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Jungdal A, Tousig CG, Christiansen TK, Birkelund L, Sørensen AN, Roskilde J, Birkelund R. Cross-sectoral exchange of nurses: An intervention study. Scand J Caring Sci 2024; 38:378-386. [PMID: 38310602 DOI: 10.1111/scs.13238] [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] [Received: 08/29/2023] [Revised: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND In health policy, much attention has been paid to collaboration between the primary and secondary health care sectors, especially in relation to hospitalisation and discharge. Despite ideal plans for collaboration, the research literature shows that inadequate communication is a well-known problem that can be a barrier to a safe trajectory for the citizen. Based on the assumption that better knowledge of each other's work will lead to better collaboration, a cross-sectoral exchange program with nurses was initiated. AIM The aim was to investigate which barriers to good patient trajectories the involved nurses attributed to cross-sectoral collaboration and what impact the exchange to the opposite sector had for them. METHODS Twenty-eight nurses were exchanged: 14 from a cardiology department and 14 from municipal home care. The nurses shadowed a colleague from the opposite sector in their daily work. Subsequently, six focus group interviews were conducted. The transcribed material was analysed based on Ricoeur's interpretation theory. RESULTS Two main themes, including sub-themes emerged: (1) Challenging communicative conditions: (a) Inadequate digital communication, (b) Inadequate care plans and discharge reports, (c) Conversation promotes understanding, and (d) Challenging collaboration and communication with the discharge coordinators. (2) Perceived importance of the exchange: (a) Cross-sectoral relationship, prejudice and gaining respect for each other and (b) Working in two different worlds. CONCLUSION Electronic communication is inadequate, and the IT systems do not support sufficient cross-sectoral communication. The organisational model in the municipal care sector is inflexible in terms of allocations for the current needs of citizens, and professionals feel that their professional judgements are not recognised. The nurses gained insight into each other's work and working conditions and respect for each other's professionalism. The exchange has the potential to both improve the relationship and communication between the sectors for the benefit of a better and more coherent patient course.
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Affiliation(s)
- Anni Jungdal
- Department of Cardiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Charlotte Gad Tousig
- Department of Cardiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Lisbeth Birkelund
- Odense University Hospital - University of Southern Denmark, Odense, Denmark
| | - Anette Nissen Sørensen
- Department of Cardiology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Jesper Roskilde
- Public Administration and Diploma of Leadership, Senior Healthcare, Vejle, Denmark
| | - Regner Birkelund
- Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle Kommune, Vejle, Denmark
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Chen C, Sun Y, Chen C, Zhang M, Lin S, Dai T, Li R, Huang J, Zheng J, Chen Y. Development and Validation of a Patient Discharge Readiness Scale for Daytime Cataract Surgery (DRS-CAT). J Perianesth Nurs 2024; 39:195-201.e3. [PMID: 38099885 DOI: 10.1016/j.jopan.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/02/2023] [Accepted: 07/19/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE To ensure the safety of patients discharged from the hospital, a nurse-assessed scale for outpatient cataract surgery patients was constructed to provide a special tool for cataract patients' discharge readiness evaluation. DESIGN This is a methodological study. METHODS The development of the tool was completed between 2021 and 2022. Based on the literature review and qualitative interviews, the initial entry pool of the discharge readiness scale was established. After consultation with Delphi experts, the preliminary scale was tested by 312 participants to screen items and test reliability and validity. The analysis included internal consistency, content validity, and construct validity. The Strengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist was used as the reporting guideline for this study. FINDINGS The final Discharge Readiness Scale for Cataract surgery consists of 21 items in five dimensions: cognition of discharge readiness, personal status, mastery of health education knowledge, coping capacity, and social support. Five common factors were extracted from the exploratory factor analysis, and they explained 70.12% of the total variance. All of the indexes of the confirmatory factor analysis were within the theoretical allowable range. The Cronbach's α of the total scale was 0.903, and the scale-level content validity index/average variance extracted was 0.99. CONCLUSIONS The Discharge Readiness Scale for Cataract surgery, evaluated by nurses, has good reliability and validity and can be used to determine the discharge readiness of cataract patients undergoing day surgery.
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Affiliation(s)
- Chen Chen
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiwen Sun
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Caifen Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengyue Zhang
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shudan Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tingting Dai
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rong Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiali Huang
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingwei Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanyan Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Landi S, Panella MM, Leardini C. Disentangling organizational levers and economic benefits in transitional care programs: a systematic review and configurational analysis. BMC Health Serv Res 2024; 24:46. [PMID: 38195545 PMCID: PMC10777542 DOI: 10.1186/s12913-023-10461-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Promoting safe and efficient transitions of care is critical to reducing readmission rates and associated costs and improving the quality of patient care. A growing body of literature suggests that transitional care (TC) programs are effective in improving quality of life and reducing unplanned readmissions for several patient groups. TC programs are highly complex and multidimensional, requiring evidence on how specific practices and system characteristics influence their effectiveness in patient care, readmission reduction and costs. METHODS Using a systematic review and a configurational approach, the study examines the role played by system characteristics (size, ownership, professional skills, technology used), the organizational components implemented, analyzing their combinations, and the potential economic impact of TC programs. RESULTS The more organizational components are implemented, the greater the likelihood that a TC program will be successful in reducing readmission rates. Not all components have the same effect. The results show that certain components, 'post-discharge symptom monitoring and management' and 'discharge planning', are necessary but not sufficient to achieve the outcome. The results indicate the existence of two different combinations of components that can be considered sufficient for the reduction of readmissions. Furthermore, while system characteristics are underexplored, the study shows different ways of incorporating the skill mix of professionals and their mode of coordination in TC programs. Four organizational models emerge: the health-based monocentric, the social-based monocentric, the multidisciplinary team and the mono-specialist team. The economic impact of the programs is generally positive. Despite an increase in patient management costs, there is an overall reduction in all post-intervention costs, particularly those related to readmissions. CONCLUSIONS The results underline the importance of examining in depth the role of system characteristics and organizational factors in facilitating the creation of a successful TC program. The work gives preliminary insights into how to systematize organizational practices and different coordination modes for facilitating decision-makers' choices in TC implementation. While there is evidence that TC programs also have economic benefits, the quality of economic evaluations is relatively low and needs further study.
