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Smith M, Tepe KA, Sauers-Ford H, Atarama D, Gilliam M, Unaka N, Beck AF, Shah AN, Schondelmeyer AC, Auger KA. Addressing food insecurity in the inpatient setting: Results of a postdischarge pilot study. J Hosp Med 2024; 19:993-1000. [PMID: 38837594 DOI: 10.1002/jhm.13421] [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: 02/28/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND OBJECTIVES With a growing interest in screening for food insecurity (FI) during pediatric hospitalization, there is a parallel need to develop interventions. With input from caregivers experiencing FI, we sought to identify interventions to assist with short-term FI after discharge and evaluate their feasibility, acceptability, and appropriateness. METHODS We first employed qualitative methods to identify potential interventions. Next, we conducted a pilot study of selected interventions for families experiencing FI. Seven days postdischarge, caregivers rated the intervention's feasibility, acceptability, and appropriateness. We also assessed for ongoing FI. We summarized the median and proportion of "completely agree" responses to feasibility, acceptability, and appropriateness questions, and we compared in-hospital and postdischarge FI using McNemar's test. RESULTS In the qualitative stage, 14 caregivers prioritized three interventions: grocery store gift cards, grocery delivery/pick-up, and frozen meals. In the pilot study, 53 caregivers (25% of those screened) endorsed FI during their child's hospitalization and received one or more of the interventions. Every caregiver selected the grocery gift card option; 37 families (69.8%) also received frozen meals. Seven days after discharge, most caregivers rated the intervention as "completely" feasible (76%), acceptable (90%), and appropriate (88%). There was a significant decrease in caregivers who reported FI after discharge compared to during the hospitalization (p < .001). CONCLUSIONS This study demonstrates the feasibility, acceptability, and appropriateness of inpatient interventions to address FI, particularly at the time of pediatric hospital discharge and transition home. Randomized trials are needed to further evaluate the efficacy of interventions employed during hospitalization.
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Affiliation(s)
- Megan Smith
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kerry A Tepe
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Hadley Sauers-Ford
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Denise Atarama
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Monique Gilliam
- Division of Hospital Medicine, Parent Partner Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ndidi Unaka
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew F Beck
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Anita N Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katherine A Auger
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Frey SM, Sanchez I, Fagnano M, Milne Wenderlich A, Mammen JR, Halterman JS. The Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) pilot study. J Asthma 2024:1-11. [PMID: 39352693 DOI: 10.1080/02770903.2024.2408304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/18/2024] [Accepted: 09/20/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVE To evaluate the feasibility of a novel intervention of health literacy-informed, telemedicine-enhanced asthma education and home management support for hospitalized children and caregivers, and assess caregiver perspectives of the intervention. METHODS We conducted a pilot randomized trial of the Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) intervention vs. standardized care (SC) for children (5-13 yrs) hospitalized with asthma. Participants in TEACHH received health literacy-informed teaching prior to discharge, including pictorial materials (e.g. flipchart, action plan), color- and shape-coded medication labels, and medication demonstration. Two Zoom-based follow-up teaching visits were completed within 1-month of discharge. Feasibility was assessed by tracking visit completion, and we measured preliminary outcomes using health records (i.e. total asthma-related acute healthcare visits) and blinded surveys of caregivers 2-, 4-, and 6-months post-discharge (i.e. symptom-free days, quality of life). We interviewed caregivers about their perceptions of TEACHH. Transcripts were coded inductively. RESULTS We enrolled 26 children and interviewed 14 caregivers (9 TEACHH, 5 SC). All inpatient sessions were completed, as were 77% of virtual visits. Both groups experienced improved symptoms and quality of life over time. Caregivers valued the teaching, involvement of children, visual tools, and color-coded information of TEACHH. They described child-specific benefits, greater support after discharge, and improved asthma-related communication, and indicated that other families would benefit from similar teaching. CONCLUSIONS A novel program of patient-centered asthma education was feasible in both hospital and home settings and well received by caregivers. A larger study is needed to assess the impact of TEACHH on childhood asthma morbidity. CLINICALTRIALS.GOV IDENTIFIER NCT04995692 (Registration date 8/9/2021).
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Affiliation(s)
- Sean M Frey
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Ignacio Sanchez
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | - Maria Fagnano
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
| | | | | | - Jill S Halterman
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
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Bloomhardt H, Schechter S, Fischer A, Schlosser Metitiri K, McCann T, McCarthy C, Rivera C, Lakhaney D. Communication Strategies for Transferring Medically Complex Children Out of Intensive Care. Clin Pediatr (Phila) 2024; 63:1337-1342. [PMID: 38205734 DOI: 10.1177/00099228231223098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Affiliation(s)
- Hadley Bloomhardt
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | - Sarah Schechter
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
| | - Avital Fischer
- Division of Pediatric Palliative Care, Maine Medical Center, Portland, ME, USA
| | - Katherine Schlosser Metitiri
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
| | - Teresa McCann
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
| | - Colleen McCarthy
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
| | - Cory Rivera
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
| | - Divya Lakhaney
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Morgan Stanley Children's Hospital, NewYork-Presbyterian, New York, NY, USA
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Vieira LG, Schneider G, Margatho AS, Braga FTMM, Vasques CI, Møller T, Ferreira EB, Silveira RCDCP. Teaching-Learning Programs to Prevent and Control Infections Related to Long-Term Central Venous Access Device in Cancer Patients: A Systematic Review. Semin Oncol Nurs 2024; 40:151650. [PMID: 38705798 DOI: 10.1016/j.soncn.2024.151650] [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: 01/17/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of teaching-learning programs for cancer patients and/or their caregivers or family in preventing and controlling infections associated with long-term central venous access devices. DATA SOURCES This systematic review used the CINAHL, Cochrane Library, EMBASE, LILACS, and MEDLINE via PubMed portal, Scopus, and Web of Science. Google Scholar was used for the gray literature search. The included studies were analyzed, and the obtained data were qualitatively synthesized. The risk of bias was assessed using Cochrane tools: RoB 2 and ROBINS-I. The certainty of the evidence was evaluated using the GRADE. The review protocol was registered in PROSPERO (CRD42021267530). CONCLUSION The teaching-learning programs were implemented through theoretical-practical and theoretical dimensions in five and two studies, respectively. The risk of bias in the studies was low, moderate, severe, and high in one, three, two, and one of them, respectively. The certainty was very low. Teaching-learning programs on central venous access devices care for cancer patients and/or their caregivers or families could be effective in reducing infection rates. IMPLICATIONS FOR NURSING PRACTICE This systematic review addressed the teaching-learning programs for preventing and controlling infections associated with long-term central venous access devices. We identified that the most programs were effective in reducing the infection rates. The results may influence the clinical practice of oncology nurses, and consequently, the educational strategies and methods provided not only to these patients but for caregivers and families.
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Affiliation(s)
- Leticia Genova Vieira
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Guilherme Schneider
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | | | - Tom Møller
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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You S, Li N, Guo M, Ji H. Are patients ready for discharge from the hospital after fast-track total knee arthroplasty?-A qualitative study. PLoS One 2024; 19:e0303935. [PMID: 38809900 PMCID: PMC11135671 DOI: 10.1371/journal.pone.0303935] [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: 10/13/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The fast-track based on evidence-based medicine, has dramatically reduced the length of stay for patients undergoing total knee arthroplasty (TKA). Therefore, patients must assume the responsibility for self-functional exercise and care as early as possible. Also, higher standards and expectations of care delivery have been set. Studies into patients' experiences when faced with a discharge decision under a fast-track program are lacking. OBJECTIVES (1) Increase the knowledge about patients' experiences of discharged from hospital via a fast-track process after TKA. (2) Explore what gaps exist in the current discharge preparation care service for TKA under fast-track and what can be improved. METHODS A qualitative research design was chosen to conduct semi-structured face-to-face interviews with 21 patients from one Chinese hospital who successfully underwent TKA and received discharge orders. Interview data were meticulously analyzed, summarized and thematically distilled using Interpretative Phenomenological Analysis (IPA). RESULTS Three themes emerged from the structural analyses: a) Preparing for discharge despite concerns about symptoms-a sense of joy at discharge despite feelings of helplessness, stigmatisation, anxiety about prosthetic function. b) Managing the rehabilitation difficulties-vigilance is needed for medication management, environmental changes, and intimate relationships. c) Creating conditions for safe transition-compassionate bedside manner, listening to patients, and providing a humanized continuing care and referral services are important for safe transitions. CONCLUSION Findings suggest that patients undergoing fast-track TKA report good discharge preparation experiences. However, closer analysis reveals difficulties with this process and important directions in which discharge readiness care services can strive.
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Affiliation(s)
- Simeng You
- The affiliated hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Na Li
- Nursing department, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Manjie Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Hong Ji
- Nursing department, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
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Brokamp C, Jones MN, Duan Q, Rasnick Manning E, Ray S, Corley AMS, Michael J, Taylor S, Unaka N, Beck AF. Causal Mediation of Neighborhood-Level Pediatric Hospitalization Inequities. Pediatrics 2024; 153:e2023064432. [PMID: 38426267 DOI: 10.1542/peds.2023-064432] [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] [Accepted: 01/18/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Population-wide racial inequities in child health outcomes are well documented. Less is known about causal pathways linking inequities and social, economic, and environmental exposures. Here, we sought to estimate the total inequities in population-level hospitalization rates and determine how much is mediated by place-based exposures and community characteristics. METHODS We employed a population-wide, neighborhood-level study that included youth <18 years hospitalized between July 1, 2016 and June 30, 2022. We defined a causal directed acyclic graph a priori to estimate the mediating pathways by which marginalized population composition causes census tract-level hospitalization rates. We used negative binomial regression models to estimate hospitalization rate inequities and how much of these inequities were mediated indirectly through place-based social, economic, and environmental exposures. RESULTS We analyzed 50 719 hospitalizations experienced by 28 390 patients. We calculated census tract-level hospitalization rates per 1000 children, which ranged from 10.9 to 143.0 (median 45.1; interquartile range 34.5 to 60.1) across included tracts. For every 10% increase in the marginalized population, the tract-level hospitalization rate increased by 6.2% (95% confidence interval: 4.5 to 8.0). After adjustment for tract-level community material deprivation, crime risk, English usage, housing tenure, family composition, hospital access, greenspace, traffic-related air pollution, and housing conditions, no inequity remained (0.2%, 95% confidence interval: -2.2 to 2.7). Results differed when considering subsets of asthma, type 1 diabetes, sickle cell anemia, and psychiatric disorders. CONCLUSIONS Our findings provide additional evidence supporting structural racism as a significant root cause of inequities in child health outcomes, including outcomes at the population level.
