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Martin D, Weetman K. Writing letters to patients attending psychiatry clinics. BMJ 2023; 383:p2857. [PMID: 38049178 DOI: 10.1136/bmj.p2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Dave Martin
- Avon and Wiltshire Mental Health Partnership NHS Trust
- Centre for Academic Mental Health, University of Bristol
| | - Katharine Weetman
- Interactive Studies Unit, Institute of Clinical Sciences, University of Birmingham
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick
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2
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Gauly J, Court R, Seers K, Currie G, Grove A. In which context and for whom can interventions improve leadership of surgical trainees, surgeons and surgical teams and why: a realist review protocol. NIHR OPEN RESEARCH 2023; 3:16. [PMID: 37881463 PMCID: PMC10593322 DOI: 10.3310/nihropenres.13364.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 10/27/2023]
Abstract
Background Improving effective leadership of individuals, groups, and healthcare organisations is essential for improving surgical performance and indirectly improving health outcomes for patients. Numerous systematic reviews have been conducted which seek to determine the effectiveness of specific leadership interventions across a range of disciplines and healthcare outcomes. The purpose of this realist review is to systematically synthesise the literature which examines in which context and for whom leadership interventions improve leadership of surgeons, surgical teams, and trainees. Methods Several approaches will be used to iteratively search the scientific and grey literature to identify relevant evidence. Selected articles will inform the development of a programme theory that seeks to explain in which context and for whom interventions can improve leadership of surgical trainees, surgeons, and surgical teams. Next, empirical studies will be searched systematically in order to test and, where necessary, refine the theory. Once theoretical saturation has been achieved, recommendations for advancing leadership in surgery will be developed. Stakeholder and patient and public consultations will contribute to the development of the programme theory. The review will be written up according to the Realist And Meta-narrative Evidence Synthesis: Evolving Standards publication standards. No ethical review will be required for the conduct of this realist review. Discussion The knowledge gained from this review will provide evidence-based guidance for those planning or designing leadership interventions in surgery. The recommendations will help policymakers, educationalists, healthcare providers, and those delivering or planning leadership development programmes across the surgical disciplines to design interventions that are acceptable to the surgical community and successful in improving surgical leadership.PROSPERO registration: CRD42021230709.
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Affiliation(s)
- Julia Gauly
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Kate Seers
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, CV4 7AL, UK
| | - Amy Grove
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Adnan NBB, Dafny HA, Baldwin C, Jakimowitz S, Chalmers D, Aroury AMA, Chamberlain D. What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care. BMJ Open 2022; 12:e060973. [PMID: 36691206 PMCID: PMC9462087 DOI: 10.1136/bmjopen-2022-060973] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals. DESIGN This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme. RESULTS A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience. CONCLUSIONS These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.
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Affiliation(s)
- Nurul Bahirah Binte Adnan
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Hila Ariela Dafny
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Claire Baldwin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Samantha Jakimowitz
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Ammar Moh'd Ahmad Aroury
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
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4
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Weetman K, Dale J, Mitchell SJ, Ferguson C, Finucane AM, Buckle P, Arnold E, Clarke G, Karakitsiou DE, McConnell T, Sanyal N, Schuberth A, Tindle G, Perry R, Grewal B, Patynowska KA, MacArtney JI. Communication of palliative care needs in discharge letters from hospice providers to primary care: a multisite sequential explanatory mixed methods study. Palliat Care 2022; 21:155. [PMID: 36064662 PMCID: PMC9444706 DOI: 10.1186/s12904-022-01038-8] [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: 05/11/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background The provision of palliative care is increasing, with many people dying in community-based settings. It is essential that communication is effective if and when patients transition from hospice to community palliative care. Past research has indicated that communication issues are prevalent during hospital discharges, but little is known about hospice discharges. Methods An explanatory sequential mixed methods study consisting of a retrospective review of hospice discharge letters, followed by hospice focus groups, to explore patterns in communication of palliative care needs of discharged patients and describe why these patients were being discharged. Discharge letters were extracted for key content information using a standardised form. Letters were then examined for language patterns using a linguistic methodology termed corpus linguistics. Thematic analysis was used to analyse the focus group transcripts. Findings were triangulated to develop an explanatory understanding of discharge communication from hospice care. Results We sampled 250 discharge letters from five UK hospices whereby patients had been discharged to primary care. Twenty-five staff took part in focus groups. The main reasons for discharge extracted from the letters were symptoms “managed/resolved” (75.2%), and/or the “patient wishes to die/for care at home” (37.2%). Most patients had some form of physical needs documented on the letters (98.4%) but spiritual needs were rarely documented (2.4%). Psychological/emotional needs and social needs were documented in 46.4 and 35.6% of letters respectively. There was sometimes ambiguity in “who” will be following up “what” in the discharge letters, and whether described patients’ needs were resolved or ongoing for managing in the community setting. The extent to which patients received a copy of their discharge letter varied. Focus groups conveyed a lack of consensus on what constitutes “complexity” and “complex pain”. Conclusions The content and structure of discharge letters varied between hospices, although generally focused on physical needs. Our study provides insights into patterns associated with those discharged from hospice, and how policy and guidance in this area may be improved, such as greater consistency of sharing letters with patients. A patient-centred set of hospice-specific discharge letter principles could help improve future practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01038-8.
