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QJM : Monthly Journal of the... Oct 2023
Topics: Humans; Aged; Patient Discharge; Aftercare
PubMed: 37261861
DOI: 10.1093/qjmed/hcad113 -
Journal of Perianesthesia Nursing :... Aug 2023This study was conducted to determine if postoperative nurse-driven telehealth visits for patients undergoing septorhinoplasty decreased patient anxiety while improving...
PURPOSE
This study was conducted to determine if postoperative nurse-driven telehealth visits for patients undergoing septorhinoplasty decreased patient anxiety while improving comfort and satisfaction levels.
DESIGN
The present study was an intervention-control study completed with a total of 320 participants (n = 160, intervention group; n = 160, control group). The intervention postseptorhinoplasty training using the telenursing method was conducted at three time points in this study; preoperatively-postoperatively, on days 3, and 10.
METHODS
Data were collected from a group of patients undergoing septorhinoplasty in the Ear, Nose, and Throat department of a University Hospital in Turkey between October 2021 and February 2022. The data collected in the study were evaluated with the SPSS 23.00 program and were analyzed with the independent sample t test for two independent groups and the F test (ANOVA) for more than two groups. Correlation analysis was performed to examine the relationship between scales, and P < .05 was considered statistically significant.
FINDINGS
In the postoperative period, the mean anxiety inventory score of the experimental group was found to be significantly lower than that of the control group (P < .01). Telenursing increased the satisfaction and comfort of the patients and shortened the discharge time. There was a negative and statistically significant relationship between satisfaction and State Anxiety Inventory and Trait Anxiety Inventory (r = -0.715, r = -0.739, P < .01).
CONCLUSIONS
This study confirms the importance of postoperative telenursing for septorhinoplasty patients in promoting continuity of care, reducing anxiety and discharge time, improving comfort and satisfaction levels during the Covid-19 pandemic. Remote care was well received during the study and should be used more frequently. There is a need for further research regarding telehealth; and the international incentives and regulations which will be needed to make telenursing a standard of care should be pursued.
Topics: Humans; Telenursing; Pandemics; COVID-19; Telemedicine; Patient Discharge
PubMed: 36690512
DOI: 10.1016/j.jopan.2022.11.011 -
Revista Brasileira de Enfermagem 2023to analyze care transition in hospital discharge planning for patients with chronic noncommunicable diseases.
OBJECTIVE
to analyze care transition in hospital discharge planning for patients with chronic noncommunicable diseases.
METHOD
a qualitative study, based on the Care Transitions Intervention theoretical model, with four pillars of intervention, to ensure a safe transition. Twelve professionals participated in a public hospital in the countryside of São Paulo. Data were collected through observation, document analysis and semi-structured interviews.
RESULTS
there was a commitment of a multidisciplinary team to comprehensive care and involvement of family members in patient care. The documents facilitated communication between professionals and/or levels of care. However, the lack of time to prepare for discharge can lead to fragmented care, impairing communication and jeopardizing a safe transition.
FINAL CONSIDERATIONS
they were shown to be important elements in discharge planning composition, aiming to ensure a safe care transition, team participation with nurses as main actors, early discharge planning and family involvement.
Topics: Humans; Patient Discharge; Patient Transfer; Noncommunicable Diseases; Brazil; Hospitals, Public; Qualitative Research
PubMed: 38055480
DOI: 10.1590/0034-7167-2022-0772 -
Journal of Clinical Nursing Apr 2024To undertake a systematic review of the practice patterns and roles of advanced practice nurses (APNs) in inpatient and outpatient stroke-care services; and to evaluate...
AIM(S)
To undertake a systematic review of the practice patterns and roles of advanced practice nurses (APNs) in inpatient and outpatient stroke-care services; and to evaluate the impact of APN-led inpatient and outpatient stroke-care services on clinical and patient-reported outcomes.
DESIGN
A mixed-methods systematic review.
