1
|
Moradi Rekabdar Kalaiee Z, Ghafouri R, Zandi M, Nasiri M. Effect of implementing of the IDEAL discharge model on satisfaction of patient referred to trauma emergency department. PLoS One 2024; 19:e0304969. [PMID: 38870177 PMCID: PMC11175502 DOI: 10.1371/journal.pone.0304969] [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: 10/12/2023] [Accepted: 05/11/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Patient education at the time of discharge is one of the most important challenges in the emergency department. This study aimed to evaluate the Effect of implementing the IDEAL, or integrated discharge model, on the satisfaction of patients referred to the trauma emergency department. METHODS This quasi-experimental study was conducted on the patients referred to the trauma emergency department of Imam Hossein Hospital in Tehran. Eighty-six patients were recruited from January 20, 2023, until July 30, 2023. In the intervention group, the educational content was taught using the IDEAL (Inclusion, Discussion, Education, Assessment, Listening) or integrated discharge model, and in the control group, it was taught using the emergency department routine method. The satisfaction questionnaire of the emergency department was completed before and after the education in both groups and compared between the two groups. The data were analyzed by using SPSS (version 20) software. RESULTS The results showed that out of the 86 participating patients, 52 (60.5%) were male and 34 (39.5%), with a mean (Standard Deviation) of 39.14 (10.89) years old. Demographic characteristics were homogeneous between the two groups (P > 0.05). The mean (standard deviation) of satisfaction of the participants after education, totally was 63.56 (16.21), in the intervention group it was 77.37 (7.95), and in the Control group it was 49.74 (8.84). The mean (SD) participants satisfaction on arrival at the emergency department in the intervention group was 19.16 (2.75) and in the control group was 13.51 (2.51), during hospitalization in the intervention group was 10.72 (1.77) and in the Control group 6.74 (1.81), discharge time in the intervention group 14.51 (2.93) and in the control group 2.93 (2.04), Overall satisfaction with nursing care in intervention group 13.85 (2.46) and in the control group 8.46 (2.41), Overall satisfaction with medical procedures in the intervention group 12.81 (2.73) and in the control group 8.58 (3.20) and Overall patient satisfaction in the intervention group 2.27 (1.81) and 41.4 (1.66) in the control group. An independent T-test was used to compare satisfaction and its dimensions in two groups, and there was a statistically significant difference between the two groups (P<0.01). CONCLUSION The study results showed a statistically significant difference in the satisfaction in the intervention and control groups, so it can be concluded that conducting the integrated discharge model is effective in increasing the satisfaction of trauma patients. Therefore, it is recommended to use this educational method to increase patient satisfaction and decrease readmission rates.
Collapse
Affiliation(s)
- Zahra Moradi Rekabdar Kalaiee
- Student Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Raziyeh Ghafouri
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Zandi
- Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Basic Sciences, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Chang E, Mello K, Paskal S, Dill M, Miner LA. The Development and Implementation of an Evidence-Based Tumescent Liposuction Protocol, Online Educational Course for Perioperative Staff, and Discharge Instructions: A Quality Improvement Project. J Perianesth Nurs 2024; 39:24-31. [PMID: 37843482 DOI: 10.1016/j.jopan.2023.06.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The purpose of this quality improvement project was to improve perioperative management of patients undergoing tumescent liposuction (TL) through the development and implementation of a perioperative evidence-based protocol, educational course for perioperative staff, and patient discharge instructions. DESIGN The TL protocol was validated using the modified Delphi process. The educational course and discharge instructions used a pre and postimplementation design. METHODS An evidence-based protocol, an educational course for perioperative staff, and readable discharge instructions for patients undergoing TL were developed in accordance with best practice guidelines. The protocol was validated by subject matter experts at the facility and submitted for adoption. The evidence-based educational course was implemented, and the effectiveness of the course was evaluated for improving providers' knowledge and self-confidence. The evidence-based discharge instructions were implemented and evaluated for patient satisfaction and readability. FINDINGS Three items were removed from the protocol, 2 items were modified, and 25 items were accepted with no change from modified Delphi analysis. Provider knowledge scores improved from 85.7% ± 16.18 to 97.1% ± 4.88; however, this was not statistically significant (P = .066). There was a trend toward improved confidence scores (P = .180). Overall patient satisfaction scores slightly improved postimplementation; results were not statistically significant (P > .05). CONCLUSIONS All three phases of perioperative care in patients receiving TL were evaluated, reflecting best practice guidelines and successful adoption. There was no statistically significant improvement in provider knowledge, provider self-confidence, or patient satisfaction. A small sample size was a significant limiting factor.
