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Surgery For Obesity and Related... May 2024
Topics: Humans; Bariatric Surgery; Patient Discharge; Obesity, Morbid; Enhanced Recovery After Surgery; Length of Stay; Postoperative Complications
PubMed: 38272787
DOI: 10.1016/j.soard.2023.12.012 -
Journal of Clinical Nursing Feb 2024To synthesise and describe the combined evidence from systematic reviews of interventions using elements from the Transitional Care Model, on the content and timeframe... (Review)
Review
AIMS
To synthesise and describe the combined evidence from systematic reviews of interventions using elements from the Transitional Care Model, on the content and timeframe of the interventions and the related improvement of outcomes for older patients with multiple chronic conditions.
BACKGROUND
The population of older patients with multiple chronic conditions is increasing worldwide and trajectories are often complicated by risk factors. The Transitional Care Model may contain elements to support transitions between hospital and home.
DESIGN
An umbrella review.
REVIEW METHODS
A comprehensive search in five electronic databases was performed in April 2021 based on the search terms: 'Patients ≥60 years,' 'multi-morbidity,' 'Transitional care model,' 'Transitional care,' and 'Systematic review.' PRISMA guidelines was used.
RESULTS
Five systematic reviews published from 2011 to 2020 comprising 62 intervention studies (59 randomised controlled trials and three quasi-experimental trials) were included in the review. The synthesis predominantly revealed significant improvements in decreasing re-admissions and financial costs and increasing patients' quality of life and satisfaction during discharge.
CONCLUSION
The results of the review indicate that multiple elements from the Transitional Care Model have achieved significant improvements in older patients' transitions from hospital to home. Especially a combination of coordination, communication, collaboration and continuity of care in transitions, organised information and education for patients and pre-arranged structured post-discharge follow-ups.
IMPACT
The transition from hospital to home is a complex process for older patients with multiple chronic conditions. A specific focus on coordination, continuity, and patient education should be implemented in the discharge process. Nurses with specialised knowledge in transitional care are needed to ensure safe transitions.
PATIENT AND PUBLIC CONTRIBUTION
The umbrella review is part of a larger research program which involved a patient expert advisory board, which participated in discussing the relevance of the elements within the umbrella review.
Topics: Humans; Aged; Transitional Care; Patient Discharge; Multiple Chronic Conditions; Quality of Life; Aftercare
PubMed: 38108223
DOI: 10.1111/jocn.16913 -
Injury Feb 2024The number of older people hospitalised with major trauma is rapidly increasing. New models of care have emerged, such as co-management, and trauma centres dedicated to... (Review)
Review
INTRODUCTION
The number of older people hospitalised with major trauma is rapidly increasing. New models of care have emerged, such as co-management, and trauma centres dedicated to delivering geriatric trauma care. The aim of this scoping review was to explore in-hospital models of care for older adults who experience physical trauma.
PATIENTS AND METHODS
The search was conducted in accordance with the PRISMA- SC (preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews) reporting guidelines. The National Heart Lung, and Blood Institute (NIH) study quality assessment tool was used to evaluate risk of bias in before and after non-randomised experimental studies.
RESULTS
Of 2127 records returned from the database search, 43 papers were included. We identified five types of care models investigated in the reviewed studies: centralised trauma management, consultation services, co-management, patient care protocols, and alert and triage systems. The majority of patients were admitted under a specialised trauma service, intervention teams were for the most part multidisciplinary, and follow-up of patients post-discharge was seldom reported. Consultation services more often had advanced care and discharge planning as treatment objectives. In contrast, patient care protocol and alert systems commonly had management of anticoagulation as a treatment objective. Overall, the impact of the five models of care on patient outcomes was mixed.
DISCUSSION
Given the variability in patient characteristics and capabilities of health services, models of care need to be matched to the local profile of older trauma patients. However, some standards should be incorporated into a care model, including identifying goals of care, medication review and follow up post-discharge.
Topics: Aged; Humans; Aftercare; Hospitalization; Hospitals; Patient Discharge; Triage
PubMed: 38035863
DOI: 10.1016/j.injury.2023.111200 -
Critical Care Nursing Clinics of North... Dec 2023The demand for surgical intervention and hospitalization is expected to increase with the growth of the older adult population. Despite advances in technology and... (Review)
Review
The demand for surgical intervention and hospitalization is expected to increase with the growth of the older adult population. Despite advances in technology and minimally invasive surgical procedures, the needs of the older adult in the perioperative period are unique. Transitions of care from the decision to support surgery through surgical intervention, subsequent hospitalization, and postacute discharge must be supported to achieve optimal patient outcomes. The clinical nurse specialist is well suited to address care delivery and assure implementation of best practices across the continuum.
