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Canadian Journal of Anaesthesia =... Dec 2022While patient and family engagement may improve clinical care and research, current practices for engagement in Canadian intensive care units (ICUs) are unknown.
PURPOSE
While patient and family engagement may improve clinical care and research, current practices for engagement in Canadian intensive care units (ICUs) are unknown.
METHODS
We developed and administered a cross-sectional questionnaire to ICU leaders of current engagement practices, facilitators, and barriers to engagement, and whether engagement was a priority, using to an ordinal Likert scale from 1 to 10.
RESULTS
The response rate was 53.4% (124/232). Respondents were from 11 provinces and territories, mainly from medical surgical ICUs (76%) and community hospitals (70%). Engagement in patient care included bedside care (84%) and bedside rounds (66%), presence during procedures/crises (65%), and survey completion (77%). Research engagement included ethics committees (36%), protocol review (31%), and knowledge translation (30%). Facilitators of engagement in patient care included family meetings (87%), open visitation policies (81%), and engagement as an institutional priority (74%). Support from departmental (43%) and hospital (33%) leadership was facilitator of research engagement. Time was the main barrier to engagement in any capacity. Engagement was a higher priority in patient care vs research (median [interquartile range], 8 [7-9] vs 3 [1-7]; P < 0.001) and in pediatric vs adult ICUs (10 [9-10] vs 8 [7-9]; P = 0.003). Research engagement was significantly higher in academic vs other ICUs (7 [5-8] vs 2 [1-4]; P < 0.001), and pediatric vs adult ICUs (7 [5-8] vs 3 [1-6]; P = 0.01).
CONCLUSIONS
Organizational strategies and institutional support were key facilitators of engagement. Engagement in patient care was a higher priority than engagement in research.
Topics: Adult; Humans; Child; Cross-Sectional Studies; Canada; Intensive Care Units; Patient Care; Surveys and Questionnaires; Critical Care; Family
PubMed: 36344874
DOI: 10.1007/s12630-022-02342-w -
Current Opinion in Anaesthesiology Aug 2020The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic... (Review)
Review
PURPOSE OF REVIEW
The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic reasons. Considering the high risk of anaesthesia-related adverse events in this population, along with the limitations of NORA, more specific knowledge and skills are required.
RECENT FINDINGS
Advanced age appears to be an independent risk factor for anaesthesia-related adverse events in a NORA setting, similar to the traditional operating room. As significant changes occur in the pharmacological effects of anaesthetic agents with aging, reducing dosage and carefully titrating drugs are essential. Because NORA-related injury is frequently related to airway obstruction/respiratory depression, non-invasive respiratory activity monitoring is more useful for sedation of elderly patients. Additionally, advanced age increases the risk of aspiration and cognitive complications, even during sedation.
SUMMARY
Elderly patients may greatly benefit from the lower invasiveness and faster recovery offered by interventional procedures. However, as they represent a highly heterogeneous population with large variations in physiological reserves and comorbidities, anaesthesiologists should strive to maintain the same practice standards throughout all anaesthetizing locations. Knowledge of the unique hazards associated with NORA in elderly patients may further enhance patient safety.Video abstract: NORA for elderly patients.mp4: http://links.lww.com/COAN/A66.
Topics: Age Factors; Aged; Ambulatory Care Facilities; Anesthesia; Anesthesiologists; Anesthesiology; Anesthetics; Drug-Related Side Effects and Adverse Reactions; Humans; Patient Care; Patient Safety
PubMed: 32618686
DOI: 10.1097/ACO.0000000000000883 -
Journal of the American College of... Nov 2020
Topics: Cardiovascular Diseases; Humans; Patient Care; Practice Guidelines as Topic; Treatment Outcome
PubMed: 33121724
DOI: 10.1016/j.jacc.2020.09.578 -
Professional Case ManagementCare transitions from one setting to another are vulnerable spaces where patients are susceptible to complications. Health systems, accountable care organizations, and...
PURPOSE/OBJECTIVES
Care transitions from one setting to another are vulnerable spaces where patients are susceptible to complications. Health systems, accountable care organizations, and payers recognize that care transition interventions are necessary to reduce unnecessary cost and utilization and improve patient outcomes following a hospitalization. Multiple care transition models exist, with varying degrees of intensity and success. This article describes a quality improvement project for a care transition model that incorporates key elements from the American Case Management Association's Transitions of Care Standards and the Transitional Care Management services as outlined by the Centers for Medicare & Medicaid Services.
PRIMARY PRACTICE SETTING
A collaboratively developed care transition model was implemented between a health system population health management office and a primary care organization.
FINDINGS/CONCLUSIONS
An effective care transitions model is stronger with collaboration among core members of a patient's care team, including a nurse care manager and a primary care provider. Ongoing quality improvement is necessary to gain efficiencies and effectiveness of such a model.
IMPLICATIONS FOR CASE MANAGEMENT PRACTICE
Care managers are integral in coordinating effective transitions. Care management practice includes transition of care standards that are associated with improved outcomes for patients at high risk for readmission. Interventions inclusive of medication reconciliation, identification and addressing of health-related social needs, review of discharge instructions, and coordinated follow-up are important factors that impact patient outcomes. Patients and their health system care teams benefit from the role of a care manager when there is a collaborative, coordinated, and timely approach to hospital follow-up.