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Affiliation(s)
- Cole Brokamp
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Margaret N Jones
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Qing Duan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Sarah Ray
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexandra M S Corley
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joseph Michael
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stuart Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ndidi Unaka
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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Carroll AR, Johnson JA, Stassun JC, Greevy RA, Mixon AS, Williams DJ. Health Literacy-Informed Communication to Reduce Discharge Medication Errors in Hospitalized Children: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2350969. [PMID: 38227315 PMCID: PMC10792470 DOI: 10.1001/jamanetworkopen.2023.50969] [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: 08/29/2023] [Accepted: 11/20/2023] [Indexed: 01/17/2024] Open
Abstract
Importance Inadequate communication between caregivers and clinicians at hospital discharge contributes to medication dosing errors in children. Health literacy-informed communication strategies during medication counseling can reduce dosing errors but have not been tested in the pediatric hospital setting. Objective To test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. Design, Setting, and Participants This parallel, randomized clinical trial was performed from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Interventions Permuted block (n = 4) randomization (1:1) to a health literacy-informed discharge medication communication bundle (n = 99) compared with standard counseling (n = 99). A study team member delivered the intervention consisting of a written, pictogram-based medication instruction sheet, teach back (caregivers state information taught), and demonstration of dosing with show back (caregivers show how they would draw the liquid medication in the syringe). Main Outcome and Measures Observed dosing errors, assessed using a caregiver-submitted photograph of their child's medication-filled syringe and expressed as the percentage difference from the prescribed dose. Secondary outcomes included caregiver-reported medication knowledge. Outcome measurements were blinded to participant group assignment. Results Among 198 caregivers randomized (mean [SD] age, 31.4 [6.5] years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 [95% CI, 1.0-3.6] percentage points; P < .001). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group (P = .003). The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]; P = .03), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%]; P = .04), and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]; P < .001). There were no differences in knowledge of medication name, indication, frequency, or storage. Conclusions and Relevance A health literacy-informed discharge medication communication bundle reduced home liquid medication administration errors and enhanced caregiver medication knowledge compared with standard counseling. Routine use of these standardized strategies can promote patient safety following hospital discharge. Trial Registration ClinicalTrials.gov Identifier: NCT05143047.
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Affiliation(s)
- Alison R. Carroll
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jakobi A. Johnson
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Justine C. Stassun
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amanda S. Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Derek J. Williams
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
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Warniment A, Sauers-Ford H, Brady PW, Beck AF, Callahan SR, Giambra BK, Herzog D, Huang B, Loechtenfeldt A, Loechtenfeldt L, Miller CL, Perez E, Riddle SW, Shah SS, Shepard M, Sucharew HJ, Tegtmeyer K, Thomson JE, Auger KA. Garnering effective telehealth to help optimize multidisciplinary team engagement (GET2HOME) for children with medical complexity: Protocol for a pragmatic randomized control trial. J Hosp Med 2023; 18:877-887. [PMID: 37602537 DOI: 10.1002/jhm.13192] [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: 05/24/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Children and young adults with medical complexity (CMC) experience high rates of healthcare reutilization following hospital discharge. Prior studies have identified common hospital-to-home transition failures that may increase the risk for reutilization, including medication, technology and equipment issues, financial concerns, and confusion about which providers can help with posthospitalization needs. Few interventions have been developed and evaluated for CMC during this transition period. OBJECTIVE We will compare the effectiveness of the garnering effective telehealth 2 help optimize multidisciplinary team engagement (GET2HOME) transition bundle intervention to the standard hospital-based care coordination discharge process by assessing healthcare reutilization and patient- and family-centered outcomes. DESIGNS, SETTINGS, AND PARTICIPANTS We will conduct a pragmatic 2-arm randomized controlled trial (RCT) comparing the GET2HOME bundle intervention to the standard hospital-based care discharge process on CMC hospitalized and discharged from hospital medicine at two sites of our pediatric medical center between November 2022 and February 2025. CMC of any age will be identified as having complex chronic disease using the Pediatric Medical Complexity Algorithm tool. We will exclude CMC who live independently, live in skilled nursing facilities, are in custody of the county, or are hospitalized for suicidal ideation or end-of-life care. INTERVENTION We will randomize participants to the bundle intervention or standard hospital-based care coordination discharge process. The bundle intervention includes (1) predischarge telehealth huddle with inpatient providers, outpatient providers, patients, and their families; (2) care management discharge task tracker; and (3) postdischarge telehealth huddle with similar participants within 7 days of discharge. As part of the pragmatic design, families will choose if they want to complete the postdischarge huddle. The standard hospital-based discharge process includes a pharmacist, social worker, and care management support when consulted by the inpatient team but does not include huddles between providers and families. MAIN OUTCOME AND MEASURES Primary outcome will be 30-day urgent healthcare reutilization (unplanned readmission, emergency department, and urgent care visits). Secondary outcomes include 7-day urgent healthcare reutilization, patient- and family-reported transition quality, quality of life, and time to return to baseline using electronic health record and surveys at 7, 30, 60, and 90 days following discharge. We will also evaluate heterogeneity of treatment effect for the intervention across levels of financial strain and for CMC with high-intensity neurologic impairment. The primary analysis will follow the intention-to-treat principle with logistic regression used to study reutilization outcomes and generalized linear mixed modeling to study repeated measures of patient- and family-reported outcomes over time. RESULTS This pragmatic RCT is designed to evaluate the effectiveness of enhanced discharge transition support, including telehealth huddles and a care management discharge tool, for CMC and their families. Enrollment began in November 2022 and is projected to complete in February 2025. Primary analysis completion is anticipated in July 2025 with reporting of results following.
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Affiliation(s)
- Amanda Warniment
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Hadley Sauers-Ford
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Patrick W Brady
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andrew F Beck
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Cincinnati Children's HealthVine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Michael Fisher Child Health Equity Center Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Scott R Callahan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Barbara K Giambra
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, USA
| | - Diane Herzog
- Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Huang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Allison Loechtenfeldt
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Chelsey L Miller
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Combined Pediatrics/Medicine House Staff, Cincinnati Children's Hospital Medical Center and University of Cincinnati Hospital, Cincinnati, Ohio, USA
| | | | - Sarah W Riddle
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Heidi J Sucharew
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ken Tegtmeyer
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Center for Telehealth, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joanna E Thomson
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Katherine A Auger
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Shah AN, Goodman E, Lawler J, Bosse D, Rubeiz C, Beck AF, Parsons A. Inpatient Screening of Parental Adversity and Strengths. Hosp Pediatr 2023; 13:922-930. [PMID: 37724391 DOI: 10.1542/hpeds.2022-007111] [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] [Indexed: 09/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Social adversities, including health-harming social risks and adverse childhood experiences, contribute to poor outcomes after hospital discharge. Screening for social adversities is increasingly pursued in outpatient settings. Identifying and addressing such adversities has been linked to improved child outcomes. Screening for social adversities and strengths in the inpatient setting may contribute to better transitions from hospital to home. Our goal was twofold: 1. to use qualitative methods to understand parent perspectives around screening tools for potential use in inpatient settings; and 2. to develop a family-friendly inpatient screening tool for social adversity. METHODS We used in-depth, cognitive qualitative interviews with parents to elicit their views on existing screening tools covering social adversities and strengths. We partnered with a local nonprofit to recruit parents who recently had a child hospitalized or visited the emergency department. There were 2 phases of the study. In the first phase, we used qualitative methods to develop a screening prototype. In the second phase, we obtained feedback on the prototype. RESULTS We interviewed 18 parents who identified 3 major themes around screening: 1. factors that promote parents to respond openly and honestly during screening; 2. feedback about screening tools and the prototype; and 3. screening should include resources. CONCLUSIONS Social adversity routinely affects children; hospitalization is an important time to screen families for adversity and potential coexisting strengths. Using qualitative parent feedback, we developed the family friendly Collaborate to Optimize Parent Experience screening tool.
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Affiliation(s)
- Anita N Shah
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - Julianne Lawler
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Gross I, Berkun L, Egbaria D, Hashavya S, Rief S. Parents' Adherence to Follow-up Testing Instructions Following Hospital Discharge. Clin Pediatr (Phila) 2023; 62:571-575. [PMID: 36433632 DOI: 10.1177/00099228221139979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The adherence to follow-up testing instructions post-hospitalization is influenced by a variety of factors. Our aim was to assess the parental adherence to follow-up instructions and identify the factors that influence it. Parents of 200 children were asked about their adherence with these instructions; responses were obtained from 184 of 200. Parents did not adhere in 20 of 194 (10.9%) of cases. Families of infants under 12 months and children older than 10 years had lower adherence rates. Test completion was more frequent for children discharged with a test appointment compared with those discharged without an appointment (96% vs 86.6%; P = .07). The main reasons for non-adherence were disagreement as to the value of the testing (45%) or parental misunderstanding (30%). In conclusion, in order to increase adherence with post-hospitalization follow-up testing, physicians should focus on explaining the need and importance of the test and schedule an appointment prior to discharge.
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Affiliation(s)
- Itai Gross
- Department of Pediatric Emergency Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Lina Berkun
- Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
| | - Dema Egbaria
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Saar Hashavya
- Department of Pediatric Emergency Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Shimon Rief
- Department of Pediatrics, Hadassah Medical Center, Jerusalem, Israel
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11
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Desai AD, Tolpadi A, Parast L, Esporas M, Britto MT, Gidengil C, Wilson K, Bardach NS, Basco WT, Brittan MS, Johnson DP, Wood KE, Yung S, Dawley E, Fiore D, Gregoire L, Hodo LN, Leggett B, Piazza K, Sartori LF, Weber DE, Mangione-Smith R. Improving the Quality of Written Discharge Instructions: A Multisite Collaborative Project. Pediatrics 2023; 151:e2022059452. [PMID: 37078242 DOI: 10.1542/peds.2022-059452] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Written discharge instructions help to bridge hospital-to-home transitions for patients and families, though substantial variation in discharge instruction quality exists. We aimed to assess the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. METHODS We conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). Data were from random samples of pediatric patients (N = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. These periods consisted of 3 phases: 1. a 14-month precollaborative phase; 2. a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3. a 12-month postcollaborative phase. Interrupted time-series models assessed the association between study phase and measure performance over time, stratified by baseline hospital performance, adjusting for seasonality and hospital fixed effects. RESULTS Among hospitals with high baseline performance, measure scores increased during the quality improvement collaborative phase beyond the expected precollaborative trend (+0.7 points/month; 95% confidence interval, 0.4-1.0; P < .001). Among hospitals with low baseline performance, measure scores increased but at a lower rate than the expected precollaborative trend (-0.5 points/month; 95% confidence interval, -0.8 to -0.2; P < .01). CONCLUSIONS Participation in this 8-hospital Institute for Healthcare Improvement Virtual Breakthrough Series collaborative was associated with improvement in the quality of written discharge instructions beyond precollaborative trends only for hospitals with high baseline performance.
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Affiliation(s)
- Arti D Desai
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | | | - Megan Esporas
- Children's Hospital Association, Washington, District of Columbia
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Karen Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Naomi S Bardach
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | - William T Basco
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Mark S Brittan
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - David P Johnson
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kelly E Wood
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Steven Yung
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin Dawley
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Darren Fiore
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | | | - Laura N Hodo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett Leggett
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Kirstin Piazza
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Laura F Sartori
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Danielle E Weber
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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12
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Carroll AR, Schlundt D, Bonnet K, Mixon AS, Williams DJ. Caregiver and Clinician Perspectives on Discharge Medication Counseling: A Qualitative Study. Hosp Pediatr 2023; 13:325-342. [PMID: 36987806 PMCID: PMC10071429 DOI: 10.1542/hpeds.2022-006937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Children are at increased risk for medication errors and the transition from hospital-to-home is a vulnerable time for errors to occur. This study aimed to explore the perspectives of multidisciplinary clinicians and caregivers regarding discharge medication counseling and to develop a conceptual model to inform intervention efforts to reduce discharge medication dosing errors. METHODS We conducted semistructured interviews with clinicians and caregivers of children <4 years old discharged from the hospital on a liquid medication. A hierarchical coding system was developed using the interview guide and several transcripts. Qualitative analysis employed an iterative inductive-deductive approach to identify domains and subthemes and inform a conceptual framework. RESULTS We conducted focus groups and individual interviews with 17 caregivers and 16 clinicians. Using the Donabedian structure-process-outcomes model of quality evaluation, domains and subthemes included: (1) infrastructure of healthcare delivery, including supplies for counseling, content and organization of discharge instructions, clinician training and education, roles and responsibilities of team members, and hospital pharmacy delivery and counseling program; (2) processes of healthcare delivery, including medication reconciliation, counseling content, counseling techniques, and language barriers and health literacy; and (3) measurable outcomes, including medication dosing accuracy and caregiver understanding and adherence to discharge instructions. CONCLUSIONS The conceptual model resulting from this analysis can be applied to the development and evaluation of interventions to reduce discharge medication dosing errors following a hospitalization. Interventions should use a health literacy universal precautions approach-written materials with plain language and pictures and verbal counseling with teach-back and show-back.
