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Xiong B, Stirling C, Bailey DX, Martin-Khan M. The implementation and impacts of the Comprehensive Care Standard in Australian acute care hospitals: a survey study. BMC Health Serv Res 2024; 24:800. [PMID: 38992627 PMCID: PMC11241846 DOI: 10.1186/s12913-024-11252-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 06/26/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Comprehensive care (CC) is becoming a widely acknowledged standard for modern healthcare as it has the potential to improve health service delivery impacting both patient-centred care and clinical outcomes. In 2019, the Australian Commission on Safety and Quality in Health Care mandated the implementation of the Comprehensive Care Standard (CCS). However, little is known about the implementation and impacts of the CCS in acute care hospitals. Our study aimed to explore care professionals' self-reported knowledge, experiences, and perceptions about the implementation and impacts of the CCS in Australian acute care hospitals. METHODS An online survey using a cross-sectional design that included Australian doctors, nurses, and allied health professionals in acute care hospitals was distributed through our research team and organisation, healthcare organisations, and clinical networks using various methods, including websites, newsletters, emails, and social media platforms. The survey items covered self-reported knowledge of the CCS and confidence in performing CC, experiences in consumer involvement and CC plans, and perceptions of organisational support and impacts of CCS on patient care and health outcomes. Quantitative data were analysed using Rstudio, and qualitative data were analysed thematically using Nvivo. RESULTS 864 responses were received and 649 were deemed valid responses. On average, care professionals self-reported a moderate level of knowledge of the CCS (median = 3/5) and a high level of confidence in performing CC (median = 4/5), but they self-reported receiving only a moderate level of organisational support (median = 3/5). Only 4% (n = 17) of respondents believed that all patients in their unit had CCS-compliant care plans, which was attributed to lack of knowledge, motivation, teamwork, and resources, documentation issues, system and process limitations, and environment-specific challenges. Most participants believed the CCS introduction improved many aspects of patient care and health outcomes, but also raised healthcare costs. CONCLUSION Care professionals are confident in performing CC but need more organisational support. Further education and training, resources, multidisciplinary collaboration, and systems and processes that support CC are needed to improve the implementation of the CCS. Perceived increased costs may hinder the sustainability of the CCS. Future research is needed to examine the cost-effectiveness of the implementation of the CCS.
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Affiliation(s)
- Beibei Xiong
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, 4102, Australia.
| | | | - Daniel X Bailey
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, 4102, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, 4102, Australia
- Department of Health and Life Sciences, University of Exeter, EX1 2HZ, Exeter, England, United Kingdom
- School of Nursing, University of Northern British Columbia, British Columbia, V2N 4Z9, Prince George, Canada
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Davey N, Connolly E, Mc Elwaine P, Kennelly SP. A Systematic Review of Falls Risk of Frail Patients with Dementia in Hospital: Progress, Challenges, and Recommendations. Clin Interv Aging 2024; 19:1127-1139. [PMID: 38948169 PMCID: PMC11214555 DOI: 10.2147/cia.s400582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/15/2024] [Indexed: 07/02/2024] Open
Abstract
This review article assesses the effectiveness and limitations of strategies to reduce falls among hospitalized older adults with frailty and dementia. It explores the efficacy of existing fall prevention strategies for a cohort that is acutely susceptible to falls and fall-related consequences. A systematic literature search was conducted across MEDLINE, Embase, CINAHL, and PsycINFO, employing Medical Subject Headings (MeSH) to identify studies on fall prevention strategies in hospitalized older adults with both dementia and frailty published from 2013 to 2023. The initial 643 records were distilled to eight articles, with Structured Interdisciplinary Bedside Rounds (SIBR) emerging as a notable intervention. SIBR demonstrated a reduction in falls by fostering improved interdisciplinary communication and care planning. However, a decline in family engagement during consecutive sessions suggests a need for strategies to sustain familial involvement. The findings advocate for patient-centered interventions that address the cognitive and functional challenges faced by this cohort of older adults. This review advocates for comprehensive and inclusive research in hospital environments to improve fall prevention strategies for frail older adults with dementia.
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Affiliation(s)
- Naomi Davey
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Eimear Connolly
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Paul Mc Elwaine
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age Related Healthcare, Tallaght University Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
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Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
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4
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Buchanan CJ, Young E, Mastalerz KA. Engaging resident physicians in the design, implementation, and assessment of bedside interdisciplinary rounds. J Interprof Care 2024; 38:469-475. [PMID: 36814080 DOI: 10.1080/13561820.2023.2176471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/28/2022] [Accepted: 01/07/2023] [Indexed: 02/24/2023]
Abstract
Bedside interdisciplinary rounds (IDR) improve teamwork, communication, and collaborative culture in inpatient settings. Implementation of bedside IDR in academic settings depends on engagement from resident physicians; however, little is known about their knowledge and preferences related to bedside IDR. The goal of this program was to identify medical resident perceptions about bedside IDR and to engage resident physicians in the design, implementation, and assessment of bedside IDR in an academic setting. This is a pre-post mixed methods survey assessing resident physicians' perceptions surrounding a stakeholder-informed bedside IDR quality improvement project. Resident physicians in the University of Colorado Internal Medicine Residency Program (n = 77 pre-implementation survey responses from 179 eligible participants - response rate 43%) were recruited via e-mail to participate in surveys assessing perceptions surrounding the inclusion of interprofessional team members, timing, and preferred structure of bedside IDR. A bedside IDR structure was created based on input from resident and attending physicians, patients, nurses, care coordinators, pharmacists, social workers, and rehabilitation specialists. This rounding structure was implemented on acute care wards in June 2019 at a large academic regional VA hospital in Aurora, CO. Resident physicians were surveyed post implementation (n = 58 post-implementation responses from 141 eligible participants - response rate 41%) about interprofessional input, timing, and satisfaction with bedside IDR. The pre-implementation survey revealed several important resident needs during bedside IDR. Post-implementation survey results revealed high overall satisfaction with bedside IDR among residents, improved perceived efficiency of rounds, preserved quality of education, and value added by interprofessional input. Results also suggested areas for future improvement including timeliness of rounds and enhanced systems-based teaching. This project successfully engaged residents as stakeholders in system-level interprofessional change by incorporating their values and preferences into a bedside IDR framework.
