1
|
Seddighi N, Chen YC, Merryweather AS, Foreman KB, Kuntz A, Battaglia E, Zhang H, Taylor E, Wong B, Fino PC. The Impact of Design Factors on User Behavior in a Virtual Hospital Room to Explore Fall Prevention Strategies. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241238434. [PMID: 38591574 DOI: 10.1177/19375867241238434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVES Falls in hospitals pose a significant safety risk, leading to injuries, prolonged hospitalization, and lasting complications. This study explores the potential of augmented reality (AR) technology in healthcare facility design to mitigate fall risk. BACKGROUND Few studies have investigated the impact of hospital room layouts on falls due to the high cost of building physical prototypes. This study introduces an innovative approach using AR technology to advance methods for healthcare facility design efficiently. METHODS Ten healthy participants enrolled in this study to examine different hospital room designs in AR. Factors of interest included room configuration, door type, exit side of the bed, toilet placement, and the presence of IV equipment. AR trackers captured trajectories of the body as participants navigated through these AR hospital layouts, providing insights into user behavior and preferences. RESULTS Door type influenced the degree of backward and sideways movement, with the presence of an IV pole intensifying the interaction between door and room type, leading to increased sideways and backward motion. Participants displayed varying patterns of backward and sideways travel depending on the specific room configurations they encountered. CONCLUSIONS AR can be an efficient and cost-effective method to modify room configurations to identify important design factors before conducting physical testing. The results of this study provide valuable insights into the effect of environmental factors on movement patterns in simulated hospital rooms. These results highlight the importance of considering environmental factors, such as the type of door and bathroom location, when designing healthcare facilities.
Collapse
Affiliation(s)
- Nooshin Seddighi
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Ying-Ching Chen
- Department of Entertainment Arts and Engineering, University of Utah, Salt Lake City, UT, USA
| | - Andrew S Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
- Amazon, LLC, Seattle, WA, USA
| | - K Bo Foreman
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Alan Kuntz
- Kahlert School of Computing, University of Utah, Salt Lake City, UT, USA
- Robotics Center, University of Utah, Salt Lake City, UT, USA
| | - Edoardo Battaglia
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
- Robotics Center, University of Utah, Salt Lake City, UT, USA
| | - Haohan Zhang
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
- Robotics Center, University of Utah, Salt Lake City, UT, USA
| | | | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
2
|
Duah-Owusu White M, Kelly F, Vassallo M, Nyman SR. Using a systems perspective to understand hospital falls among patients with dementia. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
3
|
Woltsche R, Mullan L, Wynter K, Rasmussen B. Preventing Patient Falls Overnight Using Video Monitoring: A Clinical Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13735. [PMID: 36360616 PMCID: PMC9657748 DOI: 10.3390/ijerph192113735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Inpatient falls are devastating for patients and their families and an ongoing problem for healthcare providers worldwide. Inpatient falls overnight are particularly difficult to predict and prevent. The aim of this cohort study was to evaluate effectiveness of overnight portable video monitoring as an adjunct falls prevention strategy for high falls risk patients in inpatient clinical units. Over three months, three clinical inpatient wards were provided with baby monitor equipment to facilitate portable video monitoring. Portable video monitoring registers were completed nightly and nursing staff were invited to complete surveys (n = 31) to assess their experiences of using portable video monitoring. A total of 494 episodes of portable video monitoring were recorded over the three-month period, with clinical areas reporting a total of four inpatient falls from monitoring participants (0.8% of total portable video monitoring episodes). Overall, there was a statistically significant reduction in total inpatient falls overnight on the target wards. Surveyed nursing staff reported feeling better equipped to prevent falls and indicated they would like to continue using portable monitoring as a falls prevention strategy. This study provides evidence to support the use of portable video monitoring as an effective falls prevention strategy in the hospital environment.