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Affiliation(s)
- Alison R. Carroll
- Divisions of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
| | - David Schlundt
- Department of Psychology (College of Arts and Science), Vanderbilt University, Nashville, Tennessee
| | - Kemberlee Bonnet
- Vanderbilt Center for Health Services Research, Qualitative Research Core, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amanda S. Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Derek J. Williams
- Divisions of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt
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13
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Buczkowski A, Craig W, Holmes R, Allen D, Longnecker L, Kondrad M, Carr A, Turchi R, Gage S, Osorio SN, Cooperberg D, Mallory L. Factors Correlated With Successful Pediatric Post-Discharge Phone Call Attempt and Connection. Hosp Pediatr 2023; 13:47-54. [PMID: 36514893 DOI: 10.1542/hpeds.2022-006675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Postdischarge phone calls can identify discharge errors and gather information following hospital-to-home transitions. This study used the multisite Project IMPACT (Improving Pediatric Patient Centered Care Transitions) dataset to identify factors associated with postdischarge phone call attempt and connectivity. METHODS This study included 0- to 18-year-old patients discharged from 4 sites between January 2014 and December 2017. We compared demographic and clinical factors between postdischarge call attempt and no-attempt and connectivity and no-connectivity subgroups and used mixed model logistic regression to identify significant independent predictors of call attempt and connectivity. RESULTS Postdischarge calls were attempted for 5528 of 7725 (71.6%) discharges with successful connection for 3801 of 5528 (68.8%) calls. Connection rates varied significantly among sites (52% to 79%, P < .001). Age less than 30 days (P = .03; P = .01) and age 1 to 6 years (P = .04; P = .04) were independent positive predictors for both call attempt and connectivity, whereas English as preferred language (P < .001) and the chronic noncomplex clinical risk group (P = .02) were independent positive predictors for call attempt and connectivity, respectively. In contrast, readmission within 3 days (P = .004) and federal or state payor (P = .02) were negative independent predictors for call attempt and call connectivity, respectively. CONCLUSIONS This study suggests that targeted interventions may improve postdischarge call attempt rates, such as investment in a reliable call model or improvement in interpreter use, and connectivity, such as enhanced population-based communication.
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Affiliation(s)
- Amy Buczkowski
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Wendy Craig
- Maine Medical Center Research Institute, Scarborough, Maine
| | - Rebekah Holmes
- Midwestern University - Chicago College of Osteopathic Medicine, Downers Grove, Illinois
| | - Dannielle Allen
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - Lee Longnecker
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Monica Kondrad
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Ann Carr
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Renee Turchi
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Sandra Gage
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix Children's Hospital, Phoenix, Arizona
| | - Snezana Nena Osorio
- Department of Pediatrics, Weill Cornell Medicine, Komansky Children's Hospital, New York Presbyterian Hospital, New York, New York
| | - David Cooperberg
- Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Leah Mallory
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
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14
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Jo J, Tran TT, Beyda ND, Simmons D, Hendrickson JA, Almutairi MS, Alnezary FS, Gonzales-Luna AJ, Septimus EJ, Garey KW. Development of the invasive candidiasis discharge [I Can discharge] model: a mixed methods analysis. Eur J Clin Microbiol Infect Dis 2022; 41:1207-1213. [PMID: 36002777 PMCID: PMC9489576 DOI: 10.1007/s10096-022-04473-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Abstract
Patients with invasive candidiasis (IC) have complex medical and infectious disease problems that often require continued care after discharge. This study aimed to assess echinocandin use at hospital discharge and develop a transition of care (TOC) model to facilitate discharge for patients with IC. This was a mixed method study design that used epidemiologic assessment to better understand echinocandin use at hospital discharge TOC. Using grounded theory methodology focused on patients given echinocandins during their last day of hospitalization, a TOC model for patients with IC, the invasive candidiasis [I Can] discharge model was developed to better understand discharge barriers. A total of 33% (1405/4211) echinocandin courses were continued until the last day of hospitalization. Of 536 patients chosen for in-depth review, 220 (41%) were discharged home, 109 (20%) were transferred, and 207 (39%) died prior to discharge. Almost half (46%, 151/329) of patients discharged alive received outpatient echinocandin therapy. Independent predictors for outpatient echinocandin use were osteomyelitis (OR, 4.1; 95% CI, 1.1-15.7; p = 0.04), other deep-seated infection (OR, 4.4; 95% CI, 1.7-12.0; p = 0.003), and non-home discharge location (OR, 3.9, 95% CI, 2.0-7.7; p < 0.001). The I Can discharge model was developed encompassing four distinct themes which was used to identify potential barriers to discharge. Significant echinocadin use occurs at hospital discharge TOC. The I Can discharge model may help clinical, policy, and research decision-making processes to facilitate smoother and earlier hospital discharges.
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Affiliation(s)
- Jinhee Jo
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA
| | - Truc T Tran
- University of Texas Health Science Center, Houston, TX, USA
| | - Nicholas D Beyda
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA
| | - Debora Simmons
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, USA
| | | | - Masaad Saeed Almutairi
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA.,Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Faris S Alnezary
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA.,Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Medinah, Saudi Arabia
| | - Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA
| | - Edward J Septimus
- Department of Population Medicine Harvard Medical School, Boston, MA, USA.,Texas A&M College of Medicine, Houston, TX, USA
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Health 2, Houston, TX, 77204, USA.
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15
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Findlater CK, Gerges S, Litynsky J, Robson K. Implementation of a Meds to Beds Medication Use Program and Parent Experience at the Time of Transition From a Neonatal Intensive Care Unit to Home. J Pediatr Pharmacol Ther 2022; 27:300-305. [DOI: 10.5863/1551-6776-27.4.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
This study aims to describe the overall experience of the neonatal intensive care unit (NICU) parent at time of transition home related to discharge medication use, following implementation of a Meds to Beds program.
METHODS
A descriptive, qualitative study was used to explore parent experiences around medication use during transition home. Eleven parents whose infants required medications at the time of transition home from the NICU participated in a semi-structured telephone interview post-discharge. The data were coded and analyzed for themes.
RESULTS
Major themes nested within the key stages of medication use in preparation for transition home from the NICU were identified: in-hospital preparation (practice early and often, Meds to Beds, and relationship with clinical pharmacist), transition home (schedule and routine, strategies for medication administration) and post-discharge (refills and long-term medication management). Strategies based on parent experiences to improve the process and ameliorate anxiety are presented.
CONCLUSIONS
Parents expressed how effective the Meds to Beds program was on the transition home by increasing parental confidence and knowledge around medications and reducing stress around the acquisition of medications for home. They also reported comfort in having a relationship with the NICU clinical pharmacist, providing a tailored approach to coordinating care both in hospital and during the transition home. Regardless of implementation of a Meds to Beds program, great opportunities remain to refine the transition home. Implementing the suggested improvement strategies could provide significant positive effects with respect to patient care and parental stress during the transition home.
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Affiliation(s)
- Carla K. Findlater
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacy (CKF, SG), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sandra Gerges
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Pharmacy (CKF, SG), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jacklyn Litynsky
- Department of Pharmacy (JL), Windsor Regional Hospital, Windsor, ON, Canada
| | - Kate Robson
- DAN Women & Babies Program (CKF, SG, KR), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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16
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Jenisch CL, Jungbauer RM, Zuckerman KE, Wagner DV, Ramsey KL, Austin JP, Everest SJ, Libak AJ, Harris MA, Vaz LE. Below the Surface: Caregivers' Experience of Hospital-to-Home Transitions. Hosp Pediatr 2022; 12:e54-e60. [PMID: 35067720 DOI: 10.1542/hpeds.2021-006248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our aim was to understand the breadth of the hospital-to-home experience from the caregiver perspective using a mixed method approach. METHODS Caregivers of children who experienced an inpatient admission (N = 184) completed a hospital-to-home transition questionnaire after discharge. Twenty-six closed-ended survey items captured child's hospitalization, discharge, and postdischarge experiences and were analyzed using descriptive statistics. Four additional free-response items allowed caregivers to expand on specific challenges or issues. A conventional content analysis coding framework was applied to the free responses. RESULTS Ninety-one percent of caregivers reported satisfaction with the hospital experience and 88% reported they understood how to manage their child's health after discharge. A majority of survey respondents (74%) provided answers to 1 or more of the qualitative free-response items. In the predischarge period, qualitative responses centered on concerns related to finances or available resources and support, communication, hospital environment, and the discharge process. Responses for the postdischarge time period centered on family well-being (child health, other family member health), finances (bills, cost of missed work), and medical follow-up (supplies, appointments, instruction). CONCLUSIONS Caregivers were generally satisfied with their hospital experience; however, incorporating survey items specifically related to family stressors either through closed- or open-ended questions gave a richer context for caregiver-identified concerns. Basing future quality improvement efforts on supporting caregiver needs and identifying stressors before discharge may make for a more robust and successful transition to home.
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Affiliation(s)
- Celeste L Jenisch
- Department of Pediatrics, Doernbecher Children's Hospital.,Build Exito Program, Portland State University, Portland, Oregon
| | | | | | - David V Wagner
- Department of Pediatrics, Doernbecher Children's Hospital
| | - Katrina L Ramsey
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon
| | - Jared P Austin
- Department of Pediatrics, Doernbecher Children's Hospital
| | - Steven J Everest
- Build Exito Program, Portland State University, Portland, Oregon
| | - Alyssa J Libak
- Build Exito Program, Portland State University, Portland, Oregon
| | | | - Louise E Vaz
- Department of Pediatrics, Doernbecher Children's Hospital
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17
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Shapiro MH, Goodman DM, Rodriguez VA. The Perfect Discharge: A Framework for High-Quality Hospital Discharges. Hosp Pediatr 2022; 12:108-117. [PMID: 34961884 DOI: 10.1542/hpeds.2021-006100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Matthew H Shapiro
- Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, California.,Children's Hospital of Orange County, Orange, California
| | - Denise M Goodman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Victoria A Rodriguez
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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18
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Guo P, Pinto C, Edwards B, Pask S, Firth A, O'Brien S, Murtagh FE. Experiences of transitioning between settings of care from the perspectives of patients with advanced illness receiving specialist palliative care and their family caregivers: A qualitative interview study. Palliat Med 2022; 36:124-134. [PMID: 34477022 PMCID: PMC8793309 DOI: 10.1177/02692163211043371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transitions between care settings (hospice, hospital and community) can be challenging for patients and family caregivers and are often an under-researched area of health care, including palliative care. AIM To explore the experience of transitions between care settings for those receiving specialist palliative care. DESIGN Qualitative study using thematic analysis. SETTING/PARTICIPANTS Semi-structured interviews were conducted with adult patients (n = 15) and family caregivers (n = 11) receiving specialist palliative care, who had undergone at least two transitions. RESULTS Four themes were identified. (1) Uncertainty about the new care setting. Most participants reported that lack of information about the new setting of care, and difficulties with access and availability of care in the new setting, added to feelings of uncertainty. (2) Biographical disruption. The transition to the new setting often resulted in changes to sense of independence and identity, and maintaining normality was a way to cope with this. (3) Importance of continuity of care. Continuity of care had an impact on feelings of safety in the new setting and influenced decisions about the transition. (4) Need for emotional and practical support. Most participants expressed a greater need for emotional and practical support, when transitioning to a new setting. CONCLUSIONS Findings provide insights into how clinicians might better negotiate transitions for these patients and family caregivers, as well as improve patient outcomes. The complexity and diversity of transition experiences, particularly among patients and families from different ethnicities and cultural backgrounds, need to be further explored in future research.
