Sample records for acute care setting

  1. Restraint use in acute and critical care settings: changing practice. (United States)

    Martin, Beth


    Reduction of physical restraint use in the acute and critical care setting is a complex issue. Ethical considerations, regulatory and professional standards, legal liability concerns, healthcare team members' knowledge and attitudes, and unit culture and practice traditions must all be considered. Restraint reduction programs may use a process improvement format that engages the support of the organization's leadership. Specific interventions for restraint reduction, such as understanding the meaning of a patient's behavior, using a team approach, and involving the family can be evaluated and modified for application in the acute and critical care setting. Successful initiatives to decrease the use of restraint in this setting require an understanding of the many factors that support and oppose this practice.

  2. Building a transdisciplinary approach to palliative care in an acute care setting. (United States)

    Daly, Donnelle; Matzel, Stephen Chavez


    A transdisciplinary team is an essential component of palliative and end-of-life care. This article will demonstrate how to develop a transdisciplinary approach to palliative care, incorporating nursing, social work, spiritual care, and pharmacy in an acute care setting. Objectives included: identifying transdisciplinary roles contributing to care in the acute care setting; defining the palliative care model and mission; identifying patient/family and institutional needs; and developing palliative care tools. Methods included a needs assessment and the development of assessment tools, an education program, community resources, and a patient satisfaction survey. After 1 year of implementation, the transdisciplinary palliative care team consisted of seven palliative care physicians, two social workers, two chaplains, a pharmacist, and End-of-Life Nursing Consortium (ELNEC) trained nurses. Palomar Health now has a palliative care service with a consistent process for transdisciplinary communication and intervention for adult critical care patients with advanced, chronic illness.

  3. Implementation of the integrated palliative care outcome scale in acute care settings - a feasibility study. (United States)

    Lind, Susanne; Sandberg, J; Brytting, T; Fürst, C J; Wallin, L


    Although hospitals have been described as inadequate place for end-of-life care, many deaths still occur in hospital settings. Although patient-reported outcome measures have shown positive effects for patients in need of palliative care, little is known about how to implement them. We aimed to explore the feasibility of a pilot version of an implementation strategy for the Integrated Palliative care Outcome Scale (IPOS) in acute care settings. A strategy, including information, training, and facilitation to support the use of IPOS, was developed and carried out at three acute care units. For an even broader understanding of the strategy, it was also tested at a palliative care unit. A process evaluation was conducted including collecting quantitative data and performing interviews with healthcare professionals. Result Factors related to the design and performance of the strategy and the context contributed to the results. The prevalence of completed IPOS in the patient's records varied from 6% to 44% in the acute care settings. At the palliative care unit, the prevalence in the inpatient unit was 53% and the specialized home care team 35%. The qualitative results showed opposing perspectives concerning the training provided: Related to everyday work at the acute care units and Nothing in it for us at the palliative care unit. In the acute care settings, A need for an improved culture regarding palliative care was identified. A context characterized by A constantly increasing workload, a feeling of Constantly on-going changes, and a feeling of Change fatigue were found at all units. Furthermore, the internal facilitators and the nurse managers' involvement in the implementation differed between the units. Significance of the results The feasibility of the strategy in our study is considered to be questionable and the components need to be further explored to enhance the impact of the strategy and thereby improve the use of IPOS.

  4. The Effects of Massage Therapy on Pain Management in the Acute Care Setting


    Adams, Rose; White, Barb; Beckett, Cynthia


    Background Pain management remains a critical issue for hospitals and is receiving the attention of hospital accreditation organizations. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy for pain management into the team-centered approach of patient care. Purpose and Setting This preliminary study evaluated the effect of the use of massage therapy on inpatient pain levels in the acute care setting. The study was conducted at Flags...

  5. Nutritional care of elderly patients in acute care settings: A qualitative study. (United States)

    Gholizadeh, Leila; Yazdi, Khadijeh; Dehghan Nayeri, Nahid; Mohammadi, Eesa


    Poor nutritional status is common in older adult patients. The present study aimed to explore barriers and facilitators to nutritional care of elderly patients in acute care settings. Data were collected through individual face-to-face interviews with 12 registered nurses, and analyzed using interpretive description methodology. Two core themes emerged from the analysis of data: (i) neglected care, with three subthemes of "support but also independence," "unsupportive environment" and "responsibility of the family;" and (ii) a humanitarian ethic, with two subthemes of "respect and dignity" and "humanitarian care." As an integral part of holistic care, elderly patient nutrition should be emphasised in health professional education, and promoted through managerial support, multidisciplinary collaborations, and implementation of appropriate monitoring and evaluation systems. © 2015 Japan Geriatrics Society.

  6. Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting. (United States)

    Bridgeman, Mary Barna; Abazia, Daniel T


    The authors review the historical use of medicinal cannabis and discuss the agent's pharmacology and pharmacokinetics, select evidence on medicinal uses, and the implications of evolving regulations on the acute care hospital setting.

  7. Examination of the Use of Healing Touch by Registered Nurses in the Acute Care Setting. (United States)

    Anderson, Joel G; Friesen, Mary Ann; Swengros, Diane; Herbst, Anna; Mangione, Lucrezia


    Acute care nursing is currently undergoing unprecedented change, with health systems becoming more open to nonpharmacological approaches to patient care. Healing Touch (HT) may be a valuable intervention for acute care patients. Research has shown that HT helps both the patient and the caregiver; however, no study to date has examined the impact that the education of nurses in and their use of HT have on daily care delivery in the acute care setting. The purpose of the current qualitative study was to examine the use of HT by registered nurses in the acute care setting during their delivery of patient care, as well as the impact of education in and use of HT on the nurses themselves. Five themes were identified: (1) use of HT techniques, processes, and sequence; (2) outcomes related to HT; (3) integration of HT into acute care nursing practice; (4) perceptions of HT, from skepticism to openness; and (5) transformation through HT. Education in HT and delivery of this modality by nurses in the acute care setting provide nurses with a transformative tool to improve patient outcomes.

  8. Fatigue in the acute care and ambulatory setting. (United States)

    McCabe, Margaret; Patricia, Branowicki


    Nurses commonly assess their patients for symptoms and intervene to ease any patient distress, yet children are seldom asked about feeling fatigued. The existing pediatric literature suggests that fatigue goes unrecognized and therefore untreated in children, particularly children experiencing stressful events, such as illness and/or hospitalization. In an effort to better understand the presence of the symptom in our environment we conducted a program specific point prevalence survey. Data were collected on nine inpatient and 11 outpatient units of a university affiliated tertiary care children's hospital. Overall, this sample reported higher levels of fatigue than published data from their healthy and chronically ill peers by total fatigue score and sub scores. This brief description of the symptom in our inpatient and ambulatory settings has provided information that will inform our nursing practice and drive future research. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Nursing sabbatical in the acute care hospital setting: a cost-benefit analysis. (United States)

    Schaar, Gina L; Swenty, Constance F; Phillips, Lori A; Embree, Jennifer L; McCool, Isabella A; Shirey, Maria R


    Practice-based acute care nurses experience a high incidence of burnout and dissatisfaction impacting retention and innovation and ultimately burdening the financial infrastructure of a hospital. Business, industry, and academia have successfully implemented professional sabbaticals to retain and revitalize valuable employees; however, the use is infrequent among acute care hospitals. This article expands upon the synthesis of evidence supporting nursing sabbaticals and suggests this option as a fiscally sound approach for nurses practicing in the acute care hospital setting. A cost-benefit analysis and human capital management strategies supporting nursing sabbaticals are identified.

  10. Studying Physician-Patient Communication in the Acute Care Setting: The Hospitalist Rapport Study (United States)

    Anderson, Wendy G.; Winters, Kathryn; Arnold, Robert M.; Puntillo, Kathleen A.; White, Douglas B.; Auerbach, Andrew D.


    Objective To assess the feasibility of studying physician-patient communication in the acute care setting. Methods We recruited hospitalist physicians and patients from two hospitals within a university system and audio-recorded their first encounter. Recruitment, data collection, and challenges encountered were tracked. Results Thirty-two physicians consented (rate 91%). Between August 2008 and March 2009, 441 patients were referred, 210 (48%) were screened, and 119 (66% of 179 eligible) consented. We audio-recorded encounters of 80 patients with 27 physicians. Physicians’ primary concern about participation was interference with their workflow. Addressing their concerns and building the protocol around their schedules facilitated participation. Challenges unique to the acute care setting were: 1) extremely limited time for patient identification, screening, and enrollment during which patients were ill and busy with clinical care activities, and 2) little advance knowledge of when physician-patient encounters would occur. Employing a full-time study coordinator mitigated these challenges. Conclusion Physician concerns for participating in communication studies are similar in ambulatory and acute care settings. The acute care setting presents novel challenges for patient recruitment and data collection. Practice Implications These methods should be used to study provider-patient communication in acute care settings. Future work should test strategies to increase patient enrollment. PMID:20444569

  11. Nurse practitioners--where do they belong within the organizational structure of the acute care setting? (United States)

    el-Sherif, C


    Nurse practitioners are expanding their scope of practice and moving into acute care settings. Striving to be part of the nursing organizational structure in the acute care setting will keep NP's practice firmly rooted in nursing theory. Remaining within the nursing realm will enable them to receive support and guidance from their nursing colleagues while advancing the profession through their knowledge and expertise. Within the nursing organizational structure, NPs can become leaders as clinicians and role models. Without the formal support of the nursing organizational structure, the unique skills and contributions nurse practitioners furnish to the profession will be lost, as others will then dictate the NP role and scope of practice within the acute care setting.

  12. Falling behind: a substantive theory of care for older people with cognitive impairment in acute settings. (United States)

    Nilsson, Anita; Rasmussen, Birgit H; Edvardsson, David


    To develop a theoretical understanding of the processes hindering person-centred care of older people with cognitive impairment in acute care settings. Although person-centred care with its holistic focus on the biopsychosocial needs of patients is commonly considered the gold standard care for older people with cognitive impairment, the extent to which care is person-centred can increase in acute care settings generally. Grounded theory inspired by Strauss and Corbin. The study used a grounded theory approach to generate and analyse data from a Swedish sample of acute care staff, patients and family members. The substantive theory postulates that staff risks 'falling behind' in meeting the needs of older patients with cognitive impairment if working without consensus about the care of these patients, if the organisation is disease-oriented and efficiency-driven, and if the environment is busy and inflexible. This facilitated 'falling behind' in relation to meeting the multifaceted needs of older patients with cognitive impairment and contributed to patient suffering, family exclusion and staff frustration. The theory highlights aspects of importance in the provision of person-centred care of older people with cognitive impairment in acute settings and suggests areas to consider in the development of caring environments in which the place, pace and space can meet the needs of the older person. The proposed substantive theory can be used to critically examine current ward practices and routines, and the extent to which these support or inhibit high-quality person-centred care for older patients with known or unknown cognitive impairments. © 2013 Blackwell Publishing Ltd.

  13. Implementation of knowledge-based palliative care in acute care settings : obstacles, opportunities and experiences


    Lind, Susanne


    Background and aim: Quality improvement is continuously ongoing at different levels in our healthcare system. In Sweden, as in other countries, guidelines are important for quality improvement in healthcare, since they summarize the best available evidence. Improved living conditions and enhanced treatments for a variety of diseases have resulted in increased longevity and the need for palliative care has therefore also increased. A high proportion of deaths occur in acute care...

  14. A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

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    Chong Mei


    Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

  15. Enhancing the Reach of Cognitive-Behavioral Therapy Targeting Posttraumatic Stress in Acute Care Medical Settings. (United States)

    Darnell, Doyanne; O'Connor, Stephen; Wagner, Amy; Russo, Joan; Wang, Jin; Ingraham, Leah; Sandgren, Kirsten; Zatzick, Douglas


    Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management. The investigation also explored the potential effectiveness of completion of CBT element homework that targeted PTSD symptom reduction. This study was a secondary analysis of data from a U.S. clinical trial of the effectiveness of a stepped collaborative care intervention versus usual care for injured inpatients. The investigation examined patients' willingness at baseline (prerandomization) to engage in CBT and pre- and postrandomization mental health service utilization among 115 patients enrolled in the clinical trial. Among intervention patients (N=56), the investigation examined acceptability of the intervention and used multiple linear regression to examine the association between homework completion as reported by the care manager and six-month PTSD symptom reduction as assessed by the PTSD Checklist-Civilian DSM-IV Version. Patients in the intervention condition reported obtaining significantly more psychotherapy or counseling than patients in the control group during the six-month follow-up, as well as a high degree of intervention acceptability. Completion of CBT element homework assignments was associated with improvement in PTSD symptoms. Integrating behavioral interventions into routine acute care service delivery may improve the reach of evidence-based mental health care targeting PTSD.

  16. Amplified hearing device use in acute care settings for patients with hearing loss: A feasibility study. (United States)

    Kimball, Amber R; Roscigno, Cecelia I; Jenerette, Coretta M; Hughart, Kimberly M; Jenkins, Wendy W; Hsu, Wesley


    The objective of this study was to assess the feasibility of using amplified hearing devices (AHD) in acute care settings for patients with hearing loss. Secondary objectives include patient and nurse satisfaction, and nursing perceived productivity. Twenty-five adult hard of hearing patients and 15 nurses were evaluated. Patients with a perceived hearing handicap were identified through the Hearing Handicap for the Elderly Screening Version. Patient and staff nurse surveys were used to assess for satisfaction with using the AHD. Nurses were surveyed to evaluate whether they felt the AHD made patient communication more efficient and effective. Twenty-four patients expressed satisfaction with the AHD and would use it in future hospitalizations. Nurses also reported satisfaction, perceived improvement of patient communication and decreased time spent communicating with patients. Results demonstrate the feasibility of using an AHD in acute care inpatient settings where elderly hard of hearing patients are common. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff. (United States)

    Langhan, Melissa L; Riera, Antonio; Kurtz, Jordan C; Schaeffer, Paula; Asnes, Andrea G


    Technologies are not always successfully implemented into practice. This study elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within 10 emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Five major categories emerged: decision-making factors, the impact on practice, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use and access difficulties. A positive outlook, sufficient training, support staff and user friendliness were facilitators. This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology.

  18. Progressively engaging: constructing nurse, patient, and family relationships in acute care settings. (United States)

    Segaric, Cheryl Ann; Hall, Wendy A


    In this grounded theory study, informed by symbolic interactionism, we explain how nurses, patients, and family members construct relationships in acute care settings, including managing effects of work environments. We recruited participants from 10 acute care units across four community hospitals in a Western Canadian city. From 33 hr of participant observation and 40 interviews with 13 nurses, 17 patients, and 10 family members, we constructed the basic social-psychological process of progressively engaging. Nurses, patients, and family members approached constructing relationships through levels of engagement, ranging from perspectives about "just doing the job" to "doing the job with heart." Progressively engaging involved three stages: focusing on tasks, getting acquainted, and building rapport. Workplace conditions and personal factors contributed or detracted from participants' movement through the stages of the process; with higher levels of engagement, participants experienced greater satisfaction and cooperation. Progressively engaging provides direction for how all participants in care can invest in relationships. © The Author(s) 2014.

  19. Assessment and Management of Whiplash From the Emergency and Acute Care Setting: Care, Questions, and Future Global Research Needs. (United States)

    Courtney, D Mark


    The primary goal of this editorial is to discuss the care patients typically receive in the immediate post-motor vehicle collision setting and the questions patients typically ask with respect to their symptoms and prognosis. Commentary and guidance are provided from the perspective of an acute care physician on what we should be able to tell patients and providers going forward. J Orthop Sports Phys Ther 2016;46(10):822-825. doi:10.2519/jospt.2016.0114.

  20. Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

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    Kornhaber R


    Full Text Available Rachel Kornhaber,1 Kenneth Walsh,1,2 Jed Duff,1,3 Kim Walker1,3 1School of Health Sciences, Faculty of Health, University of Tasmania, Alexandria, NSW, 2Tasmanian Health Services – Southern Region, Hobart, TAS, 3St Vincent’s Private Hospital, Sydney, NSW, Australia Abstract: Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician–patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients’ experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships. Keywords: health, acute care, therapeutic interpersonal relationships, relational care integrative review 

  1. The effects of massage therapy on pain management in the acute care setting. (United States)

    Adams, Rose; White, Barb; Beckett, Cynthia


    Pain management remains a critical issue for hospitals and is receiving the attention of hospital accreditation organizations. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy for pain management into the team-centered approach of patient care. This preliminary study evaluated the effect of the use of massage therapy on inpatient pain levels in the acute care setting. The study was conducted at Flagstaff Medical Center in Flagstaff, Arizona-a nonprofit community hospital serving a large rural area of northern Arizona. A convenience sample was used to identify research participants. Pain levels before and after massage therapy were recorded using a 0 - 10 visual analog scale. Quantitative and qualitative methods were used for analysis of this descriptive study. Hospital inpatients (n = 53) from medical, surgical, and obstetrics units participated in the current research by each receiving one or more massage therapy sessions averaging 30 minutes each. The number of sessions received depended on the length of the hospital stay. Before massage, the mean pain level recorded by the patients was 5.18 [standard deviation (SD): 2.01]. After massage, the mean pain level was 2.33 (SD: 2.10). The observed reduction in pain was statistically significant: paired samples t(52) = 12.43, r = .67, d = 1.38, p Qualitative data illustrated improvement in all areas, with the most significant areas of impact reported being overall pain level, emotional well-being, relaxation, and ability to sleep. This study shows that integration of massage therapy into the acute care setting creates overall positive results in the patient's ability to deal with the challenging physical and psychological aspects of their health condition. The study demonstrated not only significant reduction in pain levels, but also the interrelatedness of pain, relaxation, sleep, emotions, recovery, and finally, the healing process.

  2. Reconciling conceptualizations of relationships and person-centred care for older people with cognitive impairment in acute care settings. (United States)

    Rushton, Carole; Edvardsson, David


    Relationships are central to enacting person-centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person-centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long-term care. The acute care setting is characterized by archetypal constraints which differentiate it from long-term care, in terms of acuity and haste, task-orientated work patterns and influence from "the rule of medicine," all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re-interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re-presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person-centred care versus relationship-centred care

  3. Management of levofloxacin induced anaphylaxis and acute delirium in a palliative care setting

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    Arunangshu Ghoshal


    Full Text Available Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life.

  4. Gaps in Provision of Primary and Specialty Palliative Care in the Acute Care Setting by Race and Ethnicity. (United States)

    Chuang, Elizabeth; Hope, Aluko A; Allyn, Katherine; Szalkiewicz, Elissa; Gary, Brittany; Gong, Michelle N


    Previous research has identified a large unmet need in provision of specialist-level palliative care services in the hospital. How much of this gap is filled by primary palliative care provided by generalists or nonpalliative specialists has not been quantified. Estimates of racial and ethnic disparities have been inconsistent. The objective of this study was to 1) estimate primary and specialty palliative care delivery and to measure unmet needs in the inpatient setting and 2) explore racial and ethnic disparities in palliative care delivery. This was a cross-sectional, retrospective study of 55,658 adult admissions to two acute care hospitals in the Bronx in 2013. Patients with palliative care needs were identified by criteria adapted from the literature. The primary outcomes were delivery of primary and specialist-level palliative care. In all, 18.5% of admissions met criteria for needing palliative care. Of those, 18% received specialist-level palliative care, an estimated 30% received primary palliative care, and 37% had no evidence of palliative care or advance care planning. Black and Hispanic patients were not less likely to receive specialist-level palliative care (adjusted odds ratio [OR] black patients = 1.18, 95% CI 0.98, 1.42; adjusted OR Hispanic patients = 1.24, 95% CI 1.04, 1.48), but they were less likely to receive primary palliative care (adjusted OR black patients = 0.41, 95% CI 0.20, 0.84; adjusted OR Hispanic patients = 0.48, 95% CI 0.25, 0.94). Even when considering primary and specialty palliative care, hospitalized patients have a high prevalence of unmet palliative care need. Further research is needed understand racial and ethnic disparities in palliative care delivery. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  5. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

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    Chin Yee Cheong


    Full Text Available Background/Aims: The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT programme on mood and engagement in older patients with delirium and/or dementia (PtDD in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods: Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4 were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy on 3 consecutive days: day 1 (control condition without music and days 2 and 3 (with CMT. Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES and Observed Emotion Rating Scale (OERS. Results: Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01 in MPES and pleasure and general alertness (Z = 3.188,p = 0.01 in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014. Negative engagement (Z = 2.582, p = 0.01 and affect (Z = 2.004, p = 0.045 were both lower during CMT compared to no music. Conclusion: These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation.

  6. Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting. (United States)

    Clarke, Christina M; Persaud, Drepaul David


    Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting. A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies. A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential. Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.

  7. Management of ramsay hunt syndrome in an acute palliative care setting

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    Shrenik Ostwal


    Full Text Available Introduction: The Ramsay Hunt syndrome is characterized by combination of herpes infection and lower motor neuron type of facial nerve palsy. The disease is caused by a reactivation of Varicella Zoster virus and can be unrepresentative since the herpetic lesions may not be always be present (zoster sine herpete and might mimic other severe neurological illnesses. Case Report: A 63-year-old man known case of carcinoma of gall bladder with liver metastases, post surgery and chemotherapy with no scope for further disease modifying treatment, was referred to palliative care unit for best supportive care. He was on regular analgesics and other supportive treatment. He presented to Palliative Medicine outpatient with 3 days history of ipsilateral facial pain of neuropathic character, otalgia, diffuse vesciculo-papular rash over ophthalmic and maxillary divisions of left trigeminal nerve distribution of face and ear, and was associated with secondary bacterial infection and unilateral facial edema. He was clinically diagnosed to have Herpes Zoster with superadded bacterial infection. He was treated with tablet Valacyclovir 500 mg four times a day, Acyclovir cream for local application, Acyclovir eye ointment for prophylactic treatment of Herpetic Keratitis, low dose of Prednisolone, oral Amoxicillin and Clindamycin for 7 days, and Pregabalin 150 mg per day. After 7 days of treatment, the rash and vesicles had completely resolved and good improvement of pain and other symptoms were noted. Conclusion: Management of acute infections and its associated complications in an acute palliative care setting improves both quality and length of life.

  8. Acupuncture in the Inpatient Acute Care Setting: A Pragmatic, Randomized Control Trial

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    Jeannette Painovich


    Full Text Available Purpose. To evaluate the acceptance and effectiveness of acupuncture in a hospital setting. Methods. This 18-month pragmatic randomized controlled trial used a two-tiered consent process for all patients admitted to the acute care unit by study physician groups. The primary study comparison was between those randomized (using biased-coin randomization after initial consent to be offered acupuncture or not. The primary outcome was length of stay (LOS. Other measures include costs, self-reported anxiety, depression, health status, and patient satisfaction. Results. Of the 383 patients consented to the study, 253 were randomized to be offered acupuncture, and 130 were not offered acupuncture. Of those offered acupuncture, 173 (69% accepted and received daily acupuncture. On average, patients offered acupuncture had longer LOSs (4.9 versus 4.1 days than those not offered acupuncture (=.047. Adjustment for diagnosis and severity mix reduced this difference and its significance (=.108. No other significant differences in outcomes were found. Patients who were more anxious (=.000 or depressed (=.017 at admission tended to more often accept acupuncture when offered. Conclusion. Acupuncture is accepted by a majority of hospitalized acute care patients. However, it did not reduce LOS in this already short-stay population.

  9. Identification of barriers that impede the implementation of nicotine replacement therapy in the acute cardiac care setting. (United States)

    May, Fiona C; Stocks, Nigel; Barton, Christopher


    Nicotine replacement therapy (NRT) has been shown to increase 12-month abstinence rates by as much as 50% when compared with placebo; however, NRT seems to be underutilized in the acute cardiac setting. This study explores the attitudes and beliefs of healthcare professionals regarding the use of NRT in acute cardiac inpatients, in an effort to identify and expose barriers that may impede the use of this drug in the acute cardiac care environment. Framework analysis formed the methodological foundation of the study and provided the structure for analysis of data generated via qualitative, semistructured one-on-one interviews. A purposive sample of healthcare professionals practicing in the acute cardiac care setting informed the study. Although health care professionals expressed strong views regarding the benefits of implementing NRT as a smoking cessation intervention, barriers were identified that hinder its use. Financial implications, lack of knowledge and safety issues all contributed to the institutional justification for rejecting hospital-based NRT as a secondary prevention intervention in the acute cardiac setting. To proactively reduce the incidence of secondary cardiac events, education of healthcare professionals concerning tobacco addiction and available cessation treatments in the acute cardiac patient is paramount. Nicotine replacement products require further investigation to ascertain their safety and financial viability in the acute cardiac setting. Findings may support the implementation of NRT in the inpatient cardiac setting, and ultimately help curb the incidence of smoking-related mortality owing to secondary cardiac events.

  10. Describing Nurse Leaders' and Direct Care Nurses' Perceptions of a Healthy Work Environment in Acute Care Settings, Part 2. (United States)

    Huddleston, Penny; Gray, Jennifer


    The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Tool was developed as a simple screening tool to assess the characteristics of a healthy work environment (HWE) in critical care environments. The purposes of these 2 qualitative research studies are to explore the nurse leaders' and direct care nurses' perceptions of the meaning of a HWE, to describe the nurse leaders' and direct care nurses' perceptions of a HWE, and to define the characteristics of a HWE in acute care settings. Exploratory descriptive designs using focus groups and guided questions with tape-recorded interviews were used to define the characteristics of an HWE. The 6 original themes from AACN HWE standards and 2 new themes emerged as a result of the nurse leaders and direct care nurses defining the characteristics of a HWE, which included appropriate staffing, authentic leadership, effective decision making, meaningful recognition, skilled communication, true collaboration genuine teamwork, and physical and psychological safety. The qualitative statements from these 2 studies will be used in future studies to describe and develop HWE scales for nurse leaders and direct care nurses and to assess the psychometric properties of these new tools.

  11. Nursing sabbatical in the acute care setting: what is the evidence? (United States)

    Swenty, Constance F; Schaar, Gina L; Phillips, Lori A; Embree, Jennifer L; McCool, Isabella A; Shirey, Maria R


    To review and examine the literature supporting a professional sabbatical, a potentially viable and innovative change strategy that could renew, revitalize, and retain nursing staff practicing in the acute care setting. A literature search was completed using multiple search engines to procure articles that could answer the question: What is the evidence related to professional sabbaticals in nursing? The search yielded 19 articles: one historical document, eight scholarly business articles, and 10 nursing publications. The literature review revealed most sources described sabbaticals using anecdotal data and 14 of the 19 articles were labeled as expert opinion or consensus. Borrowing from the successes in academia and other non-nursing professions, a human capital investment opportunity exists to design and test nursing sabbaticals. The authors identified a nursing sabbatical as a viable option, which can enhance nursing retention and revitalization. © 2011 Wiley Periodicals, Inc.

  12. Management of hemichorea hemiballismus syndrome in an acute palliative care setting

    Directory of Open Access Journals (Sweden)

    Anuja Damani


    Full Text Available Hemichorea hemiballismus (HCHB is a rare and debilitating presentation of hyperglycemia and subcortical stroke. Early identification, proper assessment and management of HCHB can lead to complete symptom relief. We describe a case of HCHB presenting to a palliative care setting. A 63-year-old diabetic and hypertensive lady, with history of ovarian cancer presented to Palliative Medicine outpatient clinic with two days history of right HCHB. Blood investigations and brain imaging showed high blood sugar levels and lacunar subcortical stroke. Blood sugar levels were controlled with human insulin and Aspirin. Clopidogrel and Atorvastatin were prescribed for the management of lacunar stroke. HCHB reduced markedly post-treatment, leading to significant reduction in morbidity and improvement in quality of life. The symptoms completely resolved within one week of starting the treatment and the patient was kept on regular home and outpatient follow up for further monitoring. Acute palliative care (APC approach deals with the management of comorbidities and their complications along with supportive care. Prompt assessment and management of such complications lead to better patient outcomes.

  13. Hospital-based acute care after outpatient colonoscopy: implications for quality measurement in the ambulatory setting. (United States)

    Fox, Justin P; Burkardt, Deepika D'Cunha; Ranasinghe, Isuru; Gross, Cary P


    Ambulatory surgery centers now report immediate hospital transfer rates as a measure of quality. For patients undergoing colonoscopy, this measure may fail to capture adverse events, which occur after discharge yet still require a hospital-based acute care encounter. We conducted this study to estimate rates of immediate hospital transfer and hospital-based acute care following outpatient colonoscopy performed in ambulatory surgery centers. Using state ambulatory surgery databases from the 2009-2010 Healthcare Cost and Utilization Project, we identified adult patients who underwent colonoscopy. Immediate hospital transfer and overall acute health care utilization in the 14 days following colonoscopy was determined from corresponding inpatient, ambulatory surgery, and emergency department databases. To compare rates across centers while accounting for differences in patient populations, we calculated risk-standardized rates using hierarchical generalized linear modeling. The final sample included 1,137,381 colonoscopy discharges from 1019 centers. At the ambulatory surgery center level, the median risk-standardized hospital transfer rate was 0.0% (interquartile range=0.0%), whereas the hospital-based acute care rate was 2.1% (interquartile range=0.6%), with few centers (N=36) having no observed encounters. No correlation was noted between the risk-standardized hospital transfer and hospital-based acute care rates (volume weighted correlation coefficient=0.04, P=0.16). Patients more frequently experience hospital-based acute care encounters after colonoscopy than the need for immediate hospital transfer. Broadening existing quality measures to include hospital-based acute care in the postdischarge period may provide a more complete measure of quality.

  14. Effectively using communication to enhance the provision of pediatric palliative care in an acute care setting


    Ward-Smith, Peggy


    Rosemary Hubble, Kelly Trowbridge, Claudia Hubbard, Leslie Ahsens, Peggy Ward-SmithChildren’s Mercy Hospitals and Clinics, Kansas City, MO, USAAbstract: The capability of effectively communicating is crucial when providing palliative care, especially when the patient is a child. Communication among healthcare professionals with the child and family members must be clear, concise, and consistent. Use of a communication tool provides documentation for conversations, treatment plans, a...

  15. Adjusting Bowel Regimens When Prescribing Opioids in Women Receiving Palliative Care in the Acute Care Setting. (United States)

    Gonzales, Lucia K; Delmastro, Margaret A; Boyd, Denise M; Sterling, Melvyn L; Aube, Patricia A; Le, Rosemary N; Traucht, Lisa; Quinal, Leonida R; Georges, Jane M; Glaser, Dale N


    In palliative medicine, constipation is the third most common symptom after pain and anorexia, causing some patients to discontinue opioid therapy. Women experience higher incidence of constipation than men. The prevalence of infrequent bowel movements (opioids were studied. Referral to the palliative care team decreased the prevalence of infrequent bowel movements from 72% to 45%, and algorithm adherence increased from 38% to 78%. Education of oncology nurses decreased the prevalence of infrequent bowel movements among patients with cancer from 71% to 60%, and algorithm adherence increased from 0% to 10%. Patients benefit from stool softeners and stimulants when receiving opioids. © The Author(s) 2015.

  16. Complementary Health Practitioners in the Acute and Critical Care Setting: Nursing Considerations. (United States)

    Kramlich, Debra


    In response to the rising demand by patients and their families for complementary health approaches, hospitals are increasingly integrating complementary health approaches with their conventional medical practices to create healing environments. Results of the 2010 Complementary and Alternative Medicine Survey of Hospitals indicated that the top 6 inpatient modalities included pet therapy, massage therapy, music or art therapy, guided imagery, relaxation therapy, and Reiki and therapeutic touch. Whether complementary health approaches are provided by complementary health practitioners through hospital-based integrative medicine programs, volunteer practitioners, or bedside nurses, the regulatory, legal, ethical, and safety concerns remain constant. Previous articles in this column of Critical Care Nurse provided an overview of complementary health approaches that nurses may encounter in their practices, with specific attention to implications for acute and critical care nurses, as well as important legal, ethical, safety, quality, and financial implications that acute and critical care nurses should consider when integrating complementary health approaches with conventional care. This column provides the acute and critical care nurse with key information about validation of credentials, experience, and competence of nurses and volunteers providing complementary health approaches, as well as about institutional policies and scope of practice. ©2017 American Association of Critical-Care Nurses.

