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JAMA Cardiology Mar 2020
Topics: Electrocardiography; Humans; Patients; Physician-Patient Relations; Physicians; Self Concept; Tachycardia, Ventricular
PubMed: 31968051
DOI: 10.1001/jamacardio.2019.5302 -
Annals of Palliative Medicine Jul 2023Geographic cohorting refers to localization of inpatients to designated hospital areas (typically a unit or a set of beds) based on specified criteria. One such... (Review)
Review
BACKGROUND AND OBJECTIVE
Geographic cohorting refers to localization of inpatients to designated hospital areas (typically a unit or a set of beds) based on specified criteria. One such criterion that has been commonly discussed and studied since the early days of the hospitalist movement in the US is a patient's assigned clinical care team. Because implementing cohorting of this type requires substantial operational investment, it is important to understand the benefits and the tradeoffs associated with bringing patients into closer spatial proximity with their full team of providers and allowing clinicians to work within a defined clinical space.
METHODS
We conducted a narrative review of the evidence around geographic cohorting of patients by clinical care team. We performed a comprehensive search of the PubMed, Embase, Cinahl and Scopus databases, identifying relevant English language articles. We used an inductive approach to developing thematic domains for categorization of article content.
KEY CONTENT AND FINDINGS
We reviewed eighteen articles published between 2008 and 2022, and identified four thematic outcomes domains: patient-centered outcomes, communication, efficiency, and satisfaction. The existing literature demonstrates associations with improved communication and staff satisfaction. The data regarding patient outcomes and overall work efficiency, on the other hand, are equivocal and, in general, limited by study methodology.
CONCLUSIONS
Geographic cohorting of inpatients according to clinical care team offers some promise for improved workplace culture. More rigorously designed studies are needed, however, to understand its impact on patient outcomes, and there should be added attention paid to throughput metrics and tradeoffs that often limit its implementation.
Topics: Humans; Inpatients; Communication; Databases, Factual; Hospitals; Patient Care Team
PubMed: 37081705
DOI: 10.21037/apm-22-1400 -
The Journal of the American Academy of... Jul 2019Orthopaedic injuries of the upper extremity remain common, often requiring prolonged immobilization after surgical or nonsurgical management. Upper extremity... (Review)
Review
Orthopaedic injuries of the upper extremity remain common, often requiring prolonged immobilization after surgical or nonsurgical management. Upper extremity immobilization often has a profound effect on a patient's daily life, including one's ability to safely operate a motor vehicle. Current literature on the safety of driving while immobilized is varied, although above-elbow immobilization of the upper extremity is generally thought to present a particular hazard to safe driving. Unfortunately, as common as this situation is, currently little to no guidance exists for patients, physicians, or lawmakers with regard to deciding whether a patient is safe to return to driving with upper extremity immobilization. Similar discord exists with the issue of patient and physician liability in such cases. In this review, we seek to present both historical precedent and a contemporary update of this complex, though a frequently encountered situation.
Topics: Automobile Driving; Humans; Liability, Legal; Narcotics; Patients; Physicians; Restraint, Physical; Safety; Splints; Upper Extremity
PubMed: 30431507
DOI: 10.5435/JAAOS-D-18-00435 -
Frontiers in Public Health 2022Long waiting time for treatment in the outpatient department has long been a complaint and has influenced patient's experience. It is critical to schedule patients for...
BACKGROUND
Long waiting time for treatment in the outpatient department has long been a complaint and has influenced patient's experience. It is critical to schedule patients for doctors to reduce patient's waiting time. Nowadays, multi-channel appointment has been provided for patients to get medical services, especially for those with severe illnesses and remote distance. This study aims to explore the factors that influence patient appointment channel choice in the context of multi-channel appointments, and how channel choice affects the waiting time for offline visiting.
METHODS
We collected outpatient appointment records from both online and offline appointment channels to conduct our empirical research. The empirical analysis is conducted in two steps. We first analyze the relationship between appointment channel choice and patient's waiting time and then the relationships between three determinants and appointment channel choice. The ordinary least squares and the logistic regression model are used to obtain the empirical results.