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Affiliation(s)
- Stefano Landi
- Department of Management, Università di Verona, Via Cantarane, 24, 37129, Verona, Italy.
| | - Maria Martina Panella
- IRCCS- Azienda ospedaliera universitaria Bologna, Policlinico di S.Orsola-Malpighi, Via Pietro Albertoni, 15, Bologna, Italy
| | - Chiara Leardini
- Department of Management, Università di Verona, Via Cantarane, 24, 37129, Verona, Italy
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Lei S, Sun J, Wang C, Zhang X, Han W, Wang X, Xie J. Nurse-to-patient ratios and readiness for hospital discharge: A moderated mediation model. Nurs Open 2024; 11:e2047. [PMID: 38268295 PMCID: PMC10697126 DOI: 10.1002/nop2.2047] [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] [Received: 02/22/2023] [Revised: 08/31/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To explore whether and to what extent, nurse-patient assessment differences mediate the association between nurse-to-patient ratios and readiness for hospital discharge, and examine whether nurse-patient characteristics moderate the indirect and/or direct effect of mediation model. DESIGN A cross-sectional study was carried out from March 2021 to December 2022. METHODS A total of 523 pairs of gastrointestinal cancer patients with PICC and their nurses were recruited. All the participants were invited to complete the general information questionnaire and the Readiness for Hospital Discharge Scale. Outcome measure was patient-reported readiness for hospital discharge. This study was reported according to the STROBE checklist. RESULTS The patients reported a low level of readiness for hospital discharge. Nurse-patient assessment differences were positively associated with nurse-to-patient ratios but negatively associated with readiness for hospital discharge. Furthermore, nurse-patient assessment differences fully mediated the effect of nurse-to-patient ratios on readiness for hospital discharge, and age and gender of patients only moderated the indirect path of mediation model.
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Affiliation(s)
- Shuang‐yan Lei
- Department of RadiotherapyShaanxi Provincial Cancer HospitalXi'anShaanxiChina
| | - Jia‐ru Sun
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Cai‐hua Wang
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Xiao‐fang Zhang
- Department of RadiotherapyShaanxi Provincial Cancer HospitalXi'anShaanxiChina
| | - Wen‐jin Han
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Xiao‐qin Wang
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Juan Xie
- Department of NursingShaanxi Provincial Cancer HospitalXi'anShaanxiChina
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Ko Y, Hwang JM, Baek SH. Discharge transitional care programme for older adults after hip fracture surgery: a quasi-experimental study. J Res Nurs 2023; 28:582-593. [PMID: 38162723 PMCID: PMC10756176 DOI: 10.1177/17449871231204499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Hip fractures require extended periods of recovery and rehabilitation, subjecting older adults to discontinuous care. Discharge transition is a critical point of heightened vulnerability for older adults. Aims This study aimed to evaluate the effectiveness of a transitional care programme on the physical functions and quality of life (QOL) of older adults after hip fracture surgery. Methods Seventy-five older adults were assessed from pre-discharge to 6 weeks after hip surgery, and their physical functions, including walking status and activities of daily living, were measured. The QOL was measured using the European Quality of life-5 Dimensions-5 Levels (EQ 5D 5L). Results There was a significant strong effect of time (B = 10.565; 95% CI = 2.584-18.547; p = 0.009) on the EuroQol Visual Analog Scale (EQ-VAS) for the experimental group. However, there were no significant effects of time on physical functions and EQ-5D-5L scores. Conclusions The discharge transitional care programme improved the EQ-VAS of older adults following hip fracture surgery 6 weeks post-surgery. However, there were no significant differences in physical functions and EQ-5D between the groups.
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Affiliation(s)
- YoungJi Ko
- Associate Professor, Department of Nursing, Daegu Haany University, South Korea
| | - Jong-Moon Hwang
- Assistant Professor, Department of Rehabilitation Medicine, Kyungpook National University Hospital, South Korea
| | - Seung-Hoon Baek
- Associate Professor, Department of Orthopedic Surgery, Kyungpook National University Hospital, South Korea
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Po HW, Lin FJ, Cheng HJ, Huang ML, Chen CY, Hwang JJ, Chiu YW. Factors Affecting the Effectiveness of Discharge Planning Implementation: A Case-Control Cohort Study. J Nurs Res 2023; 31:e274. [PMID: 37167623 DOI: 10.1097/jnr.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND In many hospitals, a discharge planning team works with the medical team to provide case management to ensure high-quality patient care and improve continuity of care from the hospital to the community. However, a large-scale database analysis of the effectiveness of overall discharge planning efforts is lacking. PURPOSE This study was designed to investigate the clinical factors that impact the efficacy of discharge planning in terms of hospital length of stay, readmission rate, and survival status. METHODS A retrospective study was conducted based on patient medical records and the discharge plans applied to patients hospitalized in a regional medical center between 2017 and 2018. The medical information system database and the care service management information system maintained by the Ministry of Health and Welfare were used to collect data and explore patients' medical care and follow-up status. RESULTS Clinical factors such as activities of daily living ≤ 60, having indwelling catheters, having poor control of chronic diseases, and insufficient caregiver capacity were found to be associated with longer hospitalization stays. In addition, men and those with indwelling catheters were found to have a higher risk of readmission within 30 days of discharge. Moreover, significantly higher mortality was found after discharge in men, those ≥ 75 years old, those with activities of daily living ≤ 60, those with indwelling catheters, those with pressure ulcers or unclean wounds, those with financial problems, those with caregivers with insufficient capacity, and those readmitted 14-30 days after discharge. CONCLUSIONS The findings of this study indicate that implementing case management for discharge planning does not substantially reduce the length of hospital stay nor does it affect patients' readmission status or prognosis after discharge. However, age, underlying comorbidities, and specific disease factors decrease the efficacy of discharge planning. Therefore, active discharge planning interventions should be provided to ensure transitional care for high-risk patients.
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Affiliation(s)
- Hui-Wen Po
- MSN, RN, Department of Nursing, National Taiwan University Hospital Yunlin Branch, Taiwan
| | - Fang-Ju Lin
- MS, RN, Head Nurse, Department of Nursing, National Taiwan University Hospital Yunlin Branch, Taiwan
| | - Hsing-Jung Cheng
- MS, RN, Supervisor, Department of Nursing, National Taiwan University Hospital Yunlin Branch, Taiwan
| | - Mei-Ling Huang
- MS, RN, Director, Department of Nursing, National Taiwan University Hospital Yunlin Branch, Taiwan
| | - Chung-Yu Chen
- PhD, MD, Assistant Professor, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Juey-Jen Hwang
- PhD, MD, Professor, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Wen Chiu
- PhD, RN, Associate Professor, Department of Nursing, Chung Shan Medical University, and Chung Shan Medical University Hospital, Taiwan
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Gagesch M, Hüni A, Geschwindner H, Abderhalden LA, Lang W, Bieri-Brüning G, Bischoff-Ferrari HA. Feasibility of a 12-Month Follow-Up in Swiss Older Adults after Post-Acute Care in Nursing Homes-A Pilot Study. Geriatrics (Basel) 2023; 8:geriatrics8020035. [PMID: 36960990 PMCID: PMC10037597 DOI: 10.3390/geriatrics8020035] [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: 01/15/2023] [Revised: 02/15/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
(1) Background: Post-acute care (PAC) aims to support functional recovery in older adults after acute hospitalization in order to regain a sufficient level of self-care facilitating their return home. However, the long-term outcomes of PAC are understudied due to challenges in recording a follow-up. We aimed to investigate the feasibility of a 12-month follow-up after PAC in Swiss nursing homes, examining practicability and potential factors influencing participation rate. (2) Methods: Collection of one-year follow-up data among 140 eligible patients after PAC in nursing homes was attempted. Patients were recruited using letters and phone calls between August and December 2017. We compared baseline data of all initial PAC patients with those who declined participation in the follow-up to identify factors potentially influencing participation. (3) Results: Overall mortality at 12 months was 25% (n = 35 of 140). Of the 105 survivors, 53 (50%) refused participation, 26 (25%) were interviewed, and 26 (25%) were lost to follow-up. Comparison of baseline characteristics between participants and objectors indicated significant statistical differences in Mini-Mental State Examination (MMSE) scores (participants mean of 26.0 [SD 3.92] vs. objectors mean of 23.5 points [SD 4.40], p = 0.015). Further, logistic regression showed statistically significantly greater odds of participation (OR 1.25 [95% CI 1.06-1.48]) for each point increase in MMSE scores. (4) Conclusions: Long-term follow-up studies in older adults after PAC are challenging due to high mortality and dropout rates. Of note, intact cognitive function at baseline was associated with a higher willingness to participate in a follow-up phone interview. The assessment of cognitive function should be considered when estimating the participation rate in older patients.