  17. Identification of factors that support successful implementation of care bundles in the acute medical setting: a qualitative study. (United States)

    Green, Stuart A; Bell, Derek; Mays, Nicholas


    Clinical guidelines offer an accessible synthesis of the best evidence of effectiveness of interventions, providing recommendations and standards for clinical practice. Many guidelines are relevant to the diagnosis and management of the acutely unwell patient during the first 24-48 h of admission. Care bundles are comprised of a small number of evidence-based interventions that when implemented together aim to achieve better outcomes than when implemented individually. Care bundles that are explicitly developed from guidelines to provide a set of related evidence-based actions have been shown to improve the care of many conditions in emergency, acute and critical care settings. This study aimed to review the implementation of two distinct care bundles in the acute medical setting and identify the factors that supported successful implementation. Two initiatives that had used a systematic approach to quality improvement to successfully implement care bundles within the acute medical setting were selected as case studies. Contemporaneous data generated during the initiatives included the review reports, review minutes and audio recordings of the review meetings at different time points. Data were subject to deductive analysis using three domains of the Consolidated Framework for Implementation Research to identify factors that were important in the implementation of the care bundles. Several factors were identified that directly influenced the implementation of the care bundles. Firstly, the availability of resources to support initiatives, which included training to develop quality improvement skills within the team and building capacity within the organisation more generally. Secondly, the perceived sustainability of changes by stakeholders influenced the embedding new care processes into existing clinical systems, maximising their chance of being sustained. Thirdly, senior leadership support was seen as critical not just in supporting implementation but also in

  18. Planning and process evaluation of a multi-faceted influenza vaccination implementation strategy for health care workers in acute health care settings

    NARCIS (Netherlands)

    Riphagen-Dalhuisen, Josien; Frijstein, Gerard; van der Geest-Blankert, Nannet; Danhof-Pont, Marita; de Jager, Herbert; Bos, Nita; Smeets, Ed; de Vries, Marjan; Gallee, Pieter; Hak, Eelko


    Influenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings. Therefore, immunizing HCWs against influenza should receive high priority. Despite recommendations of the World Health Organization, vaccine coverage of HCWs remains low in all

  19. Planning and process evaluation of a multi-faceted influenza vaccination implementation strategy for health care workers in acute health care settings

    NARCIS (Netherlands)

    Riphagen-Dalhuisen, Josien; Frijstein, Gerard; van der Geest-Blankert, Nannet; Danhof-Pont, Marita; de Jager, Herbert; Bos, Nita; Smeets, Ed; de Vries, Marianne; Gallee, Pieter; Hak, Eelko


    Background: Influenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings. Therefore, immunizing HCWs against influenza should receive high priority. Despite recommendations of the World Health Organization, vaccine coverage of HCWs remains

  20. Planning and process evaluation of a multi-faceted influenza vaccination implementation strategy for health care workers in acute health care settings

    NARCIS (Netherlands)

    J. Riphagen-Dalhuisen; G. Frijstein; N. van der Geest-Blankert (Nannet); M. Danhof-Pont (Marita); H. de Jager (Herbert); N. Bos (Nita); E. Smeets (Ed); M.J.T. de Vries (Marjan); P.M.M. Gallee; E. Hak (Eelko)


    textabstractBackground: Influenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings. Therefore, immunizing HCWs against influenza should receive high priority. Despite recommendations of the World Health Organization, vaccine coverage of

  1. Diagnosis and treatment of acute sinusitis in the primary care setting: A retrospective cohort. (United States)

    Pynnonen, Melissa A; Lynn, Shana; Kern, Hayley E; Novis, Sarah J; Akkina, Sarah R; Keshavarzi, Nahid R; Davis, Matthew M


    Our objectives were to characterize the quality of acute sinusitis care and to identify nonclinical factors associated with antibiotic use for acute sinusitis. We hypothesized that we would identify provider-level factors associated with antibiotic use. Retrospective cohort at a single academic institution. We developed and clinically annotated an administrative dataset of adult patients diagnosed with acute sinusitis between January 1, 2005, and December 31, 2006. We used identify factors associated with receipt of antibiotics. We find that 66.0% of patients with mild symptoms of short duration are given antibiotics, and that nonclinical factors, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence antibiotic use. Relative to internal medicine providers, family medicine providers use fewer antibiotics, and emergency medicine providers use more antibiotics for acute sinusitis. Antibiotics continue to be overused for patients with mild acute sinusitis of short duration. Nonclinical characteristics, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence use of antibiotics for acute sinusitis. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  2. Multidisciplinary team interventions to optimise health outcomes for older people in acute care settings: A systematic review. (United States)

    Hickman, Louise D; Phillips, Jane L; Newton, Phillip J; Halcomb, Elizabeth J; Al Abed, Naser; Davidson, Patricia M


    A major challenge facing our health care systems internationally is managing the needs of increasing numbers of older people in hospital with chronic and complex conditions. A multidisciplinary approach is considered central to tailoring and targeting approaches to gerontological care, although this is often not realised in reality. Comprehensive geriatric assessment (CGA) is seen as gold standard, though they are not readily available in many acute settings, compounded by the requirement for time, coordination of multidisciplinary specialties, and reimbursement issues. This systematic review aimed to identify multidisciplinary team interventions to optimise health outcomes for older people in acute care settings. Systematic review of randomised controlled trials reporting acute care multidisciplinary team based interventions, to improve care outcomes for hospitalised older people. Electronic databases (MEDLINE, CINAHL (EBSCO), Cochrane and PsycINFO) were searched from 1 January 2000 to 1 July 2014 in the English language. Data was extracted by two reviewers and checked by a third reviewer to resolve any conflicts. Seven articles reporting RCTs met the systematic review inclusion criteria. The heterogeneity of study populations, multidisciplinary team interventions and outcome measures necessitated the use of narrative analysis. Three common elements of these studies included: (i) tailored treatment by clinicians with geriatric expertise (ii) a focus on transitional care interventions that enhance discharge planning; and (iii) communication an essential ingredient to improving care. The tailoring of treatment, underpinned with clear communication strategies can reduce emergency department re-admission rates, mortality and functional decline of older people. Refining health professionals roles and responsibilities within transition models is an essential component that can improve health outcomes for older people in acute care settings. Crown Copyright © 2015

  3. Staging and defining characteristics of pressure ulcers using photographs by staff nurses in acute care settings. (United States)

    Jesada, Elizabeth C; Warren, Joan I; Goodman, Dorothy; Iliuta, Ruth W; Thurkauf, Gail; McLaughlin, Maureen K; Johnson, Joyce E; Strassner, Larry


    The aim of this study was to determine if a digital photograph obtained by a staff nurse in the acute care setting could be used to determine staging and wound characteristics of a pressure ulcer when viewed by a panel of wound experts as compared to a bedside assessment by a wound expert. One hundred digital photographs of pressure ulcers were obtained from 69 patients on general and critical care medical-surgical nursing units from 2 Magnet-designated hospitals belonging to a large Mid-Atlantic health care system. Four certified wound ostomy nurses (CWONs), 2 at each hospital site, identified patients with a pressure ulcer for bedside assessment and digital photography. This multisite nonexperimental study compared bedside assessment of wound characteristics and staging of 100 pressure ulcers by the hospital CWON to assessment of the same wound by an expert panel of 3 CWONs via digital photography. This study examined 13 wound characteristics and a total score on the Bates-Jensen Wound Assessment Tool (BWAT) as well as the staging of a pressure ulcer using the National Pressure Ulcer Advisory Panel definitions. A nonprobability sampling plan used a convenience sample of 69 adult inpatients at the 2 hospitals to obtain photographs of 100 pressure ulcers. : The BWAT, formerly the Pressure Sore Status Tool, was used by the bedside and expert panelists to assess the pressure ulcer characteristics. This tool assesses 13 wound characteristics from best to worst, using a modified Likert scale. Studies examining reliability and validity of the BWAT support it as an effective instrument. Interrater reliability among the hospital CWONs using bedside assessment and panelist CWONs using digital photography assessment for the BWAT 13 characteristics ranged from slight to fair agreement for skin color surrounding wound (κ range = 0.12-0.21, P ≤ .02) to fair to moderate agreement for necrotic tissue type (κ range = 0.37-0.60, P = .000). Only slight agreement for total BWAT

  4. The effectiveness of nurse-delivered aromatherapy in an acute care setting. (United States)

    Johnson, Jill R; Rivard, Rachael L; Griffin, Kristen H; Kolste, Alison K; Joswiak, Denise; Kinney, Mary Ellen; Dusek, Jeffery A


    To examine the use and effectiveness of essential oil therapeutic interventions on pain, nausea, and anxiety, when provided by nurses to patients in acute hospital settings across a large health system. This study expands upon the limited body of literature on aromatherapy use among inpatients. Retrospective, effectiveness study using data obtained from electronic health records. Ten Allina Health hospitals located in Minnesota and western Wisconsin. Nurse-delivered aromatherapy. Change in patient-reported pain, anxiety, and nausea, rated before and after receiving aromatherapy using a numeric rating scale (0-10). There were 10,262 hospital admissions during the study time frame in which nurse-delivered aromatherapy was part of patient care. The majority of admissions receiving aromatherapy were females (81.71%) and white (87.32%). Over 75% of all aromatherapy sessions were administered via inhalation. Lavender had the highest absolute frequency (49.5%) of use regardless of mode of administration, followed by ginger (21.2%), sweet marjoram (12.3%), mandarin (9.4%), and combination oils (7.6%). Sweet marjoram resulted in the largest single oil average pain change at -3.31 units (95% CI: -4.28, -2.33), while lavender and sweet marjoram had equivalent average anxiety changes at -2.73 units, and ginger had the largest single oil average change in nausea at -2.02 units (95% CI: -2.55, -1.49). Essential oils generally resulted in significant clinical improvements based on their intended use, although each oil also showed ancillary benefits for other symptoms. Future research should explore use of additional essential oils, modes of administration, and different patient populations. Copyright © 2016. Published by Elsevier Ltd.

  5. Delivery of physical therapy in the acute care setting: a population-based study. (United States)

    Freburger, Janet K; Heatwole Shank, Kendra; Knauer, Stefanie R; Montmeny, Richard M


    Population-based studies on physical therapy use in acute care are lacking. The purpose of this study was to examine population-based, hospital discharge data from North Carolina to describe the demographic and diagnostic characteristics of individuals who receive physical therapy and, for common diagnostic subgroups, to identify factors associated with the receipt of and intensity of physical therapy use. This was a cross-sectional, descriptive study. Hospital discharge data for 2006-2007 from the 128 acute care hospitals in the state were examined to identify the most common diagnoses that receive physical therapy and to describe the characteristics of physical therapy users. For 2 of the most common diagnoses, logistic and linear regression analyses were conducted to identify factors associated with the receipt and intensity of physical therapy. Of the more than 2 million people treated in acute care hospitals, 22.5% received physical therapy (mean age=66 years; 58% female). Individuals with osteoarthritis (admitted for joint replacement) and stroke were 2 of the most common patient types to receive physical therapy. Almost all individuals admitted for a joint replacement received physical therapy, with little between-hospital variation. Between-hospital variation in physical therapy use for stroke was greater. Demographic and hospital-related factors were associated with physical therapy use and physical therapy intensity for both diagnoses, after controlling for illness severity and comorbidities. Data from only one state were examined, and the studied variables were limited. The use and intensity of physical therapy for stroke and joint replacement in acute care hospitals in North Carolina vary by clinical and nonclinical factors. Reasons behind the association of hospital characteristics and physical therapy use need further investigation.

  6. Exploring perceptions of a learning organization by RNs and relationship to EBP beliefs and implementation in the acute care setting. (United States)

    Estrada, Nicolette


    Health care professionals are expected to provide patient care based on best evidence. The context of the acute care setting presents a challenging environment for registered nurses (RNs) to utilize research and implement best evidence in practice. No organizational infrastructure has been identified that offers acute care RNs the support needed for evidence-based practice (EBP). The value of "learning organizations" has long been understood by corporate leaders. Potentially, the dimensions of a "learning organization" may offer a supportive EBP infrastructure for acute care RNs. (1) What is the relationship of the characteristics of the learning organization to registered nurses' beliefs regarding EBP? (2) Is there an impact of EBP beliefs on RNs' implementation of EBP? A descriptive, survey design study was conducted. Three established questionnaires were distributed to 1,750 RNs employed within six acute care hospitals. There were 594 questionnaires returned for a response rate of 34%. RNs rated their organizations in the mid-range on the dimensions of learning organization. Perceptions of the learning organization were found to be significant, although relatively small, predictors explaining 6% of knowledge beliefs, 11% of value beliefs, and 14% of resource beliefs. EBP beliefs explained 23% of EBP implementation reported by RNs. The study results indicate relationships between RNs' reported perception of a learning organization and EBP beliefs, and between EBP beliefs and implementation. However, findings were mixed. Overall, nurses rated their organizations the lowest in the dimensions of "promote inquiry and dialogue" and "empower people toward a collective vision." Leaders have an opportunity to offer a more supportive infrastructure through improving their organization in these two areas. RN beliefs explained 23% of EBP implementation in this study with a residual 77% yet to be identified. Acute care hospitals were perceived mid-range on learning

  7. Nurses' experiences of caring for the suddenly bereaved in adult acute and critical care settings, and the provision of person-centred care: A qualitative study. (United States)

    Walker, Wendy; Deacon, Kate


    To explore nursing interventions for person-centred bereavement care in adult acute and critical care settings. A descriptive exploratory study, involving focused, face-to-face interviews. Participants comprised nine registered nurses and one auxiliary nurse, working in environments where sudden death was known to occur, i.e. emergency, cardiac and critical care. Interviews were transcribed verbatim and data subjected to directed content analysis. The provision of person-centred care was examined by applying a validated Person-Centred Nursing Framework. Five main themes were identified. Participants' accounts contained descriptions of bereavement care and the presence of person-centred interventions. Contextual, professional and attitudinal factors influenced the degree to which person-centred care operated. Caring for suddenly bereaved families was important to nurses, but also a source of tension and unrest. An important consideration for person-centred practice is movement away from sudden bereavement as a 'here and now' event, towards a pathway of supportive care that envisions the longer-term. Further research is required to gain a deeper understanding of person-centred care for the suddenly bereaved and the perceived effectiveness of nursing interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Venous thromboembolism risk and prophylaxis in the acute hospital care setting: the Irish results of the ENDORSE study.

    LENUS (Irish Health Repository)

    Murphy, O


    ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting), is a multinational, cross-sectional survey of venous thromboembolism (VTE) risk prevalence and effective prophylaxis in the acute hospital care setting. Three Irish hospitals enrolled in the study. The American College of Chest Physicians (ACCP) guidelines were employed to evaluate VTE risk and prophylaxis. Of 552 patients, 297 (53.8%) and 255 (46.2%) were categorised as surgical or medical, respectively, with 175 (59%) surgical and 109 (43%) medical patients deemed to be at risk for VTE. Of these, only 112 (64%) and 51 (47%) received recommended VTE prophylaxis, respectively. The results are consistent with those observed in other countries and demonstrate a high prevalence of risk for VTE and a low rate of prophylaxis use, particularly in medical patients. Awareness of VTE guidelines should be an integral component of health policy.

  9. Does the Acute Care Spinal Cord Injury Setting Predict the Occurrence of Pressure Ulcers at Arrival to Intensive Rehabilitation Centers? (United States)

    Richard-Denis, Andréane; Thompson, Cynthia; Bourassa-Moreau, Étienne; Parent, Stefan; Mac-Thiong, Jean-Marc


    The objective of this study was to evaluate the impact of acute care in specialized spinal cord injury (SCI) trauma centers on the prevalence of pressure ulcers (PU) upon arrival at a functional rehabilitation center after a traumatic SCI. This is a retrospective cohort study among 123 patients with traumatic SCI referred to intensive functional rehabilitation between January 1, 2009, and December 31, 2011. Group 1 (n = 90) was referred from a level 1 specialized SCI trauma center and group 2 (n = 33) was referred from seven trauma centers not specialized in SCI. The total prevalence of patients with PU at admission to functional rehabilitation was 33.3% (26.7% in group 1 and 51.5% in group 2, P = 0.017). There were also more patients with multiple PU in group 2 (24.2% vs. 2.2%, P = 0.0001). A binary logistic regression showed a significant relationship between the occurrence of PU and the type of acute care facility as well as the ASIA (American Spinal Injury Association) Impairment Scale grade. Receiving acute care at the specialized SCI trauma center was associated with a decrease in the number of patients developing one and multiple PU. These results highlight the importance of specialized SCI trauma centers in acute care of patients with traumatic SCI in reducing PU at their admission to functional rehabilitation settings.

  10. 'Designer drugs': update on the management of novel psychoactive substance misuse in the acute care setting. (United States)

    Smith, Christopher D; Robert, Stefanie


    The use of novel psychoactive substances ('legal highs' or 'designer drugs') is increasing worldwide. Patients misusing such substances have been reported to experience severe or prolonged side effects requiring admission to acute or critical care wards. These complications can be life threatening if misdiagnosed or mismanaged. As physicians have traditionally had less involvement with the management of such patients compared with their colleagues in emergency departments an update in the management of such patients is indicated. Here we present a summary of the management of those novel substances with the potential for serious complications based on a review of current literature. © 2014 Royal College of Physicians.

  11. Clinical staff perceptions of palliative care-related quality of care, service access, education and training needs and delivery confidence in an acute hospital setting. (United States)

    Frey, Rosemary; Gott, Merryn; Raphael, Deborah; O'Callaghan, Anne; Robinson, Jackie; Boyd, Michal; Laking, George; Manson, Leigh; Snow, Barry


    Central to appropriate palliative care management in hospital settings is ensuring an adequately trained workforce. In order to achieve optimum palliative care delivery, it is first necessary to create a baseline understanding of the level of palliative care education and support needs among all clinical staff (not just palliative care specialists) within the acute hospital setting. The objectives of the study were to explore clinical staff: perceptions concerning the quality of palliative care delivery and support service accessibility, previous experience and education in palliative care delivery, perceptions of their own need for formal palliative care education, confidence in palliative care delivery and the impact of formal palliative care training on perceived confidence. A purposive sample of clinical staff members (598) in a 710-bed hospital were surveyed regarding their experiences of palliative care delivery and their education needs. On average, the clinical staff rated the quality of care provided to people who die in the hospital as 'good' (x̄=4.17, SD=0.91). Respondents also reported that 19.3% of their time was spent caring for end-of-life patients. However, only 19% of the 598 respondents reported having received formal palliative care training. In contrast, 73.7% answered that they would like formal training. Perceived confidence in palliative care delivery was significantly greater for those clinical staff with formal palliative care training. Formal training in palliative care increases clinical staff perceptions of confidence, which evidence suggests impacts on the quality of palliative care provided to patients. The results of the study should be used to shape the design and delivery of palliative care education programmes within the acute hospital setting to successfully meet the needs of all clinical staff. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  12. Effective change management in a regional Sub-acute Ambulatory Care Services setting. (United States)

    Campbell, Bruce W


    Government policies and community expectations in Australia continually lead to calls for healthcare change. These changes are often met with resistance from clinicians and managers. Making change happen requires consideration of the way policies, culture, context, shared vision and leadership can drive or impede change. This reflective case study critically investigates one change process; the evolution of a Sub-acute Ambulatory Care Services (SACS) program in an Australian regional hospital over a 3-year period. The new Community Rehabilitation Services (CRS) program evolved from a merger of Centre and Home Based Rehabilitation (CBR and HBR). Hospital amalgamations, closures and privatisation, and the Department of Health policy relating to SACS, ambulatory care and rehabilitation were some of the key elements explored in this paper.

  13. Reducing Inappropriate Antibiotic Prescribing for Adults With Acute Bronchitis in an Urgent Care Setting: A Quality Improvement Initiative. (United States)

    Link, Tamara L; Townsend, Mary L; Leung, Eugene; Kommu, Sekhar; Vega, Rhonda Y; Hendrix, Cristina C

    Acute bronchitis is a predominantly viral illness and, according to clinical practice guidelines, should not be treated with antibiotics. Despite clear guidelines, acute bronchitis continues to be the most common acute respiratory illness for which antibiotics are incorrectly prescribed. Although the national benchmark for antibiotic prescribing for adults with acute bronchitis is 0%, a preliminary record review before implementing the intervention at the project setting showed that 96% (N = 30) of adults with acute bronchitis in this setting were prescribed an antibiotic. This quality improvement project utilized a single-group, pre-post design. The setting for this project was a large urgent care network with numerous locations in central North Carolina. The purpose was to determine whether nurse practitioners and physician assistants, after participating in a multifaceted provider education session, would reduce inappropriate antibiotic prescribing for healthy adults with acute uncomplicated bronchitis. Twenty providers attended 1 of 4 training sessions offered in October and November 2015. The face-to-face interactive training sessions focused on factors associated with inappropriate antibiotic prescribing, current clinical practice guidelines, and patient communication skills. Retrospective medical record review of 217 pretraining and 335 posttraining encounters for acute bronchitis by 19 eligible participating providers demonstrated a 61.9% reduction in immediate antibiotic prescribing from 91.7% to 29.8%. Delayed prescribing, which accounted for a small percentage of the total prescriptions given, had a small but significant increase of 9.3% after training. Overall, this multifaceted, interactive provider training resulted in significant reductions in inappropriate prescriptions.

  14. Basic nursing care: retrospective evaluation of communication and psychosocial interventions documented by nurses in the acute care setting. (United States)

    Juvé-Udina, Maria-Eulàlia; Pérez, Esperanza Zuriguel; Padrés, Núria Fabrellas; Samartino, Maribel Gonzalez; García, Marta Romero; Creus, Mònica Castellà; Batllori, Núria Vila; Calvo, Cristina Matud


    This study aimed to evaluate the frequency of psychosocial aspects of basic nursing care, as e-charted by nurses, when using an interface terminology. An observational, multicentre study was conducted in acute wards. The main outcome measure was the frequency of use of the psychosocial interventions in the electronic nursing care plans, analysed over a 12 month retrospective review. Overall, 150,494 electronic care plans were studied. Most of the intervention concepts from the interface terminology were used by registered nurses to illustrate the psychosocial aspects of fundamentals of care in the electronic care plans. The results presented help to demonstrate that the interventions of this interface terminology may be useful to inform psychosocial aspects of basic and advanced nursing care. The identification of psychosocial elements of basic nursing care in the nursing documentation may lead to obtain a deeper understanding of those caring interventions nurses consider essential to represent nurse-patient interactions. The frequency of psychosocial interventions may contribute to delineate basic and advanced nursing care. © 2013 Sigma Theta Tau International.

  15. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    Directory of Open Access Journals (Sweden)

    Travers Catherine M


    Full Text Available Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will

  16. Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting. (United States)

    Lim, Eric; Wynaden, Dianne; Heslop, Karen


    Consumer aggression is common in the acute mental health inpatient setting. Mental health nurses can utilize a range of interventions to prevent aggression or reduce its impact on the person and others who have witnessed the event. Incorporating recovery-focussed care into clinical practice is one intervention, as it fosters collaborative partnerships with consumers. It promotes their engagement in decisions about their care and encourages self-management of their presenting behaviours. It also allows the consumer to engage in their personal recovery as their mental health improve. Yet there is a paucity of literature on how nurses can utilize recovery-focussed care with consumers who are hospitalized and in the acute phase of their illness. In the present study, we report the findings of a scoping review of the literature to identify how recovery-focussed care can be utilized by nurses to reduce the risk of consumer aggression. Thirty-five papers met the inclusion criteria for review. Four components were identified as central to the use of recovery-focussed care with consumers at risk of becoming aggressive: (i) seeing the person and not just their presenting behaviour; (ii) interact, don't react; (iii) coproduction to achieve identified goals; and (iv) equipping the consumer as an active manager of their recovery. The components equip nurses with strategies to decrease the risk of aggression, while encouraging consumers to self-manage their challenging behaviours and embark on their personal recovery journey. Further research is required to evaluate the translation of these components clinically in the acute care setting. © 2017 Australian College of Mental Health Nurses Inc.

  17. Recovery-oriented care in older-adult acute inpatient mental health settings in Australia: an exploratory study. (United States)

    McKenna, Brian; Furness, Trentham; Dhital, Deepa; Ireland, Susan


    Recovery-oriented care acknowledges the unique journey that consumers lead with the aim of regaining control of their lives in order to live a good life. Recovery has become a dominant policy-directed model of many mental health care organizations, but in older-adult acute mental health inpatient settings, nurses do not have a clear description of how to be recovery-oriented. The aims of this study were to determine the extent to which elements of existing nursing practice resemble the domains of recovery-oriented care and provide a baseline understanding of practice in preparation for transformation to recovery-oriented mental health care provision. An exploratory, qualitative research design was used to meet the research aims. A purposive sample of mental health nurses (N = 12) participated in focus groups in three older-adult inpatient settings in Australia. A general inductive approach was used to analyze the qualitative data. The mental health nurses in this study readily discussed aspects of their current practice within the recovery domains. They described pragmatic ways to promote a culture of hope, collaborative partnerships, meaningful engagement, autonomy and self-determination, and community participation and citizenship. Nurses also discussed challenges and barriers to recovery-oriented care in older-adult acute mental health settings. This study identified a reasonable baseline understanding of practice in preparation for transformation to recovery-oriented older-adult mental healthcare provision. A concerted drive focused on recovery education is required to effectively embed a recovery-orientated paradigm into older-adult mental health settings. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  18. Access to primary health care for acute vascular events in rural low income settings: a mixed methods study. (United States)

    Ahmed, Shyfuddin; Chowdhury, Muhammad Ashique Haider; Khan, Md Alfazal; Huq, Nafisa Lira; Naheed, Aliya


    Cardiovascular diseases (CVDs) are the leading cause of global mortality. Among the CVDs, acute vascular events (AVE) mainly ischemic heart diseases and stroke are the largest contributors. To achieve 25% reduction in preventable deaths from CVDs by 2025, health systems need to be equipped with extended service coverage in order to provide person-centered care. The overall goal of this proposed study is to assess access to health care in-terms of service availability, care seeking patterns and barriers to access care after AVE in rural Bangladesh. We will consider myocardial infarction (MI) and stroke as acute vascular events. We will conduct a mixed methods study in rural Matlab, Bangladesh. This study will comprise of a) health facility survey, b) structured questionnaire interview and c) qualitative study. We will assess service availabilities by creating an inventory of public and private health facilities. Readiness of the facilities to deliver services for AVE will be assessed through a health facility survey using 'service availability and readiness assessment' (SARA) tools of the World Health Organization (WHO). We will interview survivors of AVE and caregivers (present and accompanied the person during the event) of person who died from AVE for exploring patterns of care seeking during an AVE. For exploring barriers to access care for AVE, we will conduct in-depth interview with survivors of AVE and caregivers of the person who died from AVE. We will also conduct key informant interviews with the service providers at primary health care (PHC) facilities and government high level officials at central health administration of Bangladesh. This study will provide a comprehensive picture of access to primary health care services during acute cardiovascular events as stroke & MI in rural context of Bangladesh. It will explore available service facilities in rural area for management, utilization of services and barriers to access care during an acute emergency

  19. Validation of the palliative performance scale in the acute tertiary care hospital setting. (United States)

    Olajide, Oludamilola; Hanson, Laura; Usher, Barbara M; Qaqish, Bahjat F; Schwartz, Robert; Bernard, Stephen


    Physicians are often asked to prognosticate patient survival. However, prediction of survival is difficult, particularly with critically ill and dying patients within the hospitals. The Palliative Performance Scale (PPS) was designed to assess functional status and measure progressive decline in palliative care patients, yet it has not been validated within hospital health care settings. This study explores the application of the PPS for its predictive ability related to length of survival. Other variables examined were correlates of symptom distress in a tertiary academic setting. Patients were assigned a score on the PPS ranging from 0% to 100% at initial consultation. Standardized symptom assessments were carried out daily, and survival was determined by medical record review and search of the National Death Index. Of 261 patients seen since January 2002, 157 had cancer and 104 had other diagnoses. PPS scores ranged from 10% to 80% with 92% of the scores between 10% and 40%. Survival ranged from 0 to 30 months, with a median of 9 days. By 90 days, 83% of patients had died. Proportional hazards regression estimates showed that a 10% decrement in PPS score was associated with a hazard ratio of 1.65 (95% confidence interval [CI]: 1.42-1.92). Proportional odds regression models showed that a lower PPS was significantly associated with higher levels of dyspnea. The PPS correlated well with length of survival and with select symptom distress scores. We consider it to be a useful tool in predicting outcomes for palliative care patients.

  20. The accessibility of research-based knowledge for nurses in United Kingdom acute care settings. (United States)

    Thompson, C; McCaughan, D; Cullum, N; Sheldon, T A; Mulhall, A; Thompson, D R


    The successful dissemination of the results of the National Health Service (NHS) research and development strategy and the development of evidence based approaches to health care rely on clinicians having access to the best available evidence; evidence fit for the purpose of reducing the uncertainties associated with clinical decisions. To reveal the accessibility of those sources of information actually used by nurses, as well as those which they say they use. Mixed method case site, using interview, observational, Q sort and documentary audit data in medical, surgical and coronary care units (CCUs) in three acute hospitals. Three perspectives on accessibility were identified: (a) the humanist--in which human sources of information were the most accessible; (b) local information for local needs--in which locally produced resources were seen as the most accessible and (c) moving towards technology--in which information technology begins to be seen as accessible. Nurses' experience in a clinical specialty is positively associated with a perception that human sources such as clinical nurse specialists, link nurses, doctors and experienced clinical colleagues are more accessible than text based sources. Clinical specialization is associated with different approaches to accessing research knowledge. Coronary care unit nurses were more likely to perceive local guidelines, protocols and on-line databases as more accessible than their counterparts in general medical and surgical wards. Only a third of text-based resources available to nurses on the wards had any explicit research base. These, and the remainder were out of date (mean age of textbooks 11 years), and authorship hard to ascertain. A strategy to increase the use of research evidence by nurses should harness the influence of clinical nurse specialists, link nurses and those engaged in practice development. These roles could act as 'conduits' through which research-based messages for practice, and information

  1. Prevention and Control of Methicillin-Resistant Staphylococcus aureus in Acute Care Settings. (United States)

    Lee, Andie S; Huttner, Benedikt; Harbarth, Stephan


    Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health care-associated infections worldwide. Controversies with regard to the effectiveness of various MRSA control strategies have contributed to varying approaches to the control of this pathogen in different settings. However, new evidence from large-scale studies has emerged, particularly with regards to MRSA screening and decolonization strategies, which will inform future control practices. The implementation as well as outcomes of control measures in the real world is not only influenced by scientific evidence but also depends on economic, administrative, governmental, and political influences. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings

    National Research Council Canada - National Science Library

    Scott, Vicky; Votova, Kristine; Scanlan, Andria; Close, Jacqueline


    Objective: to conduct a systematic review of published studies that test the validity and reliability of fall-risk assessment tools for use among older adults in community, home-support, long-term and acute care settings. Methods...

  3. Acute bacteremic pneumonia due to melioidosis developing in the intensive care setting

    Directory of Open Access Journals (Sweden)

    Huda Zainal Abidin


    Full Text Available In Malaysia, melioidosis is commonly encountered as this infection is known as part of the endemic area for the disease. Managing cases of positive Burkholderia pseudomallei infection can involve multidisciplinary unit mainly, microbiologist, infectious disease team and intensive care as it may be quite difficult to distinguish melioidosis from a number of other diseases on the clinical setting alone. Laboratory diagnosis plays a vital role in determining the direction of management. Investigations such as culture, polymerase chain reaction (PCR and serology should be evaluated once the disease is suspected. In this particular case, the patient is a young adult involved in a road traffic accident. Unlike any other cases with melioidosis, he had no potential risk factors which may have contributed to the severity of the disease and it is likely that the site of the accident was the source of acquisition of this gram negative bacterium.

  4. No Racial Difference in Rehabilitation Therapy Across All Post-Acute Care Settings in the Year Following a Stroke. (United States)

    Skolarus, Lesli E; Feng, Chunyang; Burke, James F


    Black stroke survivors experience greater poststroke disability than whites. Differences in post-acute rehabilitation may contribute to this disparity. Therefore, we estimated racial differences in rehabilitation therapy utilization, intensity, and the number of post-acute care settings in the first year after a stroke. We used national Medicare data to study 186 168 elderly black and white patients hospitalized with a primary diagnosis of stroke in 2011. We tabulated the proportion of stroke survivors receiving physical, occupational, and speech and language therapy in each post-acute care setting (inpatient rehabilitation facility, skilled nursing facility, and home health agency), minutes of therapy, and number of transitions between settings. We then used generalized linear models to determine whether racial differences in minutes of physical therapy were influenced by demographics, comorbidities, thrombolysis, and markers of stroke severity. Black stroke patients were more likely to receive each type of therapy than white stroke patients. Compared with white stroke patients, black stroke patients received more minutes of physical therapy (897.8 versus 743.4; P <0.01), occupational therapy (752.7 versus 648.9; P <0.01), and speech and language therapy (865.7 versus 658.1; P <0.01). There were no clinically significant differences in physical therapy minutes after adjustment. Blacks had more transitions (median, 3; interquartile range, 1-5) than whites (median, 2; interquartile range, 1-5; P <0.01). There are no clinically significant racial differences in rehabilitation therapy utilization or intensity after accounting for patient characteristics. It is unlikely that differences in rehabilitation utilization or intensity are important contributors to racial disparities in poststroke disability. © 2017 American Heart Association, Inc.

  5. Measuring Nurse Leaders' and Direct Care Nurses' Perceptions of a Healthy Work Environment in an Acute Care Setting, Part 1: A Pilot Study. (United States)

    Huddleston, Penny; Gray, Jennifer


    The American Association of Critical-Care Nurses Healthy Work Environment Assessment tool (AACN HWEAT) was developed as a simple screening assessment for clinical units to quickly get individual feedback on the status of the nurses' work environments based on the AACN standards of a healthy work environment (HWE). Pilot studies were conducted to determine the psychometric properties of the tool after seeking permission from AACN and the Vital Smarts Company. The purposes of these research studies were to assess the psychometric properties of the AACN HWEAT and to measure the nurse leaders' and direct care nurses' perceptions of an HWE in an acute care setting. Nonexperimental descriptive survey designs were implemented with 3 convenience samples for a total sample of 321 nurse leaders and direct care nurses. Cronbach's αs of .97 for nurse leaders and .91 for direct care nurses demonstrated strong reliability or internal consistency of the tool. Face validity demonstrated 13 of 18 items placed in the correct category. The scale content validity index score was 96.63. Concurrent validity demonstrated that items were highly correlated, ranging from 0.42, with 95% confidence interval (CI) of 0.57 to 0.69, to 0.85, with 95% CI of 0.70-0.93, P nurses at all levels in acute care settings.

  6. Changing the Publication Culture From "Nice to Do" to "Need to Do": Implications for Nurse Leaders in Acute Care Settings. (United States)

    Tyndall, Deborah E; Caswell, Nicole I


    Nurses in clinical settings often generate innovative practice ideas to inform their practice and improve patient outcomes. Yet, few publish and share these innovations with a wider audience. Barriers impeding clinical nurses from writing for publication include discomfort with writing, lack of time, and scarce resources. A qualitative study was designed to determine obstacles and facilitators to writing for publication. Interviews were conducted with five clinical nurses who had recently published in peer-reviewed journals. Three themes emerged from the data: culture of "nice to do," personal motivation, and writing experiences. Findings from the study offer implications for nurse leaders to help increase publication efforts by clinical nurses in acute care settings. Nurse leaders can promote publication by clinical nurses through three main strategies: create a culture that supports publication, offer incentives to motivate nurses to publish and reward those who do publish, and provide writing experiences that facilitate writing for publication. © 2016 Wiley Periodicals, Inc.