Topics: Aged; Humans; United States; Patient Transfer; Patient Readmission; Medicare; Patient Care; Transitional Care; Patient Discharge
PubMed: 38015801
DOI: 10.1097/NCM.0000000000000687 -
The Surgical Clinics of North America Oct 2019Palliative care is an interdisciplinary field that focuses on optimizing quality of life for patients with serious, life-limiting illnesses and includes aggressive... (Review)
Review
Palliative care is an interdisciplinary field that focuses on optimizing quality of life for patients with serious, life-limiting illnesses and includes aggressive management of pain and symptoms; psychological, social, and spiritual support; and discussions of advance care planning, including treatment decision making and complex care coordination. Early palliative care is associated with increased quality of life, decreased symptom burden, decreased health care expenditures, and improved caregiver outcomes. This article discusses integrating interdisciplinary palliative care into surgical practice, and some current models of using and expanding palliative care skill sets in surgery, including training initiatives for both physicians and nurses.
Topics: Chronic Disease; Humans; Palliative Care; Patient Care Team; Perioperative Care; Quality of Life; Terminal Care
PubMed: 31446910
DOI: 10.1016/j.suc.2019.05.004 -
Annals of Hematology Mar 2021While recent medical advances have led to cure, remission, or long-term disease control for patients with hematologic malignancy, many still portend poor prognoses, and... (Review)
Review
While recent medical advances have led to cure, remission, or long-term disease control for patients with hematologic malignancy, many still portend poor prognoses, and frequently are associated with significant symptom and quality of life burden for patients and families. Patients with hematological cancer are referred to palliative care (PC) services less often than those with solid tumors, despite higher inpatient mortality and shorter interval between first consultation and death. The complexity of individual prognostication, ongoing therapeutic goals of cure, the technical nature and complications of treatment, the intensity of medical care even when approaching end of life, and the speed of change to a terminal event all pose difficulties and hinder referral. A modified palliative care model is an unmet need in hemato-oncology, where PC is introduced early from the diagnosis of hematological malignancy, provided alongside care of curative or life-prolonging intent, and subsequently leads to death and bereavement care or cure and survivorship care depending on disease course. From current evidence, the historical prioritization of cancer care at the center of palliative medicine did not guarantee that those diagnosed with a hematological malignancy were assured of referral, timely or otherwise. Hopefully, this article can be a catalyst for debate that will foster a new direction in integration of clinical service and research, and subspecialty development at the interface of hemato-oncology and palliative care.
Topics: Continuity of Patient Care; Delivery of Health Care, Integrated; Hematologic Neoplasms; Humans; Interdisciplinary Communication; Medical Oncology; Palliative Care; Patient Care Team; Referral and Consultation
PubMed: 33388859
DOI: 10.1007/s00277-020-04386-8 -
British Journal of Nursing (Mark Allen... Aug 2019
Topics: Evidence-Based Practice; Health Care Costs; Humans; Patient Care; State Medicine; United Kingdom; Wounds and Injuries
PubMed: 31393757
DOI: 10.12968/bjon.2019.28.15.S4 -
The Journal of Neuroscience Nursing :... Oct 2023BACKGROUND: Nonconvulsive seizures are a major source of in-hospital morbidity and a cause of unexplained encephalopathy in critically ill patients....
BACKGROUND: Nonconvulsive seizures are a major source of in-hospital morbidity and a cause of unexplained encephalopathy in critically ill patients. Electroencephalography (EEG) is essential to confirm nonconvulsive seizures and can guide patient-specific workup, treatment, and prognostication. In a 208-bed community hospital, EEG services were limited to 1 part-time EEG technician and 1 EEG machine shared between inpatient and outpatient settings. Its use was restricted to typical business hours. A nursing-led quality improvement (QI) project endeavored to enhance access to EEG by introducing a point-of-care rapid-response EEG program. METHODS: For this project, a multidisciplinary protocol was developed to deploy a Food and Drug Administration-cleared, point-of-care rapid-response EEG platform (Ceribell Inc) in a community hospital's emergency department and inpatient units to streamline neurodiagnostic workups. This QI project compared EEG volume, study location, time-to-EEG, number of cases with seizures captured on EEG, and hospital-level financial metrics of diagnosis-related group reimbursements and length of stay for the 6 months before (pre-QI, using conventional EEG) and 6 months after implementing the rapid-response protocol (post-QI). RESULTS: Electroencephalography volume increased from 35 studies pre-QI to 115 post-QI (3.29-fold increase), whereas the median time from EEG order to EEG start decreased 7.6-fold (74 [34-187] minutes post-QI vs 562 [321-1034] minutes pre-QI). Point-of-care EEG was also associated with more confirmed seizure diagnoses compared with conventional EEG (27/115 post-QI vs 0/35 pre-QI). This resulted in additional diagnosis-related group reimbursements and hospital revenue. Availability of point-of-care EEG was also associated with a shorter median length of stay. CONCLUSION: A nurse-led, rapid-response EEG protocol at a community hospital resulted in significant improvements in EEG accessibility and seizure diagnosis with hospital-level financial benefits. By expanding access to EEG, confirming nonconvulsive seizures, and increasing care efficiency, rapid-response EEG protocols can enhance patient care.
Topics: Humans; Hospitals, Community; Seizures; Electroencephalography; Patient Care; Critical Care
PubMed: 37556461
DOI: 10.1097/JNN.0000000000000715 -
Chest Jul 2020
Topics: Airway Management; Critical Care; Humans; Patient Care; Simulation Training; Video Recording
PubMed: 32654705
DOI: 10.1016/j.chest.2020.03.019 -
Journal of Public Health (Oxford,... May 2024
Topics: Humans; Patient Care; Caregivers; United Kingdom
PubMed: 38102796
DOI: 10.1093/pubmed/fdad264