Collapse
Affiliation(s)
- Rebecca Woltsche
- Directorate of Nursing & Midwifery, Western Health, 176 Furlong Road, St. Albans, VIC 3021, Australia
| | - Leanne Mullan
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 1100 Nudgee Road, Banyo, QLD 4014, Australia
| | - Karen Wynter
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation—Western Health Partnership, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation—Western Health Partnership, Deakin University, 1 Gheringhap St., Geelong, VIC 3220, Australia
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Campusvej 55, 5230 Odense, Denmark
| |
Collapse
|
4
|
The Effect of Nursing Discharge Planning Program to Prevent Recurrent Falls, Readmission, and Length of Hospital Stay in the Aged Patients. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
5
|
Chen Z, Zhong Q, Chen Y, Chen L, Peng H. The U-shaped association between hospitalization time and fall incidence in inpatients using publicly available data: A cross-sectional study in Japan. Nurs Open 2022; 10:1526-1535. [PMID: 36177862 PMCID: PMC9912438 DOI: 10.1002/nop2.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/17/2021] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To examine the association between the hospitalization time and fall incidence. DESIGN A secondary analysis using the Dryad Digital Repository public database. METHODS Data were extracted from the Fukushima Medical University Hospital cohort study between August 2008 and September 2009. The final analytic sample included 8,598 participants, 156 of who fell. The risk of fall incidents according to hospitalization time was estimated using logistic proportional hazards models, and restricted cubic splines with four knots model were developed. RESULTS The median hospitalization time was 9.00 (4.00, 17.00) days. The incidence of falls was 1.81% (N = 156). A U-shaped association between the hospitalization time and fall incidence, with an inflextion point of 8 days. We found a decreasing fall incidence as the hospitalization time increased from 0 to 8 days (OR 0.72 [0.62 ~ 0.83], p < .001); beyond 8 days, the fall incidence increased as the hospitalization time increased (OR 1.06 [1.04 ~ 1.09]).
Collapse
Affiliation(s)
- Zihong Chen
- Department of OncologyWuzhou Red Cross HospitalWuzhouChina
| | - Qiang Zhong
- Department of RadiotherapyWuzhou Red Cross HospitalWuzhouChina
| | - Yonghong Chen
- Department of OncologyWuzhou Red Cross HospitalWuzhouChina
| | - Lihua Chen
- Department of Intensive CareWuzhou Red Cross HospitalWuzhouChina
| | - Huanhuan Peng
- Department of CardiologyWuzhou Red Cross HospitalWuzhouChina
| |
Collapse
|
6
|
Kotoku K, Eguchi E, Kobayashi H, Nakashima S, Asai Y, Nishikawa J. Dissonance Between Human Nurses And Technology: Understanding Nurses’ Experience Using Technology Beds With Monitoring Functions Within Clinical Nursing Practice. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2206100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims:
Are nurses adapting to the mechanized nursing practice environment? Is it possible for nurses to collaborate with technology to provide care to patients? The aim of the study is to investigate what nurses feel about using technology in nursing practice.
Background:
Preventing patients from falling is one of the nursing tasks that can be helped by using technology, such as sensors. However, little is known about how nurses experience and feel the use of technological beds for monitoring functionality within clinical nursing practice. Especially it is indicated that alarm fatigue makes nurses and patients fatigued and induces a dissonance between nurses and technology.
Objective:
To clarify the experiences of nurses in clinical practice following the introduction of a bed with monitoring and fall prevention technology (technology bed).
Methods:
We interviewed 12 nurses working at a hospital about their nursing practice experiences with the technology bed.
Results:
The content of the interview was classified into three categories: ‘providing a safe environment’, ‘limitation of entry into machine care scenes’, and ‘nurses’ dilemmas’; with eight themes describing nursing practice: (1) strategies of fall prevention, (2) decrease in nurses’ burden, (3) not good at using technology (all tools must be easy to use), (4) inefficiency such as over-engineering, (5) patients feel annoyed by frequent visits from nurses, (6) limitations of utilization from a nursing perspective, (7) nurse resistance to equipment introduction and (8) ethical issues.
Conclusion:
Although technology beds could effectively prevent falls, many nurses face an ethical dilemma in using these beds. It would be important for nurses to recognize the role of technology, embrace it, and raise awareness of collaborating with technology to eliminate a dissonance between technology and nurses.
Collapse
|
7
|
Morris ME, Webster K, Jones C, Hill AM, Haines T, McPhail S, Kiegaldie D, Slade S, Jazayeri D, Heng H, Shorr R, Carey L, Barker A, Cameron I. Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age Ageing 2022; 51:6581612. [PMID: 35524748 PMCID: PMC9078046 DOI: 10.1093/ageing/afac077] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital. DESIGN Systematic review and meta-analysis. PARTICIPANTS Hospitalised adults. INTERVENTION Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches. OUTCOME MEASURES Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR). RESULTS There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias. CONCLUSION Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.