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Affiliation(s)
- Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Cathryn Pinto
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Beth Edwards
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Sophie Pask
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Alice Firth
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Suzanne O'Brien
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Fliss Em Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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19
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Abstract
In this section, we present Interdisciplinary Guidelines and Recommendations for Neonatal Intensive Care Unit (NICU) Discharge Preparation and Transition Planning. The foundation for these guidelines and recommendations is based on existing literature, practice, available policy statements, and expert opinions. These guidelines and recommendations are divided into the following sections: Basic Information, Anticipatory Guidance, Family and Home Needs Assessment, Transfer and Coordination of Care, and Other Important Considerations. Each section includes brief introductory comments, followed by the text of the guidelines and recommendations in table format. After each table, there may be further details or descriptions that support a guideline or recommendation. Our goal was to create recommendations that are both general and adaptable while also being specific and actionable. Each NICU's implementation of this guidance will be dependent on the unique makeup and skills of their team, as well as the availability of local programs and resources. The recommendations based only on expert opinion could be topics for future research.
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20
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Dworsky ZD, Rhee KE, Patel AR, McMahon MK, Pierce HC, Stucky Fisher E. Assessing Parental Discharge Readiness by Using the Ticket to Home Survey Tool. Hosp Pediatr 2022; 12:85-93. [PMID: 34889352 DOI: 10.1542/hpeds.2021-005832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Ticket to Home (TTH), a survey tool designed to assess parental comprehension of their child's hospitalization and postdischarge care needs, allows providers to address knowledge gaps before discharge. Our goal was to evaluate the impact of TTH on parents' retention of discharge teaching. METHODS In this pilot study, we enrolled a convenience sample of families admitted to pediatric hospital medicine and randomly assigned families on the basis of team assignment. The intervention group received TTH before discharge. The control group received usual care (without TTH survey tool). Both groups were sent a survey 24 to 72 hours postdischarge to assess parental understanding of discharge teaching. A senior-level provider also completed a survey; responses were compared with evaluate parent level of understanding. Descriptive statistics and logistic regression were used for analysis. RESULTS Although 495 parents consented to participate, only 100 completed the necessary surveys (41 intervention and 59 control). Both groups showed high parent-provider concordance regarding reason for admission (92.7% intervention versus 86.4% control; P = .33). The intervention group had significantly higher concordance for return precautions (90.2% vs 58.2%; P < .001), which remained significant when controlling for covariates (odds ratio 6.24, 95% confidence interval 1.78-21.93). Most parents in the intervention group felt sharing TTH responses with their medical team was beneficial (95.0%). CONCLUSIONS Parents who received TTH before discharge were more likely to accurately recall return precautions and valued sharing TTH results with the team. Given that response bias may have affected pilot results, additional studies in which researchers use larger samples with more diverse patient populations is required.
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Affiliation(s)
- Zephyr D Dworsky
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Kyung E Rhee
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Aarti R Patel
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Molly K McMahon
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California.,College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California
| | - Heather C Pierce
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
| | - Erin Stucky Fisher
- Rady Children's Hospital San Diego and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
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21
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Yilmaz Yegit C, Kilinc AA, Can Oksay S, Unal F, Yazan H, Köstereli E, Gulieva A, Arslan H, Uzuner S, Onay ZR, Kilic Baskan A, Collak A, Atag E, Ergenekon AP, Bas Ikizoğlu N, Ay P, Oktem S, Gokdemir Y, Girit S, Cakir E, Uyan ZS, Cokugras H, Karadag B, Karakoc F, Erdem Eralp E. The ISPAT project: Implementation of a standardized training program for caregivers of children with tracheostomy. Pediatr Pulmonol 2022; 57:176-184. [PMID: 34562057 DOI: 10.1002/ppul.25704] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/15/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tracheostomy-related morbidity and mortality mainly occur due to decannulation, misplacement, or obstruction of the tube. A standardized training can improve the skills and confidence of the caregivers in tracheostomy care (TC). OBJECTIVE Our primary aim was to evaluate the efficiency of standardized training program on the knowledge and skills (changing-suctioning the tracheostomy tube) of the participants regarding TC. MATERIALS AND METHODS Sixty-five caregivers of children with tracheostomy were included. First, participants were evaluated with written test about TC and participated in the practical tests. Then, they were asked to participate in a standardized training session, including theoretical and practical parts. Baseline and postintervention assessments were compared through written and practical tests conducted on the same day. RESULTS A significant improvement was observed in the written test score after the training. The median number of correct answers of the written test including 23 questions increased 26%, from 12 to 18 (p < .001). The median number of correct steps in tracheostomy tube change (from 9 to 16 correct steps out of 16 steps, 44% increase) and suctioning the tracheostomy tube (from 9 to 17 correct steps out of 18 steps, 44% increase) also improved significantly after the training (p < .001, for both). CONCLUSION Theoretical courses and practical hands-on-training (HOT) courses are highly effective in improving the practices in TC. A standardized training program including HOT should be implemented before discharge from the hospital. Still there is a need to assess the impact of the program on tracheostomy-related complications, morbidity, and mortality in the long term.
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Affiliation(s)
- Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ayse Ayzit Kilinc
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sinem Can Oksay
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Fusun Unal
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Ebru Köstereli
- Division of Pediatric Pulmonology, Koc University, School of Medicine, Istanbul, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Hüseyin Arslan
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Selçuk Uzuner
- Division of Pediatrics, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Zeynep Reyhan Onay
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Azer Kilic Baskan
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Abdulhamit Collak
- Division of Pediatrics, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Emine Atag
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Nilay Bas Ikizoğlu
- Division of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital
| | - Pinar Ay
- Division of Public Health, Marmara University, School of Medicine, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, Koc University, School of Medicine, Istanbul, Turkey
| | - Haluk Cokugras
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
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22
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Kokorelias KM, DasGupta T, Hitzig SL. Designing the Ideal Patient Navigation Program for Older Adults with Complex Needs: A Qualitative Exploration of the Preferences of Key Informants. J Appl Gerontol 2021; 41:1002-1010. [PMID: 34905440 DOI: 10.1177/07334648211059056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Navigating the healthcare system is complex. Many older adults and their family members report sub-optimal outcomes when transitioning from hospital to home. Patient navigation has been introduced as a model of care to help improve hospital to home transitions and to better integrate care across care environments. There are no best-practice guidelines for designing a patient navigation program for older adults with complex needs. This qualitative descriptive study interviewed 38 healthcare professionals to determine key characteristics of the "ideal" patient navigator program. Thematic analysis revealed four themes describing key components of an ideal patient navigator program for older adults with complex needs: (1) Easy accessibility and open communication amongst staff; (2) flexible eligibility requirements; (3) characteristics of the patient navigator; and (4) appropriate program size and duration. We suggest directions for future research, program design, and implementation considers to improve patient navigation for older adults and their family caregivers.
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Affiliation(s)
- Kristina M Kokorelias
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Sander L Hitzig
- St John's Rehab Research Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Temerty Faculty of Medicine, Rehabilitation Sciences Institute, 12366University of Toronto, Toronto, Ontario, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, 12366University of Toronto, Toronto, Canada
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23
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Sauers-Ford HS, Aboagye JB, Henderson S, Marcin JP, Rosenthal JL. Disconnection in Information Exchange During Pediatric Trauma Transfers: A Qualitative Study. J Patient Exp 2021; 8:23743735211056513. [PMID: 34869838 PMCID: PMC8640298 DOI: 10.1177/23743735211056513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pediatric patients experiencing an emergency department (ED) visit for a traumatic injury often transfer from the referring ED to a pediatric trauma center. This qualitative study sought to evaluate the experience of information exchange during pediatric trauma visits to referring EDs from the perspectives of parents and referring and accepting clinicians through semi-structured interviews. Twenty-five interviews were conducted (10 parents and 15 clinicians) and analyzed through qualitative thematic analysis. A 4-person team collaboratively identified codes, wrote memos, developed major themes, and discussed theoretical concepts. Three interdependent themes emerged: (1) Parents’ and clinicians’ distinct experiences result in a disconnect of information exchange needs; (2) systems factors inhibit effective information exchange and amplify the disconnect; and (3) situational context disrupts the flow of information contributing to the disconnect. Individual-, situational-, and systems-level factors contribute to disconnects in the information exchanged between parents and clinicians. Understanding how these factors’ influence information disconnect may offer avenues for improving patient–clinician communication in trauma transfers.
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24
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Brown A, Quaile M, Morris H, Tumin D, Parker CL, Warren L, Wall B, Crickmore K, Ledoux M, Eldridge DL, Aikman I. Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital. Clin Pediatr (Phila) 2021; 60:512-519. [PMID: 34541911 DOI: 10.1177/00099228211047242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. METHODS We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children's hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. RESULTS Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission (P = .020) and prolonged length of stay (P = .004) were associated with decreased likelihood of completing recommended follow-up. CONCLUSIONS Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.
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Affiliation(s)
| | - Mary Quaile
- East Carolina University, Greenville, NC, USA
| | | | | | - Clayten L Parker
- James and Connie Maynard Children's Hospital at Vidant Medical Center, Greenville, NC, USA
| | - Lana Warren
- James and Connie Maynard Children's Hospital at Vidant Medical Center, Greenville, NC, USA
| | - Bennett Wall
- James and Connie Maynard Children's Hospital at Vidant Medical Center, Greenville, NC, USA
| | - Kim Crickmore
- James and Connie Maynard Children's Hospital at Vidant Medical Center, Greenville, NC, USA
| | | | | | - Inga Aikman
- East Carolina University, Greenville, NC, USA
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25
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Choe AY, Schondelmeyer AC, Thomson J, Schwieter A, McCann E, Kelley J, Demeritt B, Unaka NI. Improving Discharge Instructions for Hospitalized Children With Limited English Proficiency. Hosp Pediatr 2021; 11:1213-1222. [PMID: 34654727 DOI: 10.1542/hpeds.2021-005981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with limited English proficiency (LEP) have increased risk of adverse events after hospitalization. At our institution, LEP families did not routinely receive translated discharge instructions in their preferred language. Our objective for this study was to increase the percentage of patients with LEP on the hospital medicine (HM) service receiving translated discharge instructions from 12% to 80%. METHODS Following the Model for Improvement, we convened an interdisciplinary team that included HM providers, pediatric residents, language access services staff, and nurses to design and test interventions aimed at key drivers through multiple plan-do-study-act cycles. Interventions addressed the translation request process, care team education, standardizing discharge instructions for common conditions, and identification and mitigation of failures. We used established rules for analyzing statistical process control charts to evaluate the percentage of patients with translated discharge instructions for all languages and for Spanish. RESULTS During the study period, 540 patients with LEP were discharged from the HM service. Spanish was the preferred language for 66% of patients with LEP. The percentage of patients with LEP who received translated discharge instructions increased from 12% to 50% in 3 months and to 77% in 18 months. For patients whose preferred language was Spanish, the percentage increased from 16% to 69% in 4 months and to 96% in 18 months. CONCLUSIONS Interventions targeting knowledge of the translation process and standardized Spanish discharge instructions were associated with an increased percentage of families receiving translated discharge instructions. Future work will be used to assess the impact of these interventions on postdischarge disparities, including emergency department revisits and readmissions.