  7. Evidence-based practice for pain management for cancer patients in an acute care setting. (United States)

    Choi, Mona; Kim, Hee Sun; Chung, Su Kyoung; Ahn, Mee Jung; Yoo, Jae Yong; Park, Ok Sun; Woo, So Rah; Kim, So Sun; Kim, Sun Ah; Oh, Eui Geum


    The purpose of this study is to implement an evidence utilization project using an audit and feedback approach to improve cancer pain management. A three-phased audit and feedback approach was used. A 46-bed oncology nursing unit in the university's cancer centre was selected as a research site. Nursing records extracted from 137 patients (65 for the baseline assessment and 72 for the follow-up audit) were used to examine nurse compliance with four audit criteria derived from best practice guidelines related to the assessment and management of pain. We observed a significant improvement in compliance from baseline to follow-up for the following criteria: documenting the side effects of opioids (2-83%), use of a formalized pain assessment tool (22-75%), and providing education for pain assessment and management to patients and caregivers (0-47%). The audit and feedback method was applicable to the implementation of clinical practice guidelines for cancer pain management. Leadership from both administrative personnel and staff nurses working together contributes to the spread of an evidence-based practice culture in clinical settings. As it was conducted in a single oncology nursing unit and was implemented over a short period of time, the results should be carefully interpreted. © 2013 Wiley Publishing Asia Pty Ltd.

  8. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting

    Directory of Open Access Journals (Sweden)

    Fischer Michael


    Full Text Available Abstract Background The aim of this study was to assess the effectiveness of homeopathy compared to conventional treatment in acute respiratory and ear complaints in a primary care setting. Methods The study was designed as an international, multi-centre, comparative cohort study of non-randomised design. Patients, presenting themselves with at least one chief complaint: acute (≤ 7 days runny nose, sore throat, ear pain, sinus pain or cough, were recruited at 57 primary care practices in Austria (8, Germany (8, the Netherlands (7, Russia (6, Spain (6, Ukraine (4, United Kingdom (10 and the USA (8 and given either homeopathic or conventional treatment. Therapy outcome was measured by using the response rate, defined as the proportion of patients experiencing 'complete recovery' or 'major improvement' in each treatment group. The primary outcome criterion was the response rate after 14 days of therapy. Results Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H and 720 conventional (C treatment. The majority of patients in both groups reported their outcome after 14 days of treatment as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing. In the per-protocol set (H: 576 and C: 540 patients similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019. Further subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C: 84.5% and adults (H: 85.6%; C: 86.6%. The unadjusted odds ratio (OR of the primary outcome criterion was 1.40 (0.89–2.22 in children and 0.92 (0.63–1.34 in adults. Adjustments for demographic differences at baseline did not significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon homeopathic

  9. Peer mentoring supports the learning needs of nurses providing palliative care in a rural acute care setting. (United States)

    Rabbetts, Lyn


    A specific set of assessment scales can underpin the management of distressing symptoms of patients requiring palliative care. A research assistant supported nurses working in a rural hospital setting during the introduction of these scales. A secondary analysis was conducted to further explore the qualitative data of a previously reported mixed-method study. In particular, the experiences of nurses working alongside a research assistant in the facilitation of using a new assessment form. Purposeful sampling was employed: participating nurses were invited to attend one of three focus group meetings. Data analysis revealed three main themes: a contact person, coach/mentor and extra help initiatives. Three to four subthemes corresponded with each main theme. Findings suggest nurses benefit from having someone to assist in learning about new documentation. Nurses respond positively to mentorship and practical guidance when integrating a new assessment form into routine evidence-based practice.

  10. Role of clevidipine butyrate in the treatment of acute hypertension in the critical care setting: a review

    Directory of Open Access Journals (Sweden)

    Ahmed S Awad


    Full Text Available Ahmed S Awad, Michael E GoldbergDepartment of Anesthesiology, Cooper University Hospital, UMDNJ-Robert Wood Johnson Medical School, Camden Campus, Camden, New Jersey, USAAbstract: Acutely elevated blood pressure in the critical care setting is associated with a higher risk of acute end-organ damage (eg, myocardial ischemia, stroke, and renal failure and perioperative bleeding. Urgent treatment and careful blood pressure control are crucial to prevent significant morbidity. Clevidipine butyrate (Cleviprex™ is an ultrashort-acting, third-generation intravenous calcium channel blocker. It is an arterial-selective vasodilator with no venodilatory or myocardial depressive effects. Clevidipine has an extremely short half-life of approximately 1 minute as it is rapidly metabolized by blood and tissue esterases. These metabolites are then primarily eliminated through urine and fecal pathways. The rapid onset and the short duration of action permit tighter and closer adjustment of the blood pressure than is possible with other intravenous agents.Keywords: calcium channel blocker, antihypertensive medications, end-organ damage, hypertensive crisis, hypertensive urgency

  11. Human resource management strategies for the retention of nurses in acute care settings in hospitals in Australia. (United States)

    Hogan, Pamela; Moxham, Lorna; Dwyer, Trudy


    It is paramount that there is an adequate nursing workforce supply for now and in the future, to achieve equitable and quality health outcomes and consumer access to healthcare, regardless of geographic location. Nursing forms the largest body of employees in the health care system, spanning all segments of care. A shortage of nurses, particularly in the acute care settings in hospitals, jeopardizes the provision of quality health care to consumers. This article provides a literature review of Australian State and Federal Government reports into nurse retention. All reports discuss staff turnover rates; the average age of nurses; enrolment numbers in nursing courses; workloads; nursing workforce shortfalls and the effect on the work environment; leadership and management styles; organizational culture; change management; the mobility of nursing qualifications both locally and internationally and the critical need to value nurses. Then why has the situation of nurse retention not improved? Possible reasons for the continued nurse shortage and the promise of strategic HRM in addressing nurse retention are discussed.

  12. The experience of being an advanced practice nurse in Australian acute care settings: A systematic review of qualitative evidence. (United States)

    Ramis, Mary-Anne; Pearson, Alan; Jo Wu, Chiung-Jung


    There is a vast amount of international literature which, although agreeing on the need for advanced practice nurse roles, simultaneously debates and discusses the difficulties with nomenclature, definition and subsequent implementation of such roles. Due to this ambiguity it is difficult to equally compare evidence in this field across different countries. A context-specific systematic review on the qualitative evidence of the experience of being an advanced practice nurse in Australia has not been undertaken previously, however it is imperative for nursing managers and leaders to understand the complexities of advanced nursing roles in order to effectively utilise and retain these experienced and valuable nurses. With the creation of a national nursing regulating authority in 2010, it is timely to explore in-depth the experience of being an advanced practice nurse from a national perspective. To identify the experience of being an advanced practice nurse working in Australian acute care settings. Registered nurses working in advanced practice roles in acute care settings throughout Australia.The experience of being an advanced practice registered nurse working in an Australian acute care setting, as reported by the nurses themselves.Interpretive qualitative studies including designs such as phenomenology, grounded theory and ethnography. A three step search strategy was used to identify published and unpublished studies. The search process was conducted from August to October 2011 and considered published and unpublished studies from 1990 to October 2011. Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Qualitative Assessment and Review Instrument. Data was extracted from the papers included in the review using the standardised Joanna Briggs Institute Qualitative Assessment and Review Instrument data extraction tool. Research findings were pooled using the Joanna Briggs Institute Qualitative Data and Review

  13. Hemoglobin A1c as a screen for previously undiagnosed prediabetes and diabetes in an acute-care setting. (United States)

    Silverman, Robert A; Thakker, Urvi; Ellman, Tovah; Wong, Ivan; Smith, Kelly; Ito, Kazuhiko; Graff, Kirsten


    Hemoglobin A(1c) (HbA(1c)) is recommended for identifying diabetes and prediabetes. Because HbA(1c) does not fluctuate with recent eating or acute illness, it can be measured in a variety of clinical settings. Although outpatient studies identified HbA(1c)-screening cutoff values for diabetes and prediabetes, HbA(1c)-screening thresholds have not been determined for acute-care settings. Using follow-up fasting blood glucose (FBG) and the 2-h oral glucose tolerance test (OGTT) as the criterion gold standard, we determined optimal HbA(1c)-screening cutoffs for undiagnosed dysglycemia in the emergency department setting. This was a prospective observational study of adults aged ≥18 years with no known history of hyperglycemia presenting to an emergency department with acute illness. Outpatient FBS and 2-h OGTT were performed after recovery from the acute illness, resulting in diagnostic categorizations of prediabetes, diabetes, and dysglycemia (prediabetes or diabetes). Optimal cutoffs were determined and performance data identified for cut points. A total of 618 patients were included, with a mean age of 49.7 (±14.9) years and mean HbA(1c) of 5.68% (±0.86). On the basis of an OGTT, the prevalence of previously undiagnosed prediabetes and diabetes was 31.9 and 10.5%, respectively. The optimal HbA(1c)-screening cutoff for prediabetes was 5.7% (area under the curve [AUC] = 0.659, sensitivity = 55%, and specificity = 71%), for dysglycemia 5.8% (AUC = 0.717, sensitivity = 57%, and specificity = 79%), and for diabetes 6.0% (AUC = 0.868, sensitivity = 77%, and specificity = 87%). We identified HbA(1c) cut points to screen for prediabetes and diabetes in an emergency department adult population. The values coincide with published outpatient study findings and suggest that an emergency department visit provides an opportunity for HbA(1c)-based dysglycemia screening.

  14. An exploration of nursing documentation of pressure ulcer care in an acute setting in Ireland.

    LENUS (Irish Health Repository)

    O Brien, J A Jordan


    OBJECTIVE: To explore the nature and quality of documented care planning for pressure ulcers in a large teaching hospital in the Republic of Ireland. METHOD: A mixed method design was used; this encompassed a descriptive survey that retrospectively evaluated nursing records (n=85) in two wards (orthopaedic and care of the older adult) and a focus group (n=13) that explored nurses\\' perspectives of the factors influencing concordance and the quality of nursing documentation. Only records of at-risk patients (Waterlow score of >10) were included. RESULTS: It was identified that 47% (n=40) were assessed as at high or very high risk of developing a pressure ulcer. Fifty-two patients (61%) had a weekly risk assessment, but 25% (n=21) had only one follow-up assessment. Only 45% (n=38) of charts had some evidence of documented care planning, and of those 53% (n=20) had no evidence of implementation of the care plan and 66% (n=25) had no evidence of outcome evaluation. Only 48% (n=41) of this at-risk population was nutritionally assessed. Of patients admitted with and without a pressure ulcer, there was no record of regular positioning in 70% (n=59) and 60% (n=51) respectively. CONCLUSION: Documentation on pressure ulcer care is not standardised and requires development. Conflict of interest: None.

  15. Attitudes and behaviors of hospital staff toward elders in an acute care setting. (United States)

    Jacelon, Cynthia S


    This study was a grounded-theory approach to the social processes engaged in by elderly people while in the hospital. Staff behaviors were identified along two continua, attitude, which affected the elders' dignity and autonomy, and managing care, which affected the elders' health. Elders described the physicians' role as the director of their health care. The elders characterized the nurses' role to provide their medications and direct needs, whereas the nurses identified their role as providing education and emotional support. Implications and recommendations for practice are offered. Copyright 2002, Elsevier Science (USA). All rights reserved.

  16. Determining a set of measurable and relevant factors affecting nursing workload in the acute care hospital setting: a cross-sectional study. (United States)

    Myny, Dries; Van Hecke, Ann; De Bacquer, Dirk; Verhaeghe, Sofie; Gobert, Micheline; Defloor, Tom; Van Goubergen, Dirk


    While there has been great interest in the effect of nurse staffing levels have on the quality of care in hospitals, less attention has been given to determining the factors that affect the nursing workload. There are no existing studies that help define measurable factors that have a clear relation to nursing workload. The aim of this study was to determine the most important and measurable factors, other than patient acuity, that influence nursing workload. A cross-sectional design. Hospitals within the acute hospital care setting. Persons with a nursing educational background, working in Belgian acute care hospitals. A self-administered questionnaire was developed based on the results of an integrative review, the use of focus groups and a survey on measurability and relevance of the included factors. The questionnaire listed relevant and measurable factors related to nursing workload. Weight and frequency of each factor was assessed. The initial list consisted of 94 factors. These factors were regrouped and organised into a questionnaire of 28 measurable and sufficiently relevant factors affecting the nursing workload. More than half of the initial factors seemed to be relevant, but hard to measure on a daily basis. Based on the impact of each factor, the number of work interruptions was the most important factor related to nursing workload. It is unlikely that a workload instrument will ever be able to take into account all possible factors affecting the nursing workload. Nevertheless, the number of work interruptions, the patient turnover rate and the number of mandatory registrations should be included in the development or revision of a workload measurement tool. © 2011 Elsevier Ltd. All rights reserved.

  17. Integrative review of clinical decision support for registered nurses in acute care settings. (United States)

    Dunn Lopez, Karen; Gephart, Sheila M; Raszewski, Rebecca; Sousa, Vanessa; Shehorn, Lauren E; Abraham, Joanna


    To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses. We performed an integrative review of qualitative and quantitative peer-reviewed original research studies using a structured search of PubMed, Embase, Cumulative Index to Nursing and Applied Health Literature (CINAHL), Scopus, Web of Science, and IEEE Xplore (Institute of Electrical and Electronics Engineers Xplore Digital Library). We included articles that reported on CDS targeting bedside nurses and excluded in stages based on rules for titles, abstracts, and full articles. We extracted research design and methods, CDS purpose, electronic health record integration, usability, and process and patient outcomes. Our search yielded 3157 articles. After removing duplicates and applying exclusion rules, 28 articles met the inclusion criteria. The majority of studies were single-site, descriptive or qualitative (43%) or quasi-experimental (36%). There was only 1 randomized controlled trial. The purpose of most CDS was to support diagnostic decision-making (36%), guideline adherence (32%), medication management (29%), and situational awareness (25%). All the studies that included process outcomes (7) and usability outcomes (4) and also had analytic procedures to detect changes in outcomes demonstrated statistically significant improvements. Three of 4 studies that included patient outcomes and also had analytic procedures to detect change showed statistically significant improvements. No negative effects of CDS were found on process, usability, or patient outcomes. Clinical support systems targeting bedside nurses have positive effects on outcomes and hold promise for improving care quality; however, this research is lagging behind studies of CDS targeting medical decision-making in both volume and level of evidence.

  18. Impact of patient communication problems on the risk of preventable adverse events in acute care settings. (United States)

    Bartlett, Gillian; Blais, Régis; Tamblyn, Robyn; Clermont, Richard J; MacGibbon, Brenda


    Up to 50% of adverse events that occur in hospitals are preventable. Language barriers and disabilities that affect communication have been shown to decrease quality of care. We sought to assess whether communication problems are associated with an increased risk of preventable adverse events. We randomly selected 20 general hospitals in the province of Quebec with at least 1500 annual admissions. Of the 145,672 admissions to the selected hospitals in 2000/01, we randomly selected and reviewed 2355 charts of patients aged 18 years or older. Reviewers abstracted patient characteristics, including communication problems, and details of hospital admission, and assessed the cause and preventability of identified adverse events. The primary outcome was adverse events. Of 217 adverse events, 63 (29%) were judged to be preventable, for an overall population rate of 2.7% (95% confidence interval [CI] 2.1%-3.4%). We found that patients with preventable adverse events were significantly more likely than those without such events to have a communication problem (odds ratio [OR] 3.00; 95% CI 1.43-6.27) or a psychiatric disorder (OR 2.35; 95% CI 1.09-5.05). Patients who were admitted urgently were significantly more likely than patients whose admissions were elective to experience an event (OR 1.64, 95% CI 1.07-2.52). Preventable adverse events were mainly due to drug errors (40%) or poor clinical management (32%). We found that patients with communication problems were more likely than patients without these problems to experience multiple preventable adverse events (46% v. 20%; p = 0.05). Patients with communication problems appeared to be at highest risk for preventable adverse events. Interventions to reduce the risk for these patients need to be developed and evaluated.

  19. Planning and process evaluation of a multi-faceted influenza vaccination implementation strategy for health care workers in acute health care settings. (United States)

    Riphagen-Dalhuisen, Josien; Frijstein, Gerard; van der Geest-Blankert, Nannet; Danhof-Pont, Marita; de Jager, Herbert; Bos, Nita; Smeets, Ed; de Vries, Marjan; Gallee, Pieter; Hak, Eelko


    Influenza transmitted by health care workers (HCWs) is a potential threat to frail patients in acute health care settings. Therefore, immunizing HCWs against influenza should receive high priority. Despite recommendations of the World Health Organization, vaccine coverage of HCWs remains low in all European countries. This study explores the use of intervention strategies and methods to improve influenza vaccination rates among HCWs in an acute care setting. The Intervention Mapping (IM) method was used to systematically develop and implement an intervention strategy aimed at changing influenza vaccination behaviour among HCWs in Dutch University Medical Centres (UMCs). Carried out during the influenza seasons 2009/2010 and 2010/2011, the interventions were then qualitatively and quantitatively evaluated by way of feedback from participating UMCs and the completion of a web-based staff questionnaire in the following spring of each season. The IM method resulted in the development of a transparent influenza vaccination intervention implementation strategy. The intervention strategy was offered to six Dutch UMCs in a randomized in a clustered Randomized Controlled Trial (RCT), where three UMCs were chosen for intervention, and three UMCs acted as controls. A further two UMCs elected to have the intervention. The qualitative process evaluation showed that HCWs at four of the five intervention UMCs were responsive to the majority of the 11 relevant behavioural determinants resulting from the needs assessment in their intervention strategy compared with only one of three control UMCs. The quantitative evaluation among a sample of HCWs revealed that of all the developed communication materials, HCWs reported the posters as the most noticeable. Our study demonstrates that it is possible to develop a structured implementation strategy for increasing the rate of influenza vaccination by HCWs in acute health care settings. The evaluation also showed that it is impossible to

  20. What is the role of specialist palliative care in an acute hospital setting? A qualitative study exploring views of patients and carers. (United States)

    Yang, Grace M; Ewing, Gail; Booth, Sara


    Since the medical specialty of palliative medicine was recognized in 1988, the role of hospital specialist palliative care services has been developing, extending to patients who have a life-limiting illness but are not in the terminal phase. This qualitative study aims to explore patient and carer perspectives of the role of palliative care in the acute hospital setting, with patients not imminently dying. Semi-structured interviews with 12 patients and 10 carers. Data were analysed using framework analysis. Patients recruited were adults who had palliative care input for symptom control or psychological support and were discharged either to general ward care or to home. The family member/friend designated as their carer was also approached to take part. All patients in this study were treated in an acute hospital, described as a bewildering and pressured environment of care. Initial perceptions of palliative care were varied, some interpreting referral as an indication that they were approaching the end of life. However, after palliative care input, patients and carers developed an understanding of their role which they saw as three-fold: physical symptom control, psychological support and a reliable liaison. The theme of cross-cutting interviews was that the palliative care team made time for patients, giving them a sense of value and worth. Feeling their care was a priority and being listened to made palliative care input effective. These findings will aid continuing development and evaluation of palliative care teams, in the domains of effectiveness as well as patient experience.

  1. 'Being a conduit' between hospital and home: stakeholders' views and perceptions of a nurse-led Palliative Care Discharge Facilitator Service in an acute hospital setting. (United States)

    Venkatasalu, Munikumar Ramasamy; Clarke, Amanda; Atkinson, Joanne


    To explore and critically examine stakeholders' views and perceptions concerning the nurse-led Palliative Care Discharge Service in an acute hospital setting and to inform sustainability, service development and future service configuration. The drive in policy and practice is to enable individuals to achieve their preferred place of care during their last days of life. However, most people in UK die in acute hospital settings against their wishes. To facilitate individuals' preferred place of care, a large acute hospital in northeast England implemented a pilot project to establish a nurse-led Macmillan Palliative Care Discharge Facilitator Service. A pluralistic evaluation design using qualitative methods was used to seek stakeholders' views and perceptions of this service. In total, 12 participants (five bereaved carers and seven health professionals) participated in the evaluation. Semi-structured interviews were conducted with bereaved carers who used this service for their relatives. A focus group and an individual interview were undertaken with health professionals who had used the service since its inception. Individual interviews were also conducted with the Discharge Facilitator and service manager. Analysis of all data was guided by Framework Analysis. Four key themes emerged relating to the role of the Discharge Facilitator Service: achieving preferred place of care; the Discharge Facilitator as the 'conduit' between hospital and community settings; delays in hospital discharge and stakeholders' perceptions of the way forward for the service. The Discharge Facilitator Service acted as a reliable resource and support for facilitating the fast-tracking of end-of-life patients to their preferred place of care. Future planning for hospital-based palliative care discharge facilitating services need to consider incorporating strategies that include: increased profile of the service, expansion of service provision and the Discharge Facilitator's earlier

  2. Dissociative identity disorder and the nurse-patient relationship in the acute care setting: an action research study. (United States)

    McAllister, M; Higson, D; McIntosh, W; O'Leary, S; Hargreaves, L; Murrell, L; Mullen, V; Lovell, F; Kearney, J; Sammon, D; Woelders, S; Adams, T; Davies-Cotter, D; Wilson, J; O'Brien, J


    This paper presents the results of an action research study into the acute care experience of Dissociative Identity Disorder. The study, which was grounded in principles of critical social science, utilized focus group interviews and narrative construction. Nurses and patients are under-represented in all clinical evaluation and their voices need to be heard if services are to be truly collaborative. Findings of the study extend intrapsychic theories of trauma to emphasize the interpersonal relationship between nurse and person who can work together to facilitate recovery from trauma, make connections both intra and interpersonally and build resilience.

  3. Retracted: Nurses learning in the workplace: a comparison of workplace attributes in acute care settings in Australia and Singapore. (United States)

    Chan, S W; Chan, M F; Lee, S-Y; Henderson, A


    Workplaces need to foster teaching and learning interactions so staff collaborate and learn from each other. Internationally, many countries provide support to graduates and experienced staff to foster engagement necessary for learning and quality care. Workplace attributes can differ across countries depending on managerial, contextual, social and policy issues. This study compared workplace attributes of two Australian hospitals with a Singaporean hospital. A representative sample of nurses in two acute care facilities in Australia (n = 203) and a comparable facility in Singapore (n = 154) during 2010 and 2011 responded to a survey requesting demographic data and responses about workplace attributes. Attributes were determined through validated tools that measure staff perception of support when facilitating others learning (Support Instrument for Nurses Facilitating the Learning of Others) and the clinical learning organizational culture (Clinical Learning Organizational Culture Survey). Results indicated Singaporean nurses rated perception of acknowledgement, workload management and teamwork support in facilitating learners in their hospital as significantly better than the Australian cohort despite similar provisions for support and development. There were no significant differences across the two sites in the clinical learning culture. Analysis across three health facilities only provides a snapshot. Targeting more facilities would assist in confirming the extent of reported trends. Findings indicate differences in nurses' perceptions of support when facilitating learners. Further exploration of Singaporean nurses' increased perceptions of support is worthy. Clinical learning organizational culture findings across Australian and Singaporean acute care facilities suggest common attributes within the nursing profession that transcend contextual factors, for example, a strong sense of task accomplishment. Nurses across both countries demonstrate

  4. Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. (United States)

    Ocampo, Wrechelle; Geransar, Rose; Clayden, Nancy; Jones, Jessica; de Grood, Jill; Joffe, Mark; Taylor, Geoffrey; Missaghi, Bayan; Pearce, Craig; Ghali, William; Conly, John


    Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  5. Reconciling concepts of space and person-centred care of the older person with cognitive impairment in the acute care setting. (United States)

    Rushton, Carole; Edvardsson, David


    Although a large body of literature exists propounding the importance of space in aged care and care of the older person with dementia, there is, however, only limited exploration of the 'acute care space' as a particular type of space with archetypal constraints that maybe unfavourable to older people with cognitive impairment and nurses wanting to provide care that is person-centred. In this article, we explore concepts of space and examine the implications of these for the delivery of care to older people who are cognitively impaired. Our exploration is grounded in theorisations of space offered by key geographers and phenomenologists, but also draws on how space has been constructed within the nursing literature that refers specifically to acute care. We argue that space, once created, can be created and that nursing has a significant role to play in the process of its recreation in the pursuit of care that is person-centred. We conclude by introducing an alternative logic of space aimed at promoting the creation of more salutogenic spaces that invokes a sense of sanctuary, safeness, and inclusion, all of which are essential if the care provided to the older person with cognitive impairment is apposite to their needs. The concept of 'person-centred space' helps to crystallize the relationship between space and person-centred care and implies more intentional manipulation of space that is more conducive to caring and healing. Significantly, it marks a return to Nightingale's wisdom, that is, to put the person in the best possible conditions for nature to act upon them. © 2016 John Wiley & Sons Ltd.

  6. Integrated Care Pathways and Care Bundles for Dementia in Acute Care: Concept Versus Evidence. (United States)

    Sullivan, Dawn O; Mannix, Mary; Timmons, Suzanne


    Caring for people with dementia in acute settings is challenging and confounded by multiple comorbidities and difficulties transitioning between community and acute care. Recently, there has been an increase in the development and use of integrated care pathways (ICPs) and care bundles for defined illnesses and medical procedures, and these are now being promoted for use in dementia care in acute settings. We present a review of the literature on ICPs and/or care bundles for dementia care in the acute sector. This includes a literature overview including "gray literature" such as relevant websites, reports, and government publications. Taken together, there is clearly a growing interest in and clinical use of ICPs and care bundles for dementia. However, there is currently insufficient evidence to support the effectiveness of ICPs for dementia care in acute settings and limited evidence for care bundles for dementia in this setting.

  7. Settings for Terminal Care. (United States)

    Corless, Inge B.


    Examines topics related to delivery of terminal care services: ability of various hospice programs to survive financially, contributions of various models of hospice care, impact of Medicare legislation on hospice movement, demonstration of unique hospice intervention, integration of spiritual care into hospice, and role of hospice in care of…

  8. Infection prevention in alternative health care settings. (United States)

    Flanagan, Elaine; Chopra, Teena; Mody, Lona


    With the changing health care delivery, patients receive care at various settings, including acute care hospitals, skilled nursing facilities (SNFs), and ambulatory clinics, thus becoming exposed to pathogens. Various health care settings face unique challenges requiring individualized infection control programs. The programs in SNFs should address surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs. In ambulatory clinics, the program should address triage and standard transmission-based precautions; cleaning, disinfection, and sterilization principles; surveillance in surgical clinics; safe injection practices; and bioterrorism and disaster planning. Published by Elsevier Inc.

  9. Knowledge, perceptions, and practices of methicillin-resistant Staphylococcus aureus transmission prevention among health care workers in acute-care settings. (United States)

    Seibert, Dorothy J; Speroni, Karen Gabel; Oh, Kyeung Mi; DeVoe, Mary C; Jacobsen, Kathryn H


    Health care workers (HCWs) play a critical role in prevention of health care-associated infections such as methicillin-resistant Staphylococcus aureus (MRSA), but glove and gown contact precautions and hand hygiene may not be consistently used with vulnerable patients. A cross-sectional survey of MRSA knowledge, attitudes/perceptions, and practices among 276 medical, nursing, allied health, and support services staff at an acute-care hospital in the eastern United States was completed in 2012. Additionally, blinded observations of hand hygiene behaviors of 104 HCWs were conducted. HCWs strongly agreed that preventive behaviors reduce the spread of MRSA. The vast majority reported that they almost always engage in preventive practices, but observations of hand hygiene found lower rates of adherence among nearly all HCW groups. HCWs who reported greater comfort with telling others to take action to prevent MRSA transmission were significantly more likely to self-report adherence to recommended practices. It is important to reduce barriers to adherence with preventive behaviors and to help all HCWs, including support staff who do not have direct patient care responsibilities, to translate knowledge about MRSA transmission prevention methods into consistent adherence of themselves and their coworkers to prevention guidelines. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  10. Predictors of image quality of coronary computed tomography in the acute care setting of patients with chest pain

    Energy Technology Data Exchange (ETDEWEB)

    Bamberg, Fabian; Abbara, Suhny; Schlett, Christopher L.; Cury, Ricardo C.; Truong, Quynh A.; Rogers, Ian S. [Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Nagurney, John T. [Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Brady, Thomas J. [Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Hoffmann, Udo [Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States)], E-mail:


    Objective: We aimed to determine predictors of image quality in consecutive patients who underwent coronary computed tomography (CT) for the evaluation of acute chest pain. Method and materials: We prospectively enrolled patients who presented with chest pain to the emergency department. All subjects underwent contrast-enhanced 64-slice coronary multi-detector CT. Two experienced readers determined overall image quality on a per-patient basis and the prevalence and characteristics of non-evaluable coronary segments on a per-segment basis. Results: Among 378 subjects (143 women, age: 52.9 {+-} 11.8 years), 345 (91%) had acceptable overall image quality, while 33 (9%) had poor image quality or were unreadable. In adjusted analysis, patients with diabetes, hypertension and a higher heart rate during the scan were more likely to have exams graded as poor or unreadable (odds ratio [OR]: 2.94, p = 0.02; OR: 2.62, p = 0.03; OR: 1.43, p = 0.02; respectively). Of 6253 coronary segments, 257 (4%) were non-evaluable, most due to severe calcification in combination with motion (35%). The presence of non-evaluable coronary segments was associated with age (OR: 1.08 annually, 95%-confidence interval [CI]: 1.05-1.12, p < 0.001), baseline heart rate (OR: 1.35 per 10 beats/min, 95%-CI: 1.11-1.67, p = 0.003), diabetes, hypertension, and history of coronary artery disease (OR: 4.43, 95%-CI: 1.93-10.17, p < 0.001; OR: 2.27, 95-CI: 1.01-4.73, p = 0.03; OR: 5.12, 95%-CI: 2.0-13.06, p < 0.001; respectively). Conclusion: Coronary CT permits acceptable image quality in more than 90% of patients with chest pain. Patients with multiple risk factors are more likely to have impaired image quality or non-evaluable coronary segments. These patients may require careful patient preparation and optimization of CT scanning protocols.

  11. Acute dialysis and continuous renal replacement: the emergence of new technology involving the nephrologist in the intensive care setting. (United States)

    Yagi, N; Paganini, E P


    The emergence of dialytic support for patients with reversible renal failure was one of the most significant advances in critical care medicine. Supporting a patient with a failed organ till organ recovery has not had the same success with other organ failures. Despite the indispensable nature of the support, dialysis was intermittent at best, and carried its own morbidity. The emergence of a "continuous" dialysis delivery system, originally through an arteriovenous access and later through veno-venous methodology, began to simulate the continuity of the natural kidney, and lifted much of the fluid and drug restrictions imposed by the intermittent nature of standard dialytic therapies. Components of the system were next reviewed for improvement and biocompatability. Differences in patient outcome were documented with various component comparisons, and disparate patient tolerance of delivery modality was also clearly proven. The hemodynamic stability of continuous treatment created utilization to be focused on the more unstable, the more severely compromised patient group. In this context, comparative studies with intermittent delivery methods showed improved hemodynamic stability among patients treated with continuous renal replacement therapies (CRRT), but no clear difference in patient mortality. Patient characteristics and severity scoring have recently been undertaken to better describe the population, and attempts at dialysis dosing is currently being developed for ARF dialysis recipients. Early results seem to point toward a dialysis dose effect on mortality in certain groups of ICU acute renal failure patients. However, the dialytic process is only depurative and artificial. Plastic membrane bio-incompatibility, human physiological responses to foreign material exposure, either in the circuit material itself or introduced from therapy methodology, pose practical and theoretical problems. Recent advances in the field of bio-artificial technology have allowed

  12. RecoverNow: Feasibility of a Mobile Tablet-Based Rehabilitation Intervention to Treat Post-Stroke Communication Deficits in the Acute Care Setting.

    Directory of Open Access Journals (Sweden)

    Karen H Mallet

    Full Text Available Approximately 40% of patients diagnosed with stroke experience some degree of aphasia. With limited health care resources, patients' access to speech and language therapies is often delayed. We propose using mobile-platform technology to initiate early speech-language therapy in the acute care setting. For this pilot, our objective was to assess the feasibility of a tablet-based speech-language therapy for patients with communication deficits following acute stroke.We enrolled consecutive patients admitted with a stroke and communication deficits with NIHSS score ≥1 on the best language and/or dysarthria parameters. We excluded patients with severe comprehension deficits where communication was not possible. Following baseline assessment by a speech-language pathologist (SLP, patients were provided with a mobile tablet programmed with individualized therapy applications based on the assessment, and instructed to use it for at least one hour per day. Our objective was to establish feasibility by measuring recruitment rate, adherence rate, retention rate, protocol deviations and acceptability.Over 6 months, 143 patients were admitted with a new diagnosis of stroke: 73 had communication deficits, 44 met inclusion criteria, and 30 were enrolled into RecoverNow (median age 62, 26.6% female for a recruitment rate of 68% of eligible participants. Participants received mobile tablets at a mean 6.8 days from admission [SEM 1.6], and used them for a mean 149.8 minutes/day [SEM 19.1]. In-hospital retention rate was 97%, and 96% of patients scored the mobile tablet-based communication therapy as at least moderately convenient 3/5 or better with 5/5 being most "convenient".Individualized speech-language therapy delivered by mobile tablet technology is feasible in acute care.