Collapse
Affiliation(s)
- Meg E Morris
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia,The Victorian Rehabilitation Centre, Healthscope, Glen Waverley, Victoria, Australia,Address correspondence to: Meg E. Morris, La Trobe University, Bundoora, Victoria 3186, Australia.
| | - Kate Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Cathy Jones
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Anne-Marie Hill
- Western Australian Centre for Health & Ageing, School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia Australia,Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Debra Kiegaldie
- Holmesglen Institute and Monash University, Melbourne, Victoria, Australia
| | - Susan Slade
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Dana Jazayeri
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Hazel Heng
- La Trobe University Academic and Research Collaborative in Health, Melbourne, Victoria, Australia
| | - Ronald Shorr
- Geriatric Research Education and Clinical Center, Malcom Randall VAMC, Department of Epidemiology, University of Florida, Gainesville, FL, USA,Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Leeanne Carey
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Anna Barker
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, Australia,Silver Chain, Melbourne, Victoria, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
8
|
Barkai G, Amir H, Dulberg O, Itelman E, Gez G, Carmon T, Merhav L, Zigler S, Atamne A, Pinhasov O, Zimlichman E, Segal G. “Staying at Home”: A pivotal trial of telemedicine-based internal medicine hospitalization at a nursing home. Digit Health 2022; 8:20552076221125958. [PMID: 36133002 PMCID: PMC9483959 DOI: 10.1177/20552076221125958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background In-hospital stay of acutely ill elderlies could be reduced by increasing the
availability of community-based hospitalizations. The feasibility of
remotely managing these patients by specialized internists, without leaving
their nursing homes should be sought. In the current pivotal study, we aimed
to evaluate the aforementioned model. Methods This was a prospective, open-label study at a tertiary medical center and a
nursing home. The study aimed at comparing clinical outcomes of patients
hospitalized in each location. Results Over a period of 5.5 months, we recruited 18 patients designated for
hospitalization, meeting our inclusion criteria to either in-hospital stay
or staying in their nursing home and treated by means of telemedicine from
our tertiary medical center. The mean age was 85.3 years. Out of 114
hospitalization days, 44 days (48%) were at the nursing home. No significant
difference was noted in terms of age, gender, and length of stay between the
patients who were hospitalized in either location. In almost all cases,
diagnosis changed during hospitalization. Three patients died during the
study, all included in the in-hospital group. No safety breaching events
happened in the nursing home-hospitalization group. Conclusions Remote, telemedicine-based hospitalization of nursing home-dwelling elderlies
is safe and feasible, potentially reducing the length of in-hospital stay by
almost 50%. Larger studies in this realm are warranted.
Collapse
Affiliation(s)
- G Barkai
- Sackler faculty of medicine, Tel Aviv university, Chaim Sheba Medical Center, Sheba BEYOND Virtual Hospital, Ramat Gan, Israel
| | - H Amir
- Sackler faculty of medicine, Tel Aviv university, Chaim Sheba Medical Center, Sheba BEYOND Virtual Hospital, Ramat Gan, Israel
| | - O. Dulberg
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - E Itelman
- Sackler faculty of medicine, Tel Aviv university, Internal Medicine “I”, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - G Gez
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - T Carmon
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - L Merhav
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - S Zigler
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - A Atamne
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - O Pinhasov
- AMAL Holdings, AMAL Geriatric Hospitals Division, Nursing Home, Raanana, Israel
| | - E Zimlichman
- Sackler faculty of medicine, Tel Aviv university, Management Wing, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - G Segal
- Sackler faculty of medicine, Tel Aviv university, Chaim Sheba Medical Center, Sheba BEYOND Virtual Hospital, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv university, Internal Medicine “I”, Chaim Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
9
|
Kin Kok M, Vlaskovsky P, Low E, Shim R, Lian A. Within-unit bed moves in a short-stay in-patient unit are associated with increased falls. AUST HEALTH REV 2021; 45:497-503. [PMID: 33757625 DOI: 10.1071/ah20196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022]
Abstract
Objective This study evaluated a patient's likelihood of a fall using information available at the time of presentation to a short-stay acute medical unit (AMU) with a high patient turnover rate and estimated the effect of within-unit bed moves on the occurrence of in-patient falls. Methods This study was a 3-year retrospective cross-sectional study of 28713 consecutive admissions comparing patients who fell and patients who did not fall. Factors assessed included premorbid falls risk factors, presenting issues and within-unit bed moves. Logistic regression was used to identify factors associated with patients who fell. Each admission was treated as a unit of measure. Results Of 28713 admissions, 182 (0.6%) involved at least one fall event. The fall rate was 5.67 falls per 1000 occupied bed days. Premorbid cognitive impairment (odds ratio (OR) 4.88), a presenting issue of confusion (OR 2.92) and a fall immediately before admission (OR 2.49) were associated with patients who fell (all P<0.001). Each bed move corresponded to a 27% increase in the odds of a fall (OR 1.27; P=0.027). Conclusion Premorbid cognitive impairment was the strongest risk factor for an in-patient fall on the unit. Within-unit bed moves significantly increased the risk of an in-patient fall and should be minimised. What is known about the topic? In-patient falls can cause significant patient harm at cost to the health system. There is limited research examining the association between within-unit bed moves and falls in a short-stay AMU. What does this paper add? Care in the short-stay AMU is complex and the number of bed moves is a modifiable factor that can reduce a patient's risk of an in-patient fall. What are the implications for practitioners? Bed moves need to be minimised, especially for patients with cognitive impairment. If bed moves are inevitable, operational plans can be designed to mitigate the increased risk caused by these moves.