RESULTS
Our results show that a patient with an online appointment decision has a shorter consultation waiting time compared with a patient with on-site appointment (β = -0.320, < 0.001). High-quality resource demand (β = 0.349, < 0.001), high-severity disease (β = 0.011, < 0.001), and high non-disease costs (β = 0.039, < 0.001) create an obvious incentive for patients to make appointments the Internet. Further, only the effect of non-disease cost on channel choice is lower for patients with multiple visit histories (β = -0.021, < 0.001).
CONCLUSIONS
Our study confirms the effect of Internet use on reducing patient's waiting time. Patients consider both health-related risk factors and cost-related risk factors to make decisions on appointment channels. Our study produces several insights, which have implications for channel choice and patient's behavior literature. More importantly, these insights contribute to the design of appointment systems in hospitals.
Topics: Appointments and Schedules; Empirical Research; Humans; Outpatients; Physicians; Referral and Consultation
PubMed: 35979451
DOI: 10.3389/fpubh.2022.923661 -
Best Practice & Research. Clinical... Dec 2021Patient-reported outcomes (PROs) have been increasingly recognized as valuable information for delivery of optimal perioperative care to high-risk surgical patients in... (Review)
Review
Patient-reported outcomes (PROs) have been increasingly recognized as valuable information for delivery of optimal perioperative care to high-risk surgical patients in recent years. However, progress from clinical research on PROs has not been widely adopted in routine patient care. This review discusses the current concepts and practice status regarding PROs and addresses the missing links from research to practice adoption to further improve patient's experiences and clinical outcomes in perioperative care. Insufficient empirical research on appropriate PROs and its methodologies, insufficient implementation research to solve the practical issues, and insufficient data collection methods and experiences on ePROs are also discussed. Future research agenda should focus on evidence-supported, PRO-based symptom monitoring systems for early diagnosis and management of impending compromised clinical outcomes.
Topics: Humans; Patient Reported Outcome Measures; Patient-Centered Care; Patients; Perioperative Care
PubMed: 34801218
DOI: 10.1016/j.bpa.2020.10.006 -
Journal of the American Board of Family... 2020In this narrative account, the author, a medical student, describes his encounters with several inpatients at a community hospital. He becomes acquainted with a...
In this narrative account, the author, a medical student, describes his encounters with several inpatients at a community hospital. He becomes acquainted with a patient's son, who, initially withdrawn, over the course of his mother's hospitalizations transforms into a compassionate volunteer. This change is made especially evident when the author meets another patient who recognizes the volunteer and reveals his very different past.
Topics: Empathy; Humans; Inpatients; Male; Students, Medical; Volunteers
PubMed: 32430384
DOI: 10.3122/jabfm.2020.03.190291 -
Western Journal of Nursing Research Oct 2020Dementia is a serious condition that has become a public health priority worldwide. Reminiscence is the process of recollecting personal memories from the distant past.... (Review)
Review
Dementia is a serious condition that has become a public health priority worldwide. Reminiscence is the process of recollecting personal memories from the distant past. This metasynthesis aims to present a thorough analysis of available qualitative literature concerning patients' perspectives about reminiscence in dementia care. A search of CINAHL, PubMed, PsycINFO, Scopus, and ProQuest for qualitative studies published in English between 2005 and 2019 generated 110 studies. Eleven studies were retrieved, assessed for quality using the Critical Appraisal Skills Programme tool, and then synthesized according to Noblit and Hare's seven-step approach. Metaphors were arranged in a list and translated into one another. Five reciprocal themes emerged: Promoting a Comfort Zone, Keeping the Conversation Going, Creating a Dynamic Life, Reliving Painful Memories and Emotional Turmoil, and Strengthening Inner Forces. Increased awareness of patients' perspectives about reminiscence can help design a better framework for interventions that will serve this vulnerable population.
Topics: Dementia; Humans; Memory, Long-Term; Patient Satisfaction; Patients; Qualitative Research; Quality of Health Care
PubMed: 31959082
DOI: 10.1177/0193945919897927 -
Primary Health Care Research &... Mar 2023Lack of access to primary care providers (PCPs) is a significant hurdle to receiving high-quality comprehensive health care and creates greater reliance on emergency... (Review)
Review
INTRODUCTION
Lack of access to primary care providers (PCPs) is a significant hurdle to receiving high-quality comprehensive health care and creates greater reliance on emergency departments and walk-in clinics.