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Affiliation(s)
- Michael Gagesch
- Department of Aging Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
- Center on Aging and Mobility, University Hospital Zurich and University of Zurich, 8006 Zurich, Switzerland
| | - Andreas Hüni
- Department of Aging Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
- Center on Aging and Mobility, University Hospital Zurich and University of Zurich, 8006 Zurich, Switzerland
| | - Heike Geschwindner
- Geriatric Service and Nursing Homes of the City of Zurich, 8050 Zurich, Switzerland
| | - Lauren A Abderhalden
- Center on Aging and Mobility, University Hospital Zurich and University of Zurich, 8006 Zurich, Switzerland
| | - Wei Lang
- Center on Aging and Mobility, University Hospital Zurich and University of Zurich, 8006 Zurich, Switzerland
| | - Gaby Bieri-Brüning
- Geriatric Service and Nursing Homes of the City of Zurich, 8050 Zurich, Switzerland
| | - Heike A Bischoff-Ferrari
- Department of Aging Medicine, University Hospital Zurich, 8091 Zurich, Switzerland
- Center on Aging and Mobility, University Hospital Zurich and University of Zurich, 8006 Zurich, Switzerland
- University Clinic for Aging Medicine, Zurich City Hospital-Waid, 8037 Zurich, Switzerland
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Petersen JJ, Østergaard B, Svavarsdóttir EK, Palonen M, Brødsgaard A. Hospital and homecare nurses' experiences of involvement of patients and families in transition between hospital and municipalities: A qualitative study. Scand J Caring Sci 2023; 37:196-206. [PMID: 36349680 DOI: 10.1111/scs.13130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/08/2022] [Accepted: 10/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Involving patients and families in nursing care is essential to improve patients' health outcomes. Furthermore, families play an essential role in supporting patients by helping nurses understand the patient's everyday life. However, families also need support. Involvement of patients and families is especially important when patients are transferred between hospital and home as transitions heighten the risk of compromising quality and safety in care. However, no consensus exists on how to involve them. Consequently, this may challenge a systematic approach toward patient and family involvement. AIM To describe hospital and homecare nurses' experiences with involving patients and their family members in nursing care in the transition between hospital and municipalities. METHOD Focus group interviews were conducted in the Gastro unit at a large university hospital in Denmark. Participants included 10 hospital nurses from three wards at the Gastro unit and six homecare nurses from one of three municipalities in the hospital catchment area (total n = 16). Data were analysed using qualitative content analysis. The study is reported according to the Consolidated Criteria for Reporting Qualitative Research. FINDINGS Our analysis revealed one overall theme - "The complexity of involvement" - based on four categories: gap between healthcare sectors increases the need for patient and family involvement, lack of time is a barrier to patient and family involvement, involvement is more than information, and involvement as a balancing act. CONCLUSION The nurses experienced patients' and families' involvement as essential, but a discrepancy was found between nurses' intentions and their actions. Aspects related to a gap between healthcare sectors and various understandings of involvement challenged the systematic involvement of patients and families in the transition between healthcare sectors. However, the nurses were highly motivated to achieve a close cross-sectoral collaboration and to show commitment towards patients and families.
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Affiliation(s)
- Julie Jacoby Petersen
- Department of Surgical Gastroenterology, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark.,Section for Nursing, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Mira Palonen
- Faculty of Social Sciences, health sciences, Tampere University, Tampere, Finland
| | - Anne Brødsgaard
- Section for Nursing, Department of Public Health, University of Aarhus, Aarhus, Denmark.,Department of Paediatrics and Adolescent Medicin, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
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Skerry L, Kervin E, Hanson N, Jarrett P, McCloskey R. Investigating areas for improvement in the transition from hospital-to-home for frail older adults: A mixed methods study. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221135115] [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
Background The planning and execution of discharge plans to successfully transition frail older adults from hospital-to-home can be a complicated endeavour. Objective To identify areas for improvement in the transitional process of frail older adults who were discharged from hospital based, geriatric units to their homes in the community. Method A prospective multi-phased mixed methods design was used, and cross-case thematic analysis of Phase 2 data were triangulated with Phase 1 findings. Results Thematic analysis findings indicated several related areas of importance within the transitional process: 1) Coordination of discharge; 2) Transition-to-home planning; 3) Home and community care; 4) Following of recommendations; and, 5) Medical follow-up. Conclusions Strengthening communication between stakeholders, as well as the implementation of harmonized policies and guidelines are needed to facilitate more consistent care delivery and provide patients and families with information on what to expect during the transitional process.
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Affiliation(s)
| | | | | | - Pamela Jarrett
- Horizon Health Network, Saint John, Canada
- Dalhousie University, Saint John, Canada
| | - Rose McCloskey
- University of New Brunswick Saint John, Saint John, Canada
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The Effect of Nursing Discharge Planning Program to Prevent Recurrent Falls, Readmission, and Length of Hospital Stay in the Aged Patients. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dunagan A, Green A, Hodges T, McCormick R, Painter L, Pierce C, Seibenhener S, Wilburn S, Young D. The Art of Discharge Planning: Teaching Nursing Students to Address Disparities Through Simulation. Creat Nurs 2022; 28:192-197. [DOI: 10.1891/cn-2021-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Discharge planning is crucial to ensuring that patients’ care and recovery needs are addressed. A new nurse graduate must be prepared to enter a clinical practice environment in which hospitals face penalties for patient readmissions. Methods: Student nurses were assigned simulated patients with a variety of health disparities and health-care diagnoses to address. A qualitative research design evaluated student perceptions of discharge planning and cultural competency. Results: Students found the simulation to be vital to their clinical experience. Students were able to develop discharge teaching that was culturally congruent for each simulated patient. Conclusions: Incorporating discharge teaching simulation into the nursing curriculum can positively impact students’ ability to transition to clinical practice and build confidence in a skill that is rarely incorporated into nursing curricula.