Collapse
Affiliation(s)
| | - Kendall Mello
- University of Pittsburgh School of Nursing, Pittsburgh, PA
| | | | - Megan Dill
- University of Pittsburgh School of Nursing, Pittsburgh, PA.
| | - Laurel A Miner
- University of Pittsburgh School of Nursing, Pittsburgh, PA
| |
Collapse
|
3
|
Press Ganey: Patient-Centered Communication Drives Provider and Hospital Revenue. Plast Reconstr Surg 2021; 147:526-535. [PMID: 33565840 DOI: 10.1097/prs.0000000000007591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spurred on in part by government policies that base a portion of reimbursement around patient satisfaction, in 2016, Texas Children's Hospital instituted a patient-focused communication course entitled Breakthrough Communication. The aim of this study is to examine the effect of this training on provider-specific Press Ganey scores within the Department of Surgery, and to assess whether changes in Press Ganey scores correlate to hospital volume and revenue. METHODS The intervention period was defined as calendar year 2017. Full-time faculty between 2016 and 2018 who completed the course in 2017 and had at least 10 returned Press Ganey surveys before and after the course were included in this study. Patient volume and revenue were analyzed. A subgroup analysis was conducted to compare participant against nonparticipant plastic surgeons. RESULTS For the 56 surgeons who met the inclusion criteria, mean provider Press Ganey ratings increased from 92.0 to 94.3 following participation (p = 0.003). When compared to before intervention, clinical encounters increased by 26.2 percent, the number of patients increased by 26.0 percent, payments increased by 25.2 percent, and charges increased by 21.2 percent. In our subgroup analysis, there was a relative increase of 11 percent in the number of patients and 10 percent in the number of encounters for participant plastic surgeons. Participants reported 113 percent increases in charges and 71 percent increases in payments, whereas nonparticipants had decreases of 10 percent in charges and 4 percent in payments. CONCLUSION The authors' findings indicate that improving surgeons' patient-centered communication skills is associated with an increase in patient satisfaction and an accompanying increase in both volume and reimbursements.
Collapse
|
4
|
Facchinetti G, Albanesi B, Piredda M, Marchetti A, Ausili D, Ianni A, Di Mauro S, De Marinis MG. "The light at the end of the tunnel". Discharge experience of older patients with chronic diseases: A multi-centre qualitative study. J Adv Nurs 2021; 77:2417-2428. [PMID: 33591572 DOI: 10.1111/jan.14790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/02/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore the experiences of being discharged from hospital of older patients with chronic diseases at time of discharge. DESIGN Multi-centre descriptive qualitative study. METHODS Semi-structured interviews were conducted with older patients with chronic diseases discharged from two Italian university hospitals, between March 2017 and October 2019. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis. Several strategies were used to ensure the credibility, dependability, confirmability, authenticity and transferability of the findings. The study was reported in accordance with Standards for Reporting Qualitative Research and Consolidated criteria for reporting qualitative research. RESULTS Sixty-five patients participated in the study. Six main categories emerged: feelings, need for information, time of fragility, need for support, need for trusting relationships, and home as a caring place. CONCLUSION Older patients with chronic diseases are patients who require quality discharge planning with a patient-centred care vision. Healthcare professionals should intervene more extensively and deeply in the discharge process, balancing the patients' perception of their needs against organizational priorities and the wish to return home with that of not being abandoned. IMPACT Discharge from hospital remains an area of concern as older people have varying degrees of met and unmet needs during and following hospital discharge. Discharge is characterized by conflicting feelings of patients, who need information and support of healthcare professionals through trusting and continuous relationships. Understanding the experience of discharge is essential to support older patients with chronic diseases, considering that discharge from hospital is not an end point of care but a stage of the process involving care transition. The reframing of discharge as another transition point is crucial for healthcare professionals, who will be responsible for making their patients fit for discharge by preparing them to manage their chronic condition at home.