METHODS
We conducted a rapid review and analysis of the literature that discusses approaches to increasing access to continuous care for patients with no PCP ('unattached patients').
RESULTS
Five distinct themes across 38 resources were identified: financial incentives for patients and providers, health care organization, policy intervention, virtual care and health information technology (HIT), and medical education. Approaches that increased attachment were primary care models that combined two or more of these and reflected the Patient's Medical Home (PMH) model.
CONCLUSIONS
Although there are individual initiatives that could allow for temporary relief, long-term and community-wide success lies in designing models of primary care that use multiple tools, meet the needs of the community, and are supported by regional, provincial, and national policies.
Topics: Humans; Primary Health Care; Patients; Comprehensive Health Care; Quality of Health Care; Emergency Service, Hospital
PubMed: 36919838
DOI: 10.1017/S1463423623000099 -
The Journal of Surgical Research Jan 2022Same-day surgery in the carefully selected patient decreases costs, improves inpatient capacity, and decreases patient exposure to hospital-acquired conditions....
INTRODUCTION
Same-day surgery in the carefully selected patient decreases costs, improves inpatient capacity, and decreases patient exposure to hospital-acquired conditions. Outpatient adrenalectomy has been shown to be safe and effective, but patients' perspectives have yet to be addressed. This study compares patient satisfaction following inpatient and outpatient adrenalectomy.
METHODS
An institutional database was queried for minimally-invasive adrenalectomies performed from 2017 to 2020. Patients were contacted up to two times to participate in a phone survey consisting of 25 questions modeled after the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems Survey (OAS CAHPS) assessing preparation for surgery, discharge experience, post-operative course, and overall satisfaction. Statistical analysis was performed using Kruskal Wallis, Wilcoxon-Mann Whitney, and Chi-square tests, as appropriate.
RESULTS
One hundred five adrenalectomy patients were identified, of which 98 were contacted and 58 responded (59%). Two surgeons contributed patients, with no difference in the percentage of patients in the outpatient group (51.7% versus 62.1%, P = 0.423). Outpatient adrenalectomy patients had slightly higher overall experience scores, but this difference was not statistically significant (9.12 ± 1.36 versus 8.93 ± 1.51, P = 0.367). Patients undergoing outpatient adrenalectomy were more likely to have their discharge plan discussed pre-operatively (94% versus 62%, P = 0.005), but no significant differences were noted between inpatient and outpatient groups regarding preparation for surgery, readiness for discharge, night of surgery experiences, or self-reported pain or complications (P > 0.05 for all). Significantly higher overall experience scores were reported by patients counseled about their discharge plan (9.27 versus 7.9, P = 0.036), felt prepared for recovery (9.39 versus 5.5, P < 0.001), received information about pain control (9.13 versus 7.00, P = 0.031), felt prepared at time of discharge (9.33 versus 5.80, P < 0.001), and received information about potential complications (9.29 versus 7.00, P = 0.001). Although not statistically significant, there was a trend towards outpatients being more likely to choose the same approach if they were to undergo surgery again (97% versus 84%, P = 0.081).
CONCLUSIONS
Patient satisfaction following adrenalectomy is significantly associated with patients' self-reported degree of preparation for surgery and discharge, with no significant difference in patient satisfaction between inpatient and outpatient groups. Patients undergoing outpatient adrenalectomy would be likely to choose the same approach compared to inpatients. Targeted pre-operative counseling can contribute to enhanced patient outcomes for all patients undergoing adrenalectomy.
Topics: Adrenalectomy; Ambulatory Surgical Procedures; Humans; Inpatients; Outpatients; Patient Satisfaction
PubMed: 34601371
DOI: 10.1016/j.jss.2021.08.019 -
BMC Psychiatry Jun 2020Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research.
METHOD
PsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis.
RESULTS
Thirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what's unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends.
CONCLUSIONS
Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account.
Topics: Depression; Humans; Patients; Psychotherapy, Psychodynamic; Qualitative Research
PubMed: 32552748
DOI: 10.1186/s12888-020-02682-1