METHODS
A systematic search was conducted across six electronic databases for primary studies. Data were synthesised using a convergent integrated approach. DATA SOURCES (INCLUDE SEARCH DATES) *FOR REVIEWS ONLY: A systematic search was conducted across PubMed, CINAHL, Cochrane Library, Embase, PsycInfo and ProQuest Dissertations & Theses Global, for primary studies published between the inception of the databases and 3 November 2022.
RESULTS
Findings based on the 18 included primary studies indicate that the APNs' roles have been implemented across the continuum of stroke care, including pre-intervention care, inpatient care and post-discharge care. Practicing at an advanced level, the APNs engaged in clinical, operational and educational undertakings across services and disciplines. Positive clinical and patient-reported outcomes have been attributed to their practice.
CONCLUSION
The review highlights the critical role of APNs in improving stroke care, especially in the pre-intervention phase. Their clinical expertise, patient-centered approach and collaboration can transform stroke care. Integrating APNs into stroke care teams is essential for better management and outcomes in light of the increasing stroke burden.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE
Healthcare institutions should integrate APNs to enhance pre-intervention stroke care, improve diagnostic accuracy and expedite treatment. APNs can prioritise patient-centric care, including assessments, coordination and education. Medication reconciliation, timely rehabilitation referrals and lifestyle modifications for secondary stroke prevention are crucial. Implementing advanced practice nursing frameworks ensures successful APN integration, leading to improved stroke care and better patient outcomes in response to the growing stroke burden.
IMPACT (ADDRESSING)
What problem did the study address? Poor clarity of the role of advanced practice nurses among patients, physicians, healthcare professionals, health policymakers and nurses. What were the main findings? Advanced practice nurses practise across the continuum of stroke care, mainly in pre-intervention care which takes place before initiating treatment, inpatient care and post-discharge care. The implementation of the advanced practice nurse role in stroke care has contributed positively to clinical and patient-reported outcomes. Where and on whom will the research have an impact? Insights from the review are envisioned to inform healthcare policymakers and leaders in the implementation and evaluation of the APN role in stroke care.
REPORTING METHOD
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.
PATIENT OR PUBLIC CONTRIBUTION
No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: https://figshare.com/ndownloader/files/41606781; Registered on Open Science Framework osf.io/dav8j.
Topics: Humans; Advanced Practice Nursing; Aftercare; Delivery of Health Care; Educational Status; Patient Discharge
PubMed: 38131430
DOI: 10.1111/jocn.16970 -
Hospital Pediatrics Feb 2024Children with medical complexity (CMC) are high health care utilizers prompting hospitals to implement care models focused on this population, yet practices have not...
BACKGROUND AND OBJECTIVES
Children with medical complexity (CMC) are high health care utilizers prompting hospitals to implement care models focused on this population, yet practices have not been evaluated on a national level. Our objective with this study is to describe the presence and structure of care models and the use of discharge services for CMC admitted to freestanding children's hospitals across the nation.
METHODS
We distributed an electronic survey to 48 hospitals within the Pediatric Health Information System exploring the availability of care models and discharge services for CMC. Care models were grouped by type and number present at each institution. Discharge services were grouped by low (never, rarely), medium (sometimes), and high (most of the time, always) frequency use.
RESULTS
Of 48 eligible hospitals, 33 completed the survey (69%). There were no significant differences between responders and non-responders for both hospital and patient characteristics. Most participants identified an outpatient care model (67%), whereas 21% had no dedicated care model for CMC in the inpatient or outpatient setting. High-frequency discharge services included durable medical equipment delivery, medication delivery, and communication with outpatient provider before discharge. Low-frequency discharge services included the use of a structured handoff tool for outpatient communication, personalized access plans, inpatient team follow-up with family after discharge, and the use of discharge checklists.
CONCLUSIONS
Children's hospitals vary largely in care model structure and discharge services. Future work is needed to evaluate the associations between care models and discharge services for CMC with various health care outcomes.