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12
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Yen HY, Chi MJ, Huang HY. Effects of discharge planning services and unplanned readmissions on post-hospital mortality in older patients: a time-varying survival analysis. Int J Nurs Stud 2022; 128:104175. [DOI: 10.1016/j.ijnurstu.2022.104175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/16/2021] [Accepted: 01/08/2022] [Indexed: 12/11/2022]
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13
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Kokorelias KM, DasGupta T, Hitzig SL. Designing the Ideal Patient Navigation Program for Older Adults with Complex Needs: A Qualitative Exploration of the Preferences of Key Informants. J Appl Gerontol 2021; 41:1002-1010. [PMID: 34905440 DOI: 10.1177/07334648211059056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Navigating the healthcare system is complex. Many older adults and their family members report sub-optimal outcomes when transitioning from hospital to home. Patient navigation has been introduced as a model of care to help improve hospital to home transitions and to better integrate care across care environments. There are no best-practice guidelines for designing a patient navigation program for older adults with complex needs. This qualitative descriptive study interviewed 38 healthcare professionals to determine key characteristics of the "ideal" patient navigator program. Thematic analysis revealed four themes describing key components of an ideal patient navigator program for older adults with complex needs: (1) Easy accessibility and open communication amongst staff; (2) flexible eligibility requirements; (3) characteristics of the patient navigator; and (4) appropriate program size and duration. We suggest directions for future research, program design, and implementation considers to improve patient navigation for older adults and their family caregivers.
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Affiliation(s)
- Kristina M Kokorelias
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Sander L Hitzig
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, Rehabilitation Sciences Institute, 12366University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, 12366University of Toronto, Toronto, Canada
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14
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Schusselé Filliettaz S, Moiroux S, Marchand G, Gilles I, Peytremann-Bridevaux I. Transitional shared decision-making processes for patients with complex needs: A feasibility study. J Eval Clin Pract 2021; 27:1326-1334. [PMID: 33742747 DOI: 10.1111/jep.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Shared decision-making (SDM) processes, combining patients' and professionals' perspectives, are especially necessary for patients with complex needs (CNs) during their care transitions. In 2016, we started implementing interprofessional and interinstitutional SDM processes (IIPs) for patients admitted to a short-stay unit (SSU) for inpatient care and then followed-up by primary care providers. Two types of IIPs were identified: (a) iterative IIPs, and (b) meeting IIPs. These differed in terms of the timing of SDM processes: whereas the former were multilateral and iterative, meeting IIPs were simultaneous. However, the two processes had similar outcomes and participants had similar characteristics. The intervention included other components, such as CNs assessment and a care coordinator position. The present study aimed to assess the feasibility of the intervention's implementation. METHODS The intervention's feasibility was assessed using fidelity and coverage indicators. We collected data from the patients' records on (a) patients' and professionals' characteristics, (b) the fidelity (CNs evaluations and occurrences of IIPs), and (c) the intervention's coverage (types of IIPs, participants). RESULTS The study included 453 patients between September 2017 and February 2019: mean age of 82.3 years, 65.6% women and 61.1% considered to have CNs. For patients with CNs, iterative IIPs and meeting IIPs occurred in 78.3% and 23.8% of cases, respectively. 35.1% of iterative IIPs and 8.8% of meeting IIPs for patients with CNs involved patients or their informal caregivers, inpatient professionals, primary care physicians and homecare professionals. DISCUSSION These results showed that an intervention targeting the implementation of formalized IIPs for SDM in transitional care was feasible. However, to improve the evaluation of such interventions, other methods should be used to measure their appropriateness and acceptability. Additionally, assessing the effects of IIPs would legitimize their funding, supporting their sustainability and generalisability.
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Affiliation(s)
- Séverine Schusselé Filliettaz
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.,Association for the Promotion of Integrated Patient Care Networks (PRISM), Geneva, Switzerland
| | | | | | - Ingrid Gilles
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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15
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Henry OP, Li G, Freundlich RE, Sandberg WS, Wanderer JP. Understanding the Accuracy of Clinician Provided Estimated Discharge Dates. J Med Syst 2021; 46:2. [PMID: 34786607 DOI: 10.1007/s10916-021-01793-w] [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: 09/28/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
Discharge planning is a vital tool in managing hospital capacity, which is essential for maintaining hospital throughput for surgical postoperative admissions. Early discharge planning has been effective in reducing length of stay and hospital readmissions. Between 2014 and 2017, Vanderbilt University Medical Center (VUMC) implemented a tool in the electronic health record (EHR) requiring providers to input the patient's estimated discharge date on each hospital day. We hypothesized discharge estimates would be more accurate, on average, for surgical patients compared to non-surgical patients because treatment plans are known in advance of surgical admissions. We also analyzed the data to identify factors associated with more accurate discharge estimates. In this retrospective observational study, via an analysis of covariance (ANCOVA) approach, we identified factors associated with more accurate discharge estimates for admitted adult patients at VUMC. The primary outcome was the difference between estimated and actual discharge date, and the primary exposure of interest was whether the patient underwent surgery while admitted to the hospital. A total of 304,802 date of discharge estimate entries from 68,587 inpatient encounters met inclusion criteria. After controlling for measured confounding, we found the discharge estimates were more precise as the difference between estimated and actual discharge date narrowed; for each additional day closer to discharge, prediction accuracy improved by .67 days (95% confidence interval [CI], 0.66 to 0.67; p < 0.001), on average. No difference was observed on the primary outcome in patients undergoing surgery compared with non-surgical treatment (0.02 days; 95% CI, 0.00 to 0.03; p = 0.111). Faculty members were found to perform best among all clinicians in predicting estimated discharge date with a 0.24-day better accuracy (95% CI, 0.20 to 0.27; p < 0.001), on average, than other staff. Weekend and holiday, specific clinical teams, staff types, and discharge dispositions were associated with the variability in estimated versus actual discharge date (p < 0.001). Given the widespread variation in current efforts to improve discharge planning and the recommended approach of assigning a discharge date early in the hospital stay, understanding provider estimated discharge dates is an important tool in hospital capacity management. While we did not determine a difference in discharge estimates among surgical and non-surgical patients, we found estimates were more accurate as discharge came nearer and identified notable trends in provider inputs and patient factors. Assessing factors that impact variability in discharge accuracy can allow hospitals to design targeted interventions to improve discharge planning and reduce unnecessary hospital days.