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Affiliation(s)
- Katharine Weetman
- Interactive Studies Unit, Institute of Clinical Sciences, Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK. .,Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Claire Ferguson
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | - Anne M Finucane
- Marie Curie Hospice Edinburgh, Edinburgh, UK.,The University of Edinburgh School of Health in Social Science, Clinical Psychology, Edinburgh, UK
| | - Peter Buckle
- Marie Curie Research Voices Group, Marie Curie, England, London, UK
| | | | - Gemma Clarke
- Marie Curie Hospice Bradford, Bradford, UK.,University of Leeds, Academic Unit of Palliative Care, Leeds, West Yorkshire, UK
| | | | - Tracey McConnell
- Marie Curie Hospice Belfast, Belfast, UK.,Queen's University Belfast School of Nursing and Midwifery, Belfast, UK
| | - Nikhil Sanyal
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | | | - Georgia Tindle
- Marie Curie Hospice Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Rachel Perry
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | | | | | - John I MacArtney
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.,Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
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Broome E, Meyer C, Church P, Henshaw H. What factors are important to whom in what context, when adults are prescribed hearing aids for hearing loss? A realist review protocol. BMJ Open 2022; 12:e059836. [PMID: 35840307 PMCID: PMC9295669 DOI: 10.1136/bmjopen-2021-059836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Hearing aids are the gold standard treatment to help manage hearing loss. However, not everyone who needs them has them, and of those who do, a significant proportion of people do not use them at all, or use them infrequently. Despite literature reviews listing key barriers and enablers to the uptake and use of hearing aids, there is little evidence to describe how this varies by population and context. This review will describe what factors are important to whom in what context when considering the provision of hearing aids for hearing loss in adults. METHODS AND ANALYSIS The aims of this review are as follows: (1) To iteratively review and synthesise evidence surrounding the provision of hearing aids for hearing loss in adults. (2) To generate a theory-driven understanding of factors that are important, for whom, and in what context. (3) To develop a programme theory describing contexts that can support the provision of hearing aids to result in improved outcomes for adults with hearing loss. A scoping literature search will aid the development of programme theories, to explain how the intervention is expect to work, for whom, in what circumstances and in which contexts. We will locate evidence in the following databases: CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMED, Web of Science with no date restrictions. A realist analytic approach will be used to refute and refine these initial programme theories. Throughout the review, relevant key stakeholders (eg, patients and clinicians) will be consulted to test and refine the programme theories. ETHICS AND DISSEMINATION This study was approved by the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee: (FMHS 95-0820) and the London Brent NHS Research Ethics Committee (Ref: 21/PR/0259). The review will be reported according to the RAMESES guidelines and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021282049.