Topics: Child; Humans; Patient Discharge; Hospitalization; Hospitals, Pediatric; Outpatients; Inpatients
PubMed: 38196385
DOI: 10.1542/hpeds.2023-007423 -
Journal of Gerontological Nursing Oct 2023Older adults have challenges understanding newly prescribed medications after discharge and must be more adherent with medications and follow up with their primary care...
Older adults have challenges understanding newly prescribed medications after discharge and must be more adherent with medications and follow up with their primary care provider. A collaborative discharge process is critical to improving patient outcomes and reducing avoidable readmission rates. This quality improvement (QI) initiative engaged 44 patients and families in the IDEAL Discharge Protocol-an evidence-based collaborative care process focused on discussion, education, and post-discharge follow up. Post-discharge follow up resulted in the completion of 52.2% of follow-up calls and 45.5% of follow-up appointments scheduled, and a 4% reduction in readmission rates. Medication adherence was assessed and found to be 93.3%, and 100% of participants received education while engaged in the study. The IDEAL Discharge Protocol aided in improving the discharge process to better equip patients with the tools to transition home successfully after discharge. [(10), 13-19.].
Topics: Humans; Aged; Aftercare; Patient Discharge; Patient Readmission; Quality Improvement; Geriatric Nursing
PubMed: 37768584
DOI: 10.3928/00989134-20230915-04 -
Nursing Nov 2023To identify patient characteristics and perioperative factors associated with non-home patient discharges and the impact of current delirium nursing interventions on...
PURPOSE
To identify patient characteristics and perioperative factors associated with non-home patient discharges and the impact of current delirium nursing interventions on discharge disposition, especially non-home dispositions.
METHODS
A retrospective pilot chart review was conducted using electronic health records from five networked hospitals in the Mountain West region of the US. The sample comprised 75 randomly selected patients aged 65 or older who screened positive for delirium during hospitalization. Relationships between patient characteristics, nursing interventions, and discharge dispositions were analyzed using chi-square tests and logistic regression.
RESULTS
Most participants (69.3%) were discharged to non-home facilities. Delayed urinary catheter removal was a significant nursing intervention factor. Patients with delayed urinary catheter removal were at increased risk of being discharged to a non-home setting compared with those with early urinary catheter removal (aOR: 14.11, P = .010). Preoperative hypoalbuminemia and surgery durations exceeding 60 minutes were associated with non-home dispositions.
CONCLUSION
Delayed urinary catheter removal, surgery duration greater than 1 hour, and preoperative hypoalbuminemia increased the likelihood of non-home discharge placement for older adults who experience postoperative delirium.
Topics: Humans; Aged; Patient Discharge; Retrospective Studies; Emergence Delirium; Hypoalbuminemia; Hospitalization
PubMed: 37856302
DOI: 10.1097/01.NURSE.0000978892.66327.23 -
Internal Medicine Journal Nov 2023Inaccurate medication documentation in prescriptions and discharge summaries produce poorer patient outcomes, are costly to healthcare systems and result in more...
BACKGROUND
Inaccurate medication documentation in prescriptions and discharge summaries produce poorer patient outcomes, are costly to healthcare systems and result in more readmissions to hospital. Errors in medication documentation are common in Australian hospitals.
AIM
To determine whether pharmacist-led partnered prescribing (PPP) on discharge reduced errors and improved accuracy in documentation of medications in the discharge prescription and the discharge summary of people with kidney disease compared with medical prescribing (MP).
METHODS
This interventional two-phase study compared current workflow (MP) with the subsequent implementation of the interventional workflow (PPP) in the renal unit of a tertiary referral hospital. Patients were included if they were discharged within pharmacy working hours and had a discharge prescription and discharge summary. The primary outcome was the percentage of discharge prescriptions with at least one error. The secondary outcome was the percentage of discharge summaries with at least one error.
