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Fret B, Smetcoren AS, De Donder L, Verté D. Preventive Home Visits Among Frail Community-Dwelling Older Adults. The Added Value of Follow-Up Telephone Calls. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:444-457. [PMID: 38491960 DOI: 10.1080/19371918.2024.2325555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
People in need of care and support do not always find appropriate services. This paper aims to explore the content and added value of monthly follow-up telephone calls after preventive home visits. We used both monitoring data and qualitative semi-structured interviews (with older adults, formal and informal caregivers). Results indicate that a majority of older adults (N = 95) received a regular follow-up of four telephone calls. Social connection and involvement were mentioned by all three groups as positive aspects of the program. Although time-consuming, this paper draws attention to the added value of follow-up telephone calls after preventive home visits.
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Affiliation(s)
- Bram Fret
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - An-Sofie Smetcoren
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Liesbeth De Donder
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dominique Verté
- Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Ruiss M, Pai V, Pilwachs C, Bayer N, Palkovits S, Findl O. Quality assurance via telephone interviews after cataract surgery: An explorative study. PLoS One 2024; 19:e0298149. [PMID: 38451971 PMCID: PMC10919583 DOI: 10.1371/journal.pone.0298149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/13/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Cataract surgery is a relatively safe procedure with satisfactory postoperative results in most patients. However, in rare cases severe complications can occur shortly after the intervention. Therefore, patients are advised to undergo an ophthalmological examination postoperatively, which should be performed as soon as possible in case of emergencies. However, exactly when these follow-up visits should take place is still discussed. A time- and cost-saving alternative to this could be short-term postoperative telemedical approaches. The aim of this study was to analyze patient complaints as well as satisfaction with and the best timepoint to perform telephone calls after cataract surgery. METHODS Patients scheduled for cataract surgery received a telephone call on the surgery day or the day after (study group) during which they were asked about complaints or additional examination visits. Patients without telephone calls served as control group. All patients had a follow-up visit one week after the intervention during which a questionnaire was filled out and the study group was asked about their satisfaction with the telephone calls. RESULTS 181 patients were recruited in this study. Ocular surface problems were the most common postoperative symptom. More than 80% of the patients were very satisfied with the telephone calls, with patients being contacted on the day of surgery being more calmed than those called on the next day. No difference in additional and planned follow-up visits was found between the study and the control group (P > .40). Postoperative patient complaints (Phi 0.372, P < .001) and additional prescribed therapy (Phi 0.480, P < .001) were moderately associated with additional visits. CONCLUSION Satisfaction with telephone reviews shortly after cataract surgery was very high and contacting patients on the evening of the day of the procedure could be a time- and cost-saving alternative to short-term in-house follow-up visits.
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Affiliation(s)
- Manuel Ruiss
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Viktoria Pai
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Caroline Pilwachs
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Natascha Bayer
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Stefan Palkovits
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
| | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna, Austria
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Rodarte P, O'Marr J, Haonga B, Patrick D, Niknam K, Urva M, Cortez A, Metsemakers WJ, Shearer D, Morshed S. Diagnostic Performance of a telephone questionnaire for fracture-related infections (FRIs) in open tibia fracture patients in Tanzania. Injury 2024; 55:111179. [PMID: 37972489 DOI: 10.1016/j.injury.2023.111179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Fracture-related infections (FRIs) are a major cause of trauma-associated morbidity worldwide. In 2018, an expert group supported by the AO Foundation, European Bone and Joint Infection Society developed a consensus definition of FRI. Still, there is limited knowledge on the applicability of this definition in low- and middle-income countries (LMICs). Given the unique barriers that cause low follow-up rates for orthopaedic trauma patients in LMICs, this study aims to evaluate the diagnostic performance of a telephone questionnaire in identifying patients with FRIs after open tibia fracture fixation in Tanzania. MATERIALS AND METHODS Patients from a randomized controlled trial investigating the infection prevention benefit of locally applied gentamycin for open tibial fractures were included. Patients completed FRI based telephone questionnaires 7-10 days prior to scheduled follow-ups at 6 weeks, 3 months, 6 months, 9 months, and 1 year. The questionnaire included two "confirmatory" criteria questions for FRI (i.e., open wound and purulent drainage) and three "suggestive" criteria questions (i.e., wound drainage, fever, and warmth). Contingency tests were performed to identify the sensitivity and specificity between answers and adjudicated FRI diagnoses at the corresponding in-person follow-up. Data was analysed using STATA version 15.0 and MedCalc's online diagnostic test calculator. RESULTS There were a total of 234 complete questionnaires and 85 unique patients included. The sensitivity and specificity of having any positive answer in the questionnaire was highest at 6 months (100 % and 92.5 %, respectively). For all time-points pooled, sensitivity was 71.4 % and specificity was 93.0 %. Drainage had the highest sensitivity (71.4 %) while fever had the highest specificity (99.6 %). For confirmatory criteria, sensitivity was 14.3 % and specificity was 96.0 %. Contrastingly, the sensitivity for suggestive criteria was higher (71.4 %), with a similar specificity (93.8 %). CONCLUSION Our study indicates that telephone questionnaires have adequate diagnostic performance when assessing FRIs. The presence of drainage identified the majority of patients with FRI, and specificities were high across confirmatory and suggestive criteria. Our study is one of the first to evaluate telephone questionnaires as a diagnostic tool for FRIs in patients with open tibia fractures in a LMIC hospital and validates the FRI consensus definition criteria.