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Affiliation(s)
- Angela Y Choe
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine.,James M. Anderson Center for Health Systems Excellence.,Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joanna Thomson
- Division of Hospital Medicine.,Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Erin McCann
- Pediatric Residency Program, and Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Brenda Demeritt
- Pediatric Residency Program, and Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ndidi I Unaka
- Division of Hospital Medicine .,Department of Pediatrics, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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26
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Hamline MY, Sauers-Ford H, Kair LR, Vadlaputi P, Rosenthal JL. Parent and Physician Qualitative Perspectives on Reasons for Pediatric Hospital Readmissions. Hosp Pediatr 2021; 11:1057-1065. [PMID: 34521700 PMCID: PMC8813048 DOI: 10.1542/hpeds.2020-004499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES One in 5 parents report a problem in their child's hospital-to-home transition, leading to adverse events, dissatisfaction, and readmissions. Although researchers in several studies have explored parent insights into discharge needs, few have explored perceptions of causes for pediatric readmissions. We sought to investigate factors contributing to pediatric readmissions, from both parent and physician perspectives. METHODS We conducted a qualitative study using semistructured interviews with parents, discharging and readmitting physicians, and subspecialist consultants of children readmitted within 30 days of initial discharge from the pediatric ward at an urban nonfreestanding children's hospital. Participants were interviewed during the readmission and asked about care transition experiences during the initial admission and potential causes and preventability of readmission. Data were analyzed iteratively by using a constant-comparative approach. We identified major themes, solicited feedback, and inferred relationships between themes to develop a conceptual model for preventing readmissions. RESULTS We conducted 53 interviews from 20 patient readmissions, including 20 parents, 20 readmitting physicians, 11 discharging physicians, and 3 consulting subspecialists. Major themes included the following: (1) unclear roles cause lack of ownership in patient care tasks, (2) lack of collaborative communication leads to discordant understanding of care plans, and (3) incomplete hospital-to-home transitions result in ongoing reliance on the hospital. CONCLUSIONS Clear definition of team member roles, improved communication among care team members and between care teams and families, and enhanced care coordination to facilitate the hospital-to-home transition were perceived as potential interventions that may help prevent readmissions.
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Affiliation(s)
- Michelle Y Hamline
- Department of Pediatrics, University of California, Davis, Davis, California
| | - Hadley Sauers-Ford
- Department of Pediatrics, University of California, Davis, Davis, California
| | - Laura R Kair
- Department of Pediatrics, University of California, Davis, Davis, California
| | - Pranjali Vadlaputi
- Department of Pediatrics, University of California, Davis, Davis, California
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27
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Osorio SN, Gage S, Mallory L, Soung P, Satty A, Abramson EL, Provost L, Cooperberg D. Factorial Analysis Quantifies the Effects of Pediatric Discharge Bundle on Hospital Readmission. Pediatrics 2021; 148:peds.2021-049926. [PMID: 34593650 DOI: 10.1542/peds.2021-049926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Factorial design of a natural experiment was used to quantify the benefit of individual and combined bundle elements from a 4-element discharge transition bundle (checklist, teach-back, handoff to outpatient providers, and postdischarge phone call) on 30-day readmission rates (RRs). METHODS A 24 factorial design matrix of 4 bundle element combinations was developed by using patient data (N = 7725) collected from January 2014 to December 2017 from 4 hospitals. Patients were classified into 3 clinical risk groups (CRGs): no chronic disease (CRG1), single chronic condition (CRG2), and complex chronic condition (CRG3). Estimated main effects of each bundle element and their interactions were evaluated by using Study-It software. Because of variation in subgroup size, important effects from the factorial analysis were determined by using weighted effect estimates. RESULTS RR in CRG1 was 3.5% (n = 4003), 4.1% in CRG2 (n = 1936), and 17.6% in CRG3 (n = 1786). Across the 3 CRGs, the number of subjects in the factorial groupings ranged from 16 to 674. The single most effective element in reducing RR was the checklist in CRG1 and CRG2 (reducing RR by 1.3% and 3.0%) and teach-back in CRG3 (by 4.7%) The combination of teach-back plus a checklist had the greatest effect on reducing RR in CRG3 by 5.3%. CONCLUSIONS The effect of bundle elements varied across risk groups, indicating that transition needs may vary on the basis of population. The combined use of teach-back plus a checklist had the greatest impact on reducing RR for medically complex patients.
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Affiliation(s)
- Snezana Nena Osorio
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Sandra Gage
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin.,Department of Child Health, College of Medicine-Phoenix, University of Arizona and Phoenix Children's Hospital, Phoenix, Arizona
| | - Leah Mallory
- Department of Pediatrics, School of Medicine, Tufts University and The Barbara Bush Children's Hospital, Portland, Maine
| | - Paula Soung
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Alexandra Satty
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
| | - Erika L Abramson
- Department of Pediatrics, Weill Cornell Medical College and New York Presbyterian Hospital, New York, New York
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28
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Zhou H, Roberts PA, Della PR. Nurse-Caregiver Communication of Hospital-To-Home Transition Information at a Tertiary Pediatric Hospital in Western Australia: A Multi-Stage Qualitative Descriptive Study. J Pediatr Nurs 2021; 60:83-91. [PMID: 33676143 DOI: 10.1016/j.pedn.2021.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To observe and describe nurse-caregiver communication of hospital-to-home transition information at the time of discharge at a tertiary children's hospital of Western Australia. DESIGN AND METHODS A multi-stage qualitative descriptive design involved 31 direct clinical observations of hospital-to-home transition experiences, and semi-structured interviews with 20 caregivers and 12 nurses post-discharge. Eleven caregivers were re-interviewed 2-4 weeks post-discharge. Transcripts of audio recordings and field notes were analyzed using content analysis. Medical records were examined to determine patients' usage of hospital services within 30 days of discharge. RESULTS Four themes emerged from the content analysis: structure of hospital-to-home transition information; transition information delivery; readiness for discharge; and recovery experience post-hospital discharge. Examination of medical records found seven patients presented to the Emergency Department within 2-19 days post-discharge, of which three were readmitted. Primary caregivers of three readmitted patients all had limited English proficiency. CONCLUSION The study affirmed the complexity of transitioning pediatric patients from hospital to home. Inconsistent content and delivery of information impacted caregivers' perception of readiness for discharge and the recovery experience. PRACTICE IMPLICATIONS Nurses need to assess readiness for discharge to identify individual needs using a validated tool. Inclusion of education on hospital-to-home transition information and discharge planning/process is required in the orientation program for junior and casual staff to ensure consistency of information delivery. Interpreter services should be arranged for caregivers with limited language proficiency throughout the hospital stay especially when transition information is being provided. Nurses should apply teach-back techniques to improve caregivers' comprehension of information.
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Affiliation(s)
- Huaqiong Zhou
- Perth Children's Hospital, Western Australia, Australia; Curtin School of Nursing, Curtin University, Western Australia, Western Australia, Australia.
| | - Pamela A Roberts
- Curtin School of Nursing, Curtin University, Western Australia, Western Australia, Australia.
| | - Phillip R Della
- Curtin School of Nursing, Curtin University, Western Australia, Western Australia, Australia.
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29
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Gold JM, Chadwick W, Gustafson M, Valenzuela Riveros LF, Mello A, Nasr A. Parent Perceptions and Experiences Regarding Medication Education at Time of Hospital Discharge for Children With Medical Complexity. Hosp Pediatr 2021; 10:679-686. [PMID: 32737165 DOI: 10.1542/hpeds.2020-0078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with medical complexity (CMC) often require complex medication regimens. Medication education on hospital discharge should provide a critical safety check before medication management transitions from hospital to family. Current discharge processes may not meet the needs of CMC and their families. The objective of this study is to describe parent perspectives and priorities regarding discharge medication education for CMC. METHODS We performed a qualitative, focus-group-based study, using ethnography. Parents of hospitalized CMC were recruited to participate in 1 of 4 focus groups; 2 were in Spanish. Focus groups were recorded, transcribed, and then coded and organized into themes by using thematic analysis. RESULTS Twenty-four parents participated in focus groups, including 12 native English speakers and 12 native Spanish speakers. Parents reported a range of 0 to 18 medications taken by their children (median 4). Multiple themes emerged regarding parental ideals for discharge medication education: (1) information quality, including desire for complete, consistent information, in preferred language; (2) information delivery, including education timing, and delivery by experts; (3) personalization of information, including accounting for literacy of parents and level of information desired; and (4) self-efficacy, or education resulting in parents' confidence to conduct medical plans at home. CONCLUSIONS Parents of CMC have a range of needs and preferences regarding discharge medication education. They share a desire for high-quality education provided by experts, enabling them to leave the hospital confident in their ability to care for their children once home. These perspectives could inform initiatives to improve discharge medication education for all patients, including CMC.
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Affiliation(s)
- Jessica M Gold
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; and .,Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Whitney Chadwick
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; and.,Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | | | - Luisa F Valenzuela Riveros
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; and.,Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Ashley Mello
- Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Annette Nasr
- Lucile Packard Children's Hospital Stanford, Palo Alto, California
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30
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Sauers-Ford H, Statile AM, Auger KA, Wade-Murphy S, Gold JM, Simmons JM, Shah SS. Short-term Focused Feedback: A Model to Enhance Patient Engagement in Research and Intervention Delivery. Med Care 2021; 59:S364-S369. [PMID: 34228018 PMCID: PMC8263145 DOI: 10.1097/mlr.0000000000001588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Our grant from the Patient-Centered Outcomes Research Institute (PCORI) focused on the use of nurse home visits postdischarge for primarily pediatric hospital medicine patients. While our team recognized the importance of engaging parents and other stakeholders in our study, our project was one of the first funded to address transitions of care issues in patients without chronic illness; little evidence existed about how to engage acute stakeholders longitudinally. OBJECTIVE This manuscript describes how we used both a short-term focused feedback model and longitudinal engagement methods to solicit input from parents, home care nurses, and other stakeholders throughout our 3-year study. RESULTS Short-term focused feedback allowed the study team to collect feedback from hundreds of stakeholders. Initially, we conducted focus groups with parents with children recently discharged from the hospital. We used this feedback to modify our nurse home visit intervention, then used quality improvement methods with continued short-term focus feedback from families and nurses delivering the visits to adjust the visit processes and content. We also used their feedback to modify the outcome collection. Finally, during the randomized controlled trial, we added a parent to the study team to provide longitudinal input, as well as continued to solicit short-term focused feedback to increase recruitment and retention rates. CONCLUSION Research studies can benefit from soliciting short-term focused feedback from many stakeholders; having this variety of perspectives allows for many voices to be heard, without placing an undue burden on a few stakeholders.