  13. Interprofessional working in acute care. (United States)

    Holland, Chris; Bench, Suzanne; Brown, Kate; Bradley, Claire; Johnson, Lorna; Frisby, Jayne


    This paper describes the development and implementation of an interprofessional (IP) module for pre-qualification medical, nursing and physiotherapy students. The module focuses on clinical care in the acute care setting, and is called Interprofessional Working in Acute Care (IWAC). The authors are acute-care practitioners and educators familiar with an environment where good interprofessional collaboration and communication are prerequisite for, and linked to, good patient outcomes. We believe that explicit opportunities to learn the skills of collaborative IP working are required. We developed a blended-learning 15-credit module that was vertically integrated into the existing curricula of the three programmes. It used several different types of learning: self-directed learning; in-practice teaching; clinical observation; simulation-based teaching (SBT); and collaborative peer-group working and student presentations. The contact teaching time had to be limited because of the constraints of three divergent timetables, and was dominated by SBT that featured four acute care scenarios. The scenarios were formulated so that they could not be managed without interprofessional collaboration. Each student was assigned to an IP group (comprising at least one student from each discipline) for the whole module. A common assessment included a collaborative presentation by each IP group where members were expected to discuss and reflect upon the role of a different professional within their group. This narrative account exhibits our development of teaching praxis in the story of teaching innovation, and highlights some of the challenges and opportunities within IP learning in undergraduate education. © Blackwell Publishing Ltd 2013.

  14. Antibiotic prescribing practice for acute, uncomplicated respiratory tract infections in primary care settings in New Delhi, India. (United States)

    Kotwani, Anita; Holloway, Kathleen


    To obtain information on prescribing rates and choice of antibiotics for acute, uncomplicated respiratory tract infections (RTIs) in the community. Antibiotic use in acute, uncomplicated RTIs consisting of common cold/sore throat/cough for not more than five days was surveyed in the community (December 2007-November 2008) using patient exit interviews at public and private facilities from four localities in New Delhi. Data were collected from 10 public sector facilities and 20 private clinics over one year. The percentage of acute, uncomplicated RTIs patients receiving antibiotics in general and using the Anatomical Therapeutic Chemical classification and the Defined Daily Dose (ATS/DDD) were analysed. At public and private facilities, 45% (746/1646) and 57% (259/457) of acute, uncomplicated RTI patients were prescribed at least one antibiotic, respectively. The main antibiotic class calculated as percentage of total antibiotics DDDs/1000 prescribed to acute, uncomplicated RTI patients at private clinics was cephalosporins, J01DA (39%), followed by fluoroquinolones, J01MA (24%), penicillins, J01C (19%) and macrolides, J01FA (15%). Newer members from each class were prescribed; older antibiotics such as co-trimoxazole or tetracyclines were rarely prescribed. At public facilities, the main class of antibiotic prescribed was penicillins (31%), followed by macrolides (25%), fluoroquinolones (20%) and cephalosporins (10%). Study clearly shows overuse and inappropriate choice of antibiotics for the treatment of acute, uncomplicated RTIs which are mainly due to virus and do not require antibiotic treatment. Results of the study warrant interventional strategies to promote rational use of antibiotics to decrease the overgrowing threat of antibiotic resistance. © 2014 John Wiley & Sons Ltd.

  15. Cross-cultural adaptation of a patient-based tool for evaluating the implementation of patient education in acute care settings. (United States)

    Golaghaie, Farzaneh; Bastani, Farideh


    The purpose was cross-cultural adaptation, validation, and psychometric analysis of an originally Norwegian patient-based tool measuring the patient education practices of the nurses. Systematic translation and validation of the Patient Information and Nurse Interaction (PINI) scale was performed. Exploratory factor analysis of the modified Persian version was conducted using a sample consisting of 163 Persian-speaking patients discharging from a neurosurgery unit. The scale included three factors, cumulatively accounting for 61% of the variance. The first factor with seven items reflected "providing information on treatment and care plans". The second and the third factors each contained four items and reflected "nurses' interactions with the clients" and "providing advice on care after discharge", respectively. Alpha coefficients were 0.90 for the overall scale, 0.87 for the first, 0.77 for the second, and 0.88 for the third subscale. The study supported that the modified scale had good psychometric properties measuring three major components including providing information, interaction with the client, and providing advice about post-discharge care. It seems that the modified version of the PINI scale can provide sound assessment of the implementation of patient education in a different acute care setting with a new language and culture. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. First-generation versus third-generation comprehensive geriatric assessment instruments in the acute hospital setting: a comparison of the Minimum Geriatric Screening Tools (MGST) and the interRAI Acute Care (interRAI AC). (United States)

    Wellens, N I H; Deschodt, M; Flamaing, J; Moons, P; Boonen, S; Boman, X; Gosset, C; Petermans, J; Milisen, K


    Comparison of the first-generation Minimum Geriatric Screening Tools (MGST) and the third-generation interRAI Acute Care (interRAI AC). Based on a qualitative multiphase exchange of expert opinion, published evidence was critically analyzed and translated into a consensus. Both methods are intended for a multi-domain geriatric assessment in acute hospital settings, but each with a different scope and goal. MGST contains a collection of single-domain, internationally validated instruments. Assessment is usually triggered by care givers' clinical impression based on geriatric expertise. A limited selection of domains is usually assessed only once, by disciplines with domain-specific expertise. Clinical use results in improvement to screen geriatric problems. InterRAI AC, tailored for acute settings, intends to screen a large number of geriatric domains. Based on systematic observational data, risk domains are triggered and clinical guidelines are suggested. Multiple observation periods outline the evolution of patients' functioning over stay in comparison to the premorbid situation. The method is appropriate for application on geriatric and non-geriatric wards, filling geriatric knowledge gaps. The interRAI Suite contains a common set of standardized items across settings, facilitating data transfer in transitional care. The third-generation interRAI AC has advantages compared to the first-generation MGST. A cascade system is proposed to integrate both, complementary methods in practice. The systematic interRAI AC assessment detects risk domains. Subsequently, clinical protocols suggest components of the MGST as additional assessment. This cascade approach unites the strength of exhaustive assessment of the interRAI AC with domain-specific tools of the MGST.

  17. [Road traffic injuries in Catalonia (Spain): an approach using the minimum data set for acute-care hospitals and emergency resources]. (United States)

    Clèries, Montse; Bosch, Anna; Vela, Emili; Bustins, Montse


    To verify the usefulness of the minimum data set (MDS) for acute-care hospitals and emergency resources for the study of road traffic injuries and to describe the use of health resources in Catalonia (Spain). The study population consisted of patients treated in any kind of emergency service and patients admitted for acute hospitalization in Catalonia in 2013. A descriptive analysis was performed by age, gender, time and clinical variables. A total of 48,150 patients were treated in hospital emergency departments, 6,210 were attended in primary care, and 4,912 were admitted to hospital. There was a higher proportion of men (56.2%), mainly aged between 20 and 40 years. Men accounted for 54.9% of patients with minor injuries and 75.1% of those with severe injuries. Contusions are the most common injury (30.2%), followed by sprains (28.7%). Fractures mostly affected persons older than 64 years, internal injuries particularly affected men older than 64 years, and wounds mainly affected persons younger than 18 years and older than 64 years. In the adult population, the severity of the injuries increased with age, leading to longer length of stay and greater complexity. Hospital mortality was 0.2%. Fractures, internal injuries and wounds were more frequent in the group of very serious injuries, and sprains and contusions in the group of minor injuries. MDS records (acute hospitals and emergency resources) provide information that is complementary to other sources of information on traffic accidents, increasing the completeness of the data. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  18. Influenza in the acute hospital setting. (United States)

    Salgado, Cassandra D; Farr, Barry M; Hall, Keri K; Hayden, Frederick G


    Influenza poses special hazards inside healthcare facilities and can cause explosive outbreaks of illness. Healthcare workers are at risk of acquiring influenza and thus serve as an important reservoir for patients under their care. Annual influenza immunisation of high-risk persons and their contacts, including healthcare workers, is the primary means of preventing nosocomial influenza. Despite influenza vaccine effectiveness, it is substantially underused by healthcare providers. Influenza can be diagnosed by culturing the virus from respiratory secretions and by rapid antigen detection kits; recognition of a nosocomial outbreak is important in order to employ infection-control efforts. Optimal control of influenza in the acute-care setting should focus upon reducing potential influenza reservoirs in the hospital, including: isolating patients with suspected or documented influenza, sending home healthcare providers or staff who exhibit typical symptoms of influenza, and discouraging persons with febrile respiratory illness from visiting the hospital during a known influenza outbreak in the community. (Note: influenza and other respiratory viruses can cause non-febrile illness but are still transmissible.) The antiviral M2 protein inhibitors (amantadine, rimantadine) and neuraminidase inhibitors (zanamivir, oseltamivir) have proven efficacy in treating and preventing influenza illness; however, their role in the prevention and control of influenza in the acute hospital setting remains to be more fully studied.

  19. The association of leadership styles and empowerment with nurses' organizational commitment in an acute health care setting: a cross-sectional study

    National Research Council Canada - National Science Library

    Asiri, Samirah A; Rohrer, Wesley W; Al-Surimi, Khaled; Da'ar, Omar O; Ahmed, Anwar


    .... This study intends to measure the effects of nurses' overall perception of the leadership style of their managers, and psychological empowerment on their organizational commitment in acute care units...

  20. Assessing the economic value of avoiding hospital admissions by shifting the management of gram+ acute bacterial skin and skin-structure infections to an outpatient care setting. (United States)

    Ektare, V; Khachatryan, A; Xue, M; Dunne, M; Johnson, K; Stephens, J


    To estimate, from a US payer perspective, the cost offsets of treating gram positive acute bacterial skin and skin-structure infections (ABSSSI) with varied hospital length of stay (LOS) followed by outpatient care, as well as the cost implications of avoiding hospital admission. Economic drivers of care were estimated using a literature-based economic model incorporating inpatient and outpatient components. The model incorporated equal efficacy, adverse events (AE), resource use, and costs from literature. Costs of once- and twice-daily outpatient infusions to achieve a 14-day treatment were analyzed. Sensitivity analyses were performed. Costs were adjusted to 2015 US$. Total non-drug medical cost for treatment of ABSSSI entirely in the outpatient setting to avoid hospital admission was the lowest among all scenarios and ranged from $4039-$4924. Total non-drug cost for ABSSSI treated in the inpatient setting ranged from $9813 (3 days LOS) to $18,014 (7 days LOS). Inpatient vs outpatient cost breakdown was: 3 days inpatient ($6657)/11 days outpatient ($3156-$3877); 7 days inpatient ($15,017)/7 days outpatient ($2495-$2997). Sensitivity analyses revealed a key outpatient cost driver to be peripherally inserted central catheter (PICC) costs (average per patient cost of $873 for placement and $205 for complications). Drug and indirect costs were excluded and resource use was not differentiated by ABSSSI type. It was assumed that successful ABSSSI treatment takes up to 14 days per the product labels, and that once-daily and twice-daily antibiotics have equal efficacy. Shifting ABSSSI care to outpatient settings may result in medical cost savings greater than 53%. Typical outpatient scenarios represent 14-37% of total medical cost, with PICC accounting for 28-43% of the outpatient burden. The value of new ABSSSI therapies will be driven by eliminating the need for PICC line, reducing length of stay and the ability to completely avoid a hospital stay.

  1. The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: strengths, weaknesses, opportunities and threats in the acute hospital setting. (United States)

    Devriendt, Els; Wellens, Nathalie I H; Flamaing, Johan; Declercq, Anja; Moons, Philip; Boonen, Steven; Milisen, Koen


    The interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons' medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patients' data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context. In a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants. The primary strengths of the BelRAI-system were a structured overview of the patients' condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of care. An actual shortage of

  2. Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting. (United States)

    Liu, Wei; Gerdtz, Marie; Manias, Elizabeth


    This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication

  3. Impact of an easy-access telephonic interpreter program in the acute care setting: an evaluation of a quality improvement intervention. (United States)

    Tuot, Delphine S; Lopez, Monica; Miller, Cecily; Karliner, Leah S


    Language barriers render interaction with the health care system difficult and lead to health disparities for patients with limited English proficiency (LEP). Despite a long-standing legal obligation for large health care organizations in the United States to try to provide free language access services for patients with LEP, professional interpretation is not always widely accessible, and even when it is, its use is often suboptimal. A dual-handset phone with 24-hour access to professional telephonic interpretation was placed at the bedside of all patients admitted to the general medicine floor of a tertiary care academic hospital. Nurses and physicians were surveyed before and after the easy-access interpretation program's implementation. Distribution of pre- and postimplementation surveys to 127 and 122 nurses, respectively, yielded a total of 163 completed surveys (overall participation rate, 65%). Distribution of surveys to 96 and 78 physicians, respectively, yielded 116 completed surveys (overall participation rate, 67%). After implementation, use of professional telephonic interpreters for communication with LEP patients increased fourfold, without a decrease in use of professional in-person interpreters. There were significant increases in professional interpreter use during brief communications with high error potential, including medication administration (odds ratio [OR] = 1.9, 95% confidence interval [CI] 1.1-3.2) and pre-rounding (OR = 3.4, 95% CI 1.2-9.8). Increasing ease of access to dual-handset interpreter telephones promotes use of professional interpreters in the acute care setting. Future hospital policy should focus on further integrating language services into the hospital environment, accompanied by an educational program to assist in shifting professional norms toward use of professional interpreters.

  4. Use of Risk Assessment Tool for Inpatient Traumatic Intracranial Hemorrhage after Falls in Acute Care Hospital Setting (United States)

    Toyabe, Shin-ichi


    Severe injuries such as intracranial hemorrhage (ICH) are the most serious problem after falls in hospital, but they have not been considered in risk assessment scores for falls. We tried to determine the risk factors for ICH after falls in 20,320 inpatients (696,364 patient-days) aged from 40 to 90 years who were admitted to a tertiary-care university hospital. Possible risk factors including STRATIFY risk score for falls and FRAX™ risk score for fractures were analyzed by univariate and multivariate analyses. Fallers accounted for 3.2% of the patients, and 5.0% of the fallers suffered major injuries, including peripheral bone fracture (59.6%) and ICH (23.4%). In addition to STRATIFY, FRAX™ was significantly associated not only with bone fractures but also ICH. Concomitant use of risk score for falls and risk score for fractures might be useful for the prediction of major injuries such as ICH after falls. PMID:22980233

  5. Improving Publication Quality and Quantity for Acute Care Authors From Low- and Middle-Income Settings. (United States)

    Bruijns, Stevan R; Banner, Megan; Jacquet, Gabrielle A


    Researchers from low- and middle-income countries have limited access to publishing and editing resources. This study describes a journal-initiated platform to improve publication quantity and quality in Sub-Saharan Africa emergency care research: Author Assist. This is a descriptive report of a quality improvement project of referrals to the African Journal of Emergency Medicine's (AfJEM's) Author Assist program between January 2011 and December 2015. After either pre- or post-peer review rejection, authors are matched to an experienced volunteer assistant to revise and resubmit their article in a process that blinds handling editors and reviewers, but not the editor in chief, to participation. Participant data were collected from an Author Assist coordination database and linked to Scopus (Elsevier, Amsterdam, The Netherlands) and the journal's online submission platform. Of the 47 articles referred for Author Assist, 12 (26%) were originally rejected in the pre-peer review stage and 35 (74%) after peer review. Twenty-eight (60%) authors offered Author Assist enrolled. Of the 14 resubmissions during the study period, 12 (86%) were accepted for publication. For comparison, 37 of 40 regular revisions (93%) (without assistance) were accepted for publication during the same period. Author Assist reversed 1 in 4 rejection decisions through a process that unavoidably but minimally biases peer review. Of the few free publication-improvement services targeting researchers in low- and middle-income countries, AfJEM's Author Assist is the only journal-led initiative, and the only one specific to emergency medicine. To continue to refine the design of the program, we recommend further qualitative research exploring author decisions to pursue or forgo enrollment in Author Assist and research examining author and assistant experiences once enrolled. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  6. Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting

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    Cucalón José M


    Full Text Available Abstract Background Ischaemic heart disease is a global priority of health-care policy, because of its social repercussions and its impact on the health-care system. Yet there is little information on coronary morbidity in Spain and on the effect of the principal risk factors on risk of coronary heart disease. The objective of this study is to describe the epidemiology of coronary disease (incidence, mortality and its association with cardiovascular risk factors using the information gathered by primary care practitioners on cardiovascular health of their population. Methods A prospective study was designed. Eight primary-care centres participated, each contributing to the constitution of the cohort with the entire population covered by the centre. A total of 6124 men and women aged over 25 years and free of cardiovascular disease agreed to participate and were thus enrolled and followed-up, with all fatal and non-fatal coronary disease episodes being registered during a 5-year period. Repeated measurements were collected on smoking, blood pressure, weight and height, serum total cholesterol, high-density and low-density lipoproteins and fasting glucose. Rates were calculated for acute myocardial infarction and ischaemic heart disease. Associations between cardiovascular risk factors and coronary disease-free survival were evaluated using Kaplan-Meier and Cox regression analyses. Results Mean age at recruitment was 51.6 ± 15, with 24% of patients being over 65. At baseline, 74% of patients were overweight, serum cholesterol over 240 was present in 35% of patients, arterial hypertension in 37%, and basal glucose over 126 in 11%. Thirty-four percent of men and 13% of women were current smokers. During follow-up, 155 first episodes of coronary disease were detected, which yielded age-adjusted rates of 362 and 191 per 100,000 person-years in men and women respectively. Disease-free survival was associated with all risk factors in univariate

  7. The association of leadership styles and empowerment with nurses' organizational commitment in an acute health care setting: a cross-sectional study. (United States)

    Asiri, Samirah A; Rohrer, Wesley W; Al-Surimi, Khaled; Da'ar, Omar O; Ahmed, Anwar


    commitment include TAL (P = 0.027), Laissez-faire Leadership (LFL (P = 0.012), and autonomy (P = 0.016). The linear combination of these predictors explained 20 % of the variability of the nurses' commitment. The study findings suggest that leadership styles and employee empowerment could play an instrumental role in promoting organizational commitment of nurses working in acute health care settings, at least in the Saudi Arabian context.

  8. Measuring Nurse Leaders' and Direct Care Nurses' Perceptions of a Healthy Work Environment in Acute Care Settings, Part 3: Healthy Work Environment Scales for Nurse Leaders and Direct Care Nurses. (United States)

    Huddleston, Penny; Mancini, Mary E; Gray, Jennifer


    Survey items on the Healthy Work Environment Scales (HWES) for nurse leaders (NLs) and direct care nurses (DCNs) were developed using statements from 2 qualitative research studies conducted in a healthcare system. The purposes of 2 quantitative studies were to develop items on the HWES for NLs and DCNs, to assess the validity and reliability of these new tools, and to describe the NLs and DCNs perceptions of a healthy work environment (HWE) using nonexperimental descriptive designs. Each research study had 2 separate phases. In phase 1 of the studies, NLs and DCNs assigned each item to 1 of the 8 characteristics of an HWE to assess face validity. Content validity was determined by calculating the scale content validity and item content validity indices. Based on these results, the items were revised or deleted to obtain version 3 of both tools. In phase 2 of the studies, principal component analysis (PCA) assessed the validity of the tools, Cronbach's α served as the test for reliability, and the NLs and DCNs perceptions of an HWE were measured. Samples included 314 subjects for the HWES for NL study and 986 subjects for the HWES for DCN study. Principal component analysis for the HWES for NLs (version 3) revealed 40 items comprising 4 components, and PCA for the HWES for DCNs (version 3) revealed 39 items comprising 5 components. Internal consistencies of the tools were 0.974 and 0.957, respectively. Based on the findings of these studies, the tools demonstrated promising psychometric properties to measure a HWE in acute care settings.

  9. Occupational therapy practice in acute physical hospital settings: Evidence from a scoping review. (United States)

    Britton, Lauren; Rosenwax, Lorna; McNamara, Beverley


    Increased accountability and growing fiscal limitations in global health care continue to challenge how occupational therapy practices are undertaken. Little is known about how these changes affect current practice in acute hospital settings. This article reviews the relevant literature to further understanding of occupational therapy practice in acute physical hospital settings. A scoping review of five electronic databases was completed using the keywords Occupational therapy, acute hospital settings/acute physical hospital settings, acute care setting/acute care hospital setting, general medicine/general medical wards, occupational therapy service provision/teaching hospitals/tertiary care hospitals. Criteria were applied to determine suitability for inclusion and the articles were analysed to uncover key themes. In total 34 publications were included in the review. Analysis of the publications revealed four themes: (1) Comparisons between the practice of novice and experienced occupational therapists in acute care (2) Occupational therapists and the discharge planning process (3) Role of occupation in the acute care setting and (4) Personal skills needed and organisation factors affecting acute care practice. The current literature has highlighted the challenges occupational therapists face in practicing within an acute setting. Findings from this review enhance understanding of how occupational therapy department managers and educators can best support staff that practise in acute hospital settings. © 2015 Occupational Therapy Australia.

  10. Charge nurse perspectives on frontline leadership in acute care environments

    National Research Council Canada - National Science Library

    Sherman, Rose O; Schwarzkopf, Ruth; Kiger, Anna J


    ... leadership development at every level in order to transform the healthcare system. Charge nurses, at the frontline of patient care in acute care settings, are in key positions to lead this change...

  11. Neuroscience nurses caring for family members of patients with acquired brain injury in acute ward settings: nursing defensively in a double bind. (United States)

    Yetman, Linda


    This article presents the findings from a doctoral research study that led to the development of an inductively derived substantive theory, "Nursing Defensively". This theory describes the process of coping used by staff nurses when caring for family members of acquired brain injury (ABI) patients. This study was conducted in two acute care teaching and one non-teaching neuroscience wards in Toronto, Canada, using grounded theory method. A total of 20 registered nurses participated in the study. Supporting data are presented to permit the reader to "hear" the voices of the nurses caring for families of ABI patients in today's clinical environments. In addition, the author's interpretation of the significance of the findings for nursing is offered for the reader's reflection for applicability to relevant clinical environments and a call for clinical leadership in practice, education and research.

  12. Antibiotic prescribing for acute lower respiratory tract infections (LRTI - guideline adherence in the German primary care setting: An analysis of routine data.

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    Eva Maria Kraus

    Full Text Available Antibiotic overprescribing in primary care has major impacts on the development of antibiotic resistance. The objective of this study is to provide insight in antibiotics prescriptions for patients suffering from cough, acute bronchitis or community acquired pneumonia in primary care.Data from 2009 to 2013 of electronic health records of 12,880 patients in Germany were obtained from a research database. The prescription of antibiotics for acute lower respiratory tract infections was compared to the national S3 guideline cough from the German Society of General Practitioners and Family Medicine.Antibiotics were prescribed in 41% of consultations. General practitioners' decision of whether or not to prescribe an antibiotic was congruent with the guideline in 52% of consultations and the antibiotic choice congruence was 51% of antibiotic prescriptions. Hence, a congruent prescribing decision and a prescription of recommendation was found in only 25% of antibiotic prescriptions. Split by diagnosis we found that around three quarters of antibiotics prescribed for cough (73% and acute bronchitis (78% were not congruent to the guidelines. In contrast to that around one quarter of antibiotics prescribed for community acquired pneumonia (28% were not congruent to the guidelines.Our results show that there is a big gap between guideline recommendation and actual prescribing, in the decision to prescribe and the choice of antibiotic agent. This gap could be closed by periodic quality circles on antibiotic prescribing for GPs.

  13. Nurses' workarounds in acute healthcare settings: a scoping review. (United States)

    Debono, Deborah S; Greenfield, David; Travaglia, Joanne F; Long, Janet C; Black, Deborah; Johnson, Julie; Braithwaite, Jeffrey


    Workarounds circumvent or temporarily 'fix' perceived workflow hindrances to meet a goal or to achieve it more readily. Behaviours fitting the definition of workarounds often include violations, deviations, problem solving, improvisations, procedural failures and shortcuts. Clinicians implement workarounds in response to the complexity of delivering patient care. One imperative to understand workarounds lies in their influence on patient safety. This paper assesses the peer reviewed empirical evidence available on the use, proliferation, conceptualisation, rationalisation and perceived impact of nurses' use of workarounds in acute care settings. A literature assessment was undertaken in 2011-2012. Snowballing technique, reference tracking, and a systematic search of twelve academic databases were conducted to identify peer reviewed published studies in acute care settings examining nurses' workarounds. Selection criteria were applied across three phases. 58 studies were included in the final analysis and synthesis. Using an analytic frame, these studies were interrogated for: workarounds implemented in acute care settings by nurses; factors contributing to the development and proliferation of workarounds; the perceived impact of workarounds; and empirical evidence of nurses' conceptualisation and rationalisation of workarounds. The majority of studies examining nurses' workarounds have been published since 2008, predominantly in the United States. Studies conducted across a variety of acute care settings use diverse data collection methods. Nurses' workarounds, primarily perceived negatively, are both individually and collectively enacted. Organisational, work process, patient-related, individual, social and professional factors contribute to the proliferation of workarounds. Group norms, local and organisational culture, 'being competent', and collegiality influence the implementation of workarounds. Workarounds enable, yet potentially compromise, the execution of

  14. Health care utilization for acute illnesses in an urban setting with a refugee population in Nairobi, Kenya: a cross-sectional survey (United States)


    Background Estimates place the number of refugees in Nairobi over 100,000. The constant movement of refugees between countries of origin, refugee camps, and Nairobi poses risk of introduction and transmission of communicable diseases into Kenya. We assessed the care-seeking behavior of residents of Eastleigh, a neighborhood in Nairobi with urban refugees. Methods During July and August 2010, we conducted a Health Utilization Survey in Section II of Eastleigh. We used a multistage random cluster sampling design to identify households for interview. A standard questionnaire on the household demographics, water and sanitation was administered to household caretakers. Separate questionnaires were administered to household members who had one or more of the illnesses of interest. Results Of 785 households targeted for interview, data were obtained from 673 (85.7%) households with 3,005 residents. Of the surveyed respondents, 290 (9.7%) individuals reported acute respiratory illness (ARI) in the previous 12 months, 222 (7.4%) reported fever in the preceding 2 weeks, and 54 (1.8%) reported having diarrhea in the 30 days prior to the survey. Children healthcare services visited a pharmacy. Few residents of Eastleigh (38 [13.1%]) sought care at government-run facilities, and 24 (8.2%) sought care from a relative, a religious leader, or a health volunteer. Of those who did not seek any health care services (99 [23.0%]), the primary reason was cost (44.8%), followed by belief that the person was not sick enough (34.6%). Conclusion Health care utilization in Eastleigh is high; however, a large proportion of residents opt to seek care at private clinics or pharmacies, despite the availability of accessible government-provided health care services in this area. PMID:24885336

  15. Health care utilization for acute illnesses in an urban setting with a refugee population in Nairobi, Kenya: a cross-sectional survey. (United States)

    Mohamed, Abdinoor Haji; Dalal, Warren; Nyoka, Raymond; Burke, Heather; Ahmed, Jamal; Auko, Erick; Shihaji, Wilbert; Ndege, Irene; Breiman, Robert F; Eidex, Rachel B


    Estimates place the number of refugees in Nairobi over 100,000. The constant movement of refugees between countries of origin, refugee camps, and Nairobi poses risk of introduction and transmission of communicable diseases into Kenya. We assessed the care-seeking behavior of residents of Eastleigh, a neighborhood in Nairobi with urban refugees. During July and August 2010, we conducted a Health Utilization Survey in Section II of Eastleigh. We used a multistage random cluster sampling design to identify households for interview. A standard questionnaire on the household demographics, water and sanitation was administered to household caretakers. Separate questionnaires were administered to household members who had one or more of the illnesses of interest. Of 785 households targeted for interview, data were obtained from 673 (85.7%) households with 3,005 residents. Of the surveyed respondents, 290 (9.7%) individuals reported acute respiratory illness (ARI) in the previous 12 months, 222 (7.4%) reported fever in the preceding 2 weeks, and 54 (1.8%) reported having diarrhea in the 30 days prior to the survey. Children <5 years old had the highest frequency of all the illnesses surveyed: 17.1% (95% CI 12.2-21.9) reported ARI, 10.0% (95% CI 6.2-13.8) reported fever, and 6.9% (3.8-10.0) reported diarrhea during the time periods specified for each syndrome. Twenty-nine [7.5% (95% CI 4.3-10.7)] hospitalizations were reported among all age groups of those who sought care. Among participants who reported ≥1 illness, 330 (77.0%) sought some form of health care; most (174 [59.8%]) sought health care services from private health care providers. Fifty-five (18.9%) participants seeking healthcare services visited a pharmacy. Few residents of Eastleigh (38 [13.1%]) sought care at government-run facilities, and 24 (8.2%) sought care from a relative, a religious leader, or a health volunteer. Of those who did not seek any health care services (99 [23.0%]), the primary reason was

  16. The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized? (United States)

    Lau, Christine; Stilos, Kalli; Nowell, Allyson; Lau, Fanchea; Moore, Jennifer; Wynnychuk, Lesia


    Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital. We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not. A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for "EOL care" between February 2015 and March 2016. Of 83 patients, 56 (67%) received intiation of the CMOS and 27 (33%) did not for EOL care. There was significant involvement of spiritual care with the CMOS (66%), as compared to the group without CMOS (19%), P care, which was significantly less than the number of symptom management adjustments per patient when CMOS was not used (3.3), P care and assessment across the organization is still required.

  17. Neurocritical Care of Acute Subdural Hemorrhage. (United States)

    Al-Mufti, Fawaz; Mayer, Stephan A


    Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary, postoperative critical care is essential to achieve the best possible outcome. Acute SDH complicates approximately 11% of mild to moderate traumatic brain injuries (TBIs) that require hospitalization, and approximately 20% of severe TBIs. Acute SDH usually is related to a clear traumatic event, but in some cases can occur spontaneously. Management of SDH in the setting of TBI typically conforms to the Advanced Trauma Life Support protocol with airway taking priority, and management breathing and circulation occurring in parallel rather than sequence. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Economic evaluation of active implementation versus guideline dissemination for evidence-based care of acute low-back pain in a general practice setting.

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    Duncan Mortimer

    Full Text Available INTRODUCTION: The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice. METHODS: Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination against standard dissemination alone. RESULTS: The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective, yielding savings of $135 per x-ray referral avoided (-$462.93/3.43. However, confidence intervals around point estimates for the primary outcome suggest that--irrespective of willingness to pay (WTP--we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination. CONCLUSIONS: Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective.

  19. Real-world treatment patterns of gout patients treated with colchicine or other common treatments for gout in acute care settings: a retrospective chart review study. (United States)

    Shiozawa, Aki; Cloutier, Martin; Heroux, Julie; Guerin, Annie; Wu, Eric Q; Jackson, Robert


    To describe real-world treatment patterns of patients receiving colchicine or other treatments during a gout-related emergency room or acute care facility (ER/ACF) visit. An online physician-administered questionnaire was used to collect chart data on 500 patients with a gout-related ER/ACF visit after 16 October 2009; 250 patients receiving colchicine (Colchicine Cohort) and 250 receiving NSAIDs, systemic corticosteroids, narcotics, allopurinol, febuxostat, pegloticase, probenecid, or sulfinpyrazone (Other Cohort). Patient characteristics and treatment received/prescribed during the ER/ACF visit (Period 1 [P1]), at discharge (P2), and at the first follow-up visit (P3) are reported. A total of 45 rheumatologists and 63 primary care physicians participated in the study. Patient mean age was 51 years and 74.8% were male. The most common treatments in the Other Cohort were NSAIDs (59.6%), systemic corticosteroids (45.2%), and narcotics (33.6%). The 500 patients contributed 307 distinct treatment patterns from P1 to P3. Of the 20.6% patients not prescribed a treatment in P2, 60.2% were restarted on a treatment in P3. Of the 78.6% treated patients in P2, 27.0% had a treatment adjustment (dose increase, treatment add-on, or initiation of a different gout-related treatment - not with a urate lowering therapy only) in P3; for 72.6% of these patients, physicians justified the treatment adjustment by inadequacy of the treatment for maintenance therapy, insufficient dosage, or inadequate response. In the Colchicine Cohort, 60.8% of patients were prescribed colchicine consistently from P1 to P3, while 26.8% and 17.7% of patients in the Other Cohort were prescribed consistently NSAIDs and systemic corticosteroids from P1 to P3, respectively. Specific nature of the acute gout-related symptoms or potential attack/flare during the ER/ACF visit was not recorded. Real-world clinical practice reveals a substantial number of distinct treatment patterns and frequent treatment

  20. Acute care in Tanzania: Epidemiology of acute care in a small community medical centre

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    Rachel M. Little


    Discussion: Respiratory infections, malaria, and skin or soft tissue infections are leading reasons for seeking medical care at a small community medical centre in Arusha, Tanzania, highlighting the burden of infectious diseases in this type of facility. Males may be more likely to present with trauma, burns, and laceration injuries than females. Many patients required one or no procedures to determine their diagnosis, most treatments administered were inexpensive, and most patients were discharged home, suggesting that providing acute care in this setting could be accomplished with limited resources.

  1. Results from a Patient-Based Health Education Intervention in Reducing Antibiotic Use for Acute Upper Respiratory Tract Infections in the Private Sector Primary Care Setting in Singapore. (United States)

    Lee, Magdalene Hui Min; Pan, Darius Shaw Teng; Huang, Joyce Huixin; Chen, Mark I-Cheng; Chong, Joash Wen Chen; Goh, Ee Hui; Jiang, Lili; Leo, Yee Sin; Lee, Tau Hong; Wong, Chia Siong; Loh, Victor Weng Keong; Lim, Fong Seng; Poh, Adrian Zhongxian; Tham, Tat Yean; Wong, Wei Mon; Yu, Yue


    We investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) among adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at general practitioner (GP) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs, the role of antibiotics in treating URTIs, and the consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared regarding the proportions prescribed antibiotics and the patients' postconsultation views. A total of 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). The demographics of patients in both arms were similar, and 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR], 1.20; 95% confidence interval [CI], 0.83-1.73) except in patients of Indian ethnicity (OR, 0.28; 95% CI, 0.09-0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs ( P = 0.047) and on being worried about the side effects of antibiotics ( P = 0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR, 0.36; 95% CI, 0.14 to 0.92), while certain inappropriate patient responses were associated with the receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended. Copyright © 2017 Lee et al.