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Affiliation(s)
- Patricia Rodarte
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA, USA
| | - Jamieson O'Marr
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA, USA
| | - Billy Haonga
- Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | | | - Kian Niknam
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA, USA
| | - Mayur Urva
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA, USA
| | - Abigail Cortez
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA, USA
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - David Shearer
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA, USA
| | - Saam Morshed
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
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Adesina SA, Amole IO, Akinwumi AI, Adegoke AO, Durodola AO, Owolabi JI, Awotunde OT, Adefokun IG, Ojo SA, Eyesan SU. Follow-up non-attendance after long-bone fractures in a low-resource setting: a prospective study of predictors and interventions to increase attendance rates. BMC Health Serv Res 2023; 23:1405. [PMID: 38093302 PMCID: PMC10720235 DOI: 10.1186/s12913-023-10453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND While the majority of traumatic injuries occur in low- and middle-income countries, the published literature comes chiefly from high-income countries due to poor follow-up. Clinical and radiographic post-surgical trauma follow-up is essential to high-quality research and objective monitoring for healing and/or complications. This study aimed to identify the predictors of follow-up non-attendance in a low-resource setting and investigate the extent to which interventional efforts based on mobile phone technology (MPT) and home visits improved the follow-up rates for fractures treated with SIGN nails. METHODS This was a prospective study of 594 patients with long-bone fractures. Socio-demographic (e.g. age, gender, marital status, education level, etc.) and clinical (e.g. fracture type, concomitant injuries, comorbidity, etc.) data were collected on each patient. Before discharge, the importance of follow-up was explained to patients and their relations. They were encouraged to attend even if they felt well. Their residential addresses and telephone numbers were validated and securely stored. Patients who missed their appointments were contacted by phone. Those who failed to honour 2 or 3 rescheduled appointments were visited in their home. The patients were divided into those who returned for the primarily scheduled follow-up without prompting (volition group) and those who did not come (non-attenders). Univariate analyses and binary logistic regression were conducted to determine the significant predictors of non-attendance. RESULTS The proportion of patients in the volition group reduced from 96.1% at 6 weeks to 53.0% at 12 weeks and 39.2% at 6 months. However, interventional efforts increased these values to 98.5%, 92.5%, and 72.4% respectively. Walking unaided before the primarily scheduled 12-week appointment was the major reason for not attending the follow-up. Education, occupation, post-operative length of hospital stay (PLOS) and infection were significantly associated with non-attendance but younger age, long distances from the hospital, being separated or divorced, difficulty paying the in-patient care bill, closed fracture, having no (or a non-limb) concomitant injury, achieving painless weight bearing ≤ 6 weeks post-operatively and needing no additional surgery were independent predictors of non-attendance. CONCLUSIONS Our study sheds light on the predictors of follow-up non-attendance and demonstrates how interventional efforts improved attendance rates in a low-resource setting. In addition, efforts that better the socio-economic status of people such as more-encompassing health insurance coverage and greater work flexibility can improve the follow-up attendance rates.
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Affiliation(s)
- Stephen Adesope Adesina
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria.
| | - Isaac Olusayo Amole
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | | | - Adepeju Olatayo Adegoke
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | - Adewumi Ojeniyi Durodola
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | - James Idowu Owolabi
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | - Olufemi Timothy Awotunde
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | | | - Simeon Ayorinde Ojo
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
| | - Samuel Uwale Eyesan
- Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria
- Bowen University, P.M.B 284, Iwo, Osun State, Nigeria
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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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Shilati FM, Silver CM, Baskaran A, Jang A, Wafford QE, Slocum J, Schilling C, Schaeffer C, Shapiro MB, Stey AM. Transitional care programs for trauma patients: A scoping review. Surgery 2023; 174:1001-1007. [PMID: 37550166 PMCID: PMC10527729 DOI: 10.1016/j.surg.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/16/2023] [Accepted: 06/18/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Transitional care programs establish comprehensive outpatient care after hospitalization. This scoping review aimed to define participant characteristics and structure of transitional care programs for injured adults as well as associated readmission rates, cost of care, and follow-up adherence. METHODS We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews standard. Information sources searched were Medline, the Cochrane Library, CINAHL, and Scopus Plus with Full Text. Eligibility criteria were systematic reviews, clinical trials, and observational studies of transitional care programs for injured adults in the United States, published in English since 2000. Two independent reviewers screened all full texts. A data charting process extracted patient characteristics, program structure, readmission rates, cost of care, and follow-up adherence for each study. RESULTS A total of 10 studies described 9 transitional care programs. Most programs (60%) were nurse/social-worker-led post-discharge phone call programs that provided follow-up reminders and inquired regarding patient concerns. The remaining 40% of programs were comprehensive interdisciplinary case-coordination transitional care programs. Readmissions were reduced by 5% and emergency department visits by 13% among participants of both types of programs compared to historic data. Both programs improved follow-up adherence by 75% compared to historic data. CONCLUSION Transitional care programs targeted at injured patients vary in structure and may reduce overall health care use.
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Affiliation(s)
| | - Casey M Silver
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Archit Baskaran
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Angie Jang
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Q Eileen Wafford
- Galter Health Sciences Library and Learning Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John Slocum
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Christine Schilling
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Christine Schaeffer
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago IL
| | - Michael B Shapiro
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne M Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL. https://twitter.com/AnneMStey
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Park R, Mohiuddin M, Arellano R, Pogatzki-Zahn E, Klar G, Gilron I. Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis. Pain Rep 2023; 8:e1075. [PMID: 37181639 PMCID: PMC10168527 DOI: 10.1097/pr9.0000000000001075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 05/16/2023] Open
Abstract
Assessment and management of postoperative pain after hospital discharge is very challenging. We conducted a systematic review to synthesize available evidence on the prevalence of moderate-to-severe postoperative pain within the first 1 to 14 days after hospital discharge. The previously published protocol for this review was registered in PROSPERO. MEDLINE and EMBASE databases were searched until November 2020. We included observational postsurgical pain studies in the posthospital discharge setting. The primary outcome for the review was the proportion of study participants with moderate-to-severe postoperative pain (eg, pain score of 4 or more on a 10-point Numerical Rating Scale) within the first 1 to 14 days after hospital discharge. This review included 27 eligible studies involving a total of 22,108 participants having undergone a wide variety of surgical procedures. The 27 studies included ambulatory surgeries (n = 19), inpatient surgeries (n = 1), both ambulatory and inpatient surgeries (n = 4), or was not specified (n = 3). Meta-analyses of combinable studies provided estimates of pooled prevalence rates of moderate-to-severe postoperative pain ranging from 31% 1 day after discharge to 58% 1 to 2 weeks after discharge. These findings suggest that moderate-to-severe postoperative pain is a common occurrence after hospital discharge and highlight the importance of future efforts to more effectively evaluate, prevent, and treat postsurgical pain in patients discharged from the hospital.
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Affiliation(s)
- Rex Park
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Mohammed Mohiuddin
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Ramiro Arellano
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Critical Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - Gregory Klar
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, Canada
- School of Policy Studies, Queen's University, Kingston, Canada
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Blöndal K, Sveinsdóttir H, Ingadottir B. Patients' expectations and experiences of provided surgery-related patient education: A descriptive longitudinal study. Nurs Open 2022; 9:2495-2505. [PMID: 35666048 PMCID: PMC9374389 DOI: 10.1002/nop2.1270] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/03/2022] [Accepted: 05/13/2022] [Indexed: 11/08/2022] Open
Abstract
Aims The aim of this study was to explore the educational expectations and experiences of surgical patients. Design Prospective, longitudinal, descriptive and two‐centre study. Data were collected with questionnaires at the hospital and 6 weeks and 6 months postsurgery. Methods Patients undergoing elective surgery and hospitalized overnight from January to July 2016 answered questions about the content of received pre‐operative and pre‐discharge education, topics they wanted more information on, sources of information, satisfaction with and usefulness of the information and if their recovery was as expected. Results Patients (N = 697, 49% male, mean age 64.1 [SD 12.6] years) perceived the provided education as useful and satisfactory but less so after discharge. Most common topics which they expected more education about were postoperative complications, pain management, fatigue, lack of stamina and expected recovery time. Most patients received information through face‐to‐face teaching (79.7%) and in writing (78.4%). Expectations on recovery were related to patients' satisfaction with the education and how useful they evaluated it.
