristics or any of the primary and secondary outcomes. CONCLUSION A comprehensive nurse-led discharge model focusing on the individual patient's situation and needs was not capable of reducing readmissions and healthcare utilisation. No statistically significant effects on quality of life or patients' experiences of the discharge from the acute medical unit were observed.
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Affiliation(s)
- M Lisby
- Research Centre for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark; The Emergency Department, Aarhus University Hospital, Denmark.
| | - M Klingenberg
- The Emergency Department, Amager Hvidovre Hospital, Denmark; The Department of Endocrinology, Aarhus University Hospital, Denmark
| | - J M Ahrensberg
- The Emergency Department, Aarhus University Hospital, Denmark
| | - P H Hoeyem
- The Department of Endocrinology, Aarhus University Hospital, Denmark; The Emergency Department, The Regional Hospital in Horsens, Denmark
| | - H Kirkegaard
- Research Centre for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark; The Emergency Department, Aarhus University Hospital, Denmark
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Schullo-Feulner A, Krohn L, Knutson A. Reducing Medication Therapy Problems in the Transition from Hospital to Home: A Pre- & Post-Discharge Pharmacist Collaboration. PHARMACY 2019; 7:pharmacy7030086. [PMID: 31323941 PMCID: PMC6789784 DOI: 10.3390/pharmacy7030086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND With 30-day Medicare readmission rates reaching 20%, a heightened focus has been placed on improving the transition process from hospital to home. For many institutions, this charge has identified medication-use safety as an area where pharmacists are well-positioned to improve outcomes by reducing medication therapy problems (MTPs). METHODS This system-wide (425 bed community hospital plus 18 primary care clinics) prospective study recruited inpatient and ambulatory pharmacists to provide comprehensive medication management before and after hospital discharge. The results analyzed were the success rate and timing of the inpatient to ambulatory pharmacist handoff, as well as the number, type, and severity of MTPs resolved in both settings. RESULTS Of the 105 eligible patients who received a pharmacist evaluation before discharge, 61 (58%) received follow-up with an ambulatory pharmacist an average of 2.88 days after discharge (range 1-8 days). An average of 5 and 1.4 MTPs per patient were identified and resolved in the inpatient vs. ambulatory setting, respectively. Although average MTP severity ratings were higher in the inpatient setting, the highest severity rating was seen most frequently in the ambulatory setting. CONCLUSIONS In the transition from hospital to home, pharmacist evaluation in both the inpatient and ambulatory settings are necessary to resolve medication therapy problems.
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Affiliation(s)
- Anne Schullo-Feulner
- Park Nicollet Health Services, St. Louis Park, MN 55426, USA.
- Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, Minneapolis, MN 55455, USA.
| | - Lisa Krohn
- Park Nicollet Health Services, St. Louis Park, MN 55426, USA
| | - Alison Knutson
- Park Nicollet Health Services, St. Louis Park, MN 55426, USA
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Chadwick W, Bassett H, Hendrickson S, Slonaker K, Perales S, Pantaleoni J, Srinivas N, Platchek T, Destino L. An Improvement Effort to Optimize Electronically Generated Hospital Discharge Instructions. Hosp Pediatr 2019; 9:523-529. [PMID: 31243058 DOI: 10.1542/hpeds.2018-0251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The purpose of hospital discharge instructions (HDIs) is to facilitate safe patient transitions home, but electronic health records can generate lengthy documents filled with irrelevant information. When our institution changed electronic health records, a cumbersome electronic discharge workflow produced low-value HDI and contributed to a spike in discharge delays. Our aim was to decrease these delays while improving family and provider satisfaction with HDI. METHODS We used quality improvement methodology to redesign the electronic discharge navigator and HDI to address the following issues: (1) difficulty preparing discharge instructions before time of discharge, (2) suboptimal formatting of HDI, (3) lack of standard templates and language within HDI, and (4) difficulties translating HDI into non-English languages. Discharge delays due to HDI were tracked before and after the launch of our new discharge workflow. Parents and providers evaluated HDI and the electronic discharge workflow, respectively, before and after our intervention. Providers audited HDI for content. RESULTS Discharge delays due to HDI errors decreased from a mean of 3.4 to 0.5 per month after our intervention. Parents' ratings of how understandable our HDIs were improved from 2.35 to 2.74 postintervention (P = .05). Pediatric resident agreement that the electronic discharge process was easy to use increased from 9% to 67% after the intervention (P < .001). CONCLUSIONS Through multidisciplinary collaboration we facilitated advance preparation of more standardized HDI and decreased related discharge delays from the acute care units at a large tertiary care hospital.
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Affiliation(s)
- Whitney Chadwick
- Divisions of Pediatric Hospital Medicine and
- Departments of Clinical Informatics and
- Performance Improvement, Stanford Children's Health, Palo Alto, California
| | | | - Sarah Hendrickson
- Massachusetts General Hospital for Children and Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - Kimberly Slonaker
- Department of Pediatrics, Kaiser Permanente Northern California, Santa Clara, California
| | | | | | - Nivedita Srinivas
- Divisions of Pediatric Hospital Medicine and
- Pediatric Infectious Disease, School of Medicine, and
| | - Terry Platchek
- Divisions of Pediatric Hospital Medicine and
- Performance Improvement, Stanford Children's Health, Palo Alto, California
- Clinical Excellence Research Center, Stanford University, Stanford, California
| | - Lauren Destino
- Divisions of Pediatric Hospital Medicine and
- Performance Improvement, Stanford Children's Health, Palo Alto, California
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