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Affiliation(s)
- Olivia P Henry
- Vanderbilt University School of Medicine, Nashville, TN, US
| | - Gen Li
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, US
| | - Robert E Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, US.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, US
| | - Warren S Sandberg
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, US.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, US.,Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, US
| | - Jonathan P Wanderer
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, US. .,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, US.
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16
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Wang YC, Lee WY, Chou MY, Liang CK, Chen HF, Yeh SCJ, Yaung CL, Tsai KT, Huang JJ, Wang C, Lin YT, Lou SJ, Shi HY. Cost and Effectiveness of Long-Term Care Following Integrated Discharge Planning: A Prospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9111413. [PMID: 34828460 PMCID: PMC8621918 DOI: 10.3390/healthcare9111413] [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: 09/01/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Little is known about the effects of seamless hospital discharge planning on long-term care (LTC) costs and effectiveness. This study evaluates the cost and effectiveness of the recently implemented policy from hospital to LTC between patients discharged under seamless transition and standard transition. A total of 49 elderly patients in the standard transition cohort and 119 in the seamless transition cohort were recruited from November 2016 to February 2018. Data collected from medical records included the Multimorbidity Frailty Index, Activities of Daily Living Scale, and Malnutrition Universal Screening Tool during hospitalization. Multiple linear regression and Cox regression models were used to explore risk factors for medical resource utilization and medical outcomes. After adjustment for effective predictors, the seamless cohort had lower direct medical costs, a shorter length of stay, a higher survival rate, and a lower unplanned readmission rate compared to the standard cohort. However, only mean total direct medical costs during hospitalization and 6 months after discharge were significantly (p < 0.001) lower in the seamless cohort (USD 6192) compared to the standard cohort (USD 8361). Additionally, the annual per-patient economic burden in the seamless cohort approximated USD 2.9–3.3 billion. Analysis of the economic burden of disability in the elderly population in Taiwan indicates that seamless transition planning can save approximately USD 3 billion in annual healthcare costs. Implementing this policy would achieve continuous improvement in LTC quality and reduce the financial burden of healthcare on the Taiwanese government.
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Affiliation(s)
- Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
| | - Wen-Ying Lee
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
- Department of Geriatric Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
- Department of Geriatric Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Hsueh-Fen Chen
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Chih-Liang Yaung
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan;
| | - Kang-Ting Tsai
- Department of Geriatrics and Center for Integrative Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Joh-Jong Huang
- Department of Health, Kaohsiung City Government, Kaohsiung 80251, Taiwan;
| | - Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan;
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
| | - Shi-Jer Lou
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Correspondence: (S.-J.L.); (H.-Y.S.); Tel.: +886-7-3211101 (ext. 2648) (H.-Y.S.)
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40604, Taiwan
- Correspondence: (S.-J.L.); (H.-Y.S.); Tel.: +886-7-3211101 (ext. 2648) (H.-Y.S.)
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17
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Siddique SM, Tipton K, Leas B, Greysen SR, Mull NK, Lane-Fall M, McShea K, Tsou AY. Interventions to Reduce Hospital Length of Stay in High-risk Populations: A Systematic Review. JAMA Netw Open 2021; 4:e2125846. [PMID: 34542615 PMCID: PMC8453321 DOI: 10.1001/jamanetworkopen.2021.25846] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. OBJECTIVE To identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS. EVIDENCE REVIEW Multiple databases, including MEDLINE and Embase, were searched for English-language systematic reviews from January 1, 2010, through September 30, 2020, with updated searches through January 19, 2021. The scope of the protocol was determined with input from AHRQ Key Informants. Systematic reviews were included if they reported on hospital-led interventions intended to decrease LOS for high-risk populations, defined as those with high-risk medical conditions or socioeconomically vulnerable populations (eg, patients with high levels of socioeconomic risk, who are medically uninsured or underinsured, with limited English proficiency, or who are hospitalized at a safety-net, tertiary, or quaternary care institution). Exclusion criteria included interventions that were conducted outside of the hospital setting, including community health programs. Data extraction was conducted independently, with extraction of strength of evidence (SOE) ratings provided by systematic reviews; if unavailable, SOE was assessed using the AHRQ Evidence-Based Practice Center methods guide. FINDINGS Our searches yielded 4432 potential studies. We included 19 systematic reviews reported in 20 articles. The reviews described 8 strategies for reducing LOS in high-risk populations: discharge planning, geriatric assessment, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth. Interventions were most frequently designed for older patients, often those who were frail (9 studies), or patients with heart failure. There were notable evidence gaps, as there were no systematic reviews studying interventions for patients with socioeconomic risk. For patients with medically complex conditions, discharge planning, medication management, and interdisciplinary care teams were associated with inconsistent outcomes (LOS, readmissions, mortality) across populations. For patients with heart failure, clinical pathways and case management were associated with reduced length of stay (clinical pathways: mean difference reduction, 1.89 [95% CI, 1.33 to 2.44] days; case management: mean difference reduction, 1.28 [95% CI, 0.52 to 2.04] days). CONCLUSIONS AND RELEVANCE This systematic review found inconsistent results across all high-risk populations on the effectiveness associated with interventions, such as discharge planning, that are often widely used by health systems. This systematic review highlights important evidence gaps, such as the lack of existing systematic reviews focused on patients with socioeconomic risk factors, and the need for further research.
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Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
| | - Kelley Tipton
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Brian Leas
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
| | - S. Ryan Greysen
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Nikhil K. Mull
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia
| | - Meghan Lane-Fall
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia
| | - Kristina McShea
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
| | - Amy Y. Tsou
- ECRI Evidence-based Practice Center, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania
- Division of Neurology, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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18
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Freeman MH, Shinn JR, Fernando SJ, Totten D, Lee J, Malenke JA, Wood CB, Langerman AJ, Mannion K, Sinard RJ, Rohde SL. Impact of Preoperative Risk Factors on Inpatient Stay and Facility Discharge After Free Flap Reconstruction. Otolaryngol Head Neck Surg 2021; 166:454-460. [PMID: 34399644 DOI: 10.1177/01945998211037541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the preoperative risk factors most predictive of prolonged length of stay (LOS) or admission to a skilled nursing facility (SNF) or inpatient rehabilitation center (IPR) after free flap reconstruction of the head and neck. STUDY DESIGN Retrospective cohort study. SETTING Tertiary academic medical center. METHODS Retrospective review of 1008 patients who underwent tumor resection and free flap reconstruction of the head and neck at a tertiary referral center from 2002 to 2019. RESULTS Of 1008 patients (65.7% male; mean age of 61.4 years, SD 14.0 years), 161 (15.6%) were discharged to SNF/IPR, and the median LOS was 7 days. In multiple linear regression analysis, Charlson Comorbidity Index (CCI; P < .001), American Society of Anesthesiologists (ASA) classification (P = .021), female gender (P = .023), and inability to tolerate oral diet preoperatively (P = .006) were statistically significantly related to increased LOS, whereas age, body mass index (BMI), modified frailty index (MFI), a history of prior radiation or chemotherapy, and home oxygen use were not. Multiple logistic regression analysis demonstrated that CCI (odds ratio [OR] = 1.119, confidence interval [CI] 1.023-1.223), age (OR = 1.082, CI 1.056-1.108), and BMI <19.0 (OR = 2.141, CI 1.159-3.807) were the only variables statistically significantly related to posthospital placement in an SNF or IPR. CONCLUSION Common tools for assessing frailty and need for additional care may be inadequate in a head and neck reconstructive population. CCI appears to be the best of the aggregate metrics assessed, with significant relationships to both LOS and placement in SNF/IPR.