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Affiliation(s)
- Katrín Blöndal
- Surgical Services, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Herdís Sveinsdóttir
- Surgical Services, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Brynja Ingadottir
- Surgical Services, Landspitali University Hospital, Reykjavík, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Implementation of Transitional Care Planning is Associated with Reduced Readmission Rates in Patients Undergoing Lower Extremity Bypass Surgery for Peripheral Arterial Disease. Ann Vasc Surg 2022; 84:28-39. [PMID: 35271961 DOI: 10.1016/j.avsg.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Patients undergoing lower extremity bypasses (LEB) are at high risk of developing post-discharge complications requiring readmission. Health systems have developed several strategies to mitigate this risk. One such measure is developing comprehensive Transition Care Planning (TCP), which includes phone calls to patients after being discharged from the hospital. Our study aimed to assess short-term readmission, mortality, and amputation rates of patients who participated in TCP by completing at least one post-discharge follow-up phone call after undergoing LEB for revascularization for peripheral artery disease (PAD). METHODS A retrospective review was completed for patients who underwent LEB surgery between January 2010 and January 2020 to treat PAD at Penn State Hershey Medical Center. Immediate discharge follow-up was done via telephone calls using a standardized script. Patients were then divided into two groups, those who did not have a successful follow-up call (Group I) and those who had at least one successful follow-up call within seven days after discharge (Group II). Univariate analysis was used to compare preoperative demographics, intraoperative variables, and postoperative outcomes. The probability of Readmission and risk factors contributing to it were computed using multiple stepwise forward regression analyses. Epidemiological analysis was done to evaluate the risk of readmission in the group receiving post-discharge follow-up calls. RESULTS A total of 457 patients underwent LEB from 2010 to 2020 and qualified for inclusion in the study. Among these patients, 126 (27.6%) did not have a successful post-discharge follow-up call (Group I), whereas 331 (72.4%) patients did complete a successful call (Group II). The mean age of patients was 66.7 years. There were no significant differences in preoperative baseline patient characteristics or intraoperative factors. Patients who completed a successful call had lower readmission rates within thirty days of the operation (8.8% vs. 17.5%, p=0.008), and this was sustained in multivariate analysis (AOR: 0.18, [CI: 0.05-0.66], p=0.009). However, no differences were observed for thirty-day mortality (Group-I: 3.2% vs. Group-II: 1.2%, p=0.152) or amputation (Group-I: 9.6% vs. Group II 5.9%, p=0.162). Among those who had a successful call, patients with a history of smoking (AOR: 4.05 [CI: 1.21, 17.12] p=0.025], diabetes mellitus (AOR: 3.42 [CI:1.35,8.7] p=0.01) and myocardial infarction (AOR: 7.15 [CI:1.76, 20.1] p=0.006) had much higher chances of readmission. Risk analysis using epidemiological methods showed that by receiving a call, the risk of readmission could be dropped to half (RR: 0.50 [CI: 0.30, 0.84]), with an attributable risk reduction of -8.7% (CI:-15.9%,-1.4%). CONCLUSIONS This single-institution retrospective study demonstrates the importance of immediate discharge follow-up phone calls in patients who undergo open lower extremity revascularization to reduce thirty-day readmissions. Our analysis showed patients who received immediate follow-up phone calls were less likely to be readmitted to the hospital. The development of reliable and efficient systems to enhance immediate discharge follow-up in vascular surgery patients is pivotal to improving quality of care, preventing readmissions, and reducing healthcare costs.
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Larsson F, Strömbäck U, Rysst Gustafsson S, Engström Å. Postoperative Recovery: Experiences of Patients Who Have Undergone Orthopedic Day Surgery. J Perianesth Nurs 2022; 37:515-520. [DOI: 10.1016/j.jopan.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/23/2021] [Accepted: 10/02/2021] [Indexed: 10/18/2022]
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Goehner D, Kandregula S, Birk H, Carroll CP, Guthikonda B, Kosty JA. Improving patient care in neurosurgery through postoperative telephone calls: a systematic review and lessons from all surgical specialties. Neurosurg Focus 2021; 51:E5. [PMID: 34724638 DOI: 10.3171/2021.8.focus21410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/25/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postoperative telephone calls are a simple intervention that can be used to improve communication with patients, potentially affecting patient safety and satisfaction. Few studies in the neurosurgical literature have examined the effect of a postoperative telephone call on patient outcomes, although several exist across all surgical specialties. The authors performed a systematic review and analyzed studies published since 2000 to assess the effect of a postoperative telephone call or text message on patient safety and satisfaction across all surgical specialties. METHODS A search of PubMed-indexed articles was performed on June 12, 2021, and was narrowed by the inclusion criteria of studies from surgical specialties with > 50 adult patients published after 1999, in which a postoperative telephone call was made and its effects on safety and satisfaction were assessed. Exclusion criteria included dental, medical, and pediatric specialties; systematic reviews; meta-analyses; and non-English-language articles. Dual review was utilized. RESULTS Overall, 24 articles met inclusion criteria. The majority reported an increase in patient satisfaction scores after a postoperative telephone call was implemented, and half of the studies demonstrated an improvement in safety or outcomes. CONCLUSIONS Taken together, these studies demonstrate that implementation of a postoperative telephone call in a neurosurgical practice is a feasible way to enhance patient care. The major limitations of this study were the heterogeneous group of studies and the limited neurosurgery-specific studies.