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Affiliation(s)
- Cole J Buchanan
- Department of Internal Medicine, University of Colorado Internal Medicine Residency Program, Denver, CO, USA
| | - Eric Young
- Department of Hospital Medicine, Eastern Colorado VA Healthcare System, Aurora, CO, USA
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katarzyna A Mastalerz
- Department of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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5
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Schwartz JI, Gonzalez-Colaso R, Gan G, Deng Y, Kaplan MH, Vakos PA, Kenyon K, Ashman A, Sofair AN, Huot SJ, Chaudhry SI. Structured interdisciplinary bedside rounds improve interprofessional communication and workplace efficiency among residents and nurses on an inpatient internal medicine unit. J Interprof Care 2024; 38:427-434. [PMID: 33433262 DOI: 10.1080/13561820.2020.1863932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Abstract
Structured Interdisciplinary Bedside Rounds (SIBR) is a standardized, team-based intervention for hospitals to deliver high quality interprofessional care. Despite its potential for improving IPC and the workplace environment, relatively little is known about SIBR's effect on these outcomes. Our study aimed to assess the fidelity of SIBR implementation on an inpatient medicine teaching unit and its effects on perceived IPC and workplace efficiency. We conducted a quasi-experimental study with 88 residents and 44 nurses at a large academic medical center and observed 1308 SIBR encounters over 24 weeks. Of these 1308 encounters, the bedside nurse was present for 96.7%, physician for 97.6%, and care manager for 94.7, and 64.7% occurred at the bedside. Following SIBR implementation, perceived IPC improved significantly among residents (93.3% versus 67.9%, p < .024) and nurses (73.7% versus 36.0%, p < .008) compared to before implementation. Moreover, residents perceived greater workplace efficiency operationalized as being paged less frequently with questions by nurses (20.0% versus 49.1%, p = .01). No statistically significant improvements were reported regarding burnout, meaning at work, and workplace satisfaction. Our implementation of SIBR significantly improved perceived IPC and workplace efficiency, which are two important domains of healthcare quality. Future work should examine the impact of SIBR on patient-centered outcomes such as patient experience.
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Affiliation(s)
- Jeremy I Schwartz
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Geliang Gan
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Michael H Kaplan
- Department of Medicine, Icahn School of Medicine, New York, NY, USA
| | | | | | | | - Andre N Sofair
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Stephen J Huot
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sarwat I Chaudhry
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Fernandes CJ, Gautham KS. Organization of care of infants with congenital diaphragmatic hernia-Building a high-functioning CDH program. J Perinatol 2024; 44:339-347. [PMID: 37798339 DOI: 10.1038/s41372-023-01789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/09/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
Infants born with congenital diaphragmatic hernia have high mortality and morbidity and require coordinated multidisciplinary care for optimal outcomes. Over the past several decades numerous articles have been published on the technical aspects of the care of these patients demonstrating both the variation in management across institutions as well as the desirability and need for standardization of care. Unfortunately, none have focused on the organization of care for CDH patients encompassing the range from early prenatal diagnosis to long-term postnatal care. However, to achieve optimal care and optimal outcomes, it is important to not only have excellent technical surgical and medical care but also to have an organized, systematic, and purposefully designed program for the delivery of healthcare to infants with this condition. In this article, based on our experience and drawing on general principles of building clinical programs, we describe the important elements of an ideal CDH program.
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Affiliation(s)
- Caraciolo J Fernandes
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA.
| | - Kanekal S Gautham
- Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, FL, USA
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7
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Mastalerz KA, Jordan SR, Townsley N. "We're all truly pulling in the exact same direction": A qualitative study of attending and resident physician impressions of structured bedside interdisciplinary rounds. J Hosp Med 2024; 19:92-100. [PMID: 38230802 DOI: 10.1002/jhm.13272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/01/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Physicians often hold leadership roles in implementing interdisciplinary rounds (IDR) in clinical settings, thus understanding physician perspectives of bedside IDR is crucial. OBJECTIVE To understand physicians' perspectives of structured bedside IDR. DESIGN Qualitative descriptive study. SETTING AND PARTICIPANTS Medical and transitional year resident and hospitalist physicians participating in structured bedside IDR in a community teaching hospital affiliated with a large academic center. METHODS We conducted semi-structured interviews and focus groups with study participants about their experiences with participating in structured bedside IDR between July 2017 and April 2018. All interviews were recorded and professionally transcribed. We used thematic analysis to identify key themes. RESULTS We interviewed 41 resident physicians and 10 hospitalist physicians and discovered five key themes that highlight physician impressions of bedside IDR. Bedside IDR decreased unnecessary care, screened for risks/errors, created a shared mental model of care, and increased physician empathy for the patient and the interprofessional care team. Physicians felt patients valued the streamlined communication they experienced but questioned the intrusiveness of large healthcare teams. Challenges to bedside IDR included the meaningful engagement of key stakeholders and, particularly for resident physicians, the difficultly of managing unstandardized communication in a standardized time-sensitive setting. CONCLUSIONS Structured bedside IDR have the capacity to improve patient care, interprofessional teamwork, and physician empathy for patients and the interprofessional team. However, sustained leadership support and clearly defined rounds goals and objectives are necessary ingredients to maximize the benefits and address the challenges of bedside IDR.