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Affiliation(s)
- Michael Hartley Freeman
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin R Shinn
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern, Dallas, TX
| | - Shanik J Fernando
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas Totten
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jaclyn Lee
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jordan A Malenke
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - C Burton Wood
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Otolaryngology, Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Alexander J Langerman
- Division of Head and Neck, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kyle Mannion
- Division of Head and Neck, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Sinard
- Division of Head and Neck, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah L Rohde
- Division of Head and Neck, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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19
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Ahmed A, van den Muijsenbergh METC, Mewes JC, Wodchis WP, Vrijhoef HJM. Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review. BMJ Open 2021; 11:e043280. [PMID: 33895713 PMCID: PMC8074568 DOI: 10.1136/bmjopen-2020-043280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the relationships between the context in which integrated care programmes (ICPs) for community-dwelling frail older people are applied, the mechanisms by which the programmes do (not) work and the outcomes resulting from this interaction by establishing a programme theory. DESIGN Rapid realist review. INCLUSION CRITERIA Reviews and meta-analyses (January 2013-January 2019) and non-peer-reviewed literature (January 2013-December 2019) reporting on integrated care for community-dwelling frail older people (≥60 years). ANALYSIS Selection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards criteria. Data on context, mechanisms, programme activities and outcomes were extracted. Factors were categorised into the five strategies of the WHO framework of integrated people-centred health services (IPCHS). RESULTS 27 papers were included. The following programme theory was developed: it is essential to establish multidisciplinary teams of competent healthcare providers (HCPs) providing person-centred care, closely working together and communicating effectively with other stakeholders. Older people and informal caregivers should be involved in the care process. Financial support, efficient use of information technology and organisational alignment are also essential. ICPs demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and HCPs, and a delayed placement in a nursing home. Heterogeneous effects were found for hospital-related outcomes, quality of life, healthcare costs and use of healthcare services. The two most prevalent WHO-IPCHS strategies as part of ICPs are 'creating an enabling environment', followed by 'strengthening governance and accountability'. CONCLUSION Currently, most ICPs do not address all WHO-IPCHS strategies. In order to optimise ICPs for frail older people the interaction between context items, mechanisms, programme activities and the outcomes should be taken into account from different perspectives (system, organisation, service delivery, HCP and patient).
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Affiliation(s)
- Anam Ahmed
- Panaxea, Amsterdam, Netherlands
- Primary and Community Care, Radboudumc, Nijmegen, Gelderland, Netherlands
| | | | | | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Hubertus J M Vrijhoef
- Panaxea, Amsterdam, Netherlands
- Department of Patient and Care, Maastricht University Medical Centre+, Maastricht, Netherlands
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20
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Discharge lounges for optimal outcomes: A quality improvement project. Nursing 2020; 50:65-68. [PMID: 33497098 DOI: 10.1097/01.nurse.0000697212.21242.ea] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Pellet J, Weiss M, Rapin J, Jaques C, Mabire C. Nursing discharge teaching for hospitalized older people: A rapid realist review. J Adv Nurs 2020; 76:2885-2896. [DOI: 10.1111/jan.14511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/20/2020] [Accepted: 06/30/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Joanie Pellet
- Institute of Higher Education and Research in Healthcare‐IUFRSUniversity of LausanneLausanne University Hospital Lausanne Switzerland
| | - Marianne Weiss
- Marquette University College of Nursing Milwaukee WI USA
| | - Joachim Rapin
- Faculty of Nursing University of Montreal Montreal Quebec Canada
- Lausanne University Hospital Lausanne Switzerland
| | - Cecile Jaques
- Medical Library Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | - Cedric Mabire
- Institute of Higher Education and Research in Healthcare‐IUFRSUniversity of LausanneLausanne University Hospital Lausanne Switzerland
- Lausanne University Hospital Lausanne Switzerland
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22
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Standardized Hospital Discharge Communication for Patients With Pressure Injury: A Quasi-experimental Trial. J Wound Ostomy Continence Nurs 2020; 47:236-241. [PMID: 32384527 DOI: 10.1097/won.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine if improved communication between certified wound care nurses and home health nurses, through use of standardized electronic wound care order sets and discharge instructions, decreased delay in treatment and 30-day readmission rates and improved wound healing for patients discharged to home with pressure injuries. DESIGN Quasi-experimental, nonequivalent group trial. SUBJECTS AND SETTING Cognitively intact adult patients hospitalized in the Midwestern United States with a stage 2 or higher pressure injury discharged to home care services. METHODS We revised the electronic medical record to include an adapted, standardized version of the Project Re-Engineered Discharge wound care order set that included specific wound care instructions for use following discharge to home care. Medical records of 12 patients were reviewed prior to the change and 9 records were reviewed postchange for information about initiation of care, wound healing, and 30-day readmission. The Pressure Ulcer Scale of Healing tool was used to evaluate wound healing. RESULTS Time to initiation of treatment was 2.4 days for the control group and 1.6 days for the intervention group. Missing documentation made it difficult to evaluate the control group, as 73% of all wound measurements were missing from the electronic medical record. Use of the standardized wound care order set resulted in 100% of wound care orders and 92% of discharge instructions being present in the intervention group's electronic medical record at the time of hospital discharge. There was no statistically significant difference between control and intervention group's Pressure Ulcer Scale of Healing scores for any postdischarge measurement or in 30-day readmission rates. CONCLUSIONS The new standardized wound care order sets at the time of discharge did increase adherence to time to implementation and documentation of executing wound care orders by home care nurses. Further research of standardized order sets is needed to determine the impact on improving patient outcomes.