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Affiliation(s)
| | - Angela M. Statile
- Division of Hospital Medicine
- James M. Anderson Center for Healthcare Improvement, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Katherine A. Auger
- Division of Hospital Medicine
- James M. Anderson Center for Healthcare Improvement, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Susan Wade-Murphy
- Department of Patient Services
- Home Care Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jennifer M. Gold
- Home Care Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jeffrey M. Simmons
- Division of Hospital Medicine
- James M. Anderson Center for Healthcare Improvement, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Samir S. Shah
- Division of Hospital Medicine
- James M. Anderson Center for Healthcare Improvement, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
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Auger KA, Sucharew HJ, Simmons JM, Shah SS, Kahn RS, Beck AF. Differential Impact of Home Nurse Contact After Discharge by Financial Strain, Primary Care Access, and Medical Complexity. Hosp Pediatr 2021; 11:791-800. [PMID: 34330881 DOI: 10.1542/hpeds.2020-004267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Hospital to Home Outcomes (H2O) trials examined the effectiveness of postdischarge nurse support on reuse after pediatric discharge. Unexpectedly, children randomly assigned to a nurse visit had higher rates of reuse than those in the control group. Participants in randomized control trials are heterogeneous. Thus, it is possible that the effect of the intervention differed across subgroups (ie, heterogeneity of treatment effect [HTE]). We sought to determine if different subgroups responded differently to the interventions. METHODS The H2O trial is a randomized controlled trial comparing standard hospital discharge processes with a nurse home visit within 96 hours of discharge. The second trial, H2O II, was similar, except the tested intervention was a postdischarge nurse phone call. For the purposes of the HTE analyses, we examined our primary trial outcome measure: a composite of unplanned 30-day acute health care reuse (unplanned readmission or emergency department or urgent care visit). We identified subgroups of interest before the trials related to (1) financial strain, (2) primary care access, (3) insurance, and (4) medical complexity. We used logistic regression modeling with an interaction term between subgroup and treatment group (intervention or control). RESULTS For the phone call trial (H2O II), financial strain significantly modified the effect of the intervention such that the subgroup of children with high financial strain who received the intervention experienced more reuse than their control counterparts. CONCLUSIONS In HTE analyses of 2 randomized controlled trials, only financial strain significantly modified the nurse phone call. A family's financial resources may affect the utility of postdischarge support.
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Affiliation(s)
- Katherine A Auger
- Divisions of Hospital Medicine .,James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Heidi J Sucharew
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Biostatistics and Epidemiology
| | - Jeffrey M Simmons
- Divisions of Hospital Medicine.,James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Samir S Shah
- Divisions of Hospital Medicine.,James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert S Kahn
- James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,General Pediatrics
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Yuen A, Rodriguez N, Osorio SN, Nataraj C, Ward MJ, Clapper TC, Abramson E, Ching K. Simulation-Based Discharge Education Program for Caregivers of Children With Tracheostomies. Hosp Pediatr 2021; 11:571-578. [PMID: 33980665 DOI: 10.1542/hpeds.2020-000984] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To design, implement, and evaluate a simulation-based education (SBE) program for caregivers of children with tracheostomy. METHODS Self-reported comfort and confidence in knowledge as well as tracheostomy care skills were assessed before and after a single SBE session for 24 consecutively enrolled caregivers of children with tracheostomies aged <21 years who were hospitalized at an academic medical center from August 2018 to September 2019 by using a survey and checklist, respectively. Mean individual and aggregated scores were compared by using a paired samples t-test, and association between instruments was determined with Spearman correlation. RESULTS Post-SBE, there was a significant improvement in both self-reported comfort and confidence (P < .001) and checklist assessment of most tracheostomy care skills (P < .001). There were no significant correlations between caregivers' self-reported comfort and confidence and skills pre-SBE (ρ = 0.13) or post-SBE (ρ = 0.14). Cronbach's α coefficients for the survey ranged from 0.93 to 0.95 and for the checklist from 0.58 to 0.67. Seventeen percent of caregivers competently completed the entire checklist post-SBE, with most caregivers missing 1 or 2 critical skills such as obturator removal after tracheostomy insertion. CONCLUSIONS In this pilot study, we demonstrated successful design and implementation of an SBE program for caregivers of children with tracheostomies, revealing improvements in self-reported comfort and confidence as well as in their performance of tracheostomy care skills. Further optimization is needed, and caregivers may benefit from additional SBE sessions to achieve complete skills competency. Future research on the long-term impact of SBE and the peer-to-peer support element of the program is needed.
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Affiliation(s)
- Anthony Yuen
- Department of Pediatrics, Weill Cornell Medicine and
| | | | | | - Courtney Nataraj
- Family Advisory Council, Komansky Children's Hospital, New York-Presbyterian/Weill Cornell Medical Center, New York, New York; and
| | - Mary J Ward
- Department of Pediatrics, Weill Cornell Medicine and
| | | | | | - Kevin Ching
- Department of Pediatrics, Weill Cornell Medicine and
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Choe AY, Thomson JE, Unaka NI, Wagner V, Durling M, Moeller D, Ampomah E, Mangeot C, Schondelmeyer AC. Disparity in Nurse Discharge Communication for Hospitalized Families Based on English Proficiency. Hosp Pediatr 2021; 11:245-253. [PMID: 33531376 DOI: 10.1542/hpeds.2020-000745] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Effective communication is critical for safely discharging hospitalized children, including those with limited English proficiency (LEP), who are at high risk of reuse. Our objective was to describe and compare the safety and family centeredness of nurse communication at hospital discharge for English-proficient (EP) and LEP families. METHODS In this single-center, cross-sectional study, we used direct observation of hospital discharges for EP and LEP children. Observers recorded quantitative and qualitative details of nurse-family communication, focusing on 3 domains: safe discharge, family centeredness, and family engagement. Patient characteristics and percentages of encounters in which all components were discussed within each domain were compared between EP and LEP encounters by using Fisher's exact tests. We used field notes to supplement quantitative findings. RESULTS We observed 140 discharge encounters; 49% were with LEP families. Nurses discussed all safe discharge components in 31% of all encounters, most frequently omitting emergency department return precautions. Nurses used all family-centered communication components in 11% and family-engagement components in 89% of all encounters. Nurses were more likely to discuss all components of safe discharge in EP encounters when compared with LEP encounters (53% vs 9%; P < .001; odds ratio: 11.5 [95% confidence interval 4.4-30.1]). There were no differences in family centeredness or family engagement between LEP and EP encounters. CONCLUSIONS Discharge encounters of LEP patients were less likely to include all safe discharge communication components, compared with EP encounters. Opportunities to improve nurse-family discharge communication include providing written discharge instructions in families' primary language, ensuring discussion of return precautions, and using teach-back to optimize family engagement and understanding.
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Affiliation(s)
- Angela Y Choe
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California; .,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | | | - Vanessa Wagner
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Colleen Mangeot
- Division of Epidemiology, Departments of Environmental and Public Health Sciences and
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine and.,Pediatrics and.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
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Misra-Hebert AD, Rothberg MB, Fox J, Ji X, Hu B, Milinovich A, Zafirau W, Onuzuruike A, Stange KC. Healthcare utilization and patient and provider experience with a home visit program for patients discharged from the hospital at high risk for readmission. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 9:100518. [PMID: 33412440 DOI: 10.1016/j.hjdsi.2020.100518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/03/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Home visits after hospital discharge may reduce future healthcare utilization. We assessed the association of home visits by advanced practice registered nurses (APRN) and paramedics with healthcare utilization and mortality, and provider and patient experience. METHODS We conducted a retrospective cohort study using convergent mixed methods in one health system including adult medical patients discharged to home from November 2017-September 2019. We assessed outcomes for home visit vs. matched comparison patients at 30, 90, and 180 days, including hospital admission, emergency department (ED) use, and death: Phase 1 (APRN or paramedic visits assigned by geographic location) and Phase 2 (APRN and paramedic visit teams assigned to patients). Patients declining home visits and those accepting were also compared. Semi-structured interviews were conducted with home visit patients and providers, primary care providers, and nurse care coordinators. RESULTS In Phase 1, the 101 home visit matched to 303 comparison patients showed no differences in readmissions, ED visits, or death at 30, 90, and 180 days. In Phase 2, 157 home visit matched to 471 comparison patients had fewer 30-day readmissions (19.1% vs. 28.7%, p 0.024) and no differences in other outcomes. Compared with patients declining home visits, patients accepting had lower odds of 30-day readmission. In 44 interviews, themes of Medication Understanding, Knowledge Gap after Discharge, Patient Medical Complexity, Social Context, and Patient Engagement/Need for Reassurance emerged. CONCLUSION Post-discharge home visits by APRNs and paramedics working together were associated with reduced 30-day readmissions. Identified themes could inform strategies to improve patient support.
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Affiliation(s)
- Anita D Misra-Hebert
- Department of Internal Medicine, Cleveland Clinic Community Care, USA; Healthcare Delivery and Implementation Science Center, Cleveland Clinic, USA; Center for Value-Based Care Research, Cleveland Clinic Community Care, USA; Department of Quantitative Health Sciences, Cleveland Clinic, USA.
| | - Michael B Rothberg
- Department of Internal Medicine, Cleveland Clinic Community Care, USA; Center for Value-Based Care Research, Cleveland Clinic Community Care, USA
| | - Jaqueline Fox
- Center for Value-Based Care Research, Cleveland Clinic Community Care, USA
| | - Xinge Ji
- Department of Quantitative Health Sciences, Cleveland Clinic, USA
| | - Bo Hu
- Department of Quantitative Health Sciences, Cleveland Clinic, USA
| | - Alex Milinovich
- Department of Quantitative Health Sciences, Cleveland Clinic, USA
| | - William Zafirau
- Department of Connected Care, Cleveland Clinic Community Care, USA
| | - Anthony Onuzuruike
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Kurt C Stange
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
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Kim KO, Jung SY, Chang YJ. A Qualitative Study on Discharge Planning Needs for Cancer Patients. ASIAN ONCOLOGY NURSING 2021. [DOI: 10.5388/aon.2021.21.2.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kyung Ok Kim
- Department of Nursing, Kyungbok University, Namyangju, Korea
| | - So-Youn Jung
- Center for Breast Cancer, National Cancer Center, Ilsan, Korea
| | - Yoon Jung Chang
- Division of Cancer Control and Policy, National Cancer Center, Ilsan, Korea
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Mai K, Davis RK, Hamilton S, Robertson-James C, Calaman S, Turchi RM. Identifying Caregiver Needs for Children With a Tracheostomy Living at Home. Clin Pediatr (Phila) 2020; 59:1169-1181. [PMID: 32672065 DOI: 10.1177/0009922820941209] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to understand caregiver needs of children with tracheostomies (CWT) living at home and inform development of standardized tracheostomy simulation training curricula. Long-term goals are decreasing hospital readmissions following tracheostomy placement and improving family experiences while implementing a medical home model. We recruited caregivers of CWT and conducted semistructured interviews, subsequently recorded, transcribed, and analyzed for emerging themes using NVivo. Demographic data were collected via quantitative surveys. Twenty-seven caregivers participated. Emerging themes included the following: (1) caregivers felt overwhelmed, sad, frightened when learning need for tracheostomy; (2) training described as adequate, but individualized training desired; (3) families felt prepared to go home, but transition was difficult; (4) home nursing care fraught with difficulty and yet essential for families of CWT. Families of CWT have specific needs related to discharge training, resources, support, and home nursing. Provider understanding of caregiver needs is essential for child well-being, patient-/family-centered care, and may improve health outcomes.