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Affiliation(s)
- Katarzyna A Mastalerz
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah R Jordan
- Division of Healthcare Services, Molina Healthcare of Illinois, Oak Brook, Illinois, USA
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Vinci A, Furia G, Cammalleri V, Colamesta V, Chierchini P, Corrado O, Mammarella A, Ingravalle F, Bardhi D, Malerba RM, Carnevale E, Gentili S, Damiani G, De Vito C, Maurici M. Burden of delayed discharge on acute hospital medical wards: A retrospective ecological study in Rome, Italy. PLoS One 2024; 19:e0294785. [PMID: 38265995 PMCID: PMC10807762 DOI: 10.1371/journal.pone.0294785] [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: 07/05/2023] [Accepted: 11/09/2023] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Delayed discharge represents the difficulty in proceeding with discharge of patients who do not have any further benefit from prolonged stay. A quota of this problem is related to organizational issues. In the Lazio region in Italy, a macro service re-organization in on the way, with a network of hospital and territorial centers engaged in structuring in- and out- of hospital patient pathways, with a special focus on intermediate care structures. Purpose of this study is to quantify the burden of delayed discharge on a single hospital structure, in order to estimate costs and occurrence of potential resource misplacement. MATERIAL AND METHODS Observational Retrospective study conducted at the Santo Spirito Hospital in Rome, Italy. Observation period ranged from 1/09/2022, when the local database was instituted, to 1/03/2023 (6 months). Data from admissions records was anonymously collected. Data linkage with administrative local hospital database was performed in order to identify the date a discharge request was fired for each admission. Surgical discharges and Intensive Care Unit (ICU) discharges were excluded from this study. A Poisson hierarchical regression model was employed to investigate for the role of ward, Severity of Disease (SoD) and Risk of Mortality (RoM) on elongation of discharge time. RESULTS 1222 medical ward admissions were recorded in the timeframe. 16% of them were considered as subject to potentially elongated stay, and a mean Delay in discharge of 6.3 days (SD 7.9) was observed. DISCUSSION AND CONCLUSIONS Delayed discharge may cause a "bottleneck" in admissions and result in overcrowded Emergency Department, overall poor performance, and increase in overall costs. A consisted proportion of available beds can get inappropriately occupied, and this inflates both direct and indirect costs. Clinical conditions on admission are not a good predictor of delay in discharge, and the root causes of this phenomenon likely lie in organizational issues (on structure\system level) and social issues (on patient's level).
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Affiliation(s)
- Antonio Vinci
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
- Doctoral School of Nursing Sciences and Public Health, University of Rome “Tor Vergata”, Rome, Italy
| | - Giuseppe Furia
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Vittoria Cammalleri
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Vittoria Colamesta
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Patrizia Chierchini
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Ornella Corrado
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Assunta Mammarella
- Hospital Health Management Area, Local Health Authority “ASL Roma 1”, Rome, Italy
| | - Fabio Ingravalle
- Doctoral School of Nursing Sciences and Public Health, University of Rome “Tor Vergata”, Rome, Italy
- Hospital Health Management Area, Local Health Authority “ASL Roma 6”, Albano Laziale, Italy
| | - Dorian Bardhi
- Post-Graduate School of Hygiene and Preventive Medicine, University of L’Aquila, L’Aquila, Italy
| | - Rosa Maria Malerba
- School of Specialization in Hygiene and Public Health, University of Rome “Tor Vergata”, Rome, Italy
| | - Edoardo Carnevale
- School of Specialization in Hygiene and Public Health, University of Rome “Tor Vergata”, Rome, Italy
| | - Susanna Gentili
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Gianfranco Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
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Horvey K, Nairn Pederson L, Bath B, St Pierre D. "The right thing for our patients": perspectives of physical therapists transitioning to a 7 day a week service in an urban acute care center in Canada. Physiother Theory Pract 2023; 39:2377-2390. [PMID: 35587372 DOI: 10.1080/09593985.2022.2078254] [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: 10/11/2021] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND True seven day a week acute care physical therapy (PT) coverage is rare. Our facility is one of a few in Canada that has increased weekend PT coverage on medicine units to seven days of full PT staffing levels. OBJECTIVE This article investigates the perspectives of physical therapists involved in the change with the focus on the emotional experiences of those therapists. METHODS Thematic analysis of interview and focus group transcripts with 18 physical therapist and 2 manager participants were aligned with four themes of: 1) optimism, hope and excitement; 2) frustration, guilt, and resentment; 3) fear, anxiety, uncertainty, and vulnerability; and 4) ambivalence, neutrality, and impartiality. RESULTS Although there were several perceived benefits to quality of care and work/life balance, participants' comments also reflected: frustration, guilt, and resentment related to the rapid implementation of the change and the impact of altered work schedules. CONCLUSIONS Participants emphasized the need to discuss large changes with staff prior to implementation in order to prevent frustration and resentment. Participants also felt that increased acute care PT coverage over seven days is valuable, but other allied health professions also need a proportional increase in staffing to improve hospital flow.