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Affiliation(s)
- Dylan Goehner
- 1University of Massachusetts Medical School, Department of General Surgery, Worcester, Massachusetts
| | - Sandeep Kandregula
- 2Louisiana State University Health Shreveport School of Medicine, Department of Neurosurgery, Shreveport, Louisiana
| | - Harjus Birk
- 2Louisiana State University Health Shreveport School of Medicine, Department of Neurosurgery, Shreveport, Louisiana
| | - Christopher P Carroll
- 3Department of Brain & Spine Surgery, Naval Medical Center, Portsmouth, Virginia; and.,4Department of Surgery, Division of Neurosurgery, Uniformed Services University, Bethesda, Maryland
| | - Bharat Guthikonda
- 2Louisiana State University Health Shreveport School of Medicine, Department of Neurosurgery, Shreveport, Louisiana
| | - Jennifer A Kosty
- 2Louisiana State University Health Shreveport School of Medicine, Department of Neurosurgery, Shreveport, Louisiana
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12
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Eustache J, El-Kefraoui C, Ekmekjian T, Latimer E, Lee L. Do postoperative telemedicine interventions with a communication feature reduce emergency department visits and readmissions?-a systematic review and meta-analysis. Surg Endosc 2021; 35:5889-5904. [PMID: 34231068 DOI: 10.1007/s00464-021-08607-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/14/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Emergency department (ED) visits and readmissions after surgery are common and represent a significant cost-burden on the healthcare system. A notable portion of these unplanned visits are the result of expected complications or normal recovery after surgery, suggesting that improved coordination and communication in the outpatient setting could potentially prevent these. Telemedicine can improve patient-physician communication and as such may have a role in limiting unplanned emergency department visits and readmissions in postoperative patients. METHODS Major electronic databases were searched for randomized controlled trials and cohort studies in surgical patients examining the effect of postoperative telemedicine interventions with a communication feature on 30-day readmissions and emergency department visits as compared to current standard postoperative follow-up. All surgical subspecialties were included. Two independent reviewers assessed eligibility, extracted data, and evaluated risk of bias using standardized tools. Our primary outcomes of interest were 30-day ED visits and readmissions. Our secondary outcomes were patient satisfaction with the intervention. RESULTS 29 studies were included in the final analysis. Fourteen studies were RCTs, and the remaining fifteen were cohort studies. Eighteen studies reported 30-day ED visit as an outcome. There was no overall reduction in 30-day ED visit in the telemedicine group (RR: 0.89, 95%CI: 0.70-1.12). Twenty-two studies reported 30-day readmission as an outcome. The overall pooled estimate did not show a difference in this outcome (RR: 0.90, 95%CI: 0.74-1.09). Fifteen studies reported a metric of patient satisfaction regarding utilization of the telemedicine intervention. All studies demonstrated high levels of satisfaction (> 80%) with the telemedicine intervention. DISCUSSION This review fails to demonstrate a clear reduction ED visits and readmissions to support use of a telemedicine intervention across the board. This may be in part explained by significant heterogeneity in the proportions of potentially preventable visits in each surgical specialty. As such, targeting interventions to specific surgical settings may prove most useful.
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Affiliation(s)
- Jules Eustache
- Department of Surgery, McGill University Health Centre, Glen Campus-DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Charbel El-Kefraoui
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Taline Ekmekjian
- Medical Libraries, McGill University Health Centre, Montreal, QC, Canada
| | - Eric Latimer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Research Centre, Montreal, QC, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Glen Campus-DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada. .,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
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Ko Y, Hwang JM, Baek SH. The Development of a Mobile Application for Older Adults for Rehabilitation Instructions After Hip Fracture Surgery. Geriatr Orthop Surg Rehabil 2021; 12:21514593211006693. [PMID: 35186422 PMCID: PMC8848083 DOI: 10.1177/21514593211006693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 03/09/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Older patients with hip fractures require a long time to rehabilitate and recover after surgery. Although effective discharge instructions for long-term recovery are important, the discharge instructions of most acute-care hospitals are often presented as a brochure, which is difficult for older adults to follow. The purpose of this study was to develop rehabilitation instructions in the form of a mobile application for the physical recovery of older adults after hip fracture surgery. Materials and Methods: A mobile application for rehabilitation instructions after hip fracture surgery was developed in ADDIE order of analysis, design, development, implementation, and evaluation. The contents of the mobile application composed of rehabilitative exercises, activities of daily living, pain and nutrition management, fall prevention, and hospital visits. Nine experts evaluated the application and SPSS version 23.0 program was used for data analysis. Results: In the mobile application evaluation by the experts, the average score of the contents was 2.22 out of 3 points. The average score of understanding was the highest at 2.42, while accuracy was the lowest at 2.00 in the contents. The average score of the interface design was 2.32 out of 3 points. The average score of consistency was the highest at 2.42, while design suitability was the lowest at 2.25 in the interface design. The experts perceived the mobile application as simple and easy to understand while also suggesting some improvements. Conclusion: The average scores were highest for understanding of contents and consistency of the interface design and lowest for accuracy of contents and design suitability of the interface design. The mobile application was easy to understand and had consistency in design.
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Affiliation(s)
- YoungJi Ko
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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14
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Improving health-related quality of life and adherence to health-promoting behaviors among coronary artery bypass graft patients: a non-randomized controlled trial study. Qual Life Res 2020; 30:769-780. [PMID: 33064290 DOI: 10.1007/s11136-020-02675-3] [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] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to determine the impact of a healthy lifestyle empowerment program on health-related quality of life and adherence to health-promoting behaviors in coronary artery bypass graft patients. METHODS This non-randomized controlled trial was conducted in 2019 on 97 coronary artery bypass graft patients in Iran. Participants were selected by culturally pragmatic and non-randomized method and assigned to healthy lifestyle empowerment program group (HLEPG) (n = 49) and conventional education group (CEG) (n = 48). Data were collected by the 12-item short-form health survey (SF-12) and health-promoting lifestyle profile II (HPLP2), which were administered at baseline and three-month follow-up. The healthy lifestyle empowerment program and conventional education as two interventions were performed for HLEPG and CEG, respectively. Data analysis was performed using the paired t-test, independent t-test, analysis of covariance and linear mixed method at the 0.05 significance level. RESULTS In the follow-up, both groups showed a significant increase in the mean score of health-related quality of life (p ≤ 0.001) but this increase was visibly greater in the HLEPG (from 23.47 ± 7.48 to 35.60 ± 5.95) than in the CEG (from 22.93 ± 5.93 to 27.6 ± 4.90). The healthy lifestyle empowerment program also significantly increased the mean score of adherence to health-promoting behaviors in the HLEPG (p ≤ 0.001), whereas no such change was observed in the CEG. The results of the linear mixed model showed that the follow-up scores health-related quality of life and adherence to health-promoting behaviors of the HLEPG were 27.26 and 7.56 units significantly greater than the CEG after HLEP, respectively (p < 0.001). CONCLUSION Considering the results of this study, health care providers are recommended to devise and implement healthy lifestyle empowerment programs to improve the health-related quality of life of coronary artery bypass surgery patients. CLINICAL TRIAL REGISTRATION Registered at Iranian Registry of Clinical Trials (IRCT20171213037860N1).