  2. The European quality of care pathways (EQCP study on the impact of care pathways on interprofessional teamwork in an acute hospital setting: study protocol: for a cluster randomised controlled trial and evaluation of implementation processes

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    Deneckere Svin


    Full Text Available Abstract Background Although care pathways are often said to promote teamwork, high-level evidence that supports this statement is lacking. Furthermore, knowledge on conditions and facilitators for successful pathway implementation is scarce. The objective of the European Quality of Care Pathway (EQCP study is therefore to study the impact of care pathways on interprofessional teamwork and to build up understanding on the implementation process. Methods/design An international post-test-only cluster Randomised Controlled Trial (cRCT, combined with process evaluations, will be performed in Belgium, Ireland, Italy, and Portugal. Teams caring for proximal femur fracture (PFF patients and patients hospitalized with an exacerbation of chronic obstructive pulmonary disease (COPD will be randomised into an intervention and control group. The intervention group will implement a care pathway for PFF or COPD containing three active components: a formative evaluation of the actual teams’ performance, a set of evidence-based key interventions, and a training in care pathway-development. The control group will provide usual care. A set of team input, process and output indicators will be used as effect measures. The main outcome indicator will be relational coordination. Next to these, process measures during and after pathway development will be used to evaluate the implementation processes. In total, 132 teams have agreed to participate, of which 68 were randomly assigned to the intervention group and 64 to the control group. Based on power analysis, a sample of 475 team members per arm is required. To analyze results, multilevel analysis will be performed. Discussion Results from our study will enhance understanding on the active components of care pathways. Through this, preferred implementation strategies can be defined. Trail registration NCT01435538

  3. Development of a hospital reiki training program: training volunteers to provide reiki to patients, families, and staff in the acute care setting. (United States)

    Hahn, Julie; Reilly, Patricia M; Buchanan, Teresa M


    Creating a healing and healthy environment for patients, families, and staff is an ongoing challenge. As part of our hospital's Integrative Care Program, a Reiki Volunteer Program has helped to foster a caring and healing environment, providing a means for patients, family, and staff to reduce pain and anxiety and improve their ability to relax and be present. Because direct care providers manage multiple and competing needs at any given time, they may not be available to provide Reiki when it is needed. This program demonstrates that a volunteer-based program can successfully support nurses in meeting patient, family, and staff demand for Reiki services.

  4. Interprofessional practice in different patient care settings: A qualitative exploration. (United States)

    DiazGranados, Deborah; Dow, Alan W; Appelbaum, Nital; Mazmanian, Paul E; Retchin, Sheldon M


    Increasing interprofessional practice is seen as a path to improved quality, decreased cost, and enhanced patient experience. However, little is known about how context shapes interprofessional work and how interventions should be crafted to account for a specific setting of interprofessional practice. To better understand, how the work of interprofessional practice differs across patient care settings we sought to understand the social processes found in varying work contexts to better understand how care is provided. A case study design was used in this study to yield a picture of patient care across three different settings. Qualitative analysis of teams from three healthcare settings (rehabilitation, acute care, and code team) was conducted, through the use of ten in-depth semi-structured interviews. Interview data from each participant were analyzed via an inductive content analysis approach based upon theories of work and teams from organisational science, a framework for interprofessional practice, and competencies for interprofessional education. The work processes of interprofessional practice varied across settings. Information exchange was more physician-centric and decision-making was more physician dominant in the non-rehabilitation settings. Work was described as concurrent only for the code team. Goal setting varied by setting and interpersonal relationships were only mentioned as important in the rehabilitation setting. The differences observed across settings identify some insights into how context shapes the process of interprofessional collaboration and some research questions that need further study.

  5. Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

    Directory of Open Access Journals (Sweden)

    Veen Robert ER


    Full Text Available Abstract Background Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs. Method GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs within 13 European Countries. General Practitioners (GPs recruited consecutive patients with an acute cough. GPs completed a case report form (CRF and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study. Results The main challenges fell within three domains as follows: i selecting, setting up and maintaining PCNs; ii designing local context-appropriate data collection tools and efficient data management systems; and iii gaining commitment and trust from all involved and maintaining enthusiasm. The main solutions for each domain were: i appointing key individuals (National Network Facilitator and Coordinator with clearly defined tasks, involving PCNs early in the development of study materials and procedures. ii rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress; iii providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos

  6. Determining level of care appropriateness in the patient journey from acute care to rehabilitation. (United States)

    Poulos, Christopher J; Magee, Christopher; Bashford, Guy; Eagar, Kathy


    most accurate in determining ongoing medical stability, but at the cost of a longer acute stay.To avoid inpatients remaining in acute care in a state of 'terra nullius', clinical models which provide rehabilitation within acute care, and more efficient movement to a rehabilitation setting, is required. Utilization review could have a decision support role in the determination of medical stability.

  7. Determining level of care appropriateness in the patient journey from acute care to rehabilitation

    Directory of Open Access Journals (Sweden)

    Bashford Guy


    care, including rehabilitation. The rehabilitation team was the most accurate in determining ongoing medical stability, but at the cost of a longer acute stay. To avoid inpatients remaining in acute care in a state of 'terra nullius', clinical models which provide rehabilitation within acute care, and more efficient movement to a rehabilitation setting, is required. Utilization review could have a decision support role in the determination of medical stability.

  8. Long Term Care Minimum Data Set (MDS) (United States)

    U.S. Department of Health & Human Services — The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive...

  9. Promoting patient-centred fundamental care in acute healthcare systems. (United States)

    Feo, Rebecca; Kitson, Alison


    Meeting patients' fundamental care needs is essential for optimal safety and recovery and positive experiences within any healthcare setting. There is growing international evidence, however, that these fundamentals are often poorly executed in acute care settings, resulting in patient safety threats, poorer and costly care outcomes, and dehumanising experiences for patients and families. Whilst care standards and policy initiatives are attempting to address these issues, their impact has been limited. This discussion paper explores, through a series of propositions, why fundamental care can be overlooked in sophisticated, high technology acute care settings. We argue that the central problem lies in the invisibility and subsequent devaluing of fundamental care. Such care is perceived to involve simple tasks that require little skill to execute and have minimal impact on patient outcomes. The propositions explore the potential origins of this prevailing perception, focusing upon the impact of the biomedical model, the consequences of managerial approaches that drive healthcare cultures, and the devaluing of fundamental care by nurses themselves. These multiple sources of invisibility and devaluing surrounding fundamental care have rendered the concept underdeveloped and misunderstood both conceptually and theoretically. Likewise, there remains minimal role clarification around who should be responsible for and deliver such care, and a dearth of empirical evidence and evidence-based metrics. In explicating these propositions, we argue that key to transforming the delivery of acute healthcare is a substantial shift in the conceptualisation of fundamental care. The propositions present a cogent argument that counters the prevailing perception that fundamental care is basic and does not require systematic investigation. We conclude by calling for the explicit valuing and embedding of fundamental care in healthcare education, research, practice and policy. Without this

  10. Preparation and Evolving Role of the Acute Care Nurse Practitioner. (United States)

    Hoffman, Leslie A; Guttendorf, Jane


    Acute care nurse practitioners (ACNPs) are increasingly being employed as members of critical care teams, an outcome driven by increasing demand for intensive care services, a mandated reduction in house officer hours, and evidence supporting the ability of ACNPs to provide high-quality care as collaborative members of critical care teams. Integration of adult ACNPs into critical care teams is most likely to be successful when practitioners have appropriate training, supervision, and mentoring to facilitate their ability to practice efficiently and effectively. Accomplishing this goal requires understanding the educational preparation and skill set potential hires bring to the position as well as the development of an orientation program designed to integrate the practitioner into the critical care team. Pediatric ACNPs are also commonly employed in critical care settings; however, this commentary focuses on the adult ACNP role. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  11. Single-channel amplitude integrated EEG recording for the identification of epileptic seizures by nonexpert physicians in the adult acute care setting. (United States)

    Nitzschke, Rainer; Müller, Jakob; Engelhardt, Ria; Schmidt, Gunter N


    Although several studies have shown the potential of amplitude integrated electroencephalography (aEEG) in detecting neonatal seizures, no publications have evaluated the diagnostic use of aEEG for the detection of seizures in adult patients. In this prospective blinded observational study, bifrontal single-channel electroencephalography (EEG) recordings were performed with a portable EEG monitor (CSM M3 ICU, Danmeter-Goalwick Holdings Limited, Odense, Denmark) during the out-of-hospital care of emergency cases. Four intensive care unit (ICU) physicians received training in the interpretation of aEEG recordings. After the training they evaluated the stored aEEG traces for the presence of epileptic seizure activity during the recording time. The physicians were blinded to the clinical data of the patients. The results obtained were compared with the clinical diagnosis and the evaluation of the raw EEG signal. The level of interrater agreement was quantified using Fleiss' ĸ. The aEEG traces from 10 patients with generalized epileptic seizures and 46 patients without seizures were analysed. Overall, the nonexpert ICU physicians failed to identify recordings obtained from patients with seizures reliably, when compared with clinical diagnosis and the single-channel EEG results (mean sensitivity 40%, range 40-60%; mean specificity 89%, range 87-93%). Agreement between observers was high for the cases with seizures ( ĸ = 0.80 ± 0.13). Patients who suffered status epilepticus during the recordings were difficult to identify by most raters. Recording of aEEG without access to the raw EEG data is not a reliable diagnostic tool for the identification of epileptic seizures in the hands of nonexpert ICU physicians.

  12. Acute care teaching in the undergraduate nursing curriculum. (United States)

    McGaughey, Jennifer


    To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards. Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum. PRACTICE DEVELOPMENT INITIATIVE: An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module. Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care. The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.

  13. Effects of simulation-based educational program in improving the nurses' self-efficacy in caring for patients' with COPD and CHF in a post-acute care (PACU) setting. (United States)

    Genuino, Mary Jane


    The 2014 national percentage for 30-day readmissions among Medicare recipients from Post-Acute Care Unit (PACU) showed: Heart Failure (HF) with major complications and co-morbidities, an average of 24.09%, and Chronic Obstructive Pulmonary Disease (COPD) with complications and co-morbidities 23.12%. The percentage of readmissions for New Jersey among PACU showed: HF with major complications and co-morbidities, an average of 24.40% and COPD 26.35% (Avalere Health, 2014). For this study site, the hospital readmission rate was not specifically broken down according to condition/diagnosis. Overall, the hospital readmission rate was approximately 20%. A few percent lower than the national and state average, but still a considerable number. This study is significant in finding out whether a simulation based educational program will increase the nurses' self-efficacy in caring for these patients. The positive outcome of this study can provide a template for training PACU nurses to aid in decreasing hospital readmissions in this vulnerable population. The simulation-based educational program was approximately 5h in length, and it was divided into two parts, a presentation on HF and COPD, and the actual simulation scenario, using a low-fidelity manikin (LFM). There were approximately 20 Registered nurses as participants but 4 did not complete the post-simulation self-efficacy scale, and the 16 were included in the actual study. This study was able to define the effects of simulation-based educational program on the RNs self-efficacy in caring for COPD and HF patients. The participants' demographic information, i.e. age, educational attainment, years of experience, and previous work experience, did not show any differences in how much the nurses' self-efficacy improved. The post-simulation self-efficacy score of the participants showed approximately 5% increase compared to the pre-simulation score. The outcome of the study concluded the simulation-based educational program

  14. A set of care quality indicators for stroke management. (United States)

    Navarro Soler, I M; Ignacio García, E; Masjuan Vallejo, J; Gállego Culleré, J; Mira Solves, J J


    This study proposes a set of quality indicators for care outcomes in patients with acute cerebral infarction. These indicators are understandable and relevant from a clinical viewpoint, as well as being acceptable and feasible in terms of time required, ease of data capture, and interpretability. The method consisted of reaching consensus among doctors after having reviewed the literature on quality indicators in stroke. We then designed and conducted a field study to assess the understandability and feasibility of the set of indicators. Consensus yielded 8 structural indicators, 5 process indicators, and 12 result indicators. Additionally, standards of reference were established for each indicator. This set of indicators can be used to monitor the quality care for stroke patients, identify strengths, and potentially to identify areas needing improvement. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Professionalism in Long-Term Care Settings (United States)

    Lubinski, Rosemary


    Speech-language pathologists who serve elders in a variety of long-term care settings have a variety of professional skills and responsibilities. Fundamental to quality service is knowledge of aging and communication changes and disorders associated with this process, institutional alternatives, and the changing nature of today's elders in…

  16. Anaphylaxis in an emergency care setting

    DEFF Research Database (Denmark)

    Ruiz Oropeza, Athamaica; Lassen, Annmarie; Halken, Susanne


    BACKGROUND: Current data on anaphylaxis is based on retrospective and register based studies. The objective of this study was to describe the epidemiology of anaphylaxis in a 1 year prospective study at the emergency care setting, Odense University Hospital, Denmark (2013-2014). METHODS: Prospect......BACKGROUND: Current data on anaphylaxis is based on retrospective and register based studies. The objective of this study was to describe the epidemiology of anaphylaxis in a 1 year prospective study at the emergency care setting, Odense University Hospital, Denmark (2013-2014). METHODS......: Prospective study at the emergency care setting, Odense University Hospital, Denmark (2013-2014). To identify anaphylaxis cases, records from all patients with clinical suspicion on anaphylaxis or a related diagnosis according to the International Classification of Diseases 10 and from patients treated...... at the emergency care setting or at prehospital level with adrenaline, antihistamines or glucocorticoids were reviewed daily. The identified cases were referred to the Allergy Center, where a standardized interview regarding the anaphylactic reaction was conducted. International guidelines were applied...

  17. The use of echocardiography in acute cardiovascular care

    DEFF Research Database (Denmark)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor


    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiac care scenarios are also described.......Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use...

  18. The use of echocardiography in acute cardiovascular care

    DEFF Research Database (Denmark)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor


    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described.......Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use...

  19. The use of echocardiography in acute cardiovascular care

    DEFF Research Database (Denmark)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor


    of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart...... disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described.......Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/ critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use...

  20. Onconeural Antibodies in Acute Psychiatric Inpatient Care

    DEFF Research Database (Denmark)

    Sæther, Sverre Georg; Schou, Morten; Stoecker, Winfried


    Paraneoplastic neurological disorders associated with onconeural antibodies often appear with neuropsychiatric symptoms. To study the prevalence of onconeural antibodies in patients admitted to acute psychiatric inpatient care, the serum of 585 such patients was tested for antibodies targeting MOG......, GLRA1B, DPPX, GRM1, GRM5, DNER, Yo, ZIC4, GAD67, amphiphysin, CV2, Hu, Ri, Ma2, and recoverin. Only one sample was positive (antirecoverin IgG). The present findings suggest that serum onconeural antibody positivity is rare among patients acutely admitted for inpatient psychiatric care. The clinical...

  1. Infection control in equine critical care settings. (United States)

    Burgess, Brandy A; Morley, Paul S


    There is a recognizable standard of practice for infection control in veterinary medicine. Effort must be given to control and prevention of infectious disease transmission within a facility and among animal populations. In the critical care setting, patients typically have a high degree of systemic illness and immune compromise, are commonly subjected to invasive procedures and placement of indwelling devices, and frequently receive antimicrobials and gastric protectants. Every equine critical care unit is distinctive in its physical and operational features and the types of patients that are managed. Infection control programs must therefore be tailored to each facility's needs. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Acute stress impairs set-shifting but not reversal learning. (United States)

    Butts, K A; Floresco, S B; Phillips, A G


    The ability to update and modify previously learned behavioral responses in a changing environment is essential for successful utilization of promising opportunities and for coping with adverse events. Valid models of cognitive flexibility that contribute to behavioral flexibility include set-shifting and reversal learning. One immediate effect of acute stress is the selective impairment of performance on higher-order cognitive control tasks mediated by the medial prefrontal cortex (mPFC) but not the hippocampus. Previous studies show that the mPFC is required for set-shifting but not for reversal learning, therefore the aim of the present experiment is to assess whether exposure to acute stress (15 min of mild tail-pinch stress) given immediately before testing on either a set-shifting or reversal learning tasks would impair performance selectively on the set-shifting task. An automated operant chamber-based task, confirmed that exposure to acute stress significantly disrupts set-shifting but has no effect on reversal learning. Rats exposed to an acute stressor require significantly more trials to reach criterion and make significantly more perseverative errors. Thus, these data reveal that an immediate effect of acute stress is to impair mPFC-dependent cognition selectively by disrupting the ability to inhibit the use of a previously relevant cognitive strategy. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. Sedation in the intensive care setting

    Directory of Open Access Journals (Sweden)

    Hughes CG


    Full Text Available Christopher G Hughes, Stuart McGrane, Pratik P PandharipandeVanderbilt University School of Medicine, Nashville, TN, USAAbstract: Critically ill patients are routinely provided analgesia and sedation to prevent pain and anxiety, permit invasive procedures, reduce stress and oxygen consumption, and improve synchrony with mechanical ventilation. Regional preferences, patient history, institutional bias, and individual patient and practitioner variability, however, create a wide discrepancy in the approach to sedation of critically ill patients. Untreated pain and agitation increase the sympathetic stress response, potentially leading to negative acute and long-term consequences. Oversedation, however, occurs commonly and is associated with worse clinical outcomes, including longer time on mechanical ventilation, prolonged stay in the intensive care unit, and increased brain dysfunction (delirium and coma. Modifying sedation delivery by incorporating analgesia and sedation protocols, targeted arousal goals, daily interruption of sedation, linked spontaneous awakening and breathing trials, and early mobilization of patients have all been associated with improvements in patient outcomes and should be incorporated into the clinical management of critically ill patients. To improve outcomes, including time on mechanical ventilation and development of acute brain dysfunction, conventional sedation paradigms should be altered by providing necessary analgesia, incorporating propofol or dexmedetomidine to reach arousal targets, and reducing benzodiazepine exposure.Keywords: fentanyl, propofol, dexmedetomidine, Behavioral Pain Scale, Richmond Agitation-Sedation Scale, Sedation-Agitation Scale, Confusion Assessment Method for the ICU

  4. Dissociative Spectrum Disorders in the Primary Care Setting (United States)

    Elmore, James L.


    Dissociative disorders have a lifetime prevalence of about 10%. Dissociative symptoms may occur in acute stress disorder, posttraumatic stress disorder, somatization disorder, substance abuse, trance and possession trance, Ganser's syndrome, and dissociative identity disorder, as well as in mood disorders, psychoses, and personality disorders. Dissociative symptoms and disorders are observed frequently among patients attending our rural South Carolina community mental health center. Given the prevalence of mental illness in primary care settings and the diagnostic difficulties encountered with dissociative disorders, such illness may be undiagnosed or misdiagnosed in primary care settings. We developed an intervention model that may be applicable to primary care settings or helpful to primary care physicians. Key points of the intervention are identification of dissociative symptoms, patient and family education, review of the origin of the symptoms as a method of coping with trauma, and supportive reinforcement of cognitive and relaxation skills during follow-up visits. Symptom recognition, Education of the family, Learning new skills, and Follow-up may be remembered by the mnemonic device SELF. We present several cases to illustrate dissociative symptoms and our intervention. Physicians and other professionals using the 4 steps and behavioral approaches will be able to better recognize and triage patients with dissociative symptoms. Behaviors previously thought to be secondary to psychosis or personality disorders may be seen in a new frame of reference, strengthening the therapeutic alliance while reducing distress and acting-out behaviors. PMID:15014580

  5. Postoperative acute care use after freestanding ambulatory surgery. (United States)

    Molina, George; Neville, Bridget A; Lipsitz, Stuart R; Gibbons, Lorri; Childers, Ashley Kay; Gawande, Atul A; Berry, William R; Haynes, Alex B


    Surgical procedures in the United States are increasingly performed in the ambulatory setting, including freestanding ambulatory surgery centers (ASCs). However, there is a lack of research and tracking of surgical outcomes in this setting. We analyzed data from a state all-payer claims database to produce a retrospective cohort study on the rate of acute care use (emergency department [ED] visits and inpatient admissions) within 7 d after operations performed in freestanding ASCs in South Carolina. Two-level reliability-adjusted generalized linear mixed models accounting for random facility-level effects were used to adjust for patient-level and facility-level characteristics. A total of 1,328,708 procedures were performed in 86 freestanding ASCs in South Carolina from 2006-2013. The overall rate of postoperative acute care per 1000 procedures within 7 d was 17.3 (95% confidence interval [CI], 15.3-19.5). Patient characteristics associated with the highest postoperative acute care use within 7 d included Medicaid insurance (adjusted odds ratio [aOR], 1.79; 95% CI, 1.70-1.90), lowest median household income (aOR, 1.36; 95% CI, 1.30-1.43), and preoperative Charlson Comorbidity Index (CCI) score 3+ (aOR, 4.14; 95% CI, 3.95-4.34). Total charges for postoperative ED visits (n = 14,682) and inpatient admissions (n = 8945) within 7 d were approximately $51.4 and $361.1 million, respectively from 2006-2013. Acute care use within 7 d was commonly ≥10 per 1000 procedures performed in freestanding ASCs in South Carolina. These measures may be targets for quality and cost improvement and innovation. Patients at risk for acute care utilization may benefit from improvements in postoperative follow-up after procedures in ASCs. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Absenteeism in acute care hospitals. (United States)

    Taunton, R L; Perkins, S; Oetker-Black, S; Heaton, R


    Lack of standardization in formulas for calculating absenteeism impeded comparison among institutions and comparison to rates reported for the health care industry. Even though illness related benefits, replacement costs for absent employees and attendance incentives absorbed scarce financial resources, more than 40% of hospitals had no standard for excessive absence. Directors of nursing were concerned about staffing and the possibility that employees were tiring to the point of becoming ill. Among directors, concern about absenteeism was greatest in urban hospitals of 100-200 beds.

  7. Telematics in acute trauma care. (United States)

    Juhra, C; Vordemvenne, T; Hartensuer, R; Uckert, F; Raschke, M J


    Each year, 20,000 people in Germany die because of a traffic accident. Altogether, yearly productivity loss caused by these injuries is estimated to be around 5 billion Euros. International and national studies revealed the trauma center level of the primary hospital as the major predictor for trauma related mortality. In 2006 the German Society for Trauma Surgery (DGU) called its members to form regionally based networks for the exchange of data among hospitals engaged in trauma care. In April 2008 the north-west region of Germany with 49 hospitals, three hospitals in the Netherlands, and local emergency services founded the "TraumaNetwork NorthWest (TNNW). The major goals of the TNNW are: 1) to shorten the time between accident and admission to the appropriate hospital, 2) to create effective means of communication, and 3) to implement common pre- and in-hospital standards for trauma care. Since the needed application software is not commercially available, a team of computer and medical specialists has been formed for its development. Once the software is in place, a pre- and post-analysis will be performed to study the consequences of the application on transportation time and injury-related mortality within the region. The project is recognized as a pilot project by the DGU and if it is successful is meant to be adapted across Germany.

  8. Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study. (United States)

    Jangland, Eva; Kitson, Alison; Muntlin Athlin, Åsa


    To explore how patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode. Acute abdominal pain is one of the most common conditions to present in the acute care setting. Little is known about how patients' fundamental care needs are managed from presentation to post discharge. A multi-stage qualitative case study using the Fundamentals of Care framework as the overarching theoretical and explanatory mechanism. Repeated reflective interviews were conducted with five adult patients over a 6-month period in 2013 at a university hospital in Sweden. The interviews (n = 14) were analysed using directed content analysis. Patients' experiences across the acute care episode are presented as five patient narratives and synthesized into five descriptions of the entire hospital journey. The patients talked about the fundamentals of care and had vivid accounts of what they meant to them. The experiences of each of the patients were influenced by the extent to which they felt engaged with the health professionals. The ability to engage or build a rapport was identified as a central component across the fundamental care elements, but it varied in visibility. Consistent pain management, comfort, timely and accurate information, choice and dignity and relationships were identified as essential fundamental care needs of patients experiencing acute abdominal pain regardless of setting, diagnosis, or demographic variables. These were variously achieved and the patients' narratives raised areas for improvement in several areas. © 2016 John Wiley & Sons Ltd.

  9. [Chemical risk management in health care settings]. (United States)

    Crippa, M; Bregante, G; Carcano, M; Mascagni, P


    The aim of this review is pointing out the most relevant allergic and chemical risk factors in health care settings. Some tables summarize the main sensitizing agents, the most frequent allergic diseases and examples of alternative gloves and materials currently available. Some suggestions, to evaluate the allergic risk related to specific tasks in the different hospital departments, are given in order to underline possible failures and to plan focused preventive actions. The chemical hazard has been valued on the basis of the current exposure, which is significantly improved due to structural and technological changes adopted in almost all hospitals. However there are still some critical points due to the use of particularly toxic substances and new molecules, whose health effects should be carefully evaluated, and to a more extensive use of techniques and procedures previously limited to a few work realities.

  10. Safety Perceptions of Health Care Leaders in 2 Canadian Academic Acute Care Centers. (United States)

    Goldstein, David H; Nyce, James M; Van Den Kerkhof, Elizabeth G


    An estimated 7.4% of patients admitted to acute care facilities in Canada experience injury or death due to health care mishaps, and 38% of these events are deemed preventable. Commitment of executive leaders to a culture of safety is important for the reduction of risk to Canadian patients. The purpose of this study was to examine the safety climate from a leader's perspective in 2 Canadian acute care settings, with attention paid to high reliability organization (HRO) principles. The Patient Safety Culture in Healthcare Organizations questionnaire was administered to leaders in 2 acute care hospitals in Ontario between June and January 2009. The primary outcome measures were senior leadership support for safety and supervisory leadership support for safety. Misalignment between the safety climate and HRO principles was defined as greater than 10% of respondents reporting problematic or neutral leadership support for safety. Of the 142 respondents (67% response rate), both medical/nursing leaders and tertiary care clinical leaders were significantly more likely than board/administrative leaders to report problematic/neutral responses. Overall, executive leadership perceptions of the safety climate were not aligned with HRO principles. The significant differences in response between board/administrative leaders and those involved in frontline patient care suggest that a weak safety culture exists in these 2 health care organizations. The cultivation of a stronger organizational safety culture, in alignment with HRO principles, could lead to lower rates of preventable mishaps and support risk identification and mitigation in perioperative settings.

  11. Managing the interface between acute care and rehabilitation - can utilisation review assist? (United States)

    Poulos, Christopher J; Eagar, Kathy; Poulos, Roslyn G


    We piloted the InterQual Criteria tool in a large regional acute hospital in NSW to determine the utility of this tool in the Australian context. In particular to compare the current "gold standard" of physician assessment for the selection of patients for rehabilitation and the timing of transfer, with the guidance provided by the tool. Consecutive acute care patients with a diagnosis of stroke, hip fracture or amputation, and patients referred for rehabilitation assessment, were followed using the InterQual Criteria. Results on 242 acute episodes, representing 2698 days in acute care, were analysed. In accordance with overseas studies, we found that high levels of inappropriate days of stay in acute care were suggested by the tool. Using the InterQual Criteria almost all patients were deemed appropriate for transfer to rehabilitation much earlier than current practice. We conclude that the InterQual Criteria may have a useful role in patient selection for rehabilitation, in facilitating the transfer of patients from acute to subacute care, and in improving patient flow within acute care. The reasons for the variation between the results obtained from the tool and current clinical practice requires further investigation, and may indicate a lack of validity of the tool in the Australian setting, inefficiencies in processes of acute care, or the lack of suitable alternative care settings or level of support available in these settings.

  12. Managing Low Back Pain in the Primary Care Setting: The Know-Do Gap

    Directory of Open Access Journals (Sweden)

    N Ann Scott


    Full Text Available OBJECTIVE: To ascertain knowledge gaps in the diagnosis and treatment of acute and chronic low back pain (LBP in the primary care setting to prepare a scoping survey for identifying knowledge gaps in LBP management among Alberta’s primary care practitioners, and to identify potential barriers to implementing a multidisciplinary LBP guideline.

  13. Priority setting in paediatric preventive care research. (United States)

    Lavigne, Mikael; Birken, Catherine S; Maguire, Jonathon L; Straus, Sharon; Laupacis, Andreas


    To identify the unanswered research questions in paediatric preventive care that are most important to parents and clinicians, and to explore how questions from parents and clinicians may differ. Iterative mixed methods research priority setting process. Toronto, Ontario, Canada. Parents of children aged 0-5 years enrolled in a research network in Toronto, and clinicians practising in Toronto, Ontario, Canada. Informed by the James Lind Alliance's methodology, an online questionnaire collected unanswered research questions in paediatric preventive care from study participants. Similar submissions were combined and ranked. A consensus workshop attended by 28 parents and clinicians considered the most highly ranked submissions and used the nominal group technique to select the 10 most important unanswered research questions. Forty-two clinicians and 115 parents submitted 255 and 791 research questions, respectively, which were combined into 79 indicative questions. Most submissions were about nutrition, illness prevention, parenting and behaviour management. Parents were more likely to ask questions about screen time (49 parents vs 8 clinicians, ppreventive care from the perspective of parents and clinicians were identified. These research priorities may be important in advancing preventive healthcare for children. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Prevalence of wounds in a community care setting in Ireland. (United States)

    McDermott-Scales, L; Cowman, S; Gethin, G


    To establish the prevalence of wounds and their management in a community care setting. A multi-site, census point prevalence wound survey was conducted in the following areas: intellectual disability, psychiatry, GP practices, prisons, long-term care private nursing homes, long-term care, public nursing homes and the community/public health (district) nursing services on one randomly selected day. Acute services were excluded. Formal ethical approval was obtained. Data were collected using a pre-piloted questionnaire. Education was provided to nurses recording the tool (n=148). Descriptive statistical analysis was performed. A 97.2% response rate yielded a crude prevalence rate of 15.6% for wounds across nursing disciplines (290/1,854 total census) and 0.2% for the community area (290/133,562 population statistics for the study area). Crude point prevalence ranged from 2.7% in the prison services (7/262 total prison population surveyed) to 33.5% in the intellectual disability services (72/215 total intellectual disability population surveyed). The most frequent wounds recorded were pressure ulcers (crude point prevalence 4%, 76/1,854 total census; excluding category l crude point prevalence was 2.6%, 49/1,854 total census), leg ulcers (crude point prevalence 2.9%, 55/1,854 total census), self-inflicted superficial abrasions (crude point prevalence 2.2%, 41/1,854 total census) and surgical wounds (crude point prevalence 1.7%, 32/1,854 total census). These results support previous international research in that they identify a high prevalence of wounds in the community. The true community prevalence of wounds is arguably much higher, as this study identified only wounds known to the nursing services and excluded acute settings and was conducted on one day.

  15. Caring Behaviors: Perceptions of Acute Care Nurses and Hospitalized Patients with Diabetes

    Directory of Open Access Journals (Sweden)

    Mary Beth Modic DNP. R.N., CDE


    Full Text Available Caring behaviors: Perceptions of acute care nurses and hospitalized patients with diabetes Purpose: The purpose of this study was to examine the perceptions of caring behaviors that influence the patient experience in acute care nurses and hospitalized patients with diabetes. Background: Nurses are the caregivers who render most of the direct care patients receive while they are hospitalized. Understanding what patients perceive as caring behaviors is essential in tailoring nursing interventions to meet patient needs. Data sources: Data collection occurred at a 1,200 bed, nonprofit academic medical center located in the Midwest. Description: Sixty-four nurses and 54 patients with diabetes were queried about their experience with diabetes caring behaviors. Conclusion: Nurses consistently reported providing caring behaviors more frequently than patients reported receiving them. Implications: This study has implications for understanding the patient experience in the hospital setting specifically related to patient education. Providing patient education is an important caring intervention that directly affects the patient experience. However, none of the patients in this study identified this as a caring behavior used by nurses.

  16. Determining level of care appropriateness in the patient journey from acute care to rehabilitation


    Bashford Guy; Magee Christopher; Poulos Christopher J; Eagar Kathy


    Abstract Background The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care an...

  17. Nursing Care in Patient with Acute Myocardial Infarction


    Němec, Pavel


    This thesis deals with the issue of acute myocardial infarction in context of prehospital, and hospital care. Specific clinical symptoms, diagnostic procedures, and treatment of acute myocardial infarction are described in the theoretical part. The part is also devoted to nursing care. Emphasis is put especially on prevention of cardiovascular diseases development. The goal is to evaluate nursing care of patients with acute myocardial infarction in prehospital, and later on, hospital care. Th...

  18. Teamwork and Patient Care Teams in an Acute Care Hospital. (United States)

    Rochon, Andrea; Heale, Roberta; Hunt, Elena; Parent, Michele


    The literature suggests that effective teamwork among patient care teams can positively impact work environment, job satisfaction and quality of patient care. The purpose of this study was to determine the perceived level of nursing teamwork by registered nurses, registered practical nurses, personal support workers and unit clerks working on patient care teams in one acute care hospital in northern Ontario, Canada, and to determine if a relationship exists between the staff scores on the Nursing Teamwork Survey (NTS) and participant perception of adequate staffing. Using a descriptive cross-sectional research design, 600 staff members were invited to complete the NTS and a 33% response rate was achieved (N=200). The participants from the critical care unit reported the highest scores on the NTS, whereas participants from the inpatient surgical (IPS) unit reported the lowest scores. Participants from the IPS unit also reported having less experience, being younger, having less satisfaction in their current position and having a higher intention to leave. A high rate of intention to leave in the next year was found among all participants. No statistically significant correlation was found between overall scores on the NTS and the perception of adequate staffing. Strategies to increase teamwork, such as staff education, among patient care teams may positively influence job satisfaction and patient care on patient care units. Copyright © 2015 Longwoods Publishing.