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Affiliation(s)
- Karla Horvey
- Saskatchewan Health Authority, St. Paul's Hospital Interprofessional Practice Department, Saskatoon, SK, Canada
| | - Lacey Nairn Pederson
- Saskatchewan Health Authority, St. Paul's Hospital Interprofessional Practice Department, Saskatoon, SK, Canada
| | - Brenna Bath
- School of Rehabilitation Sciece, University of Saskatchewan, Saskatoon, SK, Canada
| | - Denise St Pierre
- Saskatchewan Health Authority, St. Paul's Hospital Interprofessional Practice Department, Saskatoon, SK, Canada
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Valente R, Santori G, Stanton L, Abraham A, Thaha MA. Introducing a structured daily multidisciplinary board round to safely enhance surgical ward patient flow in the bed shortage era: a quality improvement research report. BMJ Open Qual 2023; 12:bmjoq-2021-001669. [PMID: 36972925 PMCID: PMC10069591 DOI: 10.1136/bmjoq-2021-001669] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/12/2023] [Indexed: 03/29/2023] Open
Abstract
Hospital bed shortage is a worldwide concern. Their unavailability has caused elective surgery cancellations at our hospital peaking in spring 2016 at over 50%. This is often due to difficult patient step-down from intensive care (ICU) and high-dependency units (HDU). In our general/digestive surgery service admitting approximately 1000 patients yearly, ward rounds were run on a consultant firm basis.We report quality improvement (ISRCTN13976096) after we introduced a structured daily multidisciplinary board round framework (SAFER Surgery R2G) adapted from the 'SAFER patient flow bundle' and the 'Red to Green days' approaches to enhance flow. We compare 2016-2017, when our framework was applied for 12 months.We used a Plan-Do-Study-Act (PDSA) methodology. Our intervention consisted in (1) systematically communicating the key care plan after the afternoon ward rounds to the nurse in charge; (2) 30' 10:00 hours Monday-to-Friday multidisciplinary board rounds, attended daily by the senior team and weekly by hospital and site managers, revising the key care plan to aim at safe, early discharges, assessing the appropriateness of each inpatient day and tackling any cause of delay. We measured patient flow by average length of stay (LOS), ICU/HDU step-downs and operation cancellations count, monitoring safety through early 30-day readmissions. Compliance was assessed by board round attendance and staff satisfaction rate surveys.After 12 months of intervention (PDSA-1-2, N=1032), compared with baseline (PDSA-0, N=954) average LOS significantly decreased from 7.2 (8.9) to 6.3 (7.4) days (p=0.003); ICU/HDU bed step-down flow increased by 9.3% from 345 to 375 (p=0.197), surgery cancellations dropped from 38 to 15 (p=0.100). 30-day readmissions increased from 0.9% (N=9) to 1.3% (N=14)(p=0.390). Average cross-specialty attendance was 80%. Satisfaction rates were >75%, regarding enhanced teamwork and faster decisions.The SAFER Surgery R2G framework has increased patient flow in the context of an enhanced multidisciplinary approach, requiring senior staff commitment to remain sustainable.
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Affiliation(s)
- Roberto Valente
- University College London, London, UK
- Barts and The London NHS Trust, London, UK
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
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11
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Halverson CC, Scott Tilley D. Creating a culture of support for nursing surveillance. Nurs Forum 2022; 57:1204-1212. [PMID: 36308313 DOI: 10.1111/nuf.12823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/26/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND An estimated 98,000 deaths annually result from medical errors. Preventing these deaths must be a US healthcare goal. Surveillance decreases adverse events. Surveillance is essential for patient safety. Creating a unit culture that supports surveillance requires attention to its antecedents (nurse education, nurse expertise, nurse staffing, as well as organizational culture). METHOD The current literature on topics salient to creating a culture of nursing surveillance including its antecedents and its attributes were reviewed. The findings are summarized and presented. DISCUSSION Suggestions and tools enhancing a culture of safety allow the transition from one set of behaviors to another. An organizational culture that strives for excellence promotes surveillance which results in improved patient outcomes and better qualified nurses. CONCLUSION Unit change resulting in support for surveillance can minimize failure to rescue and promote interruption of adverse events. The patient outcomes include decreased morbidity and mortality.
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Affiliation(s)
| | - Donna Scott Tilley
- Research and Clinical Scholarship, College of Nursing, Texas Woman's University, Denton, Texas, USA
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Morris M, Mulhall C, Murphy PJ, Eppich WJ. Interdisciplinary collaborative working on surgical ward rounds: reality or rhetoric? A systematic review. J Interprof Care 2022; 37:674-688. [DOI: 10.1080/13561820.2022.2115023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Marie Morris
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul J. Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter J. Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Chan SJ, Archibald HL, Conner SM. NET Rounding: a novel approach to efficient and effective rounds for the modern clinical learning environment. BMC MEDICAL EDUCATION 2022; 22:600. [PMID: 35927659 PMCID: PMC9351275 DOI: 10.1186/s12909-022-03599-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Rounds are a foundational practice in patient care and education in the inpatient healthcare environment, but increased demands on inpatient teams have led to dissatisfaction with inefficient, ineffective rounds. In this study, we describe the design, implementation, and evaluation of a novel rounding framework ("NET Rounding") that provides behaviorally-based strategies to inpatient teams to achieve efficient rounds while preserving patient safety and education. METHODS NET Rounding consists of nine recommendations divided into three categories: Novel rounding strategies, shared Expectations, and Time management. This framework was introduced as a bundled intervention at a single-site, quaternary-care, academic hospital from March-May 2021. Eighty-three residents and 64 attendings rotated on the inpatient teaching service during the intervention period. Participants were surveyed before, during, and after their rotation about rounding's contribution to educational value, patient safety, resident duty hour violations and rotation experience. Additionally, rounding duration was recorded daily by team attendings. RESULTS Thirty-two residents (38.5%) and 45 attendings (70%) completed post-intervention surveys. Rounding duration was recorded on 529/626 rounding days (80.6%) and resulted in achieving efficient rounds on 412/529 days (77.9%). Residents reported improvement in perceived patient safety (54 to 84%, p = 0.0131) and educational value of rounds (38 to 69%, p = 0.0213) due to NET Rounding; no change was observed amongst attendings in these areas (79 to 84% and 70 to 80%, p = 0.7083 and 0.4237, respectively). Overall, 29/32 residents (91%) and 33/45 attendings (73%) reported a positive impact on rotation experience. CONCLUSIONS NET Rounding enabled inpatient teaching teams to complete rounds more efficiently while preserving patient safety and education.
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Affiliation(s)
- Shirley J Chan
- Department of Medicine, University of California-San Francisco, 521 Parnassus Avenue, Box 0131, San Francisco, California, 94143, USA
| | - Hannah L Archibald
- Department of Medicine, University of California-San Francisco, 521 Parnassus Avenue, Box 0131, San Francisco, California, 94143, USA
| | - Stephanie M Conner
- Department of Medicine, University of California-San Francisco, 521 Parnassus Avenue, Box 0131, San Francisco, California, 94143, USA.