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15
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Computer- and Telephone-Delivered Interventions on Patient Outcomes and Resource Utilization in Patients With Orthopaedic Conditions: A Systematic Review and Narrative Synthesis. Orthop Nurs 2020; 39:340-352. [PMID: 32956277 DOI: 10.1097/nor.0000000000000699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As the number of patients with orthopaedic conditions has risen continuously, hospital-based healthcare resources have become limited. Delivery of additional services is needed to adapt to this trend. PURPOSE The purpose of this study was to describe the current literature of computer- and telephone-delivered interventions on patient outcomes and resource utilization in patients with orthopaedic conditions. METHODS The systematic review was conducted in January 2019. The standardized checklist for randomized controlled trials was used to assess the quality of the relevant studies. A meta-analysis was not possible due to heterogeneity in the included studies, and a narrative synthesis was conducted to draw informative conclusions relevant to current research, policy, and practice. RESULTS A total of 1,173 articles were retrieved. Six randomized controlled trials met the inclusion criteria, providing evidence from 434 individuals across four countries. Two studies reported findings of computer-delivered interventions and four reported findings of telephone-delivered interventions. The patients who received both computer- and telephone-delivered interventions showed improvements in patient outcomes that were similar or better to those of patients receiving conventional care. This was without any increase in adverse events or costs. CONCLUSION Computer- and telephone-delivered interventions are promising and safe alternatives to conventional care. This review, however, identifies a gap in evidence of high-quality studies exploring the effects of computer- and telephone-delivered interventions on patient outcomes and resource utilization. In future, these interventions should be evaluated from the perspective of intervention content, self-management, and patient empowerment. In addition, they should consider the whole care journey and the development of the newest technological innovations. Additionally, future surgery studies should take into account the personalized needs of special, high-risk patient groups and focus on patient-centric care to reduce postdischarge health problems and resource utilization in this population.
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16
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Zuckerman SL, Devin CJ, Rossi V, Chotai S, Dyer EH, Knightly JJ, Potts EA, Foley KT, Bisson EF, Glassman SD, Mummaneni PV, Bydon M, Asher AL. The Institute for Healthcare Improvement-NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols. J Neurosurg Spine 2020; 33:812-821. [PMID: 32823267 DOI: 10.3171/2020.5.spine20457] [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: 03/30/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE National databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module. METHODS The NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention. RESULTS The novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0-10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342). CONCLUSIONS The NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.
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Affiliation(s)
| | - Clinton J Devin
- 2Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- 3Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado
| | - Vincent Rossi
- 4Carolina Neurosurgery & Spine Associates, Neuroscience and Musculoskeletal Institutes, Atrium Health Charlotte, North Carolina
| | | | - E Hunter Dyer
- 4Carolina Neurosurgery & Spine Associates, Neuroscience and Musculoskeletal Institutes, Atrium Health Charlotte, North Carolina
| | | | - Eric A Potts
- 6Goodman Campbell Brain and Spine, University of Indiana, Indianapolis, Indiana
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
| | - Erica F Bisson
- 8Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Steven D Glassman
- 9Norton Leatherman Spine Center, Norton Healthcare, Louisville, Kentucky
| | - Praveen V Mummaneni
- 10Department of Neurosurgery, University of California, San Francisco, California; and
| | - Mohamad Bydon
- 11Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anthony L Asher
- 4Carolina Neurosurgery & Spine Associates, Neuroscience and Musculoskeletal Institutes, Atrium Health Charlotte, North Carolina
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Christie SA, Mbianyor MA, Dissak-Delon FN, Tanjong MM, Chichom-Mefire A, Dicker RA, Juillard C. Feasibility of a Cellular Telephone Follow-Up Program After Injury in Sub-Saharan Africa. World J Surg 2020; 44:2533-2541. [PMID: 32347352 DOI: 10.1007/s00268-020-05529-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Injury disproportionately affects persons in low- and middle-income countries (LMIC). Most LMIC lack capacity for routine follow-up care, likely resulting in complications and disability. Cellular telephones may provide a new tool to improve health outcomes. The objective of this study was to establish the feasibility of a mobile health follow-up program after injury in Cameroon. METHODS Between February and October 2017, all injured patients admitted to a regional hospital in Cameroon were asked for mobile phone numbers as part of an existing trauma registry. Patients were contacted 2 weeks after leaving the hospital discharge to participate in a short triage survey. Data on program feasibility and patient condition were collected. RESULTS Of 1180 injured patients who presented for emergency care, 83% provided telephone numbers, 62% were reached, and 48% (565) of all injured patients ultimately participated in telephone follow-up. Successfully contacted patients were reached after an average of 1.76 call attempts (SD 1.91) and median call time was 4.43 min (IQR 3.67-5.36). Five patients (1%) had died from their injuries at the time of follow-up. Among surveyed patients, 27% required ongoing assistance to complete activities of daily living. Nearly, half (47%) of patients reported inability to take medicines or care for their injury as instructed at discharge. Adequate pain control was achieved in only 38% of discharged patients. CONCLUSION Pilot data suggest considerable under treatment of injury in Cameroon. Mobile telephone follow-up demonstrates potential as a feasible tool for screening discharged patients who could benefit from further care.
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Affiliation(s)
- S Ariane Christie
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Rooms 400 & 401, San Francisco, CA, 94110, USA
| | - M Agbor Mbianyor
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Rooms 400 & 401, San Francisco, CA, 94110, USA
| | | | - Mary M Tanjong
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Rooms 400 & 401, San Francisco, CA, 94110, USA
| | - Alain Chichom-Mefire
- Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Rochelle A Dicker
- Department of Surgery, University of California, Los Angeles, 10833 Le Conte Avenue, 72-215 CHS, Los Angeles, CA, 90095, USA
| | - Catherine Juillard
- Department of Surgery, University of California, Los Angeles, 10833 Le Conte Avenue, 72-215 CHS, Los Angeles, CA, 90095, USA.
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18
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Jansson MM, Rantala A, Miettunen J, Puhto AP, Pikkarainen M. The effects and safety of telerehabilitation in patients with lower-limb joint replacement: A systematic review and narrative synthesis. J Telemed Telecare 2020; 28:96-114. [PMID: 32316837 DOI: 10.1177/1357633x20917868] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement. METHODS A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes. RESULTS Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence. DISCUSSION Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation.