Collapse
Affiliation(s)
- Gabriella Facchinetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy.,Department of Biomedicine and Prevention, School of Nursing, Faculty of Medicine, Tor Vergata University, Rome, Italy
| | - Beatrice Albanesi
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy.,Department of Biomedicine and Prevention, School of Nursing, Faculty of Medicine, Tor Vergata University, Rome, Italy
| | - Michela Piredda
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico di Roma University, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Ianni
- Research Unit in Hygiene, Statistics and Public Health, Campus Bio Medico University Medical School, Rome, Italy.,Medical Directorate, Campus Bio-Medico University Hospital and Healthcare Facilities, Rome, Italy
| | - Stefania Di Mauro
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | |
Collapse
|
5
|
Beyond Access Block: Understanding the Role of Health Literacy and Self-Efficacy in Low-Acuity Emergency Department Patients. Ochsner J 2020; 20:161-169. [PMID: 32612470 PMCID: PMC7310186 DOI: 10.31486/toj.19.0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Health literacy, self-efficacy, and patient satisfaction are factors associated with healthcare utilization. The relationships among these factors and their combined impact on patients’ self-rated health have historically been studied in chronic disease populations. This study assessed low-acuity emergency department (ED) patients’ ratings of these factors, the relationships among these factors, and their effect on re-presentation rates to the ED. Methods: In this single-arm cohort survey, patients provided demographic data, completed health literacy and self-efficacy assessments prior to being seen by a physician, and completed a discharge perceptions questionnaire that included a global satisfaction question at the time of departure. Three months later, patients answered a telephone survey to measure post-ED visit health outcomes. Results: Health literacy (r=0.114, P=0.023) and self-efficacy (r=0.469, P<0.001) were both independently and positively associated with self-rated health. Neither factor was associated with patient satisfaction. Self-rated health was negatively associated with return ED visits (r=–0.137, P=0.011). Conclusion: Existing research shows that health literacy has a linear association with self-efficacy and self-rated health. The results of this study suggest that in the context of low-acuity ED patients, health literacy and self-efficacy affect patients’ understanding of their health status (self-rated health) but do not lead to better utilization of healthcare resources. Improvement of health literacy and self-efficacy, specifically to increase self-rated health, may provide a future avenue of intervention to reduce low-acuity ED patient re-presentation.
Collapse
|
6
|
Patra KP, Mains N, Dalton C, Welsh J, Iheonunekwu C, Dai Z, Murray PJ, Fisher ES. Improving Discharge Outcomes by Using a Standardized Risk Assessment and Intervention Tool Facilitated by Advanced Pediatric Providers. Hosp Pediatr 2020; 10:173-180. [PMID: 31969382 PMCID: PMC6986902 DOI: 10.1542/hpeds.2019-0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Pediatric discharge from the inpatient setting is a complex, error-prone process. In this study, we evaluated the outcomes of using a standardized process for hospital discharge of pediatric patients. METHODS A 1-year pre- and postintervention pilot study was designed to improve discharge transition of care. The bundle intervention, facilitated by advanced practice providers, included risk identification and intervention. Process and outcome metrics included patient satisfaction measures on the discharge domain (overall discharge, speed of discharge process, whether they felt ready for discharge), use of handouts, scheduling of follow-up appointments, and postdischarge phone call. RESULTS Significant improvements were found in all aspects of patient satisfaction, including speed of the discharge process and instructions for discharge, discharge readiness, and the overall discharge process. Length of stay decreased significantly after intervention. The checklist identified ∼4% of discharges without a correct primary care physician. Significant differences were found for scheduled primary care appointment before discharge and patients receiving handouts. The bundle identified risks that may complicate transition of care in approximately half of the patients. Phone communication occurred with almost half of the patients after discharge. CONCLUSIONS Integration of an evidence-based discharge checklist can improve processes, increase delivery of patient education, and improve patient and family perceptions of the discharge process. Involvement of key stakeholders, use of evidence-based interventions with local adaptation, and use of a consistent provider responsible for implementation can improve transitions of care.