  19. Measuring value for low-acuity care across settings. (United States)

    Morgan, Sofie Rahman; Smith, Meaghan A; Pitts, Stephen R; Shesser, Robert; Uscher-Pines, Lori; Ward, Michael J; Pines, Jesse M


    Increasing healthcare costs have created an emphasis on improving value, defined as how invested time, money, and resources improve health. The role of emergency departments (EDs) within value-driven health systems is still undetermined. Often questioned is the value of an ED visit for conditions that could be reasonably treated elsewhere such as office-based, urgent, and retail clinics. This paper presents a conceptual approach to assess the value of these low-acuity visits. It adapts an existing analytic model to highlight specific factors that impact key stakeholders' (patients, insurers, and society) assessments of the value of ED-based care compared with care in alternative settings. These factors are presented in 3 equations, 1 for each stakeholder, emphasizing how tangible and intangible benefits of care weigh against direct and indirect costs and how each perspective influences value. Aligning value among groups could allow stakeholders to influence each other and could guide rational change in the delivery of acute medical care for low-acuity conditions.

  20. [Continuity of care from the acute care hospital: Results]. (United States)

    Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Alsina-Ribas, Anna; Puigoriol-Juvanteny, Emma; Oriol-Ruscalleda, Margarita; Subirana-Casacuberta, Mireia


    To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  1. Transitioning from acute to primary health care nursing: an integrative review of the literature. (United States)

    Ashley, Christine; Halcomb, Elizabeth; Brown, Angela


    This paper seeks to explore the transition experiences of acute care nurses entering employment in primary health care settings. Internationally the provision of care in primary health care settings is increasing. Nurses are moving from acute care settings to meet the growing demand for a primary health care workforce. While there is significant research relating to new graduate transition experiences, little is known about the transition experience from acute care into primary health care employment. An integrative review, guided by Whittemore and Knafl's (2005) approach, was undertaken. Following a systematic literature search eight studies met the inclusion criteria. Papers which met the study criteria were identified and assessed against the inclusion and exclusion criteria. Papers were then subjected to methodological quality appraisal. Thematic analysis was undertaken to identify key themes within the data. Eight papers met the selection criteria. All described nurses transitioning to either community or home nursing settings. Three themes were identified: (1) a conceptual understanding of transition, (2) role losses and gains and (3) barriers and enablers. There is a lack of research specifically exploring the transitioning of acute care nurses to primary health care settings. To better understand this process, and to support the growth of the primary health care workforce there is an urgent need for further well-designed research. There is an increasing demand for the employment of nurses in primary health care settings. To recruit experienced nurses it is logical that many nurses will transition into primary health care from employment in the acute sector. To optimise retention and enhance the transition experience of these nurses it is important to understand the transition experience. © 2016 John Wiley & Sons Ltd.

  2. Teaching in the Ambulatory Care Setting. (United States)

    Medley, E. Scott


    "Wrap-up rounds," in which students, residents, and faculty physicians involved with patient care in a clinic gather to discuss the clinic session, are advocated. They allow a structured educational program to take place in an ambulatory care center without interfering with patient flow and care. (MLW)

  3. Information management in the Australian aged care setting. (United States)

    Davis, Jenny; Morgans, Amee; Burgess, Stephen


    Information management systems and processes have an impact on quality and safety of care in any setting and particularly in the complex care setting of aged care. Few studies have comprehensively examined information management in the Australian aged care setting. To (i) critically analyse and synthesize evidence related to information management in aged care, (ii) identify aged care data collection frameworks and (iii) identify factors impacting information management. An integrative review of Australian literature published between March 2008 and August 2014 and data collection frameworks concerning information management in aged care were carried out. There is limited research investigating the information-rich setting of aged care in Australia. Electronic systems featured strongly in the review. Existing research focuses on residential settings with community aged care largely absent. Information systems and processes in the setting of aged care in Australia are underdeveloped and poorly integrated. Data quality and access are more problematic within community aged care than residential care settings. The results of this review represent an argument for a national approach to information management in aged care to address multiple stakeholder information needs and more effectively support client care.

  4. Exploring narratives of psychological input in the acute inpatient setting. (United States)

    Donaghay-Spire, Eloise G; McGowan, John; Griffiths, Kim; Barazzone, Natalie


    This research explored what happens when psychological input is offered in the inpatient setting and examined service users' and staff members' understanding and portrayal of these experiences. Narrative analysis, an interview design, was used to examine experiences of inpatient psychological interventions in National Health Service inpatient mental health settings. Ten participants (four service users and six staff members; five males and five females; seven White British, one White Irish, one Black African, and one Black Caribbean) were recruited via clinical psychologists from an inpatient psychology department and participated in 18- to 90-min interviews. Evidence suggested that direct, indirect, and strategic psychological interventions were used in the inpatient setting, with formulation and the therapeutic relationship conceptualized as common features. Connections between inpatient psychology and change, evidenced in the stories, suggested that interventions can help people make sense of a crisis, improve relationships, and contribute to meaningful recovery. Evidence of barriers suggests that psychological input in this setting might not always be compatible with everyone's needs. This paper explored service users' and staff members' experiences of psychological input in the inpatient setting. The analysis revealed that psychological provision in the inpatient mental health setting is varied and encompasses direct and indirect input, valued by service users and clinicians. It also identified that psychological input in the acute inpatient mental health setting is perceived as meaningful and can lead to changes at an interpersonal and intrapersonal level. There is a sense that providing psychological thinking in the inpatient setting can be challenging due to environmental constraints and individual factors. This highlights the need for further research focused on the costs and clinical effectiveness of providing psychological thinking within the acute

  5. Neuro-intensive care of patients with acute CNS infections. (United States)

    Beckham, J David; Tyler, Kenneth L


    Infections in the central nervous system (CNS) are caused by a wide range of microorganisms resulting in distinct clinical syndromes including meningitis, encephalitis, and pyogenic infections, such as empyema and brain abscess. Bacterial and viral infections in the CNS can be rapidly fatal and can result in severe disability in survivors. Appropriate identification and acute management of these infections often occurs in a critical care setting and is vital to improving outcomes in this group of patients. This review of diagnosis and management of acute bacterial and viral infections in the CNS provides a general approach to patients with a suspected CNS infection and also provides a more detailed review of the diagnosis and management of patients with suspected bacterial meningitis, viral encephalitis, brain abscess, and subdural empyema.

  6. Prevention and control of infection in non-acute healthcare settings. (United States)

    Jenkinson, Helen; Wright, Debbie; Jones, Martin; Dias, Esther; Pronyszyn, Anna; Hughes, Kath; Hawker, Karen; Newsham, Linda; O'Donovan, Tracey

    This article discusses the main principles of infection prevention and control in non-acute healthcare settings. It explores the use of a set of ten tools developed by the Infection Control Nurses Association (ICNA) to audit infection prevention and control, using the standard statements and criteria within the tools as a checklist. The results of the audit of facilities, commodities and practice using the ICNA audit tools will help staff to identify areas of best practice and areas where improvements are needed to enhance patient care.

  7. Online medical care: the current state of "eVisits" in acute primary care delivery. (United States)

    Hickson, Ryan; Talbert, Jeffery; Thornbury, William C; Perin, Nathan R; Goodin, Amie J


    Online technologies offer the promise of an efficient, improved healthcare system. Patients benefit from increased access to care, physicians are afforded greater flexibility in care delivery, and the health system itself benefits from lower costs to provide such care. One method of incorporating online care into clinical practice, called electronic office visits or "eVisits," allows physicians to provide a consultation with patients online. We performed an analysis of the current published literature on eVisits as well as present emerging research describing the use of mobile platforms as the delivery model. We focused on the role of eVisits in acute primary care practice. A literature review was conducted using electronic databases with a variety of search terms related to the use of eVisits in primary care. Several advantages to eVisit utilization in the primary care setting were identified, namely, improvements in efficiency, continuity of care, quality of care, and access to care. Barriers to eVisit implementation were also identified, including challenges with incorporation into workflow, reimbursement, physician technological literacy, patient health literacy, overuse, security, confidentiality, and integration with existing medical technologies. Only one study of patient satisfaction with eVisit acute primary care services was identified, and this suggests that previous analyses of eVisit utilization are lacking this key component of healthcare service delivery evaluations. The delivery of primary care via eVisits on mobile platforms is still in adolescence, with few methodologically rigorous analyses of outcomes of efficiency, patient health, and satisfaction.

  8. Biomarkers for the diagnosis of acute coronary syndrome : studies in primary care

    NARCIS (Netherlands)

    Bruins Slot, M.H.E.


    The research described in this thesis focuses on the potential value of early cardiac biomarkers in the diagnosis of acute coronary syndrome (ACS) in the primary care setting, with special attention for point-of-care tests. The design and results of a large diagnostic study on the value of a bedside

  9. The Acute Care Assessment Tool: 'Pharmacy ACAT'. (United States)

    Jubraj, Barry; Patel, Sheena; Naseem, Iram; Copp, Samantha; Karagkounis, Dimitrios


    The Acute Care Assessment Tool (ACAT) was developed as a workplace-based assessment (WPBA) for trainee performance whilst working in acute medicine. Here, we discuss the multi-professional potential of ACAT through a pilot with foundation and senior hospital pharmacists. The pharmacy profession is engaging meaningfully with foundation training for pharmacists akin to doctor foundation training, and has launched a post-foundation recognition scheme as a route to advanced generalist or specialist practice. Foundation training has included the adoption of familiar WPBA, such as the mini-clinical evaluation exercise (mini-CEX) and case-based discussion (CbD). However, mini-CEX and CbD are 'snapshot' assessments, and we identified a need for the assessment of practice over a short period of time. A local director of medical education suggested ACAT. We identified a need for the assessment of practice over a short period of time INNOVATION: Permission was gained from the Joint Royal Colleges of Physicians to adapt the ACAT to form the 'Pharmacy ACAT'. Adaptations were based on the two current Royal Pharmaceutical Society competency frameworks used for foundation and post-foundation practice. The 'Pharmacy ACAT' was piloted across three acute hospitals (known as 'Trusts') in London for foundation trainees, and was found to be broadly acceptable in terms of time and was valued for feedback, particularly for foundation pharmacy trainees. Senior pharmacists at the single pilot site were more sceptical. We believe that the 'Pharmacy ACAT' should be considered for routine use in pharmacy foundation training in hospital and community practice as it 'plugs a gap' in the current scheme of WPBA, by allowing the assessment of a short period of practice as opposed to a snapshot. It also has potential for use at undergraduate level. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  10. Nonemergency Acute Care: When It's Not the Medical Home. (United States)

    Conners, Gregory P; Kressly, Susan J; Perrin, James M; Richerson, Julia E; Sankrithi, Usha M


    The American Academy of Pediatrics (AAP) affirms that the optimal location for children to receive care for acute, nonemergency health concerns is the medical home. The medical home is characterized by the AAP as a care model that "must be accessible, family centered, continuous, comprehensive, coordinated, compassionate, and culturally effective." However, some children and families use acute care services outside the medical home because there is a perceived or real benefit related to accessibility, convenience, or cost of care. Examples of such acute care entities include urgent care facilities, retail-based clinics, and commercial telemedicine services. Children deserve high-quality, appropriate, and safe acute care services wherever they access the health care system, with timely and complete communication with the medical home, to ensure coordinated and continuous care. Treatment of children under established, new, and evolving practice arrangements in acute care entities should adhere to the core principles of continuity of care and communication, best practices within a defined scope of services, pediatric-trained staff, safe transitions of care, and continuous improvement. In support of the medical home, the AAP urges stakeholders, including payers, to avoid any incentives (eg, reduced copays) that encourage visits to external entities for acute issues as a preference over the medical home. Copyright © 2017 by the American Academy of Pediatrics.

  11. Nasolaryngoscopic validation of a set of clinical predictors of aspiration in a critical care setting. (United States)

    Caviedes, Iván R; Lavados, Pablo M; Hoppe, Arnold J; López, María A


    Aspiration is frequent in patients with acute neurologic disorders and swallowing dysfunction. Its incidence in stroke, as high as 51%, increases mortality by up to 3 times. Pneumonia, its main complication, further increases morbidity, mortality, and patient care costs. The objective of this study was to evaluate a set of bedside predictors of aspiration ["wet voice," 3-oz water swallow test, and cervical auscultation in an intensive care unit (ICU)] and compare them with nasolaryngoscopy as the gold standard. We conducted a prospective, nonblinded study of bedside predictors of aspiration risks in 65 consecutive ICU patients with an acute neurologic disorder or a severe medical or surgical condition with decreased level of consciousness. Endoscopic aspiration was detected in 17 patients. Sensitivities for wet voice, 3-oz water swallow test, and cervical auscultation were 58.82%, 88.23%, and 82.35%; specificities were 78.26%, 62.50%, and 80.43%. Positive predictive values were 50%, 45.45%, and 60.86%, and negative predictive values were 83.72%, 93.75%, and 92.50%, respectively. Positive likelihood ratios were 2.70, 2.35, and 4.20, respectively. The association of 2 positive clinical predictors, wet voice and cervical auscultation or wet voice and 3-oz water swallow test, improved specificity to 92.85% and 84.61%, positive predictive values to 83.33% and 69.23%, and likelihood ratios to 10.76 and 5.85, respectively. Bedside clinical predictors for aspiration risks are a useful screening tool for ICU patients presenting with risk factors for this complication.

  12. Intensive Care Management of Pediatric Acute Liver Failure. (United States)

    Lutfi, Riad; Abulebda, Kamal; Nitu, Mara E; Molleston, Jean P; Bozic, Molly A; Subbarao, Girish


    Pediatric acute liver failure is rare but life-threatening illness that occurs in children without preexisting liver disease. The rarity of the disease, along with its severity and heterogeneity, presents unique clinical challenges to the physicians providing care for pediatric patients with acute liver failure. In this review, practical clinical approaches to the care of critically ill children with acute liver failure are discussed with an organ system-specific approach. The underlying pathophysiological processes, major areas of uncertainty, and approaches to the critical care management of pediatric acute liver failure are also reviewed.

  13. Transitional care management in the outpatient setting. (United States)

    Baldonado, Analiza; Hawk, Ofelia; Ormiston, Thomas; Nelson, Danielle


    Patients who are high risk high cost (HRHC), those with severe or multiple medical issues, and the chronically ill elderly are major drivers of rising health care costs.1 The HRHC patients with complex health conditions and functional limitations may likely go to emergency rooms and hospitals, need more supportive services, and use long-term care facilities.2 As a result, these patient populations are vulnerable to fragmented care and "falling through the cracks".2 A large county health and hospital system in California, USA introduced evidence-based interventions in accordance with the Triple AIM3 focused on patient-centered health care, prevention, health maintenance, and safe transitions across the care continuum. The pilot program embedded a Transitional Care Manager (TCM) within an outpatient Family Medicine clinic to proactively assist HRHC patients with outreach assistance, problem-solving and facilitating smooth transitions of care. This initiative is supported by a collaborative team that included physicians, nurses, specialists, health educator, and pharmacist. The initial 50 patients showed a decrease in Emergency Department (ED) encounters (pre-vs post intervention: 33 vs 17) and hospital admissions (pre-vs post intervention: 32 vs 11), improved patient outcomes, and cost saving. As an example, one patient had 1 ED visit and 5 hospital admission with total charges of $217,355.75 in the 6 months' pre-intervention with no recurrence of ED or hospital admissions in the 6 months of TCM enrollment. The preliminary findings showed improvement of patient-centered outcomes, quality of care, and resource utilization however more data is required.

  14. Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units

    DEFF Research Database (Denmark)

    Bonnefoy-Cudraz, Eric; Bueno, Hector; Casella, Gianni


    Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on ac...... for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller hospitals with more limited capabilities.......Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper...... on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi...

  15. Intranasal Fentanyl and Quality of Pediatric Acute Care. (United States)

    Adelgais, Kathleen M; Brent, Alison; Wathen, Joseph; Tong, Suhong; Massanari, Derrek; Deakyne, Sara; Sills, Marion R


    Changes in the manner in which medications can be delivered can have significant effects on the quality of care in the acute care setting. The objective of this study was to evaluate the change in three Institute of Medicine quality indicators (timeliness, safety, and effectiveness) in the pediatric emergency department (ED) after the introduction of the Mucosal Atomizer Device Nasal™ (MADn) for opioid analgesia. This was a retrospective review of patients receiving opioid analgesia for certain conditions over a 5-year period. We compared patients receiving intravenous opioid (IVO) to those receiving intranasal fentanyl (INF). Timeliness outcomes include time from medication order to administration, time from dose to discharge, overall time to analgesia, and ED length of stay. Effectiveness outcomes include change in pain score and frequency of repeat dosing. Safety outcomes were the frequency of reversal agent administration or a documented oxygen desaturation of pediatric ED. Published by Elsevier Inc.

  16. [Acute care of patients with bacterial meningitis]. (United States)

    Stetefeld, H R; Dohmen, C


    Bacterial meningitis is a life-threatening emergency that is still associated with high mortality and poor outcome. The purpose of this article is to provide a review of clinical presentation, diagnostic procedure, therapy, and prognosis in bacterial meningitis. Prognostic factors which could be influenced positively are identified and a focused procedure in the emergency setting and for the treatment of complications are provided. This work is based on a literature search (PubMed, guidelines) and personal experience (standard operating procedures, SOP). Despite improved health care, bacterial meningitis is still associated with high mortality and poor neurological outcome, which has remained largely unaltered during recent decades. Diagnosis and, more importantly, effective therapy of bacterial meningitis are often delayed, having an immediate negative influence on clinical outcome. Neurological and nonneurological complications often necessitate intensive care and may occur rapidly or in the further course of the disease. Immediate initiation of effective therapy is crucial to positively influence mortality and neurological outcome. Antibiotics should be administered within 30 min after admission. To achieve this, a focused and well-organized procedure in the emergency setting is necessary. Because of intra- and extracranial complications, patients need to be treated on intensive care units including neurological expertise and interdisciplinary support.

  17. Caring Behaviors: Perceptions of Acute Care Nurses and Hospitalized Patients with Diabetes


    Mary Beth Modic DNP. R.N., CDE; Sandra L. Siedlecki Ph.D., R.N.; Mary T. Quinn Griffin Ph.D., R.N. FAAN, ANEF; c Joyce J. Fitzpatrick Ph.D. R.N., FAAN


    Caring behaviors: Perceptions of acute care nurses and hospitalized patients with diabetes Purpose: The purpose of this study was to examine the perceptions of caring behaviors that influence the patient experience in acute care nurses and hospitalized patients with diabetes. Background: Nurses are the caregivers who render most of the direct care patients receive while they are hospitalized. Understanding what patients perceive as caring behaviors is essential in tailoring nursing interventi...

  18. Innovating dementia care; implementing characteristics of green care farms in other long-term care settings.

    NARCIS (Netherlands)

    Buist, Yvette; Verbeek, Hilde; de Boer, Bram; de Bruin, Simone R


    People with dementia at green care farms (GCFs) are physically more active, have more social interactions, are involved in a larger variety of activities, and come outdoors more often than those in other long-term dementia care settings. These aspects may positively affect health and well-being.

  19. Aesthetics in Asian Child Care Settings. (United States)

    Honig, Alice S.

    This speech presents observations, made on a trip in June 1976, of the aesthetic environments of children in China, Japan, and Hong Kong. Home, school and day care environments are compared in terms of living and play space, room decor, the presence of art and toys, dramatic play and performance, music, nature and outdoor appreciation, food and…

  20. Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews

    Directory of Open Access Journals (Sweden)

    Risa Fukuda


    Full Text Available Objective: Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods: This was a qualitative study using focus group interviews (FGIs. The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1–1.5 h. The qualitative synthesis method was used for data analysis. Results: In total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital. Conclusions: The two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b nurses do their best to adapt to these conditions despite feeling conflicted.

  1. Issues experienced while administering care to patients with dementia in acute care hospitals: A study based on focus group interviews (United States)

    Fukuda, Risa; Shimizu, Yasuko


    Objective Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods This was a qualitative study using focus group interviews (FGIs). The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1–1.5 h. The qualitative synthesis method was used for data analysis. Results In total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital. Conclusions The two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a) the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b) nurses do their best to adapt to these conditions despite feeling conflicted. PMID:25716983

  2. Exploring the impact of health information technology on communication and collaboration in acute care nursing. (United States)

    Cashen, Margaret S; Bradley, Victoria; Farrell, Ann; Murphy, Judy; Schleyer, Ruth; Sensmeier, Joyce; Dykes, Patricia C


    A focus group using nursing informatics experts as informants was conducted to guide development of a survey to explore the impact of health information technology on the role of nurses and interdisciplinary communication in acute care settings. Through analysis of focus group transcripts, five key themes emerged: information, communication, care coordination, interdisciplinary relationships, workflow, and practice effectiveness and efficiency. This served as the basis for development of a survey that will investigate perceptions of acute care providers across the United States regarding the impact of health information technology on the role of nurses and interdisciplinar communication in acute care settings. The purpose of this paper is to describe the process of survey development including analysis of transcripts, emergence of key themes, and the processes by which the themes will be employed to inform survey development.

  3. The Emergency Care of Patients With Cancer: Setting the Research Agenda. (United States)

    Brown, Jeremy; Grudzen, Corita; Kyriacou, Demetrios N; Obermeyer, Ziad; Quest, Tammie; Rivera, Donna; Stone, Susan; Wright, Jason; Shelburne, Nonniekaye


    To identify research priorities and appropriate resources and to establish the infrastructure required to address the emergency care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, emergency medicine, and palliative care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the emergency care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative care in the emergency department setting. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  4. Innovating dementia care; implementing characteristics of green care farms in other long-term care settings. (United States)

    Buist, Yvette; Verbeek, Hilde; de Boer, Bram; de Bruin, Simone R


    People with dementia at green care farms (GCFs) are physically more active, have more social interactions, are involved in a larger variety of activities, and come outdoors more often than those in other long-term dementia care settings. These aspects may positively affect health and well-being. This study explored which and how characteristics of GCFs could be implemented in other long-term dementia care settings, taking into account possible facilitators and barriers. Semi-structured interviews were conducted with 23 professionals from GCFs, independent small-scale long-term care facilities, and larger scale long-term care facilities in the Netherlands. The framework method was used to analyze the data. Several characteristics of GCFs (e.g. homelike aspects, domestic activities, and access to outdoor environments) have already been applied in other types of long-term dementia care settings. However, how and the extent to which these characteristics are being applied differ between GCFs and other types of long-term dementia care settings. Facilitators and barriers for the implementation of characteristics of GCFs were related to the physical environment in which the care facility is situated (e.g. the degree of urbanization), characteristics and competences of staff members (e.g. flexibility, creativity), characteristics and competences of managers (e.g. leadership, vision), and the political context (e.g. application of risk and safety protocols). Several characteristics can be implemented in other dementia care settings. However, to realize innovation in dementia care it is important that not only the physical environment but also the social and organizational environments are supporting the process of change.

  5. Credentialing and Privileging of Acute Care Nurse Practitioners to Do Invasive Procedures: A Statewide Survey. (United States)

    Jalloh, Fatmata; Tadlock, Matthew D; Cantwell, Stacy; Rausch, Timothy; Aksoy, Hande; Frankel, Heidi


    Acute care nurse practitioners have been successfully integrated into inpatient settings. They perform invasive procedures in the intensive care unit and other acute care settings. Although their general scope of practice is regulated at the state level, local and regional scope of practice is governed by hospitals. To determine if credentialing and privileging of these nurses for invasive procedures varies depending on the institution. Personnel in medical staff offices of 329 hospitals were surveyed by telephone with 6 questions. Data collected included acute care nurse practitioner and hospital demographics, frequency and type of procedures performed, proctoring and credentialing process, and the presence of residents and fellows at the institution. The response rate was 74.8% (246 hospitals). Among these, 48% (118) employed acute care nurse practitioners, of which 43.2% performed invasive procedures. Three hospitals were excluded from the final analysis. Of the hospitals that credentialed and granted privileges to the nurse practitioners for invasive procedures, 60.4% were teaching hospitals. A supervising physician was the proctor in 94% of the nonteaching hospitals and 100% of the teaching hospitals. The most common number of cases proctored was 4 to 7. The majority of hospitals employ acute care nurse practitioners. The most common method of privileging for invasive procedures is proctoring by a supervising physician. However, the amount of proctoring required before privileges and independent practice are granted varies by procedure and institution. ©2016 American Association of Critical-Care Nurses.

  6. Experiences of the Implementation of a Learning Disability Nursing Liaison Service within an Acute Hospital Setting: A Service Evaluation (United States)

    Castles, Amy; Bailey, Carol; Gates, Bob; Sooben, Roja


    It has been well documented that people with learning disabilities receive poor care in acute settings. Over the last few years, a number of learning disability liaison nurse services have developed in the United Kingdom as a response to this, but there has been a failure to systematically gather evidence as to their effectiveness. This article…

  7. Understanding the bereavement care roles of nurses within acute care: a systematic review. (United States)

    Raymond, Anita; Lee, Susan F; Bloomer, Melissa J


    To investigate nurses' roles and responsibilities in providing bereavement care during the care of dying patients within acute care hospitals. Bereavement within acute care hospitals is often sudden, unexpected and managed by nurses who may have limited access to experts. Nurses' roles and experience in the provision of bereavement care can have a significant influence on the subsequent bereavement process for families. Identifying the roles and responsibilities, nurses have in bereavement care will enhance bereavement supports within acute care environments. Mixed-methods systematic review. The review was conducted using the databases Cumulative Index Nursing and Allied Health Literature Plus, Embase, Ovid MEDLINE, PsychINFO, CareSearch and Google Scholar. Included studies published between 2006-2015, identified nurse participants, and the studies were conducted in acute care hospitals. Seven studies met the inclusion criteria, and the research results were extracted and subjected to thematic synthesis. Nurses' role in bereavement care included patient-centred care, family-centred care, advocacy and professional development. Concerns about bereavement roles included competing clinical workload demands, limitations of physical environments in acute care hospitals and the need for further education in bereavement care. Further research is needed to enable more detailed clarification of the roles nurse undertake in bereavement care in acute care hospitals. There is also a need to evaluate the effectiveness of these nursing roles and how these provisions impact on the bereavement process of patients and families. The care provided by acute care nurses to patients and families during end-of-life care is crucial to bereavement. The bereavement roles nurses undertake are not well understood with limited evidence of how these roles are measured. Further education in bereavement care is needed for acute care nurses. © 2016 John Wiley & Sons Ltd.

  8. Care of Acute Gastrointestinal Conditions in the Observation Unit. (United States)

    Ham, Jason J; Ordonez, Edgar; Wilkerson, R Gentry


    The Emergency Department Observation Unit (EDOU) provides a viable alternative to inpatient admission for the management of many acute gastrointestinal conditions with additional opportunities of reducing resource utilization and reducing radiation exposure. Using available evidence-based criteria to determine appropriate patient selection, evaluation, and treatment provides higher-quality medical care and improved patient satisfaction. Discussions of factors involved in creating an EDOU capable of caring for acute gastrointestinal conditions and clinical protocol examples of acute appendicitis, gastrointestinal hemorrhage, and acute pancreatitis provide a framework from which a successful EDOU can be built. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Managing exudate and maceration in venous leg ulceration within the acute health setting. (United States)

    Brown, Annemarie


    Exudate has beneficial effects in normal wound healing but detrimental consequences for chronic wounds. Practitioners need to identify and treat its cause, and manage the exudate and prevent if from damaging periwound skin. Management involves dressings of the most appropriate absorbency and other products, and avoiding maceration of periwound skin; compression therapy is the gold standard treatment for treating oedema and venous leg ulceration. Nurses in acute settings may not have the skills to implement or maintain compression therapy; this article is intended for nurses who may have to manage these patients temporarily while they are admitted to secondary care and may not have the skills.

  10. Generational differences in acute care nurses. (United States)

    Widger, Kimberley; Pye, Christine; Cranley, Lisa; Wilson-Keates, Barbara; Squires, Mae; Tourangeau, Ann


    Generational differences in values, expectations and perceptions of work have been proposed as one basis for problems and solutions in recruitment and retention of nurses. This study used a descriptive design. A sample of 8207 registered nurses and registered practical nurses working in Ontario, Canada, acute care hospitals who responded to the Ontario Nurse Survey in 2003 were included in this study. Respondents were categorized as Baby Boomers, Generation X or Generation Y based on their birth year. Differences in responses among these three generations to questions about their own characteristics, employment circumstances, work environment and responses to the work environment were explored. There were statistically significant differences among the generations. Baby Boomers primarily worked full-time day shifts. Gen Y tended to be employed in teaching hospitals; Boomers worked more commonly in community hospitals. Baby Boomers were generally more satisfied with their jobs than Gen X or Gen Y nurses. Gen Y had the largest proportion of nurses with high levels of burnout in the areas of emotional exhaustion and depersonalization. Baby Boomers had the largest proportion of nurses with low levels of burnout. Nurse managers may be able to capitalize on differences in generational values and needs in designing appropriate interventions to enhance recruitment and retention of nurses.

  11. Enhancing critical thinking in clinical practice: implications for critical and acute care nurses. (United States)

    Shoulders, Bridget; Follett, Corrinne; Eason, Joyce


    The complexity of patients in the critical and acute care settings requires that nurses be skilled in early recognition and management of rapid changes in patient condition. The interpretation and response to these events can greatly impact patient outcomes. Nurses caring for these complex patients are expected to use astute critical thinking in their decision making. The purposes of this article were to explore the concept of critical thinking and provide practical strategies to enhance critical thinking in the critical and acute care environment.

  12. The Balanced Scorecard of acute settings: development process, definition of 20 strategic objectives and implementation. (United States)

    Groene, Oliver; Brandt, Elimer; Schmidt, Werner; Moeller, Johannes


    Strategy development and implementation in acute care settings is often restricted by competing challenges, the pace of policy reform and the existence of parallel hierarchies. To describe a generic approach to strategy development, illustrate the use of the Balanced Scorecard as a tool to facilitate strategy implementation and demonstrate how to break down strategic goals into measurable elements. Multi-method approach using three different conceptual models: Health Promoting Hospitals Standards and Strategies, the European Foundation for Quality Management (EFQM) Model and the Balanced Scorecard. A bundle of qualitative and quantitative methods were used including in-depth interviews, standardized organization-wide surveys on organizational values, staff satisfaction and patient experience. Three acute care hospitals in four different locations belonging to a German holding group. Chief executive officer, senior medical officers, working group leaders and hospital staff. Development and implementation of the Balanced Scorecard. Twenty strategic objectives with corresponding Balanced Scorecard measures. A stepped approach from strategy development to implementation is presented to identify key themes for strategy development, drafting a strategy map and developing strategic objectives and measures. The Balanced Scorecard, in combination with the EFQM model, is a useful tool to guide strategy development and implementation in health care organizations. As for other quality improvement and management tools not specifically developed for health care organizations, some adaptations are required to improve acceptability among professionals. The step-wise approach of strategy development and implementation presented here may support similar processes in comparable organizations.

  13. Analysis of Surfing Injuries Presenting in the Acute Trauma Setting. (United States)

    Jubbal, Kevin T; Chen, Charlie; Costantini, Todd; Herrera, Fernando; Dobke, Marek; Suliman, Ahmed


    Surfing is a rapidly growing major worldwide sport; however, little is understood regarding severe injuries and resulting hospital admissions. This study explores surfing-related injuries in the major surfing hub of San Diego presenting in the acute trauma setting. The purpose of this study is to address the void of information regarding severe surfing injuries in the trauma setting, including injury patterns, associated hospitalization course, and risk factors. Understanding the injury patterns in surfing accidents is crucial for proper management of surfing injuries. A retrospective analysis was performed of all surfing-related injuries in a Level 1 trauma center between 2000 and 2016. A total of 93 patients were identified. Body parts most commonly affected include the head (42, 46%), face (21, 22%), and spine (47, 51%). Twenty-eight (30%) patients required surgical intervention, including 19 for spinal injuries, 3 for facial injuries, 4 for upper extremity injuries, and 2 for lower extremity injuries. The distribution for most presentations (55, 59%) occurred in the summer months between July and September. The Injury Severity Score demonstrated strong positive correlation with the length of hospital stay, with a Pearson coefficient of 0.52 (P injuries in patients presenting with surfing injuries in the trauma setting, consistent with its presentation as a high velocity and high impact injury. With plastic surgeons often treating severe head and facial injuries, understanding the injury patterns in severe surfing accidents is crucial for proper management. High rates of positive alcohol and drug screening signal the importance to bring awareness to the dangers of surfing under the influence.

  14. Goal setting: an integral component of effective diabetes care. (United States)

    Miller, Carla K; Bauman, Jennifer


    Goal setting is a widely used behavior change tool in diabetes education and training. Prior research found specific relatively difficult but attainable goals set within a specific timeframe improved performance in sports and at the workplace. However, the impact of goal setting in diabetes self-care has not received extensive attention. This review examined the mechanisms underlying behavioral change according to goal setting theory and evaluated the impact of goal setting in diabetes intervention studies. Eight studies were identified, which incorporated goal setting as the primary strategy to promote behavioral change in individual, group-based, and primary care settings among patients with type 2 diabetes. Improvements in diabetes-related self-efficacy, dietary intake, physical activity, and A1c were observed in some but not all studies. More systematic research is needed to determine the conditions and behaviors for which goal setting is most effective. Initial recommendations for using goal setting in diabetes patient encounters are offered.

  15. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting

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    Jaishika Seedat


    Full Text Available Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23 was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23 was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.