RESULTS
Data were collected from 185 discharged patients (95 in MP phase then 90 in PPP phase). Discharge prescriptions with at least one error reduced from 75.8% in the MP phase to 6.7% in PPP phase (P < 0.001). Discharge summaries with at least one error reduced from 53% in MP phase to 24% in the PPP phase (P < 0.001).
CONCLUSION
PPP improves the accuracy of the documentation of medications in both the discharge prescription and the discharge summary of patients with kidney disease.
Topics: Humans; Patient Discharge; Pharmacists; Australia; Drug Prescriptions; Hospitals, Teaching; Documentation; Kidney Diseases
PubMed: 36437522
DOI: 10.1111/imj.15979 -
Cardiology Clinics May 2024Acute heart failure (AHF) is a frequent cause of hospitalization around the world and is associated with high in-hospital and post-discharge morbidity and mortality.... (Review)
Review
Acute heart failure (AHF) is a frequent cause of hospitalization around the world and is associated with high in-hospital and post-discharge morbidity and mortality. This review summarizes data on diagnosis and management of AHF from the emergency department to the intensive care unit. While more evidence is needed to guide risk stratification and care of patients with AHF, hospitalization is a key opportunity to optimize evidence-based medical therapy for heart failure. Close linkage to outpatient care is essential to improve post-hospitalization outcomes.
Topics: Humans; Aftercare; Patient Discharge; Acute Disease; Heart Failure; Intensive Care Units; Emergency Service, Hospital
PubMed: 38631788
DOI: 10.1016/j.ccl.2024.02.005 -
Journal of the American Medical... Jul 2024Use patient demographic and clinical characteristics at admission and time-varying in-hospital measures of patient mobility to predict patient post-acute care (PAC)...
OBJECTIVES
Use patient demographic and clinical characteristics at admission and time-varying in-hospital measures of patient mobility to predict patient post-acute care (PAC) discharge.
DESIGN
Retrospective cohort analysis of electronic medical records.
SETTING AND PARTICIPANTS
Patients admitted to the two participating Hospitals from November 2016 through December 2019 with ≥72 hours in a general medicine service.
METHODS
Discharge location (PAC vs home) was the primary outcome, and 2 time-varying measures of patient mobility, Activity Measure for Post-Acute Care (AM-PAC) Mobility "6-clicks" and Johns Hopkins Highest Level of Mobility, were the primary predictors. Other predictors included demographic and clinical characteristics. For each day of hospitalization, we predicted discharge to PAC using the demographic and clinical characteristics and most recent mobility data within a random forest (RF) for survival, longitudinal, and multivariate (RF-SLAM) data. A regression tree for the daily predicted probabilities of discharge to PAC was constructed to represent a global summary of the RF.
RESULTS
There were 23,090 total patients and compared to PAC, those discharged home were younger (64 vs 71), had shorter length of stay (5 vs 8 days), higher AM-PAC at admission (43 vs 32), and average AM-PAC throughout hospitalization (45 vs 35). AM-PAC was the most important predictor, followed by age, and whether the patient lives alone. The area under the hospital day-specific receiver operating characteristic curve ranged from 0.76 to 0.79 during the first 5 days. The global summary tree explained 75% of the variation in predicted probabilities for PAC from the RF. Sensitivity (75%), specificity (70%), and accuracy (72%) were maximized at a PAC probability threshold of 40%.
CONCLUSIONS AND IMPLICATIONS
Daily assessment of patient mobility should be part of routine practice to help inform care planning by hospital teams. Our prediction model could be used as a valuable tool by multidisciplinary teams in the discharge planning process.
Topics: Humans; Male; Female; Aged; Retrospective Studies; Subacute Care; Middle Aged; Patient Discharge; Hospitalization; Aged, 80 and over
PubMed: 38387858
DOI: 10.1016/j.jamda.2024.01.008