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Affiliation(s)
- Miia M Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland.,Oulu University Hospital, Finland
| | - Arja Rantala
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
| | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland.,Martti Ahtisaari Institute, University of Oulu, Finland.,VTT, Technical Research Centre of Finland, Finland
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19
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Coulson EE, Kral LA. The Clinical Pharmacist’s Role in Perioperative Surgical Pain Management. J Pain Palliat Care Pharmacother 2020; 34:120-126. [DOI: 10.1080/15360288.2020.1734141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Eva E. Coulson
- Eva E. Coulson, Pharm, BCPS, The University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA; Lee A. Kral, PharmD, CPE, Clinical Assistant Professor, Department of Anesthesia, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Lee A. Kral
- Eva E. Coulson, Pharm, BCPS, The University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA; Lee A. Kral, PharmD, CPE, Clinical Assistant Professor, Department of Anesthesia, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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20
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Jansson M, Vuorinen AL, Harjumaa M, Similä H, Koivisto J, Puhto AP, Vesty G, Pikkarainen M. The digital patient journey solution for patients undergoing elective hip and knee arthroplasty: Protocol for a pragmatic randomized controlled trial. J Adv Nurs 2020; 76:1436-1448. [PMID: 32133684 DOI: 10.1111/jan.14343] [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: 12/20/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 11/28/2022]
Abstract
AIM To describe a randomized controlled trial (RCT) protocol that will evaluate the effectiveness of a digital patient journey (DPJ) solution in improving the outcomes of patients undergoing total hip and knee arthroplasty. BACKGROUND There is an urgent need for novel technologies to ensure sustainability, improve patient experience, and empower patients in their own care by providing information, support, and control. DESIGN A pragmatic RCT with two parallel arms. METHODS The participants randomized assigned to the intervention arm (N = 33) will receive access to the DPJ solution. The participants in the control arm (N = 33) will receive conventional care, which is provided face to face by using paper-based methods. The group allocations will be blinded from the study nurse during the recruitment and baseline measures, as well as from the outcome assessors. Patients with total hip arthroplasty will be followed up for 8-12 weeks, whereas patients with total knee arthroplasty will be followed up for 6-8 weeks. The primary outcome is health-related quality of life, measured by the EuroQol EQ-5D-5L scale. Secondary outcomes include functional recovery, pain, patient experience, and self-efficacy. The first results are expected to be submitted for publication in 2020. IMPACT This study will provide information on the health effects and cost benefits of using the DPJ solution to support a patient's preparation for surgery and postdischarge surgical care. If the DPJ solution is found to be effective, its implementation into clinical practice could lead to further improvements in patient outcomes. If the DPJ solution is found to be cost effective for the hospital, it could be used to improve hospital resource efficiency.
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Affiliation(s)
- Miia Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| | | | | | - Heidi Similä
- VTT Technical Research Centre of Finland, Oulu, Finland
| | - Jonna Koivisto
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland
| | - Gillian Vesty
- School of Accounting, RMIT University, Melbourne, Australia
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,VTT Technical Research Centre of Finland, Oulu, Finland.,Martti Ahtisaari Institute, Oulu Business School, Oulu University, Oulu, Finland
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21
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Totty JP, Harwood AE, Wallace T, Smith GE, Chetter IC. Use of photograph-based telemedicine in postoperative wound assessment to diagnose or exclude surgical site infection. J Wound Care 2019; 27:128-135. [PMID: 29509108 DOI: 10.12968/jowc.2018.27.3.128] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aims to assess whether a clinician reviewing photographs of a wound was an acceptable substitute for clinical review in order to identify or exclude surgical site infection (SSI). METHOD We undertook a mixed methods study consisting of a qualitative public involvement exercise and a prospective, non-randomised, single-centre study of patients undergoing clean or clean-contaminated vascular surgery. For the qualitative study, two semi-structured focus group interviews were conducted. For the prospective study, patients were invited to attend a wound review at 5-7 days and 30 days postoperatively. At review, wounds were scored by a study nurse or doctor, according to the ASEPSIS scale. Anonymised wound photographs were taken and independently reviewed, and ASEPSIS scored by two independent investigators blinded to the original 'clinical review' ASEPSIS score. RESULTS In the qualitative study, three female patients were interviewed across two dates. Emerging themes included the burden of SSI, hospital follow-up and telemedical follow-up. A total of 37 patients with a mean age of 61.14 years were included in the quantitative analysis. There was a total of 53 wound reviews. There was >85% agreement between photograph and clinical reviewers in all categories except erythema. The specificity of photograph review for diagnosis of SSI was 90%. The intraclass correlation coefficient for total ASEPSIS score was R=0.806 (95% CI 0.694, 0.881), indicating strong reliability between reviewers. CONCLUSION Our data shows that, in the assessment of SSI, there is good correlation between face-to-face clinical and remote photographic review. Incorporating this method of wound assessment into a postoperative follow-up care pathway may save patients and clinicians from unnecessary hospital visits, particularly when conducting health research.
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Affiliation(s)
- Joshua P Totty
- Clinical Research Fellow, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull
| | - Amy E Harwood
- Postdoctoral Research Fellow, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull
| | - Tom Wallace
- Clinical Lecturer, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull
| | - George E Smith
- Senior Clinical Lecturer and Consultant in Vascular Surgery, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull
| | - Ian C Chetter
- Professor of Surgery and Consultant in Vascular Surgery, Academic Vascular Surgical Unit, Hull Royal Infirmary, Anlaby Road, Hull
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22
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Jansson MM, Harjumaa M, Puhto AP, Pikkarainen M. Healthcare professionals' proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey: A qualitative interview study. J Clin Nurs 2019; 28:4434-4446. [PMID: 31408555 DOI: 10.1111/jocn.15028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/17/2019] [Accepted: 08/04/2019] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES To examine the lived experience of healthcare professionals providing care for patients with total hip and knee arthroplasty and to understand healthcare professionals' proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey. BACKGROUND There is little evidence in nursing literature to indicate how to develop new eHealth services to support surgical care journeys. Evidence is particularly lacking regarding the development of eHealth solutions. DESIGN This was a qualitative interview study. METHODS Semi-structured interviews were conducted with four surgeons, two anaesthesiologists, ten nurses and four physiotherapists in a single joint replacement centre during autumn 2018. The data were analysed using an inductive content analysis method. NVivo qualitative data analysis software was used. The COREQ checklist for qualitative studies was followed. RESULTS Our research addressed the gap in evidence by focusing on the four main parts of the patient journey in the selected context. Analysis of the data revealed nine main categories for the proposed eHealth needs: eligibility criteria, referrals, meeting the Health Care Guarantee, patient flow, postdischarge care, patient counselling, communication, transparency of the journey and receiving feedback. In addition, the requirements and further development needs for eHealth solutions were generally identified. CONCLUSIONS From the point of view of healthcare professionals, eHealth solutions have huge potential in supporting the elective primary fast-track hip and knee arthroplasty journey. However, it is important to acknowledge that these needs may be very different depending on the technological and organisational environment in question. RELEVANCE TO CLINICAL PRACTICE More effective use of information and communication technologies is needed for organisational optimisation resulting in a streamlined pathway, better access to healthcare services, improved outcomes and an improved patient experience. These results can be used in the development of new eHealth solutions to support surgical care journeys and patient education.