  16. Medicare Post-Acute Care Episodes and Payment Bundling (United States)

    U.S. Department of Health & Human Services — Published in Volume 4, Issue 1, of Medicare and Medicaid Research Review, this paper provides an overview of results examining alternative Medicare post-acute care...

  17. Evidence-Based Care of Acute Wounds: A Perspective

    NARCIS (Netherlands)

    Ubbink, Dirk T.; Brölmann, Fleur E.; Go, Peter M. N. Y. H.; Vermeulen, Hester


    Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based

  18. Integrating palliative care across settings: A retrospective cohort study of a hospice home care programme for cancer patients. (United States)

    Tan, Woan Shin; Lee, Angel; Yang, Sze Yee; Chan, Susan; Wu, Huei Yaw; Ng, Charis Wei Ling; Heng, Bee Hoon


    Terminally ill patients at the end-of-life do transit between care settings due to their complex care needs. Problems of care fragmentation could result in poor quality of care. We aimed to evaluate the impact of an integrated hospice home care programme on acute care service usage and on the share of home deaths. The retrospective study cohort comprised patients who were diagnosed with cancer, had an expected prognosis of 1 year or less, and were referred to a home hospice. The intervention group comprised deceased patients enrolled in the integrated hospice home care programme between September 2012 and June 2014. The historical comparison group comprised deceased patients who were referred to other home hospices between January 2007 and January 2011. There were 321 cases and 593 comparator subjects. Relative to the comparator group, the share of hospital deaths was significantly lower for programme participants (12.1% versus 42.7%). After adjusting for differences at baseline, the intervention group had statistically significantly lower emergency department visits at 30 days (incidence rate ratio: 0.38; 95% confidence interval: 0.31-0.47), 60 days (incidence rate ratio: 0.61; 95% confidence interval: 0.54-0.69) and 90 days (incidence rate ratio: 0.69; 95% confidence interval: 0.62-0.77) prior to death. Similar results held for the number of hospitalisations at 30 days (incidence rate ratio: 0.48; 95% confidence interval: 0.40-0.58), 60 days (incidence rate ratio: 0.71; 95% confidence interval: 0.62-0.82) and 90 days (incidence rate ratio: 0.77; 95% confidence interval: 0.68-0.88) prior to death. Our results demonstrated that by integrating services between acute care and home hospice care, a reduction in acute care service usage could occur. © The Author(s) 2016.

  19. Implementation of a competency assessment tool for agency nurses working in an acute paediatric setting. (United States)

    Hennerby, Cathy; Joyce, Pauline


    This paper reports on the implementation of a competency assessment tool for registered general agency nurses working in an acute paediatric setting, using a change management framework. The increased number of registered general agency nurses working in an acute children's hospital alerted concerns around their competency in working with children. These concerns were initially raised via informal complaints about 'near misses', parental dissatisfaction, perceived competency weaknesses and rising cost associated with their use. [Young's (2009) Journal of Organisational Change, 22, 524-548] nine-stage change framework was used to guide the implementation of the competency assessment tool within a paediatric acute care setting. The ongoing success of the initiative, from a nurse manager's perspective, relies on structured communication with the agency provider before employing competent agency nurses. Sustainability of the change will depend on nurse managers' persistence in attending the concerns of those resisting the change while simultaneously supporting those championing the change. These key communication and supporting roles highlight the pivotal role held by nurse managers, as gate keepers, in safe-guarding children while in hospital. Leadership qualities of nurse managers will also be challenged in continuing to manage and drive the change where resistance might prevail. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  20. Where did the acute medical trainees go? A review of the career pathways of acute care common stem acute medical trainees in London. (United States)

    Gowland, Emily; Ball, Karen Le; Bryant, Catherine; Birns, Jonathan


    Acute care common stem acute medicine (ACCS AM) training was designed to develop competent multi-skilled acute physicians to manage patients with multimorbidity from 'door to discharge' in an era of increasing acute hospital admissions. Recent surveys by the Royal College of Physicians have suggested that acute medical specialties are proving less attractive to trainees. However, data on the career pathways taken by trainees completing core acute medical training has been lacking. Using London as a region with a 100% fill rate for its ACCS AM training programme, this study showed only 14% of trainees go on to higher specialty training in acute internal medicine and a further 10% to pursue higher medical specialty training with dual accreditation with internal medicine. 16% of trainees switched from ACCS AM to emergency medicine or anaesthetics during core ACCS training, and intensive care medicine proved to be the most popular career choice for ACCS AM trainees (21%). The ACCS AM training programme therefore does not appear to be providing what it was set out to do and this paper discusses the potential causes and effects. © Royal College of Physicians 2016. All rights reserved.

  1. Disparities in Post-Acute Rehabilitation Care for Stroke (United States)

    Freburger, Janet K.; Holmes, George M.; Ku, Li-Jung; Cutchin, Malcolm; Heatwole-Shank, Kendra; Edwards, Lloyd


    Objective To use population-based, hospital discharge data to determine the extent to which demographic and geographic disparities exist in the use of PARC following stroke. Design Cross-sectional analysis of two years (2005-2006) of population-based, hospital discharge data. Setting All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI). Participants Individuals 45 years and older (mean age of 72.6 years) admitted to the hospital with a primary diagnosis of stroke, who survived their inpatient stay and who were not transferred to a hospice or other short-term, acute care facility (N=187,188). The sample was 52.4 percent female, 79.5 percent White, 11.4 percent Black, and 9.1 percent Hispanic. Interventions Not applicable. Main Outcome Measures 1) Discharge to an institution versus home. 2) For those discharged home, discharge home with or without home health (HH). 3) For those discharged to an institution, discharge to an inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF). Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use, controlling for illness severity/comorbidities, hospital characteristics, and PARC supply. Results Blacks, females, older individuals, and those with lower incomes were more likely to be discharged to an institution; Hispanic individuals and the uninsured were less likely. Racial minorities, females, older individuals, and those with lower incomes were more likely to receive HH; uninsured individuals and rural residents were less likely. Blacks, females, older individuals, the uninsured, and those with lower incomes were more likely to use SNF vs IRF care. PARC use varied significantly by state and by hospital. Conclusions Several demographic and geographic disparities in PARC use were identified. PMID:21807141

  2. Post-Acute Rehabilitation Care for Hip Fracture: Who Gets the Most Care? (United States)

    Freburger, Janet K.; Holmes, George M.; Ku, Li-Jung E.


    Objectives To determine the extent to which demographic and geographic disparities exist in post-acute rehabilitation care (PARC) use following hip fracture. Design Cross-sectional analysis of two years (2005–2006) of population-based, hospital discharge data. Setting All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI). Participants Individuals 65 years and older (mean age of 82.9 years) admitted to the hospital with a hip fracture and who survived their inpatient stay (N=64,065). The sample was 75.1 percent female, 91.5 percent White, 5.8 percent Hispanic, and 2.7 percent Black. Measurements 1) whether the subject received institutional PARC; 2) for subjects who did not receive institutional care, whether they received home health (HH) care; and 3) for subjects who received institutional care, whether they received skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use. Results Considering PARC on a continuum from more to less hours of care per day (IRF→SNF→HH→no HH), we found that minorities and individuals of lower socioeconomic status (SES) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (OR=0.23 [95% CI: 0.18–0.30]) and to receive HH (OR=0.46 [0.30–0.70]) and more likely to receive SNF versus IRF care (OR=2.03 [1.36–3.05]). Hispanics were less likely to receive institutional care (OR=0.70 [0.62–0.79]); and Hispanics and Blacks were more likely to receive SNF versus IRF care (ORs of 1.31 and 1.49 respectively). Geographic differences in PARC were also present. Conclusion Several demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed

  3. Association between child-care and acute diarrhea: a study in Portuguese children

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    Barros Henrique


    Full Text Available OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR and their respective 95% confidence intervals (95% CI, crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]. CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.

  4. Individual psychological therapy in an acute inpatient setting: Service user and psychologist perspectives. (United States)

    Small, Catherine; Pistrang, Nancy; Huddy, Vyv; Williams, Claire


    The acute inpatient setting poses potential challenges to delivering one-to-one psychological therapy; however, there is little research on the experiences of both receiving and delivering therapies in this environment. This qualitative study aimed to explore service users' and psychologists' experiences of undertaking individual therapy in acute inpatient units. It focused on the relationship between service users and psychologists, what service users found helpful or unhelpful, and how psychologists attempted to overcome any challenges in delivering therapy. The study used a qualitative, interview-based design. Eight service users and the six psychologists they worked with were recruited from four acute inpatient wards. They participated in individual semi-structured interviews eliciting their perspectives on the therapy. Service users' and psychologists' transcripts were analysed together using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) method of thematic analysis. The accounts highlighted the importance of forming a 'human' relationship - particularly within the context of the inpatient environment - as a basis for therapeutic work. Psychological therapy provided valued opportunities for meaning-making. To overcome the challenges of acute mental health crisis and environmental constraints, psychologists needed to work flexibly and creatively; the therapeutic work also extended to the wider context of the inpatient unit, in efforts to promote a shared understanding of service users' difficulties. Therapeutic relationships between service users and clinicians need to be promoted more broadly within acute inpatient care. Psychological formulation can help both service users and ward staff in understanding crisis and working collaboratively. Practice-based evidence is needed to demonstrate the effectiveness of adapted psychological therapy models. Developing 'human' relationships at all levels of acute inpatient care continues to be an

  5. Brief, Rapid Response, Parenting Interventions Within Primary Care Settings. (United States)

    Bultas, Margaret W; McMillin, Stephen Edward; Broom, Matthew A; Zand, Debra H


    Opportunities created by the Patient Protection and Affordable Care Act along with the increased prevalence of pediatric behavioral and mental health concerns provide new challenges for pediatric health care providers. To address these matters, providers need to change the manner by which they provide health care to families. A novel approach is providing brief, rapid response, evidence-based parenting interventions within the pediatric primary care setting. Family-focused parenting programs support the American Academy of Pediatrics recommendations of improving mental health via supports in pediatric primary care to maximize the social and psychological well-being of families. A considerable body of research indicates that parenting interventions reduce the severity and frequency of disruptive behavior disorders in children and provide support to parent by bolstering parental resilience and improving overall family functioning. Providing these services within the pediatric primary care setting addresses the need for fully integrated health services that are family-centered and easily accessible.

  6. Management of Teenage Pregnancies in Three Different Health Care Settings. (United States)

    Tatelbaum, Robert


    This paper reports a retrospective study undertaken to determine if differences existed in obstetric outcome, contraceptive usage, and repeat pregnancy rates of teenage patients cared for in three different health care settings: the Rochester Adolescent Maternity Project (RAMP), a traditional obstetric clinic, and a neighborhood health center.…

  7. Quantum Physics Principles and Communication in the Acute Healthcare Setting: A Pilot Study. (United States)

    Helgeson, Heidi L; Peyerl, Colleen Kraft; Solheim-Witt, Marit

    This pilot study explores whether clinician awareness of quantum physics principles could facilitate open communication between patients and providers. In the spirit of action research, this study was conceptualized with a holistic view of human health, using a mixed method design of grounded theory as an emergent method. Instrumentation includes surveys and a focus group discussion with twelve registered nurses working in an acute care hospital setting. Findings document that the preliminary core phenomenon, energy as information, influences communication in the healthcare environment. Key emergent themes include awareness, language, validation, open communication, strategies, coherence, incoherence and power. Research participants indicate that quantum physics principles provide a language and conceptual framework for improving their awareness of communication and interactions in the healthcare environment. Implications of this pilot study support the feasibility of future research and education on awareness of quantum physics principles in other clinical settings. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland. (United States)

    Sugrue, M; Maier, R; Moore, E E; Boermeester, M; Catena, F; Coccolini, F; Leppaniemi, A; Peitzman, A; Velmahos, G; Ansaloni, L; Abu-Zidan, F; Balfe, P; Bendinelli, C; Biffl, W; Bowyer, M; DeMoya, M; De Waele, J; Di Saverio, S; Drake, A; Fraga, G P; Hallal, A; Henry, C; Hodgetts, T; Hsee, L; Huddart, S; Kirkpatrick, A W; Kluger, Y; Lawler, L; Malangoni, M A; Malbrain, M; MacMahon, P; Mealy, K; O'Kane, M; Loughlin, P; Paduraru, M; Pearce, L; Pereira, B M; Priyantha, A; Sartelli, M; Soreide, K; Steele, C; Thomas, S; Vincent, J L; Woods, L


    Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was therefore convened to look at resources for optimal care of emergency surgery. The aim of the Donegal Summit was to set a platform in place to develop guidelines and KPIs in emergency surgery. The project had multidisciplinary global involvement in producing consensus statements regarding emergency surgery care in key areas, and to assess feasibility of producing KPIs that could be used to monitor process and outcome of care in the future. Forty-four key opinion leaders in emergency surgery, across 7 disciplines from 17 countries, composed evidence-based position papers on 14 key areas of emergency surgery and 112 KPIs in 20 acute conditions or emergency systems. The summit was successful in achieving position papers and KPIs in emergency surgery. While position papers were limited by non-graded evidence and non-validated KPIs, the process set a foundation for the future advancement of emergency surgery.

  9. A Professional Containment Method in Acute Psychiatric Care: Nursing Observations

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    Selma Sabancigullari


    Full Text Available Observation is a method that is used in place of other control methods such as chemical and physical detention, isolation. Observation is used especially as an interference method to ensure the safety of the patients with suicidal and aggressive behaviors in acute psychiatric care in many countries. Especially in acute psychiatric wards using observations of nursing as a professional control method is an important issue. This article aims to draw attention to the importance of the subject in our country about using nursing observations as a control method in acute psychiatric care from the view of the literature. In this article several studies related to risk assessment, decision making, the levels of observation, the application of observation and the ethical aspects of observation on acute psychiatric care have been discussed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(1.000: 79-91

  10. Building Care Bridges between Acute and Long-Term Care with Nursing Diagnosis. (United States)

    Taylor, Carol A.

    The increasing age of the American population and the current emphasis on cost containment in health care make the 1980s an ideal time for building bridges to span the health care needs of elderly persons in acute care and long-term care. While hospitals often discharge patients to nursing homes as an intermediate step between hospitalization and…

  11. Long-term care facilities: important participants of the acute care facility social network?

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    Bruce Y Lee

    Full Text Available Acute care facilities are connected via patient sharing, forming a network. However, patient sharing extends beyond this immediate network to include sharing with long-term care facilities. The extent of long-term care facility patient sharing on the acute care facility network is unknown. The objective of this study was to characterize and determine the extent and pattern of patient transfers to, from, and between long-term care facilities on the network of acute care facilities in a large metropolitan county.We applied social network constructs principles, measures, and frameworks to all 2007 annual adult and pediatric patient transfers among the healthcare facilities in Orange County, California, using data from surveys and several datasets. We evaluated general network and centrality measures as well as individual ego measures and further constructed sociograms. Our results show that over the course of a year, 66 of 72 long-term care facilities directly sent and 67 directly received patients from other long-term care facilities. Long-term care facilities added 1,524 ties between the acute care facilities when ties represented at least one patient transfer. Geodesic distance did not closely correlate with the geographic distance among facilities.This study demonstrates the extent to which long-term care facilities are connected to the acute care facility patient sharing network. Many long-term care facilities were connected by patient transfers and further added many connections to the acute care facility network. This suggests that policy-makers and health officials should account for patient sharing with and among long-term care facilities as well as those among acute care facilities when evaluating policies and interventions.

  12. From acute care to home care: the evolution of hospital responsibility and rationale for increased vertical integration. (United States)

    Dilwali, Prashant K


    The responsibility of hospitals is changing. Those activities that were once confined within the walls of the medical facility have largely shifted outside them, yet the requirements for hospitals have only grown in scope. With the passage of the Patient Protection and Affordable Care Act (ACA) and the development of accountable care organizations, financial incentives are focused on care coordination, and a hospital's responsibility now includes postdischarge outcomes. As a result, hospitals need to adjust their business model to accommodate their increased need to impact post-acute care settings. A home care service line can fulfill this role for hospitals, serving as an effective conduit to the postdischarge realm-serving as both a potential profit center and a risk mitigation offering. An alliance between home care agencies and hospitals can help improve clinical outcomes, provide the necessary care for communities, and establish a potentially profitable product line.

  13. [A Delphi Method Survey of the Core Competences of Post-Acute-Care Nurses in Caring for Acute Stroke Patients]. (United States)

    Chi, Shu-Ching; Yeh, Lily; Lu, Meei-Shiow; Lin, Pei-Yu


    Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. The PAC in-job training program in its current form inadequately cul-tivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.

  14. Hospital-based, acute care after ambulatory surgery center discharge. (United States)

    Fox, Justin P; Vashi, Anita A; Ross, Joseph S; Gross, Cary P


    As a measure of quality, ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. This process, however, may underestimate the acute care needs of patients after care. We conducted this study to determine rates and evaluate variation in hospital transfer and hospital-based, acute care within 7 days among patients discharged from ambulatory surgery centers. Using data from the Healthcare Cost and Utilization Project, we identified adult patients who underwent a medical or operative procedure between July 2008 and September 2009 at ambulatory surgery centers in California, Florida, and Nebraska. The primary outcomes were hospital transfer at the time of discharge and hospital-based, acute care (emergency department visits or hospital admissions) within 7-days expressed as the rate per 1,000 discharges. At the ambulatory surgery center level, rates were adjusted for age, sex, and procedure-mix. We studied 3,821,670 patients treated at 1,295 ambulatory surgery centers. At discharge, the hospital transfer rate was 1.1 per 1,000 discharges (95% confidence interval 1.1-1.1). Among patients discharged home, the hospital-based, acute care rate was 31.8 per 1,000 discharges (95% confidence interval 31.6-32.0). Across ambulatory surgery centers, there was little variation in adjusted hospital transfer rates (median = 1.0/1,000 discharges [25th-75th percentile = 1.0-2.0]), whereas substantial variation existed in adjusted, hospital-based, acute care rates (28.0/1,000 [21.0-39.0]). Among adult patients undergoing ambulatory care at surgery centers, hospital transfer at time of discharge from the ambulatory care center is a rare event. In contrast, the rate of need for hospital-based, acute care in the first week afterwards is nearly 30-fold greater, varies across centers, and may be a more meaningful measure for discriminating quality. Published by Mosby, Inc.

  15. Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel. (United States)

    Keller, H H; Vesnaver, E; Davidson, B; Allard, J; Laporte, M; Bernier, P; Payette, H; Jeejeebhoy, K; Duerksen, D; Gramlich, L


    Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed. © 2013 The British Dietetic Association Ltd.

  16. Acute mental health care and South African mental health legislation

    African Journals Online (AJOL)

    first of three that reports on a review of a local acute mental health care unit in a general ... Method: The study reviewed the existing mental health care program and activities in context of relevant policy and legislation. Results: Norms from a ... current physical facilities and structure of the unit and of the utilization of available ...

  17. Acute mental health care and South African mental health legislation ...

    African Journals Online (AJOL)

    Objective: This is the first of three reports on a follow-up review of mental health care at Helen Joseph Hospital (HJH). In this first part, qualitative and quantitative descriptions were made of the services and of demographic and clinical data on acute mental health care users managed at HJH, in a retrospective review of ...

  18. Understanding Health Care Costs in a Wisconsin Acute Leukemia Population

    Directory of Open Access Journals (Sweden)

    Patricia Steinert


    Full Text Available Purpose: We investigated factors driving health care costs of patients with a diagnosis of acute myeloid and acute lymphoblastic leukemia. Methods: Standard costs identified in insurance claims data obtained from the Wisconsin Health Information Organization were used in a sample of 837 acute leukemia patients from April 2009 to June 2011. The Andersen behavioral model of health care utilization guided selection of patient and community factors expected to influence health care costs. A generalized linear model fitting gamma-distributed data with log-link technique was used to analyze cost. Results: Type of treatment received and disease severity represented significant cost drivers, and patients receiving at least some of their treatment from academic medical centers experienced higher costs. Inpatient care and pharmacy costs of patients who received treatment from providers located in areas of higher poverty experienced lower costs, raising questions of potential treatment and medical practice disparities between provider locations. Directions of study findings were not consistent between different types of services received and underscore the complexity of investigating health care cost. Conclusions: While prevalence of acute leukemia in the United States is low compared to other diseases, its extreme high cost of treatment is not well understood and potentially influences treatment decisions. Acute leukemia health care costs may not follow expected patterns; further exploration of the relationship between cost and the treatment decision, and potential treatment disparities between providers in different socioeconomic locations, is needed.

  19. Medication administration in the domiciliary care setting: whose role? (United States)

    Bradford, Jennie


    Unqualified social care workers are increasingly delegated the responsibility of both assisting with and administering medication in the domiciliary care setting. This article discusses the considerations required before the delegation of these roles by both commissioners and nurses. In particular, variations in training, policies and provision are explored with reference to the Care Quality Commission guidance and Nursing and Midwifery Council standards. The levels of support and their definitions are clarified for use in policy documents, and the effectiveness of devices used to support self-care are critiqued within a legal framework. The importance of joint working to provide a seamless medication management service are highlighted using reflections on examples from practice.

  20. Critical care management of acute ischemic stroke. (United States)

    Andrews, Peter J D


    To review and examine the efficacy of recently described medical and surgical interventions after acute ischaemic stroke using data from well conducted, clinical trials and systematic reviews. This review will consider recently published or updated articles. As therapeutic options evolve, including thrombolysis and anti-platelet therapy, prevention of secondary insults, becomes increasingly important during periods of acute cerebral ischaemia in order to prevent worsening of the neurological injury. As in other acute medical conditions, urgent management of patients with acute ischaemic stroke should begin with the assessment and treatment of the airway, breathing, circulation, temperature, and blood glucose control. It is estimated that there will be 8.5 million patients with acute ischaemic stroke in the European Union and the USA over the next decade, and of these, about one and a half million will die within six months of stroke onset. Of those who survive, about one third will depend on other people for help with their activities of daily living. Future treatment strategies are likely to involve agents that re-canalise vessels and minimise further neuronal damage.

  1. The positioning of palliative care in acute care: A multiperspective qualitative study in the context of metastatic melanoma. (United States)

    Fox, Jennifer; Windsor, Carol; Connell, Shirley; Yates, Patsy


    The positioning and meaning of palliative care within the healthcare system lacks clarity which adds a level of complexity to the process of transition to palliative care. This study explores the transition to the palliative care process in the acute care context of metastatic melanoma. A theoretical framework drawing on interpretive and critical traditions informs this research. The pragmatism of symbolic interactionism and the critical theory of Habermas brought a broad orientation to the research. Integration of the theoretical framework and grounded-theory methods facilitated data generation and analysis of 29 interviews with patients, family carers, and healthcare professionals. The key analytical findings depict a scope of palliative care that was uncertain for users of the system and for those working within the system. Becoming "palliative" is not a defined event; nor is there unanimity around referral to a palliative care service. As such, ambiguity and tension contribute to the difficulties involved in negotiating the transition to palliative care. Our findings point to uncertainty around the scopes of practice in the transition to palliative care. The challenge in the transition process lies in achieving greater coherency of care within an increasingly specialized healthcare system. The findings may not only inform those within a metastatic melanoma context but may contribute more broadly to palliative practices within the acute care setting.

  2. Health professionals' experience of teamwork education in acute hospital settings: a systematic review of qualitative literature. (United States)

    Eddy, Kylie; Jordan, Zoe; Stephenson, Matthew


    Teamwork is seen as an important element of patient care in acute hospital settings. The complexity of the journey of care for patients highlights the need for health professionals to collaborate and communicate clearly with each other. Health organizations in western countries are committed to improving patient safety through education of staff and teamwork education programs have been integral to this focus. There are no current systematic reviews of the experience of health professionals who participate in teamwork education in acute hospital settings. The objective of this systematic review was to search for the best available evidence on the experiences of health professionals who participate in teamwork education in acute hospital settings. This review considered studies reporting on experiences of registered health professionals who work in acute hospitals. This included medical, nursing and midwifery and allied health professionals. The focus of the meta-synthesis was the experiences and reflections of health professionals who were involved in teamwork education in acute hospital settings. The geographical context for this review was acute hospitals in rural or metropolitan settings in Australia and overseas countries. The review focused on the experiences of health professionals who work in acute hospitals and participated in teamwork education programs. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.In the absence of research studies, other text such as opinion papers, discussion papers and reports were considered. Studies published in English and from 1990 to 2013 were included in this review. The literature search for relevant papers occurred between 13 September and 26 October 2013. A three-step search strategy was utilized in this review. The databases searched were PubMed, CINAHL, Embase and Scopus. The

  3. Hospital-based, acute care following ambulatory surgery center discharge (United States)

    Fox, Justin P.; Vashi, Anita A.; Ross, Joseph S.; Gross, Cary P.


    Background As a measure of quality, ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. However, this may underestimate patient’s acute care needs after care. We conducted this study to determine rates and evaluate variation in hospital transfer and hospital-based, acute care within 7 days among patients discharged from ambulatory surgery centers. Methods Using data from the Healthcare Cost and Utilization Project, we identified adult patients who underwent a medical or surgical procedure between July 2008 and September 2009 at ambulatory surgery centers in California, Florida, and Nebraska. The primary outcomes were hospital transfer at the time of discharge and hospital-based, acute care (emergency department visits or hospital admissions) within 7-days expressed as the rate per 1,000 discharges. At the ambulatory surgery center level, rates were adjusted for age, sex, and procedure-mix. Results We studied 3,821,670 patients treated at 1,295 ambulatory surgery centers. At discharge, the hospital transfer rate was 1.1/1,000 discharges (95% CI, 1.1–1.1). Among patients discharged home, the hospital-based, acute care rate was 31.8/1,000 discharges (95% CI, 31.6–32.0). Across ambulatory surgery centers, there was little variation in adjusted hospital transfer rates (median=1.0/1,000 discharges [25th–75th percentile=1.0–2.0]), while substantial variation existed in adjusted hospital-based, acute care rates (28.0/1,000 [21.0–39.0]). Conclusions Among adult patients undergoing ambulatory surgery center care, hospital transfer at discharge is a rare event. In contrast, the hospital-based, acute care rate is nearly 30-fold higher, varies across centers, and may be a more meaningful measure for discriminating quality. PMID:24787100

  4. Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings. (United States)

    Eggenberger, Eva; Heimerl, Katharina; Bennett, Michael I


    Caring for and caring about people with dementia require specific communication skills. Healthcare professionals and family caregivers usually receive little training to enable them to meet the communicative needs of people with dementia. This review identifies existent interventions to enhance communication in dementia care in various care settings. We searched MEDLINE, AMED, EMBASE, PsychINFO, CINAHL, The Cochrane Library, Gerolit, and Web of Science for scientific articles reporting interventions in both English and German. An intervention was defined as communication skills training by means of face-to-face interaction with the aim of improving basic communicative skills. Both professional and family caregivers were included. The effectiveness of such training was analyzed. Different types of training were defined. Didactic methods, training content, and additional organizational features were qualitatively examined. This review included 12 trials totaling 831 persons with dementia, 519 professional caregivers, and 162 family caregivers. Most studies were carried out in the USA, the UK, and Germany. Eight studies took place in nursing homes; four studies were located in a home-care setting. No studies could be found in an acute-care setting. We provide a list of basic communicative principles for good communication in dementia care. Didactic methods included lectures, hands-on training, group discussions, and role-play. This review shows that communication skills training in dementia care significantly improves the quality of life and wellbeing of people with dementia and increases positive interactions in various care settings. Communication skills training shows significant impact on professional and family caregivers' communication skills, competencies, and knowledge. Additional organizational features improve the sustainability of communication interventions.

  5. Mental Health Collaborative Care and Its Role in Primary Care Settings (United States)

    Goodrich, David E.; Kilbourne, Amy M.; Nord, Kristina M.; Bauer, Mark S.


    Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims under healthcare reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components. PMID:23881714

  6. Setting a new standard of care in nursing homes. (United States)

    Klaasen, Kathleen; Lamont, Lori; Krishnan, Preetha


    The Winnipeg Regional Health Authority's introduction of a full-time nurse practitioner in a 116-bed non-profit nursing home provided an opportunity to explore a collaborative relationship between an NP acting as the primary care provider and a single physician serving as the consultant for complex care and after-hours care. The outcomes were measured in terms of resident and family satisfaction, quality of care indicators and cost effectiveness. Data were collected from pre-existing quality indicators, including a resident/family satisfaction survey, transfers to acute care, and medication use statistics. Unstructured interviews were also conducted with nursing staff and members of the interdisciplinary team. Dramatic improvements in medication use were observed, including a 17 per cent reduction in overall drug costs, a 55 per cent decrease in polypharmacy rates and a 63 per cent reduction in antipsychotic drug use. Transfers to emergency decreased by 20 per cent. Family satisfaction with the quality of health care provided to residents increased by 24 per cent. The collaborative practice of an NP with physician consultation is an effective way of delivering quality care to nursing home residents.

  7. Do Resident Case Logs Meet ACGME Requirements? A Comparison Between Acute Care and Elective Cases. (United States)

    Wolf, Kathryn R; Taylor, Zachary A; Placek, Sarah B; Tsai, Michael W; Franklin, Brenton R; Ritter, E Matthew

    . Elective cases were more likely to meet documentation requirements than acute care cases, and we purport that this is possibly secondary to restricted work hours. We expect that other programs would find similar compliance in the documentation of comprehensive care. These results question whether the requirement for documenting comprehensive care to log a surgical case is practical in surgical residency training, particularly with an increasing demand for operative volume in the setting of limited work hours. Published by Elsevier Inc.

  8. Acute Ankle Sprains in Primary Care

    NARCIS (Netherlands)

    R.M. van Rijn (Rogier)


    textabstractOf all injuries of the musculoskeletal system, 25% are acute lateral ankle sprains.1 In the USA and the UK there are about 23,000 and 5000 ankle sprains, respectively, each day. In the Netherlands approximately 600,000 people sustain an ankle injury each year, of those 120,000 occur

  9. Independent validation of the modified prognosis palliative care study predictor models in three palliative care settings. (United States)

    Baba, Mika; Maeda, Isseki; Morita, Tatsuya; Hisanaga, Takayuki; Ishihara, Tatsuhiko; Iwashita, Tomoyuki; Kaneishi, Keisuke; Kawagoe, Shohei; Kuriyama, Toshiyuki; Maeda, Takashi; Mori, Ichiro; Nakajima, Nobuhisa; Nishi, Tomohiro; Sakurai, Hiroki; Shimoyama, Satofumi; Shinjo, Takuya; Shirayama, Hiroto; Yamada, Takeshi; Ono, Shigeki; Ozawa, Taketoshi; Yamamoto, Ryo; Tsuneto, Satoru


    Accurate prognostic information in palliative care settings is needed for patients to make decisions and set goals and priorities. The Prognosis Palliative Care Study (PiPS) predictor models were presented in 2011, but have not yet been fully validated by other research teams. The primary aim of this study is to examine the accuracy and to validate the modified PiPS (using physician-proxy ratings of mental status instead of patient interviews) in three palliative care settings, namely palliative care units, hospital-based palliative care teams, and home-based palliative care services. This multicenter prospective cohort study was conducted in 58 palliative care services including 16 palliative care units, 19 hospital-based palliative care teams, and 23 home-based palliative care services in Japan from September 2012 through April 2014. A total of 2426 subjects were recruited. For reasons including lack of followup and missing variables (primarily blood examination data), we obtained analyzable data from 2212 and 1257 patients for the modified PiPS-A and PiPS-B, respectively. In all palliative care settings, both the modified PiPS-A and PiPS-B identified three risk groups with different survival rates (Ppalliative care units, hospital-based palliative care teams, and home-based palliative care services. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  10. Decentralized health care priority-setting in Tanzania

    DEFF Research Database (Denmark)

    Maluka, Stephen; Kamuzora, Peter; Sebastiån, Miguel San


    Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health...... were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest...... it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were...

  11. Reducing Uncertainty for Acute Febrile Illness in Resource-Limited Settings: The Current Diagnostic Landscape. (United States)

    Robinson, Matthew L; Manabe, Yukari C


    AbstractDiagnosing the cause of acute febrile illness in resource-limited settings is important-to give the correct antimicrobials to patients who need them, to prevent unnecessary antimicrobial use, to detect emerging infectious diseases early, and to guide vaccine deployment. A variety of approaches are yielding more rapid and accurate tests that can detect more pathogens in a wider variety of settings. After decades of slow progress in diagnostics for acute febrile illness in resource-limited settings, a wave of converging advancements will enable clinicians in resource-limited settings to reduce uncertainty for the diagnosis of acute febrile illness.