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Affiliation(s)
- Emma Broome
- National Institute for Health and Care Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Carly Meyer
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
| | - Paige Church
- National Institute for Health and Care Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
- NIHR Clinical Research Network (CRN) East Midlands, Nottingham Health Science Partners, Nottingham, UK
| | - Helen Henshaw
- National Institute for Health and Care Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK
- Hearing Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
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Bender JL, Babinski S, Wong G, Tricco AC, Englesakis M, Cyr AB, Potts H, Perski O, Esplen MJ, Young C, Wassersug R, Forster V, Papadakos J, Soobiah C, Fox C, Gothard-Huang A, Witteman H. Establishing best practices in cancer online support groups: protocol for a realist review. BMJ Open 2021; 11:e053916. [PMID: 34732498 PMCID: PMC8572404 DOI: 10.1136/bmjopen-2021-053916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Considerable observational evidence suggests that cancer online support groups reduce feelings of isolation, depression and anxiety, enhance coping and self-management, and lead to better informed patients. Other studies indicate that cancer online support groups can increase distress. Yet no studies theorise the complex, context-dependent mechanisms by which cancer online support groups generate their-sometimes contrasting-outcomes. METHODS AND ANALYSIS Guided by an integrated knowledge translation approach and the strategy for patient-oriented research, we will conduct a realist review of cancer online support groups in partnership with stakeholders. We will follow Pawson's five steps and existing quality standards to develop a program theory that explains how cancer online support groups work, for whom and in what circumstances. The specific research questions will be: what positive and negative outcomes have been reported on cancer online support groups? What are the mechanisms that are associated with these outcomes, in which contexts and for whom? Through a rigorous review of relevant scientific and grey literature, as well as ongoing dialogue with stakeholders, a program theory will be developed to explain who benefits from cancer online support groups and who does not, what benefits they derive (or do not), and the factors that affect these outcomes. ETHICS AND DISSEMINATION The use of secondary data for this review precludes the need for ethical approval. Dissemination will be informed by the knowledge-to-action framework and will consist of tailored knowledge products that are conceived of collaboratively with stakeholders. These will include peer-reviewed publications on how cancer online support groups can be optimised and best practice recommendations to maximise the benefits experienced by people with cancer. These traditional scientific outputs, along with their respective evidence summaries, will be amplified through strategic social media events hosted and promoted by knowledge users. PROSPERO REGISTRATION NUMBER CRD42021250046.
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Affiliation(s)
- Jacqueline L Bender
- Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Babinski
- Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Alaina B Cyr
- Patient Education and Engagement, University Health Network, Toronto, Ontario, Canada
| | - Henry Potts
- Centre for Health Informatics and Multiprofessional Education, University College London, London, UK
| | - Olga Perski
- Department of Behavioural Science and Health, University College London, London, UK
| | - Mary Jane Esplen
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Colleen Young
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Wassersug
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria Forster
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Charlene Soobiah
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Colleen Fox
- Patient Education, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Alison Gothard-Huang
- Cancer Rehabilitation and Survivorship Program, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Holly Witteman
- Faculté de médecine de l'Université Laval, Quebec City, Quebec, Canada
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Weetman K, Dale J, Scott E, Schnurr S. Discharge communication study: a realist evaluation of discharge communication experiences of patients, general practitioners and hospital practitioners, alongside a corresponding discharge letter sample. BMJ Open 2021; 11:e045465. [PMID: 34290064 PMCID: PMC8296817 DOI: 10.1136/bmjopen-2020-045465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To develop a programme theory for the intervention of patients receiving discharge letters. DESIGN We used a realist evaluation approach and captured multiple perspectives of hospital discharge to refine our previously developed programme theory. General practitioner (GP), patient and hospital clinician views of a single discharge event in which they were all involved were collected using semi-structured interviews and surveys. These were then triangulated to match the corresponding discharge letter. Data were qualitatively synthesised and compared in meta-matrices before interrogation with realist logic of analysis to develop the programme theory that maps out how patients receiving discharge letters works in specific contexts. SETTING 14 GP practices and four hospital trusts in West Midlands, UK. PARTICIPANTS 10 complete matched cases (GP, patient and hospital practitioner), and a further 26 cases in which a letter was matched with two out of the three participants. RESULTS We identified seven context mechanism outcome configurations not found through literature searching. These related to the broad concepts of: patient preference for receiving letters, patient comprehension of letters, patient-directed letters, patient harm and clinician views on patients receiving letters. 