Collapse
Affiliation(s)
| | | | | | | | | | - Zheng Dai
- School of Public Health, West Virginia University, Morgantown, West Virginia
| | | | - Erin S Fisher
- Department of Pediatrics, University of California, San Diego and Rady Children's Hospital-San Diego, San Diego, California
| |
Collapse
|
7
|
McCaffrey R, Hale D, Kunupakaphun S, Kaufman L, Eamranond P. A Multifaceted Approach to Improve Physician Communication Scores. J Patient Exp 2019; 7:522-526. [PMID: 33062873 PMCID: PMC7534122 DOI: 10.1177/2374373519860041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Improving patient satisfaction scores has become a key focus of health-care organizations nationwide but can be a struggle for community hospitals with constrained resources, and particularly challenging for hospitalist programs due to provider variance and turnover. Using the framework of appreciative inquiry, we implemented a multipronged intervention including a rounding model whereby hospitalist leaders rounded on patients and relayed commentary back to their hospitalist providers. We communicated positive feedback preferentially over negative feedback to the entire hospitalist group through regular communication. Providers were encouraged to employ best practices including sitting with the patient, reviewing recommendations using teach back, and providing business cards. Scores improved in the physician communication category by approximately 1% annually from fiscal year 2015 through 2018, with our percentile rank improving 35 percentile points during that time. These findings indicate that a multifaceted approach including best practices is associated with improved patient experience regarding communication with physicians.
Collapse
Affiliation(s)
| | - Dane Hale
- Lawrence General Hospital, Lawrence, MA, USA
| | | | - Laura Kaufman
- Lawrence General Hospital, Lawrence, MA, USA.,Greater Lawrence Family Health Center, Lawrence, MA, USA
| | - Pracha Eamranond
- Lawrence General Hospital, Lawrence, MA, USA.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
DeStephano CC, Gajarawala SP, Espinal M, Heckman MG, Vargas ER, Robertson MA. Discharge Readiness after Robotic and Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2019; 26:910-918. [DOI: 10.1016/j.jmig.2018.09.766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/24/2022]
|
9
|
Webster CS, Jowsey T, Lu LM, Henning MA, Verstappen A, Wearn A, Reid PM, Merry AF, Weller JM. Capturing the experience of the hospital-stay journey from admission to discharge using diaries completed by patients in their own words: a qualitative study. BMJ Open 2019; 9:e027258. [PMID: 30862638 PMCID: PMC6429883 DOI: 10.1136/bmjopen-2018-027258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To capture and better understand patients' experience during their healthcare journey from hospital admission to discharge, and to identify patient suggestions for improvement. DESIGN Prospective, exploratory, qualitative study. Patients were asked to complete an unstructured written diary expressed in their own words, recording negative and positive experiences or anything else they considered noteworthy. PARTICIPANTS AND SETTING Patients undergoing vascular surgery in a metropolitan hospital. PRIMARY OUTCOME MEASURES Complete diary transcripts underwent a general inductive thematic analysis, and opportunities to improve the experience of care were identified and collated. RESULTS We recruited 113 patients in order to collect 80 completed diaries from 78 participants (a participant response rate of 69%), recording patients' experiences of their hospital-stay journey. Participating patients were a median (range) age of 69 (21-99) years and diaries contained a median (range) of 197 (26-1672) words each. Study participants with a tertiary education wrote more in their diaries than those without-a median (range) of 353.5 (48-1672) vs 163 (26-1599) words, respectively (Mann-Whitney U test, p=0.001). Three primary and eight secondary themes emerged from analysis of diary transcripts-primary themes being: (1) communication as central to care; (2) importance of feeling cared for and (3) environmental factors shaping experiences. In the great majority, participants reported positive experiences on the hospital ward. However, a set of 12 patient suggestions for improvement were identified, the majority of which could be addressed with little cost but result in substantial improvements in patient experience. Half of the 12 suggestions for improvement fell into primary theme 1, concerning opportunities to improve communication between healthcare providers and patients. CONCLUSIONS Unstructured diaries completed in a patient's own words appear to be an effective and simple approach to capture the hospital-stay experience from the patient's own perspective, and to identify opportunities for improvement.
Collapse
Affiliation(s)
- Craig S Webster
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Lucy M Lu
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Marcus A Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Antonia Verstappen
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Andy Wearn
- Medical Programme Directorate, University of Auckland, Auckland, New Zealand
| | - Papaarangi M Reid
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer M Weller
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|