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23
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The Metrics of Acute Care Reentry and Emergency Department Visits by Recently Discharged Inpatients. Adv Emerg Nurs J 2020; 42:150-160. [PMID: 32358431 DOI: 10.1097/tme.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research on acute care reentry by recently discharged inpatients has generally focused on hospital readmissions, with less attention given to presentations to the emergency department (ED). This omission results in underestimation of the extent of reentry and its impact on ED patient volumes and flow. This project involved an analysis of administrative data to examine the rate of ED presentations by recently discharged inpatients using 3 time metrics-within 0-3 days, 0-7 days, and 0-30 days of discharge. Descriptive-correlational analyses were conducted to examine the rates of reentry and ability to predict ED presentations using patient demographic (age and sex) and clinical profile (length of hospital stay and day of presentation). Approximately 12% of hospital discharges to home involved patients who presented to the ED within 30 days, and almost half occurred within the first week. Results of multivariable analyses suggest that the influences of ED presentations differ depending on the time metric examined. Emergency department presentations within 3 and 7 days of discharge compared with 30 days were not predicted by patient age or sex but were more likely to involve those with shorter hospital stays. A weekend presentation was also more likely among case patients presenting within 3 days of discharge. Only about one third of ED presentations resulted in readmission. Emergency department presentations are an important component of acute care reentry. Establishment of a common reentry metric for ED presentations would facilitate efforts to determine the impact of these events. Emergency nurses working in advanced practice roles are ideally positioned to assume a leadership role in addressing the needs of recently discharged inpatients who present to the ED. By reviewing these cases and collaborating with the inpatient unit staff, it may be possible to identify strategies for augmenting discharge planning and the provision of transitional care.
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24
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Budinich M, Sastre J. PLANIFICACIÓN DEL ALTA. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2019.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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25
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Moriya E, Nagao N, Ito S, Makaya M. The relationship between perceived difficulty and reflection in the practice of discharge planning nurses in acute care hospitals: A nationwide observational study. J Clin Nurs 2019; 29:511-524. [PMID: 31742819 DOI: 10.1111/jocn.15111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/21/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To clarify the characteristics and practice of discharge planning nurses in acute care hospitals and to elucidate the relationship between subjective difficulty perceived in practice and reflection. BACKGROUND The importance of discharge planning for an effective transition from the hospital to a care facility is increasing. In acute care hospitals, however, it is not clear what discharge planning nurses are doing for patients who are highly dependent on medical treatment, the subjective difficulties they perceive in practical activities, and whether reflection by nurses can be expected to mitigate those difficulties. DESIGN Cross-sectional survey. METHODS This survey was conducted in 2,379 acute care hospitals in Japan from 1 June-30 June 2018. The survey of discharge planning practice activities examined nine factors. A nurse who answered that he/she did reflect on his/her practices was defined as a self-reflecting nurse. The STROBE statement checklists were completed. RESULTS Questionnaires were collected from 760 respondents (response rate = 32.1%). The discharge planning nurses had fewer than 36 months of experience with discharge planning. Among the nurses who had been involved in hospital discharge support for 13 months or more, the self-reflecting nurses had fewer perceived difficulties in their practice activities than the non-self-reflecting nurses did. CONCLUSIONS It was shown that discharge planning nurses with 13 months or more of experience and who practiced reflection on their practical activities perceived less subjective difficulty. Reflection in daily practice may mitigate the subjective difficulty of practical activities experienced by discharge planning nurses, and the establishment of an effective training method that promotes such reflection is required. RELEVANCE TO CLINICAL PRACTICE In the future, it will be necessary to construct and evaluate an effective education programme for discharge planning nurses that includes self-reflection on practice cases.
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Affiliation(s)
- Eiko Moriya
- School of Nursing, Kitasato University, Sagamihara, Japan
| | - Noriko Nagao
- School of Nursing, Kitasato University, Sagamihara, Japan
| | - Shinya Ito
- School of Nursing, Kitasato University, Sagamihara, Japan
| | - Miyuki Makaya
- School of Nursing, Kitasato University, Sagamihara, Japan
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Abstract
The quality of discharge teaching is statistically linked to decreased readmission rates. Nursing most often bears the major responsibility of patient and caregiver teaching. Currently, discharge teaching is complicated by problems including time constraints, patient and caregiver overload, and coexisting comorbidities that add complexity to the patient's care needs at home. Not only are readmissions a preventable cost, more importantly, but they also are a negative patient experience signifying to our patients that they are unable to optimally care for themselves or that their disease or healing is not something they can care for alone. The following is a review of Agency for Healthcare Research and Quality's IDEAL discharge process, common problems in discharge teaching, and nursing's responsibilities with assessing a patient and his or her caregiver for discharge readiness. IDEAL is a structured discharge process with tools to help healthcare organizations improve their discharge process to decrease readmissions rates.
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Wu Z, Kim MS, Broad JB, Zhang X, Bloomfield K, Connolly MJ. Association between post-discharge secondary care and risk of repeated hospital presentation, entry into long-term care and mortality in older people after acute hospitalization. Geriatr Gerontol Int 2019; 19:1048-1053. [PMID: 31475414 DOI: 10.1111/ggi.13766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022]
Abstract
AIM Hospitalizations are frequent among acutely ill older people, and might be reduced by post-discharge secondary care (PDSC). We aimed to determine the proportion of older patients planned to receive or attending PDSC after acute hospitalization and the association with undesirable outcomes. METHODS A retrospective observational study was carried out using an electronic health record system in two hospitals in New Zealand. Patients were aged ≥75 years, initially presented at an emergency department (ED) and were discharged from medical, surgical, geriatrics or orthopedics wards in three 2-week periods. Planned PDSC at discharge, attended PDSC, ED presentation, long-term care (LTC) admission and death in 90 days after discharge were obtained through the health record system. Proportional hazards regression assessed the associations of planned or attended PDSC with undesirable outcomes (ED presentation, LTC admission and death) within 90 days of discharge. RESULTS Clinical records for 1085 patients were extracted, 963 were eligible. Of these, 413 (42.9%) had planned PDSC in discharge summaries, and 573 (59.5%) actually attended in 90 days. Patients planned for PDSC had a similarly adjusted hazard of ED presentation (HR 0.99, P = 0.92), LTC admission (HR 0.73, P = 0.25) and death (HR 0.80, P = 0.34) within 90 days of discharge, compared with those not planned. Similar non-significant associations were observed between attended PDSC and undesirable outcomes. CONCLUSIONS In patients aged ≥75 years in New Zealand, we did not find "planned PDSC" at discharge or "attended PDSC" after an acute hospitalization to be associated with ED presentation, LTC admission and death within 90 days after discharge. Other potential benefits of planned or attended PDSC require further investigation. Geriatr Gerontol Int 2019; 19: 1048-1053.