'Patient choice' was important to the success (or not) of the intervention. Other important contexts for positive effects included: letters written in plain English, lay explanations for jargon, verbal information also provided, no new information in letter and patient choice acknowledged. Three key findings were: patient understanding is perhaps greater than clinicians perceive, clinician attitudes are a barrier to patients receiving letters and that, negative outcomes more commonly manifested when patients had not received letters, rather than when they had. CONCLUSIONS We suggest how patients receiving discharge letters could be improved to enhance patient outcomes. Our programme theory has potential for use in different healthcare contexts and as a framework for policy development relating to patient discharge.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Emma Scott
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
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Ooi R, Stimson IB, Williams G. Impact of the COVID-19 pandemic on acute surgical patients’ discharge summaries – Experience of Wales worst-hit COVID-19 hospital. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211009353] [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 emergence of the COVID-19 pandemic has placed increased demands on the NHS workforce, especially in medical and intensive care units. The subsequent redistribution of surgical house officers to accommodate this in a single-centre NHS hospital has possibly negatively impacted on the effective discharge notification of acute surgical patients. Methods Discharge summaries of all patients directly discharged from a Surgical Assessment Unit were collected on the day of discharge and analysed to identify the date of completion and staff grade of the responsible clinician. Data collection was carried out before the initiation of lockdown measures and continued for a further three weeks during the peak of the COVID-19 pandemic with an interventional period in between. A poster was created and displayed in areas where discharge software could be accessed. Results In the initial audit, 36.2% of the 246 patients had delayed discharge summaries with an average of 7 days to complete. On re-evaluation, 45.3% of the 223 patients had delayed discharge summaries, taking an average of 12 days to complete. A survey conducted post-re-audit identified that the most common reason for delayed discharge summaries was due to time constraints associated with the increased workload. Conclusion The reallocation of surgical staff in response to the COVID-19 pandemic has affected communication between primary and secondary care, with a rise in delayed discharge letters of acute surgical patients. Given the potential repercussions of these delays, healthcare systems should be aware of this consequence of the pandemic, especially in preparation for any resurgences.
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Affiliation(s)
- Rucira Ooi
- Department of General Surgery, Royal Gwent Hospital, Newport, UK
| | | | - Gethin Williams
- Department of General Surgery, Royal Gwent Hospital, Newport, UK
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Nguyen J, Hunter J, Smith L, Forth A, Tyler A, Furney L, Ee C, Harnett JE. Can We All Speak the Same 'Language' for Our Patients' Sake? Feedback on Interprofessional Communication and Related Resources. Glob Adv Health Med 2021; 10:2164956121992338. [PMID: 33628627 PMCID: PMC7883148 DOI: 10.1177/2164956121992338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/22/2020] [Accepted: 01/15/2021] [Indexed: 12/02/2022] Open
Abstract
Background The Australasian Integrative Medicine Association (AIMA) established a working group to develop the AIMA Guiding Principles for Letter Writing and Letter Writing Templates. The guiding principles were developed to promote effective communication between the diverse range of healthcare practitioners (HCPs) that patients choose to consult. Following the development of the Interprofessional Communication (IPC) resources, AIMA undertook a public consultation as part of a quality assurance process to evaluate the relevance and utility of the resource. Aim This study reports stakeholder feedback on AIMA's draft guiding principles document. It explores stakeholder attitudes towards IPC and HCPs letter-writing, and interest in ongoing continuing professional development (CPD). Methods A cross-sectional survey involving 1) an online public consultation survey and 2) a paper survey collected following IPC CPD activities. Quantitative data were analysed using Chi square and Fisher-Freeman-Halton Test. Responses to open ended questions were coded and subject to a thematic analysis. Results The 64 survey participants and 55 CPD participants represented the Australian healthcare sectors and lay community. Most thought IPC is important (n = 112/117; 96%) and the resources were informative (n = 112/119; 94%), understandable (n = 111/119; 93%), and clinically relevant (n = 105/117; 90%). HCP reported wide variations in their frequency of correspondence with other practitioner types, with rates often concerningly low. Key IPC themes identified were the importance of continuity of care, clarity of communication, and professional practice. CPD participants were most interested in further IPC training (p = 0.001). Conclusions The IPC resources affirm the role of formal communication pathways, such as letters of correspondence to support coordinated, patient-centred and multidisciplinary care. Challenges with letter writing and IPC signal the need for more student and professional education on the subject to promote continuity of patient care and the delivery of high quality, integrative medicine and health care services.