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Graetz DE, Sniderman E, Villegas CA, Kaye EC, Ragab I, Laptsevich A, Maliti B, Naidu G, Huang H, Gassant PY, Nunes Silva L, Arce D, Montoya Vasquez J, Arora RS, Alcasabas AP, Rusmawatiningtyas D, Raza MR, Velasco P, Kambugu J, Vinitsky A, Rodriguez-Galindo C, Agulnik A, Moreira DC. Resilient health care in global pediatric oncology during the COVID-19 pandemic. Cancer 2021; 128:797-807. [PMID: 34767629 PMCID: PMC8653316 DOI: 10.1002/cncr.34007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/24/2021] [Accepted: 06/10/2021] [Indexed: 12/23/2022]
Abstract
Background In the face of unprecedented challenges because of coronavirus disease 2019, interdisciplinary pediatric oncology teams have developed strategies to continue providing high‐quality cancer care. This study explored factors contributing to health care resilience as perceived by childhood cancer providers in all resource level settings. Methods This qualitative study consisted of 19 focus groups conducted in 16 countries in 8 languages. Seven factors have been previously defined as important for resilient health care including: 1) in situ practical experience, 2) system design, 3) exposure to diverse views on the patient's situation, 4) protocols and checklists, 5) teamwork, 6) workarounds, and 7) trade‐offs. Rapid turn‐around analysis focused on these factors. Results All factors of health care resilience were relevant to groups representing all resource settings. Focus group participants emphasized the importance of teamwork and a flexible and coordinated approach to care. Participants described collaboration within and among institutions, as well as partnerships with governmental, private, and nonprofit organizations. Hierarchies were advantageous to decision‐making and information dissemination. Clinicians were inspired by their patients and explained creative trade‐offs and workarounds used to maintain high‐quality care. Conclusions Factors previously described as contributing to resilient health care manifested differently in each institution but were described in all resource settings. These insights can guide pediatric oncology teams worldwide as they provide cancer care during the next phases of the pandemic. Understanding these elements of resilience will also help providers respond to inevitable future stressors on health care systems. This multinational, multicenter, qualitative study illustrates how pediatric oncology providers used resilient health care strategies, illuminating creative solutions to mitigate impact, many of which may outlast the pandemic.
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Affiliation(s)
- Dylan E Graetz
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | - Erica C Kaye
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Iman Ragab
- Hematology-Oncology Unit, Ain Shams University, Children's Hospital, Cairo, Egypt
| | - Aliaksandra Laptsevich
- Belarusian Research Center for Pediatric Oncology Hematology and Immunology, Minsk, Belarus
| | | | - Gita Naidu
- Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Haiying Huang
- Guangzhou Women and Children's Medical Center, Guangzhou, China
| | | | | | - Daniela Arce
- Hospital Pediatrico de Sinaloa, Culiacan, Mexico
| | | | | | | | | | | | - Pablo Velasco
- Pediatric Oncology and Hematology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Anna Vinitsky
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Asya Agulnik
- St. Jude Children's Research Hospital, Memphis, Tennessee
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Coates E, Quisenberry E, Williams B, Blackmore C. Focusing hospitalist roles on either admitting or rounding facilitates unit-based assignment and is associated with improved discharge efficiency. Hosp Pract (1995) 2021; 49:371-375. [PMID: 34551664 DOI: 10.1080/21548331.2021.1985316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Unit-based teams may improve care delivery for hospitalized patients but can be challenging to implement broadly across all acute care units in a hospital. OBJECTIVE To determine the effect of a Lean-guided transition to hospital-wide unit-based assignment on care delivery outcomes. DESIGN, SETTING, AND PARTICIPANTS The study was a retrospective time-series with primary outcomes of discharge efficiency, 30-day readmissions, and length of stay, performed at a 336-bed tertiary academic referral hospital in the Pacific Northwest with approximately 17,000 admissions annually. INTERVENTION Implementation of a Lean-guided quality improvement intervention included division of hospitalist duties into 'admitters' and 'rounders,' with simulated patient flow exercises to determine the optimal staffing model. MAIN OUTCOMES AND MEASURES Discharge efficiency (number of patients discharged by hospitalists divided by the number of hospitalist patient encounter days per month) and 30-day readmissions were compared using the t-test or chi-square, and length of stay was analyzed in a multivariate time-series regression model. RESULTS The intervention was associated with a significant improvement in discharge efficiency, by 0.014 (from 0.168 to 0.181) discharges/encounter (95% CI = 0.024, 0.004), p = 0.009. Mean length of stay decreased by 0.98 days (95% CI 0.50, 1.47) after adjustment for patient age, patient type (medical versus surgical), critical care admissions, and discharge disposition, without a corresponding change in 30-day readmission rate (12.2% (1948/15,902) pre-intervention to 11.7% (397/3379) post-intervention (p = 0.42)). CONCLUSIONS Dividing hospitalist roles into admitters and rounders enabled implementation of unit-based teams across the hospital, with corresponding improvements in discharge efficiency and length of stay.
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Affiliation(s)
- Evan Coates
- Virginia Mason Medical Center, Seattle, WA, USA
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16
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Montero Muñoz J, Martínez Carrasco SM, Montero Ruiz E. [In which service should a patient be hospitalized?]. J Healthc Qual Res 2021; 37:61-63. [PMID: 34426175 DOI: 10.1016/j.jhqr.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/24/2021] [Accepted: 07/08/2021] [Indexed: 11/20/2022]
Affiliation(s)
- J Montero Muñoz
- Área de Gestión Clínica de Geriatría, Hospital Monte Naranco, Oviedo, España
| | - S M Martínez Carrasco
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario Central de Asturias, Oviedo, España
| | - E Montero Ruiz
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España.