Collapse
Affiliation(s)
- Mui Kin Kok
- Department of Internal Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Emails: ; ; ; and Corresponding author.
| | - Philip Vlaskovsky
- The University of Western Australia, Mounts Bay Road, Crawley, WA 6009, Australia.
| | - Evelyn Low
- Department of Internal Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Emails: ; ;
| | - Rae Shim
- Department of Internal Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Emails: ; ;
| | - Alwin Lian
- Department of Internal Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Emails: ; ;
| |
Collapse
|
10
|
Sena ACD, Alvarez AM, Nunes SFL, Costa NPD. Nursing care related to fall prevention among hospitalized elderly people: an integrative review. Rev Bras Enferm 2021; 74Suppl 2:e20200904. [PMID: 34231780 DOI: 10.1590/0034-7167-2020-0904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify scientific productions on nursing care related to fall risk prevention among hospitalized elderly people. METHODS an integrative literature review from 2015 to 2019 in the PubMed/MEDLINE, Scopus, Web of Science, LILACS, BDENF, SciELO and CINAHL databases, in Portuguese, English and Spanish. The keywords were elderly, hospitalization, accidents due to falls, nursing care. RESULTS thirty-three publications were analyzed. The synthesis of the studies resulted in the categories: Clinical nursing assessments to prevent falls among hospitalized elderly people; Fall risk factors for elderly people; Fall risk prevention strategies for elderly people. FINAL CONSIDERATIONS it was found that the scientific knowledge produced on nursing care related to fall risk prevention for hospitalized elderly people evidences the clinical assessment, risk factors and strategies such as nursing care, contributing to foster self-care behavior and promotion security for elderly people.
Collapse
|
11
|
Point of Care Nucleic Acid Testing for SARS-CoV-2 in Hospitalized Patients: A Clinical Validation Trial and Implementation Study. Cell Rep Med 2020; 1:100062. [PMID: 32838340 PMCID: PMC7362826 DOI: 10.1016/j.xcrm.2020.100062] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/26/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023]
Abstract
There is an urgent need for rapid SARS-CoV-2 testing in hospitals to limit nosocomial spread. We report an evaluation of point of care (POC) nucleic acid amplification testing (NAAT) in 149 participants with parallel combined nasal and throat swabbing for POC versus standard lab RT-PCR testing. Median time to result is 2.6 (IQR 2.3-4.8) versus 26.4 h (IQR 21.4-31.4, p < 0.001), with 32 (21.5%) positive and 117 (78.5%) negative. Cohen's κ correlation between tests is 0.96 (95% CI 0.91-1.00). When comparing nearly 1,000 tests pre- and post-implementation, the median time to definitive bed placement from admission is 23.4 (8.6-41.9) versus 17.1 h (9.0-28.8), p = 0.02. Mean length of stay on COVID-19 "holding" wards is 58.5 versus 29.9 h (p < 0.001). POC testing increases isolation room availability, avoids bed closures, allows discharge to care homes, and expedites access to hospital procedures. POC testing could mitigate the impact of COVID-19 on hospital systems.
Collapse
|
12
|
Turner K, Staggs V, Potter C, Cramer E, Shorr R, Mion LC. Fall prevention implementation strategies in use at 60 United States hospitals: a descriptive study. BMJ Qual Saf 2020; 29:1000-1007. [PMID: 32188712 DOI: 10.1136/bmjqs-2019-010642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised. OBJECTIVE To identify and describe the prevalence of specific hospital fall prevention implementation strategies. METHODS In 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables. RESULTS A total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff). CONCLUSIONS Our study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions.
Collapse
Affiliation(s)
- Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Vincent Staggs
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Catima Potter
- Press Ganey Associates Inc, South Bend, Indiana, USA
| | - Emily Cramer
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ronald Shorr
- GRECC (182), Malcom Randall VAMC, Gainesville, Florida, USA
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Lorraine C Mion
- Ohio State University College of Nursing, Columbus, Ohio, USA
| |
Collapse
|