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Affiliation(s)
- Janet Nguyen
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jennifer Hunter
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Lorraine Smith
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Amy Forth
- Institute of Oncology Massage, Waitara, Australia
| | - Amy Tyler
- The Acupuncture Pregnancy Clinic, Alexandria, Australia
| | | | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Joanna E Harnett
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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10
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Schiele F, Aktaa S, Rossello X, Ahrens I, Claeys MJ, Collet JP, Fox KAA, Gale CP, Huber K, Iakobishvili Z, Keys A, Lambrinou E, Leonardi S, Lettino M, Masoudi FA, Price S, Quinn T, Swahn E, Thiele H, Timmis A, Tubaro M, Vrints CJM, Walker D, Bueno H, Halvorsen S, Jernberg T, Jortveit J, Blöndal M, Ibanez B, Hassager C. 2020 Update of the quality indicators for acute myocardial infarction: a position paper of the Association for Acute Cardiovascular Care: the study group for quality indicators from the ACVC and the NSTE-ACS guideline group. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:224-233. [PMID: 33550362 DOI: 10.1093/ehjacc/zuaa037] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
AIMS Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence. METHODS AND RESULTS The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores). CONCLUSION Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care.
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Affiliation(s)
- François Schiele
- University Hospital Besancon, Boulevard Fleming, 25000 Besancon, France
| | | | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital Universitari Son Espases & Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Ingo Ahrens
- Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Cologne, Germany
| | | | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, Paris, France.,INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Keith A A Fox
- University and Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Zaza Iakobishvili
- Department of Community Cardiology, Clalit Health Services, Jaffa District, Tel Aviv, Israel
| | | | - Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic-Vascular Department, San Gerardo Hospital, Monza, Italy
| | | | - Susanna Price
- Royal Brompton & Harefield NHS Foundation Trust, Imperial College, London, UK
| | - Tom Quinn
- Kingston University & St. George's, University of London, London, UK
| | - Eva Swahn
- Linkoping University, Linkoping, Sweden
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Adam Timmis
- Barts Heart Centre and Queen Mary University London, London, UK
| | | | - Christiaan J M Vrints
- Antwerp University Hospital, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | | | - Hector Bueno
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Mai Blöndal
- Department of Cardiology, Tartu University, Estonia
| | - Borja Ibanez
- Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Provencher V, D'Amours M, Menear M, Obradovic N, Veillette N, Sirois MJ, Kergoat MJ. Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis. BMC Geriatr 2021; 21:84. [PMID: 33514326 PMCID: PMC7844968 DOI: 10.1186/s12877-020-01980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Older adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. This realist synthesis aimed to better understand when, where, for whom, why and how the components of these interventions produce positive outcomes. METHODS Nine indexed databases were searched to identify scientific papers and grey literature on discharge planning interventions for older adults (65+) hospitalized following a fall. Manual searches were also conducted. Documents were selected based on relevance and rigor. Two reviewers extracted and compiled data regarding intervention components, contextual factors, underlying mechanisms and positive outcomes. Preliminary theories were then formulated based on an iterative synthesis process. RESULTS Twenty-one documents were included in the synthesis. Four Intervention-Context-Mechanism-Outcome configurations were developed as preliminary theories, based on the following intervention components: 1) Increase two-way communication between healthcare providers and patients/caregivers using a family-centered approach; 2) Foster interprofessional communication within and across healthcare settings through both standardized and unofficial information exchange; 3) Provide patients/caregivers with individually tailored fall prevention education; and 4) Designate a coordinator to manage discharge planning. These components should be implemented from patient admission to return home and be supported at the organizational level (contexts) to trigger knowledge, understanding and trust of patients/caregivers, adjusted expectations, reduced family stress, and sustained engagement of families and professionals (mechanisms). These optimal conditions improve patient satisfaction, recovery, functional status and continuity of care, and reduce hospital readmissions and fall risk (outcomes). CONCLUSIONS Since transitions are critical points with potential communication gaps, coordinated interventions are vital to support a safe return home for older adults hospitalized following a fall. Considering the organizational challenges, simple tools such as pictograms and drawings, combined with computer-based communication channels, may optimize discharge interventions based on frail patients' needs, habits and values. Empirically testing our preliminary theories will help to develop effective interventions throughout the continuum of transitional care to enhance patients' health and reduce the economic burden of avoidable care.