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Redley B, Campbell D, Stockman K, Barnes S. Mixed methods quality evaluation of structured interprofessional medical ward rounds. Intern Med J 2021; 50:222-231. [PMID: 31069904 DOI: 10.1111/imj.14330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/31/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Standardised structure and content of interdisciplinary medical ward rounds can promote patient safety and patient-centred teamwork. AIMS To evaluate interdisciplinary ward rounds using a Structured Interdisciplinary Bedside Rounding (SIBR) intervention. METHODS The study involved multi-method, repeat measures with a non-equivalent control group. Non-participant observations were collected at: 1 and 6 months, on an intervention ward that introduced SIBR; and a control ward that continued traditional rounds. Focus group and survey data were also collected on the intervention ward. Participants were clinicians (medicine, nursing and allied health) working in two general medicine wards at a tertiary hospital in Melbourne, Australia. RESULTS Seventy-eight patient rounds were observed at Time 1, and 239 at Time 2. The SIBR ward rounds had all clinician disciplines represented, whereas allied health and nurses were present for less than 20% of non-SIBR rounds. Interdisciplinary participation and frequency of desired clinician behaviours increased, and variability in duration of time per patient decreased, on the SIBR rounds. Longitudinal data reflected decreased performance of some SIBR behaviours in the intervention ward, while some desired behaviours increased in the control ward. Qualitative survey and focus group data indicated many positive views, but fit with broader ward routines impacted SIBR implementation. CONCLUSIONS The overall recommendation by staff was that SIBR should continue. The results provide insights into the adoption of SIBR behaviours and illustrated diffusion of behaviours across wards. Highlighting successes and identifying barriers can help meet challenges for ongoing improvement.
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Affiliation(s)
- Bernice Redley
- Centre for Quality and Patient Safety Research - Monash Health Partnership School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
| | - Don Campbell
- Department of General Medicine, Monash Health Department of Medicine, Monash University, Monash Health, Melbourne, Victoria, Australia
| | - Keith Stockman
- Health Operations Research Unit, Monash Health Community, Melbourne, Victoria, Australia
| | - Sara Barnes
- Department of General Medicine, Monash Health Department of Medicine, Monash University, Melbourne, Victoria, Australia
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18
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Basic D, Huynh ET, Gonzales R, Shanley CG. Twice-Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients. J Am Geriatr Soc 2021; 69:779-784. [PMID: 33395498 DOI: 10.1111/jgs.17007] [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: 07/14/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVE Ineffective interdisciplinary communication has negative impacts on patient outcomes. The use of regular structured interdisciplinary bedside rounds (SIBR), where each patient interaction lasts 3-5 minutes, is a model of care that improves interdisciplinary communication. We evaluated the impact of SIBR on in-hospital falls. DESIGN Prospective before-after study of older people hospitalized with acute illness. SETTING Two side-by-side aged care wards in a university hospital in Sydney, Australia. PARTICIPANTS A total of 3,673 consecutive inpatients of mean age 83.8 ± 7.7 years, with 1,703 before SIBR compared with 1,970 after SIBR. No patients were excluded from potential participation. INTERVENTION Twice-weekly SIBR. MEASUREMENTS Falls data were manually extracted from a mandatory institutional incident reporting database. Medical diagnoses were based on the Australian Refined Diagnosis Related Groups classification system. Injuries due to falls were corroborated using the institutional electronic medical record (Cerner PowerChart). Generalized estimating equations were used to evaluate the incidence rate ratio (IRR) of falls and fall-related injuries. A negative binomial distribution and a logarithmic link function were used to linearize regression equations. RESULTS After SIBR, there were 7.4 falls per 1,000 occupied bed days (OBD), compared with 10.6 falls per 1,000 OBD before SIBR (P < .001). The implementation of SIBR reduced falls (IRR = 0.67, 95% CI = 0.52-0.85), after adjusting for age, gender, cognitive impairment, behavioral and psychological symptoms of dementia, deconditioning and frailty, but not fall-related injuries (IRR = 0.79, 95% CI = 0.52-1.20). CONCLUSION This study is the first to investigate the effect of SIBR on in-hospital falls. It provides evidence that a sustainable, twice-weekly intervention is associated with a reduction in falls. It has the potential to be used in other settings where falls are frequent.
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Affiliation(s)
- David Basic
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Elizabeth T Huynh
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Rinaldo Gonzales
- Aged Care Research Unit, Liverpool Hospital, Sydney, New South Wales, Australia
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Atkinson RB, Ortega G, Green AR, Chun MBJ, Harrington DT, Lipsett PA, Mullen JT, Petrusa E, Reidy E, Haider AH, Smink DS. Concordance of Resident and Patient Perceptions of Culturally Dexterous Patient Care Skills. JOURNAL OF SURGICAL EDUCATION 2020; 77:e138-e145. [PMID: 32739444 PMCID: PMC7704898 DOI: 10.1016/j.jsurg.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Disparities in surgical care persist. To mitigate these disparities, we are implementing and testing the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS), a curriculum to improve surgical residents' cultural dexterity during clinical encounters. We analyzed baseline data to look for concordance between residents' self-perceived cultural dexterity skills and patients' perceptions of their skills. We hypothesized that residents would rate their skills in cultural dexterity higher than patients would perceive those skills. METHODS Prior to the implementation of the curriculum, surgical residents at 5 academic medical centers completed a self-assessment of their skills in culturally dexterous patient care using a modified version of the Cross-Cultural Care Survey. Randomly selected surgical inpatients at these centers completed a similar survey about the quality of culturally dexterous care provided by a surgery resident on their service. Likert scale responses for both assessments were classified as high (agree/strongly agree) or low (neutral/disagree/strongly disagree) competency. Resident and patient ratings of cultural dexterity were compared. Assessments were considered dexterous if 75% of responses were in the high category. Univariate and multivariate analysis was conducted using STATA 16. RESULTS A total of 179 residents from 5 surgical residency programs completed self-assessments prior to receiving the PACTS curriculum, including 88 (49.2%) women and 97 (54.2%) junior residents (PGY 1-2s), of whom 54.7% were White, 19% were Asian, and 8.9% were Black/African American. A total of 494 patients with an average age of 55.1 years were surveyed, of whom 238 (48.2%) were female and 320 (64.8%) were White. Fifty percent of residents viewed themselves as culturally dexterous, while 57% of patients reported receiving culturally dexterous care; this difference was not statistically significant (p = 0.09). Residents who perceived themselves to be culturally dexterous were more likely to self-identify as non-White as compared to White (p < 0.05). On multivariate analysis, White patients were more likely to report highly dexterous care, whereas Black patients were more likely to report poorly dexterous care (p < 0.05). CONCLUSIONS At baseline, half of patients reported receiving culturally dexterous care from surgical residents at 5 academic medical centers in the United States. This was consistent with residents' self-assessment of their cultural dexterity skills. White patients were more likely to report receiving culturally dexterous care as compared to non-White patients. Non-White residents were more likely to feel confident in their cultural dexterity skills. A novel curriculum has been designed to improve these interactions between patients and surgical residents.