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Affiliation(s)
- Zhenqiang Wu
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Min Soo Kim
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna B Broad
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Xian Zhang
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
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Associations between hospital structures, processes and patient experiences of preparation for discharge in breast cancer centers: A multilevel analysis. Health Care Manage Rev 2019; 46:98-110. [PMID: 33630502 DOI: 10.1097/hmr.0000000000000237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Discharge management is a central task in hospital management. Mitchell's quality health outcomes model offers a contextual framework to derive expectations about the relationship between indicators of hospital structures and processes with patient experiences of preparation for discharge. PURPOSE The aim is to analyze the association between hospital structures and processes with patient experiences of preparation for discharge in breast cancer centers. METHODOLOGY The data were collected between February 1 and July 31, 2014-2016, with annual cross-sectional postal surveys on patient experiences of preparation for discharge in breast cancer center hospitals in Germany. These data were combined with secondary data on hospital structures, obtained from structured quality reports 2014 and the accreditation institution certifying breast cancer centers, constituting a hierarchical data structure. A total of 10,750 newly diagnosed breast cancer patients from 67 hospitals were analyzed. Following listwise deletion, 9,762 patients could be included in linear hierarchical regression analyses. RESULTS Patients felt better prepared for discharge in hospitals that communicate the discharge date timely to patients, with good coordinative processes, and which cooperate with two other breast cancer center hospitals. Hospital structures, size, teaching status, and ownership were not associated with the patient experiences of preparation for discharge. CONCLUSION The results suggest that timely and informative communication, well-organized care processes, and the network structure of centers allow for an improvement of preparation for discharge. Current and future approaches for the improvement of hospital discharge should consider the identified hospital resources. PRACTICE IMPLICATIONS Hospital management should increase the focus on structured communication and coordination processes to improve the discharge process. Cooperating networks should be expanded to increase expertise and resources. Results can be generalized to other care domains with caution. Patients' characteristics should further be assessed in order to use resources efficiently.
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Mabire C, Bachnick S, Ausserhofer D, Simon M. Patient readiness for hospital discharge and its relationship to discharge preparation and structural factors: A cross-sectional study. Int J Nurs Stud 2018; 90:13-20. [PMID: 30522054 DOI: 10.1016/j.ijnurstu.2018.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/13/2018] [Accepted: 09/28/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Nursing discharge preparation is vital to successful hospital-to-home transitions. However, despite a wealth of evidence on its effectiveness, little is known of the structure- and process-related factors that facilitate or impede its use in clinical practice. Specifically, the associations between unit size and type, leadership support, skill mix, staffing, nurse and patient characteristics, discharge teaching and patient readiness for discharge have rarely been studied. OBJECTIVES This study aimed to explore the associations between structure-individual characteristics (i.e., unit, nurse and patient characteristics) and process-related (i.e., teaching of self-care and symptom management) factors and patient readiness for hospital discharge. DESIGN A secondary data analysis of the multicentre observational "Matching Registered Nurse services with changing care demands (MatchRN)" study. SETTING AND PERIOD Data were collected between September 2015 and January 2016 on 123 surgical, medical and mixed units in 23 Swiss acute care hospitals. PARTICIPANTS A total of 1833 registered nurses and 1755 patients were included in the analyses. METHODS Structure-, process- and patient readiness-related hospital discharge variables were assessed using validated items either from existing instruments or self-developed. Multilevel mixed-effects logistic regression was used to test associations. RESULTS Fewer than half of the patients hospitalized (47.8%) reported readiness for hospital discharge. Fifty-eight percent reported receiving discharge preparation interventions for self-care and 30% for symptom management. Patients' readiness for hospital discharge was significantly lower in larger units (β = -0.001; 95% confidence interval (CI) = -0.002 to -0.001) and on medical units (β = -0.44; 95% CI = -0.70 to -0.19). Higher nurses' experience (β = .004; 95% CI = 0.001 to 0.01), better patient self-reported health (β = -0.11; 95% CI = -0.17 to -0.05), higher patient ratings of self-care teaching (β = 1.33; 95% CI = 1.07-1.59) and symptom management teaching (β = 0.79; 95% CI = 0.52-1.06) were significantly associated with greater patient readiness for hospital discharge. CONCLUSIONS Patient readiness for hospital discharge is associated with process- and structure-related factors. Our findings suggest that, for successful uptake in clinical practice, the development and implementation of effective discharge preparation programs should consider the structural context, i.e., patient population, unit size, and experience of nurses within the team. Further research, using a more accurate measure of patient readiness for hospital discharge, is needed to test associations with the nurse work environment and staffing.
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Affiliation(s)
- Cedric Mabire
- Institute of Higher Education and Research in Healthcare - IUFRS, University of Lausanne, Lausanne University Hospital, SV-A, Route de la Corniche 10, 1010 Lausanne, Switzerland.
| | - Stefanie Bachnick
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Claudiana College of Health-Care Professions, Lorenz-Böhler-Straße 13, 39100 Bolzano Italy
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Inselspital Bern University Hospital, Nursing Research Unit, 3010 Bern, Switzerland
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Walthall H, Dolan B, Jackson D. Trapped in care: Recognising and responding to frailty as a cause of delayed transfers of care. J Clin Nurs 2018; 28:5-6. [PMID: 29683525 DOI: 10.1111/jocn.14356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Helen Walthall
- Oxford Brookes University, Oxford, UK.,Oxford Institute of Nursing, Midwifery& Allied Health Research (OxINMAHR), Oxford, UK
| | - Brian Dolan
- Oxford Institute of Nursing, Midwifery& Allied Health Research (OxINMAHR), Oxford, UK.,University of Salford, Manchester, UK
| | - Debra Jackson
- University of Technology, Sydney (UTS), Sydney, NSW, Australia
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Buchan JC, Cleveland V, Sutton H, Cassels-Brown A. Post-cataract eye drops can be avoided by depot steroid injections. Br J Community Nurs 2017; 22:598-601. [PMID: 29189055 DOI: 10.12968/bjcn.2017.22.12.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There are over 400 000 cataract operations now being performed annually in the UK. With the majority of those patients being older people, comorbidities such as dementia or arthritis can prevent patients putting in their own post-operative eye drops. Where there is a lack of family or other support, district nursing services are often called upon to administer these eye drops, which are typically prescribed four times a day for 4 weeks, thus potentially totalling 112 visits for drop instillation per patient. To reduce the burden of these post-operative eye drops on district nursing services, administration of an intra-operative sub-Tenon's depot steroid injection is possible for cataract patients who then do not require any post-operative drop instillation. As a trial of this practice, 16 such patients were injected in one year, thus providing a reduction of 1792 in the number of visits requested. Taking an estimated cost of each district nurse visit of £38, this shift in practice potentially saved more than £68 000; the additional cost of the injection over the cost of eye drops was just £8.80 for the year. This practice presents an opportunity to protect valuable community nursing resources, but advocacy for change in practice would be needed with secondary care, or via commissioners.
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Affiliation(s)
- John C Buchan
- Assistant Professor, International Centre for Eye Health, London School of Hygiene and Tropical Medicine
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