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Affiliation(s)
- Véronique Provencher
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Research Centre on Aging, Sherbrooke, QC, Canada.
| | | | - Matthew Menear
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, Canada
- Centre de recherche sur les soins et les services de première ligne, Université Laval, Québec, Canada
| | - Natasa Obradovic
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Centre on Aging, Sherbrooke, QC, Canada
| | - Nathalie Veillette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie-Josée Sirois
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, Canada
| | - Marie-Jeanne Kergoat
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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12
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O'Connor L, Coffey A, Lambert V, Casey M, McNamara M, Teeling SP, O'Doherty J, Barnard M, Corcoran Y, Davies C, Doody O, Frawley T, O'Brien D, Redmond C, Smith R, Somanadhan S, Noonan M, Bradshaw C, Tuohy D, Gallen A. Quality care process metrics (QCP-Ms) in nursing and midwifery care processes: a rapid realist review (RRR) protocol. HRB Open Res 2021; 3:85. [PMID: 33564745 PMCID: PMC7848854 DOI: 10.12688/hrbopenres.13120.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 02/06/2023] Open
Abstract
Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QCP-Ms) and respective indicators for the practice areas - acute care, midwifery, children's, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QCP-Ms in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods : The review will explore if there are benefits of using the QCP-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QCP-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into the use of a rapid realist review as a framework and how nursing and midwifery QCP-Ms have been implemented previously.
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Affiliation(s)
- Laserina O'Connor
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Alice Coffey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Mary Casey
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Martin McNamara
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Sean Paul Teeling
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Jane O'Doherty
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Marlize Barnard
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Yvonne Corcoran
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Carmel Davies
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Timothy Frawley
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Denise O'Brien
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Catherine Redmond
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Rita Smith
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Suja Somanadhan
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Carmel Bradshaw
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Dympna Tuohy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Anne Gallen
- Director of Nursing and Midwifery Planning and Development Unit (NMPDU), Health Service Executive North West, Donegal, Ireland
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13
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O'Connor L, Coffey A, Lambert V, Casey M, McNamara M, Teeling SP, O'Doherty J, Barnard M, Corcoran Y, Davies C, Doody O, Frawley T, O'Brien D, Redmond C, Smith R, Somanadhan S, Noonan M, Bradshaw C, Tuohy D, Gallen A. Quality care metrics (QC-M) in nursing and midwifery care processes: a rapid realist review (RRR) protocol. HRB Open Res 2020; 3:85. [PMID: 33564745 PMCID: PMC7848854 DOI: 10.12688/hrbopenres.13120.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 04/01/2024] Open
Abstract
Background: In 2018, the Office of the Nursing and Midwifery Services Director (ONMSD) completed phase one of work which culminated in the development and launch of seven research reports with defined suites of quality care process metrics (QC-Ms) and respective indicators for the practice areas - acute care, midwifery, children's, public health nursing, older persons, mental health and intellectual disability nursing in Ireland. This paper presents a rapid realist review protocol that will systematically review the literature that examines QC-M in practice; what worked, or did not work for whom, in what contexts, to what extent, how and why? Methods : The review will explore if there are benefits of using the QC-Ms and what are the contexts in which these mechanisms are triggered. The essence of this rapid realist review is to ascertain how a change in context generates a particular mechanism that produces specific outcomes. A number of steps will occur including locating existing theories on implementation of quality care metrics, searching the evidence, selecting relevant documents, data extraction, validation of findings, synthesising and refining programme theory. This strategy may help to describe potential consequences resulting from changes in context and their interactions with mechanisms. Initial theories will be refined throughout the process by the local reference panel, comprised of eight key intervention stakeholders, knowledge users such as healthcare professionals and an expert panel. Ethical approval is not required for this rapid realist review. Conclusion: It is anticipated that the final programme theory will help to explain how QC-Ms work in practice; for whom, why and in what circumstances. Findings of this review could help to give insights into realism as a framework and how nursing and midwifery QC-Ms have been implemented previously.