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Affiliation(s)
- Rachel B Atkinson
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Gezzer Ortega
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Maria B J Chun
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - David T Harrington
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Pamela A Lipsett
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John T Mullen
- Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Massachusetts General Hospital, Boston, Massachusetts
| | - Emma Reidy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Aga Khan University Medical College, Karachi, Pakistan
| | - Douglas S Smink
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
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20
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Hallen S. Redesigning the Clinical Learning Environment to Improve Interprofessional Care and Education: Multi-Method Program Evaluation of the iPACE Pilot Unit. J Grad Med Educ 2020; 12:598-610. [PMID: 33149830 PMCID: PMC7594784 DOI: 10.4300/jgme-d-19-00675.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/17/2020] [Accepted: 07/23/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In 2016, Maine Medical Center received an Accreditation Council for Graduate Medical Education Pursuing Excellence in Innovation grant to redesign the clinical learning environment to promote interprofessional care and education. The Interprofessional Partnership to Advance Care and Education (iPACE) model was developed and piloted on an adult inpatient medicine unit as an attempt achieve these aims. OBJECTIVE We describe the iPACE model and associated outcomes. METHODS Surveys and focus groups were employed as part of a multimethod pragmatic observational strategy. Team surveys included relational coordination (RC): a validated proprietary measure of interpersonal communication and relationships within teams. Pre-iPACE respondents were a representative historical sample from comparable inpatient medical units surveyed from March to April 2017. iPACE respondents were model participants surveyed March to August 2018 to allow for adequate sample size. RESULTS Surveys were administered to pre-iPACE (N = 113, response rate 74%) and iPACE (N = 32, 54%) teams. Summary RC scores were significantly higher for iPACE respondents (iPACE 4.26 [SD 0.37] vs 3.72 [SD 0.44], P < .0001), and these respondents were also more likely to report a professionally rewarding experience (iPACE 4.4 [SD 0.6] vs 3.5 [SD 1.0], P < .0001). Learners felt the model was successful in teaching interprofessional best practices but were concerned it may hinder physician role development. Patient experience was positive. CONCLUSIONS This pilot may have a positive effect on team functioning and team member professional experience and patient experience. Learner acceptance may be improved by increasing autonomy and preserving traditional learning venues.
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Ansa BE, Zechariah S, Gates AM, Johnson SW, Heboyan V, De Leo G. Attitudes and Behavior towards Interprofessional Collaboration among Healthcare Professionals in a Large Academic Medical Center. Healthcare (Basel) 2020; 8:healthcare8030323. [PMID: 32899937 PMCID: PMC7551229 DOI: 10.3390/healthcare8030323] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
The increasing rates of comorbidities among patients and the complexity of care have warranted interprofessional collaboration (IPC) as an important component of the healthcare structure. An initial step towards assessing the effectiveness of collaboration requires the exploration of the attitudes and experience of healthcare professionals towards IPC. This online survey aimed to examine the attitudes of healthcare professionals working in a large public academic medical center toward IPC in patient care and the healthcare team, and their behavior and experience regarding IPC. The rankings, according to the perceived importance among the respondents, of the four Interprofessional Education Collaborative (IPEC) core competencies (values/ethics, roles/responsibilities, interprofessional communication, teams/teamwork) were assessed. There were strong but varying levels of consensus among healthcare professionals (N = 551) that IPC facilitates efficient patient care, improves patient problem-solving ability, and increases better clinical outcomes for patients. They acknowledged that IPC promotes mutual respect within the healthcare team and providers’ ability to make optimal patient care decisions. However, overall more than 35% of the respondents did not attend multidisciplinary education sessions (grand rounds, seminars, etc.), and about 23% did not participate in bedside patient care rounds. Interprofessional communication was ranked as the most important IPEC core competence. Although the attitude towards IPC among healthcare professionals is strongly positive, many healthcare professionals face challenges in participating in IPC. Institutional policies that facilitate interprofessional learning and interactions for this group of healthcare professionals should be formulated. Online distance learning and interactions, and simulation-enhanced interprofessional education, are options for addressing this barrier. Hospital administrators should facilitate conducive work environments that promote IPC, based on IPEC core competencies, and promote programs that address the challenges of IPC.
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Affiliation(s)
- Benjamin E. Ansa
- Applied Health Sciences Program, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA; (S.Z.); (A.M.G.); (S.W.J.)
- Institute of Public and Preventive Health, Augusta University, Augusta, GA 30912, USA
- Correspondence: (B.E.A.); (G.D.)
| | - Sunitha Zechariah
- Applied Health Sciences Program, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA; (S.Z.); (A.M.G.); (S.W.J.)
- Morrison Healthcare, Sandy Springs, GA 30350, USA
| | - Amy M. Gates
- Applied Health Sciences Program, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA; (S.Z.); (A.M.G.); (S.W.J.)
- Neonatal Intensive Care Unit, Augusta University Health, Augusta, GA 30912, USA
| | - Stephanie W. Johnson
- Applied Health Sciences Program, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA; (S.Z.); (A.M.G.); (S.W.J.)