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Affiliation(s)
- Katherine Mai
- Drexel University, Philadelphia, PA, USA.,St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Sue Hamilton
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Sharon Calaman
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Renee M Turchi
- Drexel University, Philadelphia, PA, USA.,St. Christopher's Hospital for Children, Philadelphia, PA, USA
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Johnson NL, Lerret S, Klingbeil CG, Polfuss M, Gibson C, Gralton K, Garnier-Villarreal M, Ahamed SI, Riddhiman A, Unteutsch R, Pawela L, White-Traut R, Sawin K, Weiss M. Engaging Parents in Education for Discharge (ePED): Evaluating the Reach, Adoption & Implementation of an Innovative Discharge Teaching Method. J Pediatr Nurs 2020; 54:42-49. [PMID: 32531681 PMCID: PMC10465147 DOI: 10.1016/j.pedn.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This paper describes the evaluation of the implementation of an innovative teaching method, the "Engaging Parents in Education for Discharge" (ePED) iPad application (app), at a pediatric hospital. DESIGN AND METHODS The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation. Three of the five RE-AIM elements are addressed in this study: Reach, Adoption, and Implementation. RESULTS The Reach of the ePED was 245 of 1015 (24.2%) patient discharges. The Adoption rate was 211 of 245 (86%) patients discharged in the five months' study period. High levels of fidelity (89.3%) to Implementation of the ePED were attained: the Signs and Symptoms domain had the highest (93%) and Thinking Forward about Family Adjustment screen had the lowest fidelity (83.3%). Nurse themes explained implementation fidelity: "It takes longer", and "Forgot to do it." CONCLUSIONS The ePED app operationalized how to have an engaging structured discharge conversation with parents. While the Reach of the ePED app was low under the study conditions, the adoption rate was positive. Nurses were able to integrate a theory-driven practice change into their daily routine when using the ePED app. IMPLICATIONS FOR PRACTICE The rates of adoption and implementation fidelity support the feasibility of future hospital wide implementation to improve patient and family healthcare experience. Attention to training of new content and the interactive conversation approach will be needed to fully leverage the value of the ePED app. Future studies are needed to evaluate the maintenance of the ePED app.
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Affiliation(s)
- Norah L Johnson
- College of Nursing, Marquette University, Milwaukee, WI, United States of America; Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Stacee Lerret
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | - Carol G Klingbeil
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Michele Polfuss
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Cori Gibson
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | - Karen Gralton
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America.
| | | | - S Iqbal Ahamed
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Adib Riddhiman
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
| | - Rachel Unteutsch
- Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | - Louis Pawela
- Medical College of Wisconsin, Milwaukee, WI, United States of America.
| | | | - Kathy Sawin
- Children's Hospital of Wisconsin, Milwaukee, WI, United States of America; College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America.
| | - Marianne Weiss
- College of Nursing, Marquette University, Milwaukee, WI, United States of America.
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Riddle SW, Sherman SN, Moore MJ, Loechtenfeldt AM, Tubbs-Cooley HL, Gold JM, Wade-Murphy S, Beck AF, Statile AM, Shah SS, Simmons JM, Auger KA. A Qualitative Study of Increased Pediatric Reutilization After a Postdischarge Home Nurse Visit. J Hosp Med 2020; 15:518-525. [PMID: 32195655 PMCID: PMC7489800 DOI: 10.12788/jhm.3370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Hospital to Home Outcomes (H2O) trial was a 2-arm, randomized controlled trial that assessed the effects of a nurse home visit after a pediatric hospital discharge. Children randomized to the intervention had higher 30-day postdischarge reutilization rates compared with those with standard discharge. We sought to understand perspectives on why postdischarge home nurse visits resulted in higher reutilization rates and to elicit suggestions on how to improve future interventions. METHODS We sought qualitative input using focus groups and interviews from stakeholder groups: parents, primary care physicians (PCP), hospital medicine physicians, and home care registered nurses (RNs). A multidisciplinary team coded and analyzed transcripts using an inductive, iterative approach. RESULTS Thirty-three parents participated in interviews. Three focus groups were completed with PCPs (n = 7), 2 with hospital medicine physicians (n = 12), and 2 with RNs (n = 10). Major themes in the explanation of increased reutilization included: appropriateness of patient reutilization; impact of red flags/warning sign instructions on family's reutilization decisions; hospital-affiliated RNs "directing traffic" back to hospital; and home visit RNs had a low threshold for escalating care. Major themes for improving design of the intervention included: need for improved postdischarge communication; individualizing home visits-one size does not fit all; and providing context and framing of red flags. CONCLUSION Stakeholders questioned whether hospital reutilization was appropriate and whether the intervention unintentionally directed patients back to the hospital. Future interventions could individualize the visit to specific needs or diagnoses, enhance postdischarge communication, and better connect patients and home nurses to primary care.
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Affiliation(s)
- Sarah W Riddle
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Corresponding Author: Sarah W Riddle, MD, IBCLC; ; Telephone: 513-636-1003
| | | | - Margo J Moore
- Division of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Allison M Loechtenfeldt
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Heather L Tubbs-Cooley
- College of Nursing, Martha S. Pitzer Center for Women, Children and Youth, Columbus, Ohio
| | - Jennifer M Gold
- Division of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Susan Wade-Murphy
- Division of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Andrew F Beck
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Angela M Statile
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey M Simmons
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health System Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Katherine A Auger
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health System Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Zeh RD, Santry HP, Monsour C, Sumski AA, Bridges JFP, Tsung A, Pawlik TM, Cloyd JM. Impact of visitor restriction rules on the postoperative experience of COVID-19 negative patients undergoing surgery. Surgery 2020; 168:770-776. [PMID: 32943203 PMCID: PMC7437486 DOI: 10.1016/j.surg.2020.08.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many hospitals have implemented visitor restriction policies in response to the coronavirus disease 2019 pandemic. Because caregivers serve an important role in postoperative recovery, the purpose of this study was to evaluate the impact of visitor restrictions on the postoperative experience of coronavirus disease 2019-negative patients undergoing surgery. METHODS Patients who underwent surgery immediately before or after the implementation of a visitor restriction policy were enrolled. Patients were surveyed on their inpatient experience and preparedness for discharge using items adapted from validated questionnaires. RESULTS Among 128 eligible patients, 117 agreed to participate (91.4% response rate): 58 (49.6%) in the Visitor Cohort and 59 (50.4%) in the No-Visitor Cohort. Mean age was 57.5 years (standard deviation 13.9) and 66 (56.4%) were female. Among all patients, 47.8% underwent oncologic surgery, 31.6% transplant, and 20.5% general or other. Patients in the No-Visitor Cohort were less likely to report complete satisfaction with the hospital experience (80.7% vs 66.0%, P = .044), timely receipt of medications (84.5% vs 69.0%, P = .048), and assistance getting out of bed (70.7% vs 51.7%, P = .036). No-Visitor Cohort patients were less likely to feel that their discharge preferences were adequately considered (79.3% vs 54.2%, P = .004). Qualitative analysis of patient responses highlighted the consistent psychosocial support provided by visitors after surgery (84.5%), and patients in the No-Visitor Cohort reported social isolation due to lack of psychosocial support (50.8%). CONCLUSION The implementation of hospital visitor restriction policies may adversely impact the postoperative experience of coronavirus disease 2019-negative patients undergoing surgery. These findings highlight the urgent need for novel patient-centered strategies to improve the postoperative experience of patients during ongoing or future disruptions to routine hospital practice.
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Affiliation(s)
- Ryan D Zeh
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Heena P Santry
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Christina Monsour
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alan A Sumski
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - John F P Bridges
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Allan Tsung
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
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Precce ML, Moraes JRMMD, Pacheco STDA, Silva LFD, Conceição DSD, Rodrigues EDC. Educational demands of family members of children with special health care needs in the transition from hospital to home. Rev Bras Enferm 2020; 73 Suppl 4:e20190156. [PMID: 32756741 DOI: 10.1590/0034-7167-2019-0156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 09/15/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the educational demands of family members of children with special health care needs in the transition from hospital to home Methods: qualitative research conducted between February and June 2018, using the handbook on creativity and sensitivity dynamics, from the sensitive creative method; the participants were nine family caregivers of children admitted to a public hospital in Rio de Janeiro; the data were subjected to French discourse analysis Results: the educational demands were clinical, centered on the categories complex and continuous care, technological care, modified habits, medication, development and mixed care, and social, related to the supplies and rights of children Final Considerations: the social educational demand has emerged as a new demand to be incorporated in the care of these children. The transition from hospital to home should be progressive and have the nurse as its coordinator, with the objective of providing participatory, safe, quality care, articulated within a social network.
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Affiliation(s)
- Meirilane Lima Precce
- Instituto Nacional de Saúde da Mulher, da Criança e Adolescente Fernandes Figueira, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Daniele Santos da Conceição
- Instituto Nacional de Saúde da Mulher, da Criança e Adolescente Fernandes Figueira, Rio de Janeiro, Rio de Janeiro, Brazil
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Ronan S, Brown M, Marsh L. Parents' experiences of transition from hospital to home of a child with complex health needs: A systematic literature review. J Clin Nurs 2020; 29:3222-3235. [PMID: 32621293 DOI: 10.1111/jocn.15396] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/12/2020] [Accepted: 06/21/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To critically appraise primary research on the views and experiences of parents of children with complex health needs during the transition from hospital to home. BACKGROUND Children with complex health needs frequently transition across and within healthcare systems, due to their age, care needs and ongoing health conditions. Repeated and unplanned admissions are significantly higher for children with complex health needs. Yet parents, as the primary providers of care, report being unsupported and unprepared during the transition from hospital back to home due to poor communication, inadequate discharge planning and education, resulting in stress and anxiety within the home environment. DESIGN Systematic review following PRISMA guidelines. METHODS A systematic search was completed of the databases CINAHL, MEDLINE, PsycINFO, EMBASE and the Cochrane Library Review between January 2009 and September 2019. Data were extracted, categorised and analysed using a thematic analysis approach. An adapted CASP qualitative assessment tool was utilised for quality assessment. All included articles were marked for validity and relevance to current research with an overall score from 0-20. RESULTS A total of 13 studies of mixed quality were identified. CASP quality scores ranged from 13-18. Four themes emerged highlighting parents' experiences of the emotional processes, communication, coordination and support and resources when transitioning from hospital to home. CONCLUSIONS Hospital discharge and transition from hospital to home is a complicated and at times frustrating process for parents of children with complex health needs. Parents report being exhausted and stressed during this often-challenging period of adjustment which was perceived as a difficult and emotional process. There is a clear lack of support available for parents both from hospital and community services.
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Musial A, Butts B, Loechtenfeldt A, Herrmann LE, Schmidlin E, Kelley J, Hail T, White CM, Thomson J. Challenges Following Hospital Discharge for Children With Medical Complexity. Hosp Pediatr 2020; 10:531-536. [PMID: 32444420 DOI: 10.1542/hpeds.2019-0306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The transition from hospital to home is a period of risk, particularly for children with medical complexity. Our aim was to identify and address discharge challenges through execution of postdischarge phone calls. METHODS In this prospective study, we designed and executed a postdischarge phone call for patients discharged from an inpatient complex care team between May and November 2018. The call included dichotomous and open-ended questions to identify challenges regarding health status, follow-up appointments, medications, home nursing, medical supplies and/or equipment, and discharge instructions. These were recorded in the electronic health record. Details regarding identified challenges and corrective actions were categorized by 2 reviewers and adjudicated by a third reviewer if disagreement occurred. RESULTS Descriptive statistics were used to summarize these findings. Sixty-seven phone calls were completed within 1 week of discharge. Two-thirds of calls identified at least 1 challenge, and more than one-third of calls identified 2 or more challenges for a total of 90 challenges. The most common challenges involved health status (26.7%), follow-up appointments (21.1%), and medications (20%). The majority of challenges were addressed by either caregivers or the multidisciplinary team, with the exception of home nursing challenges. CONCLUSIONS Discharge challenges were commonly identified by caregivers of children with medical complexity. The majority of postdischarge challenges were addressed, with some addressed by families themselves. These results can inform health care providers about challenges to anticipate and suggest future interventions to mitigate anticipated challenges for a safe discharge and transition of care for these at-risk patients.