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Affiliation(s)
- Laserina O'Connor
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Alice Coffey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Mary Casey
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Martin McNamara
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Sean Paul Teeling
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Jane O'Doherty
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Marlize Barnard
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Yvonne Corcoran
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Carmel Davies
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Timothy Frawley
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Denise O'Brien
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Catherine Redmond
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Rita Smith
- UCD Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Suja Somanadhan
- School of Nursing Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Carmel Bradshaw
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Dympna Tuohy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Anne Gallen
- Director of Nursing and Midwifery Planning and Development Unit (NMPDU), Health Service Executive North West, Donegal, Ireland
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14
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Dolu İ, Naharcı Mİ, Logan PA, Paal P, Vaismoradi M. Transitional 'hospital to home' care of older patients: healthcare professionals' perspectives. Scand J Caring Sci 2020; 35:871-880. [PMID: 32852086 DOI: 10.1111/scs.12904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transitional care is a key area of care provision to older people with chronic and complex health conditions and is associated with the quality of care delivered in the healthcare system. AIMS This study aimed to explore the perspectives of healthcare providers, including nurses and physicians, regarding transitional care from hospital to home in an urban area of Turkey. METHODS A qualitative study using a thematic analysis method was carried out. In-depth semi-structured interviews were held with eight clinical nurses and five general physicians involved in the provision of healthcare services to older patients in the transitional care process from hospital to home. FINDINGS The thematic analysis of in-depth semi-structured interviews with 13 healthcare professionals led to the development of the following themes: 'uninterrupted chain of care transfer', 'commitment to meet patient's needs' and 'support and removing ambiguities'. CONCLUSIONS Key factors impacting on the quality and safety of transitional care and continuity of healthcare are communication and collaboration between healthcare staff and settings, and older patients' as well as family caregivers' awareness and their feelings of responsibility towards the continuity of care at home.
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Affiliation(s)
- İlknur Dolu
- Faculty of Health Science, Bartin University, Bartın, Turkey
| | - Mehmet İlkin Naharcı
- Division of Geriatrics, Gulhane Faculty of Medicine & Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Patricia A Logan
- Faculty of Science, Charles Sturt University, Bathurst, NSW, Australia
| | - Piret Paal
- WHO Collaborating Centre at the Institute for Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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15
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Weetman K, Dale J, Spencer R, Scott E, Schnurr S. GP perspectives on hospital discharge letters: an interview and focus group study. BJGP Open 2020; 4:bjgpopen20X101031. [PMID: 32398346 PMCID: PMC7330207 DOI: 10.3399/bjgpopen20x101031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Written discharge communication following inpatient or outpatient clinic discharge is essential for communicating information to the GP, but GPs' opinions on discharge communication are seldom sought. Patients are sometimes copied into this communication, but the reasons for this variation, and the resultant effects, remain unclear. AIM To explore GP perspectives on how discharge letters can be improved in order to enhance patient outcomes. DESIGN & SETTING The study used narrative interviews with 26 GPs from 13 GP practices within the West Midlands, England. METHOD Interviews were transcribed and data were analysed using corpus linguistics (CL) techniques. RESULTS Elements pivotal to a successful letter were: diagnosis, appropriate follow-up plan, medication changes and reasons, clinical summary, investigations and/or procedures and outcomes, and what information has been given to the patient. GPs supported patients receiving discharge letters and expounded a number of benefits of this practice; for example, increased patient autonomy. Nevertheless, GPs felt that if patients are to receive direct discharge letter copies, modifications such as use of lay language and avoidance of acronyms may be required to increase patient understanding. CONCLUSION GPs reported that discharge letters frequently lacked content items they assessed to be important; GPs highlighted that this can have subsequent ramifications on resources and patient experiences. Templates should be devised that put discharge letter elements assessed to be important by GPs to the forefront. Future research needs to consider other perspectives on letter content, particularly those of patients.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Rachel Spencer
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
| | - Emma Scott
- Unit of Academic Primary Care, University of Warwick, Warwick Medical School, Coventry, UK
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16