Topics: Humans; Aged; Patient Transfer; Hospitalization; Patient Discharge; Delivery of Health Care; Nurse Clinicians
PubMed: 37838418
DOI: 10.1016/j.cnc.2023.05.009 -
Australian Journal of Primary Health Dec 2023The aim of this study was to assess the quality of effective discharge communication to primary practice from a hospital that uses ieMR (integrated electronic Medical...
BACKGROUND
The aim of this study was to assess the quality of effective discharge communication to primary practice from a hospital that uses ieMR (integrated electronic Medical Record), a complete electronic prescribing/medical record platform.
METHODS
A retrospective quantitative analysis of 232 discharge encounters from a major tertiary hospital assessed the discharge summary quality; timeliness, completeness and medication information.
RESULTS
Median time to discharge summary was 1day. 22.0% of discharge summaries were incomplete at 30days post discharge and 44.5% of discharge summaries were incomplete at 30days post discharge if discharged on a weekend compared to weekday (P -value=0.001). Rates of medication reconciliation were completed at approximately 35% at each point of the patient stay and 56.9% of patients had a GP discharge summary listing discharge medications. However, if certain progressive steps were completed (i.e. Home Medications recorded in ieMR, Discharge Reconciliation in ieMR, and Patient Discharge Medication Record in eLMs (Enterprise-wide Liaison Medication System)), then, the 'Medications on Discharge' was significantly more likely to be present in the discharge summary, at rates of 70.1%, 85.9%, and 98.6% respectively (P -value=0.007, <0.001, <0.001). Conversely not doing these steps dropped rates of having medications listed in the discharge summary to 50.0%, 40.3% and 34.1% respectively.
CONCLUSIONS
This study assessed current discharge summary quality since the introduction of electronic medical records. It demonstrated the significant value of correct use of electronic programs, including performing all crucial steps of reconciliation. Targeted interventions in future studies that rectify the shortfalls in discharge communication are warranted.
Topics: Humans; Patient Discharge; Medication Reconciliation; Retrospective Studies; Aftercare; General Practice; Tertiary Care Centers; Communication
PubMed: 37574264
DOI: 10.1071/PY22232 -
MedEdPORTAL : the Journal of Teaching... 2023Hospital discharge is a highly critical and complex process that is prone to medical errors, poor communication, and ineffective synchronization of transitional teams....
INTRODUCTION
Hospital discharge is a highly critical and complex process that is prone to medical errors, poor communication, and ineffective synchronization of transitional teams. Improving safety during postacute care transitions has become a national focus. Simulation-based training is an underutilized method of instruction for medical resident transitions of care education.
METHODS
As an integral part of a transitions curriculum, 36 PGY 1 residents from internal medicine and transitional year residency programs underwent a discharge simulation utilizing a trained simulated participant (SP) and a lay caregiver. The objective of the training was to implement a simulation-based education intervention to improve transition practices and discharge communication in graduate medical education. A faculty observer used a case-specific discharge rubric to standardize feedback to the resident and observed the resident navigate the electronic medical record (EMR) for discharge orders. Pretest and posttest surveys assessing resident attitudes and confidence regarding specific areas of the discharge process were distributed to all participating residents for completion.
RESULTS
Thirty-six internal medicine and transitional year residents (100%) completed an observed discharge simulation with an SP and a separate encounter with the EMR discharge navigator. All 36 residents (100%) completed the pretest survey, and 23 (63%) completed the postsurvey evaluation. Postsurvey results showed residents agreed (92%, < .05) that the simulation increased their confidence in safely discharging a patient.
DISCUSSION
Simulation encounters are an effective adjunct to postacute care transition education.
Topics: Humans; Patient Discharge; Simulation Training; Curriculum; Physicians; Hospitals
PubMed: 37720418
DOI: 10.15766/mep_2374-8265.11348 -
Pharmacoepidemiology and Drug Safety Nov 2023Inpatient mortality is an important variable in epidemiology studies using claims data. In 2016, MarketScan data began obscuring specific hospital discharge status types...
PURPOSE
Inpatient mortality is an important variable in epidemiology studies using claims data. In 2016, MarketScan data began obscuring specific hospital discharge status types for patient privacy, including inpatient deaths, by setting the values to missing. We used a machine learning approach to correctly identify hospitalizations that resulted in inpatient death using data prior to 2016.
METHODS
All hospitalizations from 2011 to 2015 with discharge status of missing, died, or one of the other subsequently obscured values were identified and divided into a training set and two test sets. Predictor variables included age, sex, elapsed time from hospital discharge until last observed claim and until healthcare plan disenrollment, and absence of any discharge diagnoses. Four machine learning methods were used to train statistical models and assess sensitivity and positive predictive value (PPV) for inpatient mortality.