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Affiliation(s)
- Miia Marika Jansson
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| | | | - Ari-Pekka Puhto
- Division of Operative Care, Department of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland
| | - Minna Pikkarainen
- Research Group of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,VTT Technical Research Centre of Finland, Oulu, Finland.,Martti Ahtisaari Institute, Oulu Business School, Oulu University, Oulu, Finland
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23
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Woods CE, Jones R, O’Shea E, Grist E, Wiggers J, Usher K. Nurse‐led postdischarge telephone follow‐up calls: A mixed study systematic review. J Clin Nurs 2019; 28:3386-3399. [DOI: 10.1111/jocn.14951] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/13/2019] [Accepted: 05/26/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Cindy E. Woods
- School of Health University of New England Armidale New South Wales Australia
| | - Rikki Jones
- School of Health University of New England Armidale New South Wales Australia
| | - Eilish O’Shea
- School of Health University of New England Armidale New South Wales Australia
| | - Elizabeth Grist
- Hunter New England Local Health District New Lambton New South Wales Australia
- School of Nursing and Midwifery University of Newcastle Newcastle New South Wales Australia
| | - John Wiggers
- Hunter New England Local Health District New Lambton New South Wales Australia
- School of Medicine and Public Health University of Newcastle Newcastle New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
| | - Kim Usher
- School of Health University of New England Armidale New South Wales Australia
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Wang TJ, Su JH, Leung KW, Liang SY, Wu SF, Wang HM. Effects of a mouth-opening intervention with remote support on adherence, the maximum interincisal opening, and mandibular function of postoperative oral cancer patients: A randomized clinical trial. Eur J Oncol Nurs 2019; 40:111-119. [PMID: 31229200 DOI: 10.1016/j.ejon.2019.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of the study was to investigate the effects of a mouth-opening intervention for postoperative trismus and remote support provided via telephone following hospital discharge for intervention adherence in patients with oral cancer. METHODS The study is a parallel randomized trial. Patients admitted at a general hospital for oral cancer surgery were recruited and randomly assigned to either the experimental or the active control group. Both groups underwent a 12-week intervention program, including warm compress, masticatory muscle massage, and jaw exercise. Subjects in the experimental group received additional support via telephone following hospital discharge. Data on intervention adherence maximum interincisal opening and mandibular function impairment were collected at baseline, week 4, and week 12. RESULTS Sixty subjects (30 in each group) that completed the study were included in the analysis. At week 12, the intervention practice time in the experimental group was 299.67 min (95% CI: 223.44-357.89) more than that of the active control group. From baseline to week 12, the change in maximum interincisal opening was 10.30 mm (95% CI: 8.22-12.37) greater in the experimental than in the active control group. The change in mandibular function impairment score was -0.36 (95% CI: -0.44 to -0.28) greater in the experimental than in the active control group. CONCLUSIONS The study results support the effect of remote support via telephone for enhancing adherence to the intervention protocol, and the effect of the intervention program for alleviating trismus and mandibular function impairments in patients who receive curative surgery for oral cancer.
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Affiliation(s)
- Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan.
| | - Jung-Hui Su
- Department of Nursing, Yuan's General Hospital, Kaohsiung City, Taiwan.
| | - Kam-Wing Leung
- Department of Oral and Maxillofacial Surgery, Yuan's General Hospital, Kaohsiung City, Taiwan.
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan.
| | - Shu-Fang Wu
- School of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan.
| | - Hung-Ming Wang
- Department of Hemtotolgy/Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan.
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25
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Highland KB, Tran J, Edwards H, Bedocs P, Suen J, Buckenmaier CC. Feasibility of App-Based Postsurgical Assessment of Pain, Pain Impact, and Regional Anesthesia Effects: A Pilot Randomized Controlled Trial. PAIN MEDICINE 2019; 20:1592-1599. [DOI: 10.1093/pm/pny288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Postsurgical follow-up calls enable nurses to assess a patient’s condition, provide tailored education, and improve the patient’s experience. Despite the benefits, barriers to phone-based assessments may include patient nonresponse and lack of time due to demanding clinical schedules. The purpose of this trial was to examine the feasibility and utility of a smartphone app, mCare, for assessing pain, pain impact, and peripheral nerve block effects in patients.
Design
Pilot randomized control trial.
Setting and Patients
Eligible patients at a military treatment facility undergoing same-day surgery were randomized to the mCare group (N = 24) or the standard-of-care telephone (N = 26) group.
Results
Outcomes included initial response (assessment completion) rates and participant and nurse satisfaction. There were no differences in the response rates upon initial contact attempt, and patients in both groups reported similar levels of satisfaction and convenience. Nurses reported greater satisfaction with the app compared with standard-of-care telephone calls.
Conclusions
Before wider implementation, further considerations of app-based assessment need to be fully explored.
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Affiliation(s)
- Krista B Highland
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University Henry M. Jackson Foundation, Rockville, Maryland, USA
| | - Julie Tran
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University Henry M. Jackson Foundation, Rockville, Maryland, USA
| | - Hisani Edwards
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University Henry M. Jackson Foundation, Rockville, Maryland, USA
| | - Peter Bedocs
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University Henry M. Jackson Foundation, Rockville, Maryland, USA
| | - Joshua Suen
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University Henry M. Jackson Foundation, Rockville, Maryland, USA
| | - Chester C Buckenmaier
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University Henry M. Jackson Foundation, Rockville, Maryland, USA
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26
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Szeverenyi C, Kekecs Z, Johnson A, Elkins G, Csernatony Z, Varga K. The Use of Adjunct Psychosocial Interventions Can Decrease Postoperative Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. THE JOURNAL OF PAIN 2018; 19:1231-1252. [DOI: 10.1016/j.jpain.2018.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 04/15/2018] [Accepted: 05/14/2018] [Indexed: 01/03/2023]
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27
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Croese A, Lawson A, Singh T, Brimstone S, Brunott N. An evaluation of nurse-led post-operative telephone follow-up in a regional centre. ANZ J Surg 2018; 88:397-398. [PMID: 29752795 DOI: 10.1111/ans.14279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Alex Croese
- General Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - Amy Lawson
- General Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Talbir Singh
- General Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | | | - Nathan Brunott
- General Surgery, Cairns Hospital, Cairns, Queensland, Australia
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28
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Robertson FC, Logsdon JL, Dasenbrock HH, Yan SC, Raftery SM, Smith TR, Gormley WB. Transitional care services: a quality and safety process improvement program in neurosurgery. J Neurosurg 2018; 128:1570-1577. [DOI: 10.3171/2017.2.jns161770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEReadmissions increasingly serve as a metric of hospital performance, inviting quality improvement initiatives in both medicine and surgery. However, few readmission reduction programs have targeted surgical patient populations. The objective of this study was to establish a transitional care program (TCP) with the goal of decreasing length of stay (LOS), improving discharge efficiency, and reducing readmissions of neurosurgical patients by optimizing patient education and postdischarge surveillance.METHODSPatients undergoing elective cranial or spinal neurosurgery performed by one of 5 participating surgeons at a quaternary care hospital were enrolled into a multifaceted intervention. A preadmission overview and establishment of an anticipated discharge date were both intended to set patient expectations for a shorter hospitalization. At discharge, in-hospital prescription filling was provided to facilitate medication compliance. Extended discharge appointments with a neurosurgery TCP-trained nurse emphasized postoperative activity, medications, incisional care, nutrition, signs that merit return to medical attention, and follow-up appointments. Finally, patients received a surveillance phone call 48 hours after discharge. Eligible patients omitted due to staff limitations were selected as controls. Patients were matched by sex, age, and operation type—key confounding variables—with control patients, who were eligible patients treated at the same time period but not enrolled in the TCP due to staff limitation. Multivariable logistic regression evaluated the association of TCP enrollment with discharge time and readmission, and linear regression with LOS. Covariates included matching criteria and Charlson Comorbidity Index scores.RESULTSBetween 2013 and 2015, 416 patients were enrolled in the program and matched to a control. The median patient age was 55 years (interquartile range 44.5–65 years); 58.4% were male. The majority of enrolled patients underwent spine surgery (59.4%, compared with 40.6% undergoing cranial surgery). Hospitalizations averaged 62.1 hours for TCP patients versus 79.6 hours for controls (a 16.40% reduction, 95% CI 9.30%–23.49%; p < 0.001). The intervention was associated with a higher proportion of morning discharges, which was intended to free beds for afternoon admissions and improve patient flow (OR 3.13, 95% CI 2.27–4.30; p < 0.001), and decreased 30-day readmissions (2.5% vs 5.8%; OR 2.43, 95% CI 1.14–5.27; p = 0.02).CONCLUSIONSThis neurosurgical TCP was associated with a significantly shorter LOS, earlier discharge, and reduced 30-day readmission after elective neurosurgery. These results underscore the importance of patient education and surveillance after hospital discharge.