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Weetman K, Dale J, Scott E, Schnurr S. Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews. BMC Health Serv Res 2020; 20:537. [PMID: 32539716 PMCID: PMC7294646 DOI: 10.1186/s12913-020-05250-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND UK government guidelines and initiatives emphasise equity in delivery of care, shared decision-making, and patient-centred care. This includes sharing information with patients as partners in health decisions and empowering them to manage their health effectively. In the UK, general practitioners (GPs) routinely receive hospital discharge letters; while patients receiving copies of such letters is seen as "good practice" and recommended, it is not standardised. The effects and consequences of whether or not this happens remains unclear. The aim of this study (one of three forming the Discharge Communication Study) was to explore patient perspectives on receiving discharge letters and their views on how this could be improved in order to optimise patient experience and outcomes. METHODS Semi-structured interviews were conducted with a diverse sample of 50 patients recruited from 17 GP surgeries within the West Midlands, UK. All participants were adults with a recent episode of general hospital inpatient or outpatient care. Data were audio recorded, transcribed and analysed using mixed methods corpus linguistics techniques. RESULTS Participants reported inconsistent access to discharge letters. Most wanted to receive a copy of their discharge letter although some expressed reservations. Perceived benefits included: increased understanding of their condition and treatment, reduced anxiety, and increased satisfaction. Consequences where participants had not received letters included: letter inaccuracies being overlooked, missed follow up actions, failure to fully remember diagnosis, treatment, or self-management or recommendations, and confusion and anxiety at what occurred and what will happen next. Participants felt the usefulness of receiving copies of letters could be increased by: including a patient information section, avoidance of acronyms, and jargon or technical terms explained with lay language. CONCLUSIONS Most patients value receiving copies of hospital discharge letters, and should be consistently offered them. Patients' preferences for letter receipt could be logged in their health records. To enable positive outcomes letters should have a clear and accessible format that reflects the priorities and information needs of patients. Patients appear not to be receiving or being offered copies of letters consistently despite UK policies and guidelines supporting this practice; this suggests a need for greater standardisation of practice.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Emma Scott
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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17
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18
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Weetman K, Dale J, Scott E, Schnurr S. The Discharge Communication Study: research protocol for a mixed methods study to investigate and triangulate discharge communication experiences of patients, GPs, and hospital professionals, alongside a corresponding discharge letter sample. BMC Health Serv Res 2019; 19:825. [PMID: 31711500 PMCID: PMC6849198 DOI: 10.1186/s12913-019-4612-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Discharge letters are crucial during care transitions from hospital to home. Research indicates a need for improvement to increase quality of care and decrease adverse outcomes. These letters are often sent from the hospital discharging physician to the referring clinician, typically the patient's General Practitioner (GP) in the UK, and patients may or may not be copied into them. Relatively little is known about the barriers and enablers to sending patients discharge letters. Hence, the aim of this study was to investigate from GP, hospital professional (HP) and patient perspectives how to improve processes of patients receiving letters and increase quality of discharge letters. The study has a particular focus on the impacts of receiving or not receiving letters on patient experiences and quality of care. METHODS The setting was a region in the West Midlands of England, UK. The research aimed to recruit a minimum of 30 GPs, 30 patients and 30 HPs in order to capture 90 experiences of discharge communication. Participating GPs initially screened and selected a range of recent discharge letters which they assessed to be successful and unsuccessful exemplars. These letters identified potential participants who were invited to take part: the HP letter writer, GP recipient and patient. Participant viewpoints are collected through interviews, focus groups and surveys and will be "matched" to the discharge letter sample, so forming multiple-perspective "quartet" cases. These "quartets" allow direct comparisons between different discharge experiences within the same communicative event. The methods for analysis draw on techniques from the fields of Applied Linguistics and Health Sciences, including: corpus linguistics; inferential statistics; content analysis. DISCUSSION This mixed-methods study is novel in attempting to triangulate views of patients, GPs and HPs in relation to specific discharge letters. Patient and practitioner involvement will inform design decisions and interpretation of findings. Recommendations for improving discharge letters and the process of patients receiving letters will be made, with the intention of informing guidelines on discharge communication. Ethics approval was granted in July 2017 by the UK Health Research Authority. Findings will be disseminated in peer-reviewed journals, reports and newsletters, and presentations.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Emma Scott
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Stephanie Schnurr
- Centre for Applied Linguistics, University of Warwick, Coventry, CV4 7AL UK
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