RESULTS
Overall 1 307 917 hospitalizations were included. All four machine learning approaches performed well in all datasets. Random forest performed best with 88% PPV and 93% sensitivity for the training set and both test sets. The two factors with the highest relative importance for identifying inpatient mortality were having no observed claims for the patient on days 2-91 following hospital discharge and patient disenrollment from the healthcare plan within 60 days following hospital discharge.
CONCLUSION
We successfully developed machine learning algorithms to identify inpatient mortality. This approach can be applied to obscured data to accurately identify inpatient mortality among hospitalizations with missing discharge status.
Topics: Humans; Inpatients; Machine Learning; Algorithms; Hospitalization; Patient Discharge; Retrospective Studies
PubMed: 37344984
DOI: 10.1002/pds.5658 -
Journal of Trauma Nursing : the...Comprehensive and multidisciplinary discharge planning can improve trauma patient throughput, decrease length of hospitalization, increase family and patient support,...
BACKGROUND
Comprehensive and multidisciplinary discharge planning can improve trauma patient throughput, decrease length of hospitalization, increase family and patient support, and expedite hospital discharge.
OBJECTIVE
This study aimed to assess the feasibility and acceptability of implementing a patient-centered discharge plan form for adult trauma patients.
METHODS
A single-center pilot study was conducted with adult trauma patients on a neurosurgical medical-surgical floor at a Level II trauma center in the Western United States from January to February 2023. The study had three phases: observation, pilot intervention, and follow-up. The key pilot intervention was the development of a standardized patient-centered discharge plan form, pilot tested by a trauma advanced practice provider and an inpatient discharge nurse. The primary outcome was the frequency of discharge orders being written before noon on the day of discharge. Qualitative and quantitative outcomes are reported.
RESULTS
The discharge form was used for eight patients during the pilot intervention phase; an advanced practice provider and an inpatient discharge nurse each completed the forms for four patients. Five of eight observed patients had discharge orders before noon; the incidence of orders before noon was slightly higher when the form was completed by the discharge nurse (three of four patients) than by the advanced practice provider (two of four patients).
CONCLUSIONS
The pilot study found that the patient-centered discharge plan form was feasible and acceptable to help improve the discharge process for trauma patients. Additional work to further refine the form's content and administration is warranted.
Topics: Adult; Humans; United States; Patient Discharge; Pilot Projects; Trauma Centers; Hospitalization; Patient-Centered Care
PubMed: 38484166
DOI: 10.1097/JTN.0000000000000770 -
Wiener Klinische Wochenschrift May 2024
Topics: Humans; Patient Discharge; Percutaneous Coronary Intervention; Length of Stay; Postoperative Complications; Ambulatory Surgical Procedures
PubMed: 38743082
DOI: 10.1007/s00508-024-02378-6 -
The American Surgeon Dec 2023Victims of violence (VoV) are at disproportionate risk for future violence, making consideration of patient safety by Emergency Medicine (EM) physicians and Trauma...
INTRODUCTION
Victims of violence (VoV) are at disproportionate risk for future violence, making consideration of patient safety by Emergency Medicine (EM) physicians and Trauma Surgeons (TS) essential when discharge planning (DP) for VoV. Practice patterns and ethical perspectives in DP for VoV, and their respective scenario- and specialty-specific variations, are unknown.
METHODS
We surveyed 118 EM and 37 TS physicians at a level 1 trauma center. Three clinical scenarios were presented (intimate partner violence, elder abuse, gun violence), each followed by four questions assessing practices and ethical dilemmas in DP. Responses were compared using Chi-Square testing.
RESULTS
Response rate was 51.6%. EM physicians more frequently supported patient autonomy to proceed with a potentially unsafe discharge plan after an episode of Intimate Partner Violence ( = .013) and believed that admission could facilitate change in the victim's social situation after an episode of Elder Abuse ( = .026). TS physicians were more likely to offer social admission, providing additional time to navigate safe discharge planning ( = .003), less likely to see social admission as an inappropriate use of limited resources ( = .030) and less likely to support patient autonomy to proceed with a potentially unsafe discharge ( = .003) after gun-related violence.
CONCLUSION
There appears to exist scenario- and specialty-specific variability in the practice patterns and ethical perspectives of EM and TS physicians when discharge planning for victims of violence. These findings highlight the need for further evaluation of specific factors underlying variability by situation and specialty, and their implications for patient-centered outcomes.
Topics: Humans; Aged; Patient Discharge; Violence; Intimate Partner Violence; Physicians; Physician-Patient Relations
PubMed: 37253639
DOI: 10.1177/00031348231180914