- Occupational Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA
| | - Vahé Heboyan
- Health Economics and Modeling Division, Population Health Sciences Department, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Gianluca De Leo
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA 30921, USA
- Correspondence: (B.E.A.); (G.D.)
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Walton V, Hogden A, Long JC, Johnson J, Greenfield D. Exploring interdisciplinary teamwork to support effective ward rounds. Int J Health Care Qual Assur 2020; 33:373-387. [PMID: 32840969 DOI: 10.1108/ijhcqa-10-2019-0178] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper aims to explore if health professionals share understanding of teamwork that supports collaborative ward rounds. DESIGN/METHODOLOGY/APPROACH A purpose-designed survey was conducted in two acute medical and two rehabilitation wards from a metropolitan teaching hospital. Medical officers, nurses and allied health professionals participated. To understand characteristics that support collaborative ward rounds, questions developed from literature and industry experience asked: what are the enablers and challenges to teamwork; and what are clinicians' experiences of positive teamwork? Descriptive and thematic analyses were applied to the dimensions of effective teamwork as a framework for deductive coding. FINDINGS Seventy-seven clinicians participated (93% response rate). Findings aligned with dimensions of teamwork framework. There was no meaningful difference between clinicians or specialty. Enablers to teamwork were: effective communication, shared understanding of patient goals, and colleague's roles. Challenges were ineffective communication, individual personalities, lack of understanding about roles and responsibilities, and organisational structure. Additional challenges included: time; uncoordinated treatment planning; and leadership. Positive teamwork was influenced by leadership and team dynamics. PRACTICAL IMPLICATIONS Ward rounds benefit from a foundation of collaborative teamwork. Different dimensions of teamwork present during ward rounds support clinicians' shared understanding of roles, expectations and communication. ORIGINALITY/VALUE Rounds such as structured rounding, aim to improve teamwork. Inverting this concept to first develop effective collaboration will support team adaptability and resilience. This enables teams to transition between the multiple rounding processes undertaken in a single ward. The emphasis becomes high-quality teamwork rather than a single rounding process.
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Affiliation(s)
- Victoria Walton
- Australian Institute of Health Service Management, University of Tasmania, Sydney, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, University of Tasmania, Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Julie Johnson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, Australia
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Sim MA, Lee SH, Phan PH, Lateef A. Quality improvement at an acute medical unit in an Asian Academic Center: A mixed methods study of nursing work dynamics. Nurs Outlook 2020; 68:169-183. [PMID: 32044102 DOI: 10.1016/j.outlook.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 09/07/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The acute medical unit (AMU) provides early specialist care to emergency department patients before inpatient admission. The workflows and skills for successful AMU nursing comprise a hybrid of internal and emergency medicine. PURPOSE To understand nursing work dynamics in the AMU. METHODS AMU at a 1,250-bed tertiary academic center in Singapore with 14,000 ED presentations monthly. Retrospective mixed methods study using focus group discussions and surveys. Fifteen nurses across three focus group discussions. Thirty-two physicians and 54 nurses responded to a validated questionnaire. FINDINGS Focus group discussions transcripts content analyzed by two researchers. Survey items factor analyzed and attitudinal differences between AMU physicians and nurses, and among nurses compared using Student's t- and one-way ANOVA tests. DISCUSSION AMU nursing staff faced obstacles of inadequate patient information, emergency department onboarding, unbalanced workload, and coworker conflicts, which led to them to develop processes and checklists to manage patient information, patient expectations, and teamwork. CONCLUSION AMU nursing requires a combination of specialist internal medicine and emergency medicine skills. Training should familiarize nurse workforce with managing patient expectations and multidisciplinary teamwork.
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Affiliation(s)
- Ming Ann Sim
- National University Health System, Singapore, The Republic of Singapore
| | | | | | - Aisha Lateef
- National University of Singapore, Singapore, The Republic of Singapore
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24
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Walton V, Hogden A, Long JC, Johnson JK, Greenfield D. How Do Interprofessional Healthcare Teams Perceive the Benefits and Challenges of Interdisciplinary Ward Rounds. J Multidiscip Healthc 2019; 12:1023-1032. [PMID: 31849478 PMCID: PMC6912018 DOI: 10.2147/jmdh.s226330] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/30/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Interdisciplinary bedside ward rounds have the capacity to facilitate coordinated interprofessional patient care. To be an effective means of care coordination, clinicians need an explicit understanding of how these rounds contribute to patient care. By identifying benefits and challenges to the effective use of interdisciplinary ward rounds, clinicians create an opportunity to improve interprofessional teamwork, care planning, and coordination of patient care. Methods A survey was conducted with frontline professionals in two acute care and two rehabilitation wards from a metropolitan teaching hospital. There were 77 participants, representing medical officers, nurses, and allied health clinicians. Questions examined the perceived benefits and challenges of conducting interdisciplinary ward rounds in their units. Survey findings were coded for meaning and then grouped into themes. Results Benefits revealed a desired care delivery model challenged by the complexities of organizational and professional cultures. The themes of “being on the same page”, “focusing on patients”, and “holistic care planning” underpinned the ideas of collaboration and improved patient-centred care, that is, benefits to patients. Challenges centred on health professionals' time constraints and the coordination of teams to enable participation in rounds. The themes were more distinct, logistical barriers of “time”, “workforce”, and “care planning”. Conclusion Overall, clinicians recognise there are greater benefits to IBRs and have a willingness to participate. However, careful consideration is required to introduce and continually achieve the best from IBR as they require changes in organizational context and culture.
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Affiliation(s)
- Victoria Walton
- Australian Institute of Health Service Management, University of Tasmania, Sydney, NSW 2015, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, University of Tasmania, Sydney, NSW 2015, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Julie K Johnson
- Centre for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David Greenfield
- Australian Institute of Health Service Management, University of Tasmania, Sydney, NSW 2015, Australia
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