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Affiliation(s)
| | - Jessica L. Logsdon
- 2Cushing Neurosurgical Outcomes Center,
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Hormuzdiyar H. Dasenbrock
- 1Harvard Medical School; and
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sandra C. Yan
- 2Cushing Neurosurgical Outcomes Center,
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Siobhan M. Raftery
- 2Cushing Neurosurgical Outcomes Center,
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Timothy R. Smith
- 1Harvard Medical School; and
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - William B. Gormley
- 1Harvard Medical School; and
- 3Department of Neurological Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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Abstract
After more than two decades of research focused on care transition improvement and intervention development, unfavorable outcome measures associated with care transitions across healthcare settings persist. Readmissions rates remain an important outcome to target for intervention, adverse events associated with care transitions continue to be an issue, and patients are often dissatisfied with the quality of their care. Currently, interventions to improve care transitions are disease specific, require substantial financial investments in training allied healthcare professionals, or focus primarily on hospital-based discharge planning with mixed results. This complex situation requires a method of evaluation that can provide a comprehensive, in-depth, and context-driven investigation of potential risks to safe care transitions across healthcare settings, which can lead to the creation of effective, usable, and sustainable interventions. A systems' approach known as Human Factors and Ergonomics (HFE) evaluates the factors in a system that affect human performance. This article describes how HFE can complement and further strengthen efforts to improve care transitions.
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30
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Yokoyama S, Yajima S, Sakai C, Yamashita S, Noguchi Y, Ino Y, Iguchi K, Teramachi H. Community pharmacist-led telephone follow-up enabled close management of everolimus-induced adverse events in an outpatient with metastatic breast cancer. Can Pharm J (Ott) 2017; 150:362-365. [PMID: 29123595 DOI: 10.1177/1715163517732088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Satoshi Yokoyama
- Laboratory of Community Pharmacy (Yokoyama, Yajima, Sakai, Ino, Iguchi), Gifu Pharmaceutical University, Gifu, Japan
| | - Satoko Yajima
- Laboratory of Community Pharmacy (Yokoyama, Yajima, Sakai, Ino, Iguchi), Gifu Pharmaceutical University, Gifu, Japan
| | - Chihiro Sakai
- Laboratory of Community Pharmacy (Yokoyama, Yajima, Sakai, Ino, Iguchi), Gifu Pharmaceutical University, Gifu, Japan
| | - Shuji Yamashita
- Laboratory of Community Pharmacy (Yokoyama, Yajima, Sakai, Ino, Iguchi), Gifu Pharmaceutical University, Gifu, Japan
| | - Yoshihiro Noguchi
- Laboratory of Community Pharmacy (Yokoyama, Yajima, Sakai, Ino, Iguchi), Gifu Pharmaceutical University, Gifu, Japan
| | - Yoko Ino
- Laboratory of Community Pharmacy (Yokoyama, Yajima, Sakai, Ino, Iguchi), Gifu Pharmaceutical University, Gifu, Japan
| | - Kazuhiro Iguchi
- Laboratory of Community Pharmacy (Yokoyama, Yajima, Sakai, Ino, Iguchi), Gifu Pharmaceutical University, Gifu, Japan
| | - Hitomi Teramachi
- Laboratory of Community Pharmacy (Yokoyama, Yajima, Sakai, Ino, Iguchi), Gifu Pharmaceutical University, Gifu, Japan
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Abstract
OBJECTIVES The primary aim of this study is to investigate the incidence of early patient-initiated postoperative telephone calls and reasons for those calls. Secondary goals are to determine perioperative predictive factors for calls including the procedures most frequently associated with them. DESIGN Retrospective chart review. SETTING Academic Level-1 Trauma Center. PATIENTS/PARTICIPANTS Six hundred eighty-four patients who underwent surgical treatment by our orthopaedic trauma division between 01/01/2014 and 31/12/2014. MAIN OUTCOME MEASUREMENTS Patient-initiated telephone call documented within 14 days after discharge. RESULTS Twenty-nine percent (n = 199) of patients initiated a telephone call within 14 days after discharge. The most common reasons for telephone calls were pain control (22%), bathing/dressing/wound questions (16%), and questions regarding discharge medications (8%). The procedures associated with the highest percentage of telephone calls were tibial shaft intramedullary nailing (36.0%), calcaneus open reduction internal fixation (31.3%), and cephalomedullary nailing for proximal femur fractures (29.3%). Perioperative factors predictive of an increase in phone calls included discharge directly to home, higher baseline level of health of the patient (based on comorbidities and the American Society for Anesthesiologists score), and a more robust support network (based on marital and employment status). CONCLUSIONS This study identifies the incidence and common reasons for patient-initiated calls after orthopaedic trauma surgery and an analysis of perioperative factors predictive of increased phone calls. These data give direction for communication at the time of discharge to improve efficiency, patient care, and patient satisfaction. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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