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Affiliation(s)
| | - Breann Butts
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Lisa E Herrmann
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | | | | | | | - Christine M White
- Division of Hospital Medicine and.,Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Joanna Thomson
- Division of Hospital Medicine and.,Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
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Money NM, Schroeder AR, Quinonez RA, Ho T, Marin JR, Morgan DJ, Dhruva SS, Coon ER. 2019 Update on Pediatric Medical Overuse: A Systematic Review. JAMA Pediatr 2020; 174:375-382. [PMID: 32011675 DOI: 10.1001/jamapediatrics.2019.5849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Medical overuse is common in pediatrics and may lead to unnecessary care, resource use, and patient harm. Timely scrutiny of established and emerging practices can identify areas of overuse and empower clinicians to reconsider the balance of harms and benefits of the medical care that they provide. A literature review was conducted to identify the most important areas of pediatric medical overuse in 2018. OBSERVATIONS Consistent with prior methods, a structured MEDLINE search and manual table of contents review of selected pediatric journals for the 2018 literature was conducted identifying articles pertaining to pediatric medical overuse. The structured MEDLINE search consisted of a PubMed search for articles with the Medical Subject Headings term health services misuse or medical overuse or article titles containing the term unnecessary, inappropriate, overutilization, or overuse. Articles containing the term overuse injury or overuse injuries were excluded, along with articles not published in English and those not constituting original research. The same search was performed using Embase with the additional Emtree term unnecessary procedure. Each article was evaluated by 3 independent raters for quality of methods, magnitude of potential harm, and number of patients potentially harmed. Ten articles were identified based on scores and appraisal of overall potential harm. This year's review identified both established and emerging practices that may warrant deimplementation. Examples of such established practices include antibiotic prophylaxis for urinary tract infections, routine opioid prescriptions, prolonged antibiotic courses for latent tuberculosis, and routine intensive care admission and pharmacologic therapy for neonatal abstinence syndrome. Emerging practices that merit greater inspection and discouragement of widespread adoption include postdischarge nurse-led home visits, probiotics for gastroenteritis, and intensive cardiac screening programs for athletes. CONCLUSIONS AND RELEVANCE This year's review highlights established and emerging practices that represent medical overuse in the pediatric setting. Deimplementation of disproven practices and careful examination of emerging practices are imperative to prevent unnecessary resource use and patient harm.
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Affiliation(s)
- Nathan M Money
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Alan R Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Ricardo A Quinonez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Timmy Ho
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jennifer R Marin
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel J Morgan
- University of Maryland School of Medicine, Baltimore.,VA Maryland Health Care System, Baltimore
| | - Sanket S Dhruva
- University of California, San Francisco School of Medicine, San Francisco.,San Francisco VA Medical Center, San Francisco, California
| | - Eric R Coon
- Department of Pediatrics, Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City
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Tubbs‐Cooley HL, Riddle SW, Gold JM, Wade‐Murphy S, Auger KA, Statile AM, Sucharew HS, Shah SS, Simmons JM, Pickler RH, Bachus J, Borell M, Crawford P, Gold J, Heilman JA, Lawley K, Moore M, O’Donnell L, Sullivan KP, Chang LV, Khoury JC, Kuhnell P, Khoury JC, Sherman SN. Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period. J Adv Nurs 2020; 76:1394-1403. [DOI: 10.1111/jan.14341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sarah W. Riddle
- Cincinnati Children’s Hospital Medical Center University of Cincinnati School of Medicine Cincinnati Ohio USA
| | - Jennifer M. Gold
- Cincinnati Children’s Hospital Medical Center Cincinnati Ohio USA
| | | | - Katherine A. Auger
- Cincinnati Children’s Hospital Medical Center University of Cincinnati School of Medicine Cincinnati Ohio USA
| | - Angela M. Statile
- Cincinnati Children’s Hospital Medical Center University of Cincinnati School of Medicine Cincinnati Ohio USA
| | - Heidi S. Sucharew
- Cincinnati Children’s Hospital Medical Center University of Cincinnati School of Medicine Cincinnati Ohio USA
| | - Samir S. Shah
- Cincinnati Children’s Hospital Medical Center University of Cincinnati School of Medicine Cincinnati Ohio USA
| | - Jeffrey M. Simmons
- Cincinnati Children’s Hospital Medical Center University of Cincinnati School of Medicine Cincinnati Ohio USA
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Shih TY, Lin LC, Wu SC, Yang MH. The effect of caregiver's and nurse's perception of a patient's discharge readiness on postdischarge medical resource consumption. J Adv Nurs 2020; 76:1355-1363. [PMID: 32056269 DOI: 10.1111/jan.14329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 11/27/2022]
Abstract
AIMS The purpose of this study was to validate patient's primary caregiver and their nurse's perception of patient discharge readiness assessment and their association with postdischarge medical consumption. DESIGN The study employed a descriptive research, prospective longitudinal study design. METHOD The study was performed in a ward of a medical centre in Taipei, Taiwan, from June 2017-May 2018. Obtained data were analysed using an independent t test, one-way ANOVA and logistic regression approach. RESULTS/FINDINGS The number of comorbidities and the number of days of hospital stay were positively associated with post discharge emergency room visits. Caregiver readiness for hospital discharge had significant negative correlation with patient's 30-day readmission. Both caregiver and nurse readiness for the hospital discharge scale score were not factors associated with the patients' 30-day emergency room visit. CONCLUSION Based on the research findings, to assess the discharge readiness as perceived by caregivers at patients' discharge is recommended. IMPACT Caregiver and nurse scores on readiness for hospital discharge showed a significant positive correlation. The higher the score of a caregiver's readiness for a patient's hospital discharge, the lower the 30-day readmission rate. Family-centred care enables patients to safely pass though the transition phase from hospital to community and reduces the postrelease consumption of medical resources. The discharge readiness perceived by caregivers should be included in any decision-making.
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Affiliation(s)
| | - Li-Chan Lin
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Man-Hua Yang
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan, R.O.C
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Precce ML, Moraes JRMMD. EDUCATIVE PROCESS WITH RELATIVES OF CHILDREN WITH SPECIAL HEALTH NEEDS IN THE HOSPITAL-HOME TRANSITION. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2019-0075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to analyze the dialogical educative process as a strategy to prepare the relatives of children with special health needs in the transition from hospital to home. Method: qualitative study developed from the Creative Sensitive Method, carried out between February and June 2018 at the Inpatient Unit of a public hospital located in the city of Rio de Janeiro. Family caregivers of nine children with special health needs in transition from hospital to home were included in the study, totaling nine participants. The empirical material was evaluated through the analysis of the French discourse. Results: the educative process allowed the relatives to unveil demands for technological and medicative care, modified habitual elements, clinically complex care and social demands to be worked on by the nurse in the transition from hospital to home. From the analysis, the following category emerged: The educative process as a strategy to prepare the relatives of children with special health needs in the transition from hospital to home. The dialogue was produced, however, without exhausting the I-You relationship, maintaining the dialogicity in the group and encouraging the exchange between the different realities of the relatives. Conclusion: the educative dialogic process is an adequate strategy to prepare the relatives of children with special health needs in the hospital-home transition, where the nurses act as coordinators, suggesting a minimum program-related content.
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Griffin S, McGrath L, Chesnut GT, Benfante N, Assel M, Ostrovsky A, Levine M, Vickers A, Simon B, Laudone V. Impact of caregiver overnight stay on postoperative outcomes. Int J Health Care Qual Assur 2019; 33:18-26. [PMID: 31940152 DOI: 10.1108/ijhcqa-12-2018-0282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to determine the impact of having a patient-designated caregiver remain overnight with ambulatory extended recovery patients on early postoperative clinical outcomes. DESIGN/METHODOLOGY/APPROACH This was a retrospective cohort study of patients undergoing surgery requiring overnight stay in a highly resourced free-standing oncology ambulatory surgery center. Postoperative outcomes in patients who had caregivers stay with them overnight were compared with outcomes in those who did not. All other care was standardized. Primary outcomes were postoperative length of stay, hospital readmission rates, urgent care center (UCC) visits within 30 days and perioperative complication rates. FINDINGS Among patients staying overnight, 2,462 (57 percent) were accompanied by overnight caregivers. In this group, time to discharge was significantly lower. Readmissions (though rare) were slightly higher, though the difference was not statistically significant (p=0.059). No difference in early (<30 day) complications or UCC visits was noted. Presence of a caregiver overnight was not associated with important differences in outcomes, though further research in a less well-structured environment is likely to show a more robust benefit. Caregivers are still recommended to stay overnight if that is their preference as no harm was identified. ORIGINALITY/VALUE This study is unique in its evaluation of the clinical impact of having a caregiver stay overnight with ambulatory surgery patients. Little research has focused on the direct impact of the caregiver on patient outcomes, especially in the ambulatory setting. With increased adoption of minimally invasive surgical techniques and enhanced recovery pathways, a larger number of patients are eligible for short-stay ambulatory surgery. Factors that impact discharge and early postoperative complications are important.
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Affiliation(s)
- Susan Griffin
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Leigh McGrath
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gregory T Chesnut
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicole Benfante
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Melissa Assel
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Aaron Ostrovsky
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marcia Levine
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew Vickers
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brett Simon
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vincent Laudone
- Josie Robertson Surgical Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Vepraskas SH, O'Day P, Zhang L, Simpson P, Gage S. Parents Support Teach-back, Demonstration, and a Postdischarge Phone Call to Augment Discharge Education. Hosp Pediatr 2019; 8:778-784. [PMID: 30464003 DOI: 10.1542/hpeds.2018-0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify caregiver preferences for discharge education components, content, and techniques. METHODS Before discharge education, a 9-question structured interview was performed with caregivers of children from 2 populations admitted to the hospital medicine service: patients with asthma (age 2-17 years) or children who were not dependent on technology (age <2 years). McNemar's tests were used to evaluate for significant differences between response options. Open coding was used for theme development to interpret qualitative responses about information caregivers wished to receive before leaving the hospital. RESULTS The interview was administered to 100 caregivers. More than 90% of caregivers believed that instruction regarding follow-up appointments, medications, and reasons to call the pediatrician or return to the emergency department were important aspects of discharge education. Caregivers also identified a desire for education on their child's condition, care at home, and illness prevention. Most caregivers reported that teach-back, early discharge education, and a postdischarge phone call would be beneficial. Caregivers varied in their preferences for written, verbal, and video instruction, whereas live demonstration was rated almost universally as an effective method by 97% of caregivers (P < .0001). CONCLUSIONS In our study, we provide insight into caregivers' perspectives on the content, timing, and style of education needed to promote a safe transition of care from the hospital to the home. These findings add caregiver support to the expert consensus in Project Improving Pediatric Patient-Centered Care Transitions and elucidate additional themes to aid in further study and optimization of discharge education.
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Affiliation(s)
- Sarah H Vepraskas
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Peter O'Day
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Sandra Gage
- Phoenix Children's Hospital, Phoenix, Arizona
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50
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Chase JAD, Russell D, Rice M, Abbott C, Bowles KH, Mehr DR. Caregivers' Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting. J Patient Exp 2019; 7:561-569. [PMID: 33062879 PMCID: PMC7534114 DOI: 10.1177/2374373519869156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.
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Affiliation(s)
- Jo-Ana D Chase
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Meridith Rice
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Carmen Abbott
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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