  12. Mortality associated with gastrointestinal bleeding events: Comparing short-term clinical outcomes of patients hospitalized for upper GI bleeding and acute myocardial infarction in a US managed care setting

    Directory of Open Access Journals (Sweden)

    C Mel Wilcox


    Full Text Available C Mel Wilcox1, Byron L Cryer2, Henry J Henk3, Victoria Zarotsky3, Gergana Zlateva41University of Alabama, Birmingham, AL, USA; 2University of Texas Southwestern Medical School, Dallas, TX; 3i3 Innovus, Eden Prairie, MN, USA; 4Pfizer, Inc., New York, NY, USA Objectives: To compare the short-term mortality rates of gastrointestinal (GI bleeding to those of acute myocardial infarction (AMI by estimating the 30-, 60-, and 90-day mortality among hospitalized patients.Methods: United States national health plan claims data (1999–2003 were used to identify patients hospitalized with a GI bleeding event. Patients were propensity-matched to AMI patients with no evidence of GI bleed from the same US health plan.Results: 12,437 upper GI-bleed patients and 22,847 AMI patients were identified. Propensity score matching yielded 6,923 matched pairs. Matched cohorts were found to have a similar Charlson Comorbidity Index score and to be similar on nearly all utilization and cost measures (excepting emergency room costs. A comparison of outcomes among the matched cohorts found that AMI patients had higher rates of 30-day mortality (4.35% vs 2.54%; p < 0.0001 and rehospitalization (2.56% vs 1.79%; p = 0.002, while GI bleed patients were more likely to have a repeat procedure (72.38% vs 44.95%; p < 0.001 following their initial hospitalization. The majority of the difference in overall 30-day mortality between GI bleed and AMI patients was accounted for by mortality during the initial hospitalization (1.91% vs 3.58%.Conclusions: GI bleeding events result in significant mortality similar to that of an AMI after adjusting for the initial hospitalization.Keywords: gastrointestinal, bleeding, mortality, acute myocardial infarction, claims analysis

  13. Duration of day-care attendance and acute respiratory infection

    Directory of Open Access Journals (Sweden)

    Sandra Costa Fuchs

    Full Text Available Day-care attendance accounts for an increased frequency of acute respiratory infections (ARI, in numbers of both episodes and hospitalizations. In addition to day-care exposure, risk factors include age, siblings, and crowding. The purpose of this study was to investigate a possible association between duration of day-care exposure and ARI. A cross-sectional study was carried out to compared ARI rates for children exposed to day care and children cared for at home. Children with at least one parent working in a hospital were sampled from the hospital-run day-care center and those cared for at home. An acute respiratory infection was defined as the presence of two or more signs or symptoms in the previous two weeks. Children exposed to the day-care center for 12 to 50 hours a week had a three to five times greater risk of developing ARI than those staying at home. This risk was assessed independently, taking socioeconomic status, age, and number of siblings into account. Risk of respiratory illness and day-care attendance has been described elsewhere, but this study presents original findings related to duration of exposure. With a view towards reducing risk of ARI, improvements should be made in institutional day-care centers in Brazil, where family day care is still not available.

  14. Duration of day-care attendance and acute respiratory infection

    Directory of Open Access Journals (Sweden)

    Fuchs Sandra Costa


    Full Text Available Day-care attendance accounts for an increased frequency of acute respiratory infections (ARI, in numbers of both episodes and hospitalizations. In addition to day-care exposure, risk factors include age, siblings, and crowding. The purpose of this study was to investigate a possible association between duration of day-care exposure and ARI. A cross-sectional study was carried out to compared ARI rates for children exposed to day care and children cared for at home. Children with at least one parent working in a hospital were sampled from the hospital-run day-care center and those cared for at home. An acute respiratory infection was defined as the presence of two or more signs or symptoms in the previous two weeks. Children exposed to the day-care center for 12 to 50 hours a week had a three to five times greater risk of developing ARI than those staying at home. This risk was assessed independently, taking socioeconomic status, age, and number of siblings into account. Risk of respiratory illness and day-care attendance has been described elsewhere, but this study presents original findings related to duration of exposure. With a view towards reducing risk of ARI, improvements should be made in institutional day-care centers in Brazil, where family day care is still not available.

  15. Biological treatment of acute agitation or aggression with schizophrenia or bipolar disorder in the inpatient setting. (United States)

    Correll, Christoph U; Yu, Xin; Xiang, Yutao; Kane, John M; Masand, Prakash


    Schizophrenia and bipolar disorders are chronic illnesses that commonly present with symptoms of acute agitation and aggression. These symptoms must be managed rapidly to prevent potential harm to the patient and others, including their caregivers, peers, and health care workers. A number of treatment options are available to clinicians to manage acute agitation and aggression, including non-pharmacologic behavioral and environmental de-escalation strategies, as well as biological treatment options such as pharmacologic agents and electroconvulsive therapy. We summarize the available biological treatment options for patients with schizophrenia or bipolar disorder presenting with acute agitation or aggression in the inpatient setting, focusing on antipsychotics. The following searches were used in PubMed to obtain the most relevant advances in treating schizophrenia or bipolar disorder with acute agitation and aggression: (agitation, agitated, aggression, aggressive, hostile, hostility, violent, or violence) and (schizophr*, psychosis, psychot*, psychos*, mania, manic, or bipolar) and (*pharmacologic, antipsychotic*, neuroleptic*, antiepileptic*, anti-seizure*, mood stabilizer*, lithium, benzodiazepine*, beta blocker, beta-blocker, alpha2, alpha-2, *histamine*, electroconvulsive, ECT, shock, or transcranial). Individual searches were performed for each drug class. The studies were limited to peer-reviewed, English-language, and human studies. Most were placebo-controlled randomized controlled trials (RCTs) or meta-analyses. Among pharmacologic agents, antipsychotics, benzodiazepines, anticonvulsants, and lithium have been studied in randomized trials. Some typical and, more recently, atypical antipsychotics are available as both oral and short-acting intramuscular (IM) formulations, with 1 typical antipsychotic also available as an inhalable formulation. Among the pharmacologic agents studied in RCTs, atypical antipsychotics have the best evidence to support

  16. Patient safety issues in advanced practice nursing students' care settings. (United States)

    Schnall, Rebecca; Cook, Sarah; John, Rita Marie; Larson, Elaine; Stone, Patricia W; Sullivan, Caroline; Bakken, Suzanne


    The purpose of this project was to identify and characterize patient safety issues across advanced practice nursing (APN) care settings including ambulatory care visits. A total of 162 registered nurses enrolled in an APN education program completed an online survey. Respondents reported patient safety issues related to diagnosis or management and treatment in almost half of 489 encounters. The most common issues were clinician communication problems with patients, which occurred during 42.4% of encounters. Adoption of information technology may be a pathway for improving patient safety issues in APN practice settings.

  17. 48 Acute Acalculous Cholecystitis in an Outpatient Setting

    African Journals Online (AJOL)



    Dec 2, 2006 ... report the presentation of acute acalculous cholecystitis in two young African men admitted for the first time within days of each other. ... Recognition of AAC in a subset of young male patients presenting de novo with right upper quadrant pain is stressed. .... Glenn F, Becheer CG. Acalculous cholecystitis: An ...

  18. 48 Acute Acalculous Cholecystitis in an Outpatient Setting

    African Journals Online (AJOL)



    Dec 2, 2006 ... cholecystitis associated with Q fever; report of seven cases and eview of the literature. Eur J. Clin Microbiol Infec Dis. 2003; 22(4):. 222-7. 10. Mishra OP, Das BK, Prakash J. Acute acalculous cholecystitis in typhoid fever. J Trop Pediatr. 1996; 42 (1); 58-9. 11. Maggi. 12. Rucci m, Puente AP, Rothenberg RE,.

  19. The social practice of rescue: the safety implications of acute illness trajectories and patient categorisation in medical and maternity settings. (United States)

    Mackintosh, Nicola; Sandall, Jane


    The normative position in acute hospital care when a patient is seriously ill is to resuscitate and rescue. However, a number of UK and international reports have highlighted problems with the lack of timely recognition, treatment and referral of patients whose condition is deteriorating while being cared for on hospital wards. This article explores the social practice of rescue, and the structural and cultural influences that guide the categorisation and ordering of acutely ill patients in different hospital settings. We draw on Strauss et al.'s notion of the patient trajectory and link this with the impact of categorisation practices, thus extending insights beyond those gained from emergency department triage to care management processes further downstream on the hospital ward. Using ethnographic data collected from medical wards and maternity care settings in two UK inner city hospitals, we explore how differences in population, cultural norms, categorisation work and trajectories of clinical deterioration interlink and influence patient safety. An analysis of the variation in findings between care settings and patient groups enables us to consider socio-political influences and the specifics of how staff manage trade-offs linked to the enactment of core values such as safety and equity in practice. © 2015 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

  20. Creating a Global Acute Care Surgery Fellowship to Meet International Need. (United States)

    Merchant, Amina I; Walters, Camila B; Valenzuela, Julie; McQueen, Kelly A; May, Addison K

    Existing Acute Care Surgery (ACS) fellowships are positioned to develop well-trained surgeons with specific skills to facilitate improvements in care delivery in Global ACS. Many resident and fellowship programs offer clinical electives that expose trainees to operative experiences, exposing trainees to the needs in resource-challenged settings. However, most lack a focus on long-term development and research designed to enhance the country's local skills, capability, and capacity. The Global Acute Care Surgery (Global ACS) fellowship produces a surgeon who focuses on capacity building and systems development across the world. At Vanderbilt University, the current American Association for the Surgery of Trauma-Acute Care Surgery (AAST-ACS) fellowship was adapted to create an academic Global Acute Care Surgery (Global ACS) fellowship. This fellowship specifically enhances fellowship trainee's skills in needs assessment and performing research to facilitate the development and implementation of trauma and acute care surgery systems in low- and middle income countries. This research will foster context-appropriate data, collected and based in low- and middle-income countries, to guide practice and policy. Two fellows have completed the Global ACS fellowship at Vanderbilt University. The fellowship requirements, clinical skills, project development and overall goals are outlined within the article. Challenges, funding, and mentorship must also be addressed to develop a comprehensive fellowship. A sample two-year timeline is provided to complete the fellowship track and meet the defined goals. A structured global acute care surgery fellowship enables fellows to reduce the surgical burden of disease and contribute to surgical systems development at both local and international levels by creating meaningful research and developing sustainable change in LMIC countries. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights

  1. Bereaved family members' perceptions of the quality of end-of-life care across four types of inpatient care settings. (United States)

    Stajduhar, Kelli; Sawatzky, Richard; Robin Cohen, S; Heyland, Daren K; Allan, Diane; Bidgood, Darcee; Norgrove, Leah; Gadermann, Anne M


    %), in particular resilience. Findings suggest room for improvement across all settings of care, but improving quality in acute care and palliative care should be a priority. Resiliency appears to be an important psychological characteristic in influencing how family members appraise care quality and point to possible sites for targeted intervention.

  2. Acute and critical care nurses' perceptions of palliative care competencies: a pilot study. (United States)

    White, Kenneth R; Roczen, Marisa L; Coyne, Patrick J; Wiencek, Clareen


    Competency development among acute and critical care nurses has focused primarily on the provision of life-sustaining care and less on the care of patients who fail to respond to life-prolonging treatments. Examining nurses' beliefs, perceptions, and experiences with patients' palliative care needs may improve continuing education programs, practice resources, educational curricula, and professional nursing practice. Survey methodology was used to conduct this pilot study. Forty-nine nurses completed a 33-item survey instrument in 2012. Respondents consisted of nurses attending a critical care continuing education event and graduate nursing students in an acute care nurse practitioner program. Statistical tests were used to examine differences in perceived importance of core competencies in palliative care. Findings from this study demonstrate variation in palliative care knowledge and perceived relative importance of core competencies needed in palliative care practice. This study provides preliminary data about knowledge differences among different nursing groups and a foundation for further study. Copyright 2014, SLACK Incorporated.

  3. Misdiagnosing absent pedicle of cervical spine in the acute trauma setting

    Directory of Open Access Journals (Sweden)

    Fahad H. Abduljabbar


    Full Text Available Congenital absence of cervical spine pedicle can be easily misdiagnosed as facet dislocation on plain radiographs especially in the acute trauma setting. Additional imaging, including computed tomography (CT-scan with careful interpretation is required in order to not misdiagnose cervical posterior arch malformation with subsequent inappropriate management. A 39-year-old patient presented to the emergency unit of our university hospital after being trampled by a cow over her back and head followed by loss of consciousness, retrograde amnesia and neck pain. Her initial cervical CT-scan showed possible C5-C6 dislocation, then, it became clear that her problem was a misdiagnosed congenital cervical abnormality. Patient was treated symptomatically without consequences. The congenital absence of a cervical pedicle is a very unusual condition that is easily misdiagnosed. Diagnosis can be accurately confirmed with a CT-scan of the cervical spine. Symptomatic conservative treatment will result in resolution of the symptoms.

  4. Establishing an end-of-life program in an academic acute care hospital. (United States)

    Counsell, Colleen; Adorno, Gail; Guin, Peggy


    The primary goal of end-of-life (EOL) care is to relieve suffering through measures that improve comfort and address the psychological, social, and spiritual needs of the dying. This article discusses the components of a pilot project that focused on palliative EOL care at an academic acute care hospital. An interdisciplinary team of nurses, social workers, chaplains, patient care coordinators, and advanced practice nurses established a common vision for the care of patients who were "in the dying process," or were expected to die during their hospitalizations. A nurse-social worker "Care-Pair Team" completed a consistent interdisciplinary EOL care needs assessment when treatment goals became strictly palliative. Interventions were driven by a clinical pathway and a pre-printed physician's order set that continually clarified the goals of treatment. Key elements of the program included leadership support, advance directives, education, communication, family involvement, symptom management, professional collaboration, and outcomes measurement.

  5. Current management of acute bronchitis in ambulatory care: The use of antibiotics and bronchodilators. (United States)

    Mainous, A G; Zoorob, R J; Hueston, W J


    To examine the treatment regimens for acute bronchitis in adults in a Medicaid population seen in ambulatory care settings. Cross-sectional sample of Kentucky Medicaid claims (July 1, 1993, through June 30, 1994). Individuals 18 years old or older seen in an ambulatory setting for acute bronchitis. Anyone with a primary diagnosis of asthma or chronic obstructive pulmonary disease within the time frame was excluded. Twelve hundred ninety-four individuals accounted for 1635 separate outpatient and emergency department encounters for acute bronchitis. Outpatient visits accounted for 89% (n=1448) of the encounters. In 22% (n=358) of the encounters, no medication was prescribed; in 61% (n=997), antibiotics alone were prescribed, in 3% (n=43), bronchodilators alone were prescribed; and in 14% (n=237), both antibiotics and bronchodilators were prescribed. Some type of medication was more likely to be prescribed in emergency departments than in outpatient settings (P=.04), and antibiotic/bronchodilator combination therapy was more likely to be prescribed in rural practices than in urban practices (Ptreatment is not usually indicated for treatment of acute bronchitis, these results indicate that antibiotics are still the predominant treatment regimen in ambulatory care. Furthermore, the evidence suggesting that bronchodilators are effective symptomatic treatments has not been widely adopted. These results have significant implications for the production of antibiotic-resistant bacteria and suggest investigation into why physicians have not used this information in their treatment of acute bronchitis.

  6. Surgical rescue: The next pillar of acute care surgery. (United States)

    Kutcher, Matthew E; Sperry, Jason L; Rosengart, Matthew R; Mohan, Deepika; Hoffman, Marcus K; Neal, Matthew D; Alarcon, Louis H; Watson, Gregory A; Puyana, Juan Carlos; Bauzá, Graciela M; Schuchert, Vaishali D; Fombona, Anisleidy; Zhou, Tianhua; Zolin, Samuel J; Becher, Robert D; Billiar, Timothy R; Forsythe, Raquel M; Zuckerbraun, Brian S; Peitzman, Andrew B


    The evolving field of acute care surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of "surgical rescue" in the practice of ACS. A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure. Long-term outcomes were derived from the Social Security Death Index. Of 2,410 ACS patients, 320 (13%) required "surgical rescue": most commonly, from wound complications (32%), uncontrolled sepsis (19%), and acute obstruction (15%). The majority of complications (85%) were related to an operation; 15% were related to interventional procedures. The most common rescue interventions required were bowel resection (23%), wound debridement (18%), and source control of infection (17%); 63% of patients required operative intervention, and 22% required surgical critical care. Thirty-six percent of complications occurred in ACS primary patients ("local"), whereas 38% were referred from another surgical service ("institutional") and 26% referred from another institution ("regional"). Hospital length of stay was longer, and in-hospital and 1-year mortalities were higher in rescue patients compared with those without a complication. Outcomes were equivalent between "local" and "institutional" patients, but hospital length of stay and discharge to home were significantly worse in "institutional" referrals. We here describe the distinct role of the acute care surgeon in the surgical management of complications; this is an additional pillar of ACS. In this vital role, the acute care surgeon provides crucial support to other providers as well as direct patient care in the "surgical rescue" of surgical and procedural complications

  7. Effects of acute restraint stress on set-shifting and reversal learning in male rats. (United States)

    Thai, Chester A; Zhang, Ying; Howland, John G


    Exposure to acute stress alters cognition; however, few studies have examined the effects of acute stress on executive functions such as behavioral flexibility. The goal of the present experiments was to determine the effects of acute periods of stress on two distinct forms of behavioral flexibility: set-shifting and reversal learning. Male Sprague-Dawley rats were trained and tested in an operant-chamber-based task. Some of the rats were exposed to acute restraint stress (30 min) immediately before either the set-shifting test day or the reversal learning test day. Acute stress had no effect on set-shifting, but it significantly facilitated reversal learning, as assessed by both trials to criterion and total errors. In a second experiment, the roles of glucocorticoid (GR) and mineralocorticoid receptors (MR) in the acute-stress-induced facilitation of reversal learning were examined. Systemic administration of the GR-selective antagonist RU38486 (10 mg/kg) or the MR-selective antagonist spironolactone (50 mg/kg) 30 min prior to acute stress failed to block the facilitation on reversal learning. The present results demonstrate a dissociable effect of acute stress on set-shifting and reversal learning and suggest that the facilitation of reversal learning by acute stress may be mediated by factors other than corticosterone.

  8. International practice settings, interventions and outcomes of nurse practitioners in geriatric care: A scoping review. (United States)

    Chavez, Krista S; Dwyer, Andrew A; Ramelet, Anne-Sylvie


    To identify and summarize the common clinical settings, interventions, and outcomes of nurse practitioner care specific to older people. Scoping review of the international published and grey literature. A structured literature search was conducted of CINAHL, EMBASE, MEDLINE, Google Scholar, and Cochrane Collaboration and Joanna Briggs Institute databases. Following the Arksey and O'Malley framework, randomized controlled and quasi-experimental studies of Masters-prepared nurse practitioners providing care for patients over 65 years were included. Studies were reviewed independently by two investigators. Data were extracted, collated by setting, summarized in tables and synthesized for analysis. In total, 56 primary research studies from four countries and 23 systematic reviews were identified. Primary studies were conducted in primary care (n=13), home care (n=14), long-term care (n=10), acute/hospital care (n=9), and transitional care (n=10). Nurse practitioner interventions included substitutive as well as a supplementation NP role elements to meet specific unmet patient care needs. Studies examined six main outcome measures: service utilization (n=41), cost (n=24), length of stay (n=14), health indices (n=44), satisfaction (n=14) and quality of life (n=7). Cumulatively, nurse practitioners demonstrated enhanced results in 83/144 (58%) of outcomes compared to physician-only or usual care. The most commonly measured financial-related outcome was service utilization (n=41) and benefits were frequently reported in home care (8/9, 89%) and long-term care (7/10, 70%) settings. Among patient and care-related outcomes health indices were most frequently measured (n=44). Primary care most frequently reported improved health indices (11/13, 85%). Transitional care reported improved outcomes across all measures, except for service utilization. This review demonstrates improved or non-inferiority results of nurse practitioner care in older people across settings. More well

  9. Urban Telemedicine Enables Equity in Access to Acute Illness Care. (United States)

    Ronis, Sarah D; McConnochie, Kenneth M; Wang, Hongyue; Wood, Nancy E


    Children with care for acute illness available through the Health-e-Access telemedicine model at childcare and schools were previously found to have 22% less emergency department (ED) use than counterparts without this service, but they also had 24% greater acute care use overall. We assessed the hypothesis that increased utilization reflected improved access among impoverished inner-city children to a level experienced by more affluent suburban children. This observational study compared utilization among children without and with telemedicine access, beginning in 1993, ending in 2007, and based on 84,287 child-months of billing claims-based observation. Health-e-Access Telemedicine was initiated in stepwise manner over 187 study-months among 74 access sites (childcare, schools, community centers), beginning in month 105. Children dwelled in inner city, rest-of-city Rochester, NY, or in surrounding suburbs. Rate of total acute care visits (office, ED, telemedicine) was measured as visits per 100 child-years. Observed utilization rates were adjusted in multivariate analysis for age, sex, insurance type, and season of year. When both suburban and inner-city children lacked telemedicine access, overall acute illness visits were 75% greater among suburban than inner-city children (suburban:inner-city rate ratio 1.75, p telemedicine became available to inner-city children, their overall acute visits approximated those of suburban children (suburban:inner-city rate ratio 0.80, p = 0.07), whereas acute visits among suburban children remained at least (worst-case comparison) 56% greater than inner-city children without telemedicine (rate ratio 1.56, p telemedicine to that of suburban children at baseline. Without telemedicine, however, inner-city use remained substantially less than for suburban counterparts. Health-e-Access Telemedicine redressed socioeconomic disparities in acute care access in the Rochester area, thus contributing to a more equitable community.

  10. Challenges in managing dementia in a primary health care setting ...

    African Journals Online (AJOL)


    Sep 29, 2008 ... Case Study: Challenges in managing dementia in a primary health care setting. 520. Vol 51 No 6. SA Fam Pract 2009 supportive of their father's condition and they felt more worried about the neighbours' perceptions of having an unsound family member at home. A year later, the patient became withdrawn ...

  11. Health care priority setting in Norway a multicriteria decision analysis

    NARCIS (Netherlands)

    Defechereux, T.; Paolucci, F.; Mirelman, A.; Youngkong, S.; Botten, G.; Hagen, T.P.; Niessen, L.W.


    BACKGROUND: Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and

  12. 78 FR 50495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the... (United States)


    ... Episode-of-Care for Acute Myocardial Infarction (AMI) Measure 7. Electronic Clinical Quality Measures 8... for Acute Care Hospitals and the Long Term Care; Hospital Prospective Payment System and Fiscal Year... 0938-AR73 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

  13. Elderly inpatients' priorities for acute care service quality. (United States)

    Clark, Paul Alexander; Kaldenberg, Dennis O; Drain, Maxwell; Wolosin, Robert J


    This study examines elderly and advanced elderly inpatients' perceptions of acute care service quality, prioritises opportunities for quality improvement, and assesses variation in patients' satisfaction with care. Psychometrically-validated postal questionnaires were sent to random samplings of patients discharged from the US acute care facilities in 2002 (n = 2,057,164). Quality improvement priorities among non-elderly (elderly (65-74 years), and advanced elderly (> 74 years) were similar but substantial variation was found comparing single items between age groups. Elderly and advanced elderly patients rated the quality of meals and rooms significantly lower than the non-elderly, and the advanced elderly rated treatment decision making involvement significantly lower than the other two age groups. The data reveals specific, actionable areas for quality improvement and a non-linear relationship between age and satisfaction. Findings question assumptions regarding older patients' evaluations of care and indicate directions for quality improvement that account for their unique needs.

  14. The chronic care model and diabetes management in US primary care settings: a systematic review. (United States)

    Stellefson, Michael; Dipnarine, Krishna; Stopka, Christine


    The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: "chronic care model" (and) "diabet*." We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP officd-based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making.

  15. Preschool-aged children's television viewing in child care settings. (United States)

    Christakis, Dimitri A; Garrison, Michelle M


    The goal was to quantify television viewing in day care settings and to investigate the characteristics of programs that predict viewing. A telephone survey of licensed child care programs in Michigan, Washington, Florida, and Massachusetts was performed. The frequency and quantity of television viewing for infants, toddlers, and preschool-aged children were assessed. With the exception of infants, children in home-based child care programs were exposed to significantly more television on an average day than were children in center-based programs (infants: 0.2 vs 0 hours; toddlers: 1.6 vs 0.1 hours; preschool-aged children: 2.4 vs 0.4 hours). In a regression analysis of daily television time for preschool-aged children in child care, center-based programs were found to have an average of 1.84 fewer hours of television each day, controlling for the other covariates. Significant effect modification was found, in that the impact of home-based versus center-based child care programs differed somewhat depending on educational levels for staff members; having a 2- or 4-year college degree was associated with 1.41 fewer hours of television per day in home-based programs, but no impact of staff education on television use was observed in center-based programs. For many children, previous estimates of screen time significantly underestimated actual amounts. Pediatricians should council parents to minimize screen time in child care settings.

  16. Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit. (United States)

    Feldman, Kira; Berall, Anna; Karuza, Jurgis; Senderovich, Helen; Perri, Giulia-Anna; Grossman, Daphna


    Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise. A survey was administered to staff on the unit before and after the intervention of the pain team to understand staff perceptions of pain management. Pre- and post-comparisons of the survey responses were analysed by using t-tests. This study provided some evidence for the success of this interprofessional education initiative through changes in staff confidence with respect to pain management. It also showed that embedding the pain team into the acute care team supported the KT process as an effective method of interprofessional team building. Incorporating the pain team into the acute care unit to provide training and ongoing decision support was a feasible strategy for KT and could be replicated in other clinical settings.

  17. Effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations in an acute care setting in Saudi Arabia: a quasi-experimental study. (United States)

    Haseeb, Abdul; Winit-Watjana, Win; Bakhsh, Abdul-Rahman R; Elrggal, Mahmoud E; Hadi, Muhammad Abdul; Mously, Alaa A; Gadibalban, Asmaa Z; Al-Ibraheem, Bashayir F; Almubark, Rasha A; Ekram, Rawan A; Khan, Tahir Mehmood


    To evaluate the effectiveness of a pharmacist-led educational intervention to reduce the use of high-risk abbreviations (HRAs) by healthcare professionals. Quasi-experimental study consisting of a single group before-and-after study design. A public emergency hospital in Mecca, Saudi Arabia. 660 (preintervention) and then 498 (postintervention) handwritten physician orders, medication administration records (MRAs) and pharmacy dispensing sheets of 482 and 388 patients, respectively, from emergency wards, inpatient settings and the pharmacy department were reviewed. The intervention consisted of a series of interactive lectures delivered by an experienced clinical pharmacist to all hospital staff members and dissemination of educational tools (flash cards, printed list of HRAs, awareness posters) designed in line with the recommendations of the Institute for Safe Medical Practices and the US Food and Drug Administration. The duration of intervention was from April to May 2011. Reduction in the incidence of HRAs use from the preintervention to postintervention study period. The five most common abbreviations recorded prior to the interventions were 'IJ for injection' (28.6%), 'SC for subcutaneous' (17.4%), drug name and dose running together (9.7%), 'OD for once daily' (5.8%) and 'D/C for discharge' (4.3%). The incidence of the use of HRAs was highest in discharge prescriptions and dispensing records (72.7%) followed by prescriptions from in-patient wards (47.3%). After the intervention, the overall incidence of HRA was significantly reduced by 52% (ie, 53.6% vs 25.5%; p=0.001). In addition, there was a statistically significant reduction in the incidence of HRAs across all three settings: the pharmacy department (72.7% vs 39.3%), inpatient settings (47.3% vs 23.3%) and emergency wards (40.9% vs 10.7%). Pharmacist-led educational interventions can significantly reduce the use of HRAs by healthcare providers. Future research should investigate the long

  18. Teaching About Health Care Disparities in the Clinical Setting (United States)

    Fernandez, Leonor; Irby, David M.; Harleman, Elizabeth; Fernandez, Alicia


    Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner’s need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching. PMID:20352501

  19. Supporting relationships between family and staff in continuing care settings. (United States)

    Austin, Wendy; Goble, Erika; Strang, Vicki; Mitchell, Agnes; Thompson, Elizabeth; Lantz, Helen; Balt, Linda; Lemermeyer, Gillian; Vass, Kelly


    In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family-staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of "Everybody Knows Your Name," "Loss and Laundry," "It's the Little Things That Count," and "The Chasm of Us Versus Them." Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family- staff relationships in traditional continuing care settings in Canada.

  20. Consensus of primary care in acute pancreatitis in Japan (United States)

    Otsuki, Makoto; Hirota, Masahiko; Arata, Shinju; Koizumi, Masaru; Kawa, Shigeyuki; Kamisawa, Terumi; Takeda, Kazunori; Mayumi, Toshihiko; Kitagawa, Motoji; Ito, Tetsuhide; Inui, Kazuo; Shimosegawa, Tooru; Tanaka, Shigeki; Kataoka, Keisho; Saisho, Hiromitsu; Okazaki, Kazuichi; Kuroda, Yosikazu; Sawabu, Norio; Takeyama, Yoshifumi; Pancreas, The Research Committee of Intractable Diseases of the


    The incidence of acute pancreatitis in Japan is increasing and ranges from 187 to 347 cases per million populations. Case fatality was 0.2% for mild to moderate, and 9.0% for severe acute pancreatitis in Japan in 2003. Experts in pancreatitis in Japan made this document focusing on the practical aspects in the early management of patients with acute pancreatitis. The correct diagnosis of acute pancreatitis and severity stratification should be made in all patients using the criteria for the diagnosis of acute pancreatitis and the multifactor scoring system proposed by the Research Committee of Intractable Diseases of the Pancreas as early as possible. All patients diagnosed with acute pancreatitis should be managed in the hospital. Monitoring of blood pressure, pulse and respiratory rate, body temperature, hourly urinary volume, and blood oxygen saturation level is essential in the management of such patients. Early vigorous intravenous hydration is of foremost importance to stabilize circulatory dynamics. Adequate pain relief with opiates is also important. In severe acute pancreatitis, prophylactic intravenous administration of antibiotics at an early stage is recommended. Administration of protease inhibitors should be initiated as soon as the diagnosis of acute pancreatitis is confirmed. A combination of enteral feeding with parenteral nutrition from early stage is recommended if there are no clear signs and symptoms of ileus and gastrointestinal bleeding. Patients with severe acute pancreatitis should be transferred to ICU as early as possible to perform special measures such as continuous regional arterial infusion of protease inhibitors and antibiotics, and continuous hemodiafiltration. The Japanese Government covers medical care expense for severe acute pancreatitis as one of the projects of Research on Measures for Intractable Diseases. PMID:16733846

  1. Acute mental health care and South African mental health legislation

    African Journals Online (AJOL)

    Introduction. Reliable data is necessary to facilitate the effective planning, management and ... qualitative and quantitative descriptions were made of the services and of demographic and clinical data on acute mental health care users managed at HJH, .... service psychologists, 1 OT and a part time social worker. All doctors ...

  2. Burnout among physicians in palliative care: Impact of clinical settings. (United States)

    Dréano-Hartz, Soazic; Rhondali, Wadih; Ledoux, Mathilde; Ruer, Murielle; Berthiller, Julien; Schott, Anne-Marie; Monsarrat, Léa; Filbet, Marilène


    Burnout syndrome is a work-related professional distress. Palliative care physicians often have to deal with complex end-of-life situations and are at risk of presenting with burnout syndrome, which has been little studied in this population. Our study aims to identify the impact of clinical settings (in a palliative care unit (PCU) or on a palliative care mobile team (PCMT)) on palliative care physicians. We undertook a cross-sectional study using a questionnaire that included the Maslach Burnout Inventory (MBI), and we gathered sociodemographic and professional data. The questionnaire was sent to all 590 physicians working in palliative care in France between July of 2012 and February of 2013. The response rate was 61, 8% after three reminders. Some 27 (9%) participants showed high emotional exhaustion, 12 (4%) suffered from a high degree of depersonalization, and 71 (18%) had feelings of low personal accomplishment. Physicians working on a PCMT tended (p = 0.051) to be more likely to suffer from emotional exhaustion than their colleagues. Physicians working on a PCMT worked on smaller teams (fewer physicians, p burnout in palliative care physicians was low and in fact lower than that reported in other populations (e.g., oncologists). Working on a palliative care mobile team can be a more risky situation, associated with a lack of medical and paramedical staff.

  3. Post-acute care and vertical integration after the Patient Protection and Affordable Care Act. (United States)

    Shay, Patrick D; Mick, Stephen S


    The anticipated changes resulting from the passage of the Patient Protection and Affordable Care Act-including the proposed adoption of bundled payment systems and the promotion of accountable care organizations-have generated considerable controversy as U.S. healthcare industry observers debate whether such changes will motivate vertical integration activity. Using examples of accountable care organizations and bundled payment systems in the American post-acute healthcare sector, this article applies economic and sociological perspectives from organization theory to predict that as acute care organizations vary in the degree to which they experience environmental uncertainty, asset specificity, and network embeddedness, their motivation to integrate post-acute care services will also vary, resulting in a spectrum of integrative behavior.

  4. Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review. (United States)

    Jusela, Cheryl; Struble, Laura; Gallagher, Nancy Ambrose; Redman, Richard W; Ziemba, Rosemary A


    . 2. Describe the significance of interprofessional collaboration in the delivery of quality health care. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. The purpose of the current project was to (a) examine the type of information accompanying patients on transfer from acute care to skilled nursing facilities (SNFs), (b) discuss how these findings meet existing standards, and (c) make recommendations to improve transfer of essential information. The study was a retrospective convenience sample chart audit in one SNF. All patients admitted from an acute care hospital to the SNF were examined. The audit checklist was developed based on recommendations by local and national standards. One hundred fifty-five charts were reviewed. Transferring of physician contact information was missing in 65% of charts. The following information was also missing from charts: medication lists (1%), steroid tapering instructions (42%), antiarrhythmic instructions (38%), duration/indication of anticoagulant medications (25%), and antibiotic medications (22%). Findings support the need for improved transitional care models and better communication of information between care settings. Recommendations include designating accountability and chart audits comparing timeliness, completeness, and accuracy. [Journal of Gerontological Nursing, 43(3), 19-28.]. Copyright 2016, SLACK Incorporated.

  5. A novel technique of differential lung ventilation in the critical care setting

    Directory of Open Access Journals (Sweden)

    Kuwagata Yasuyuki


    Full Text Available Abstract Background Differential lung ventilation (DLV is used to salvage ventilatory support in severe unilateral lung disease in the critical care setting. However, DLV with a double-lumen tube is associated with serious complications such as tube displacement during ventilatory management. Thus, long-term ventilatory management with this method may be associated with high risk of respiratory incidents in the critical care setting. Findings We devised a novel DLV technique using two single-lumen tubes and applied it to five patients, two with severe unilateral pneumonia and three with thoracic trauma, in a critical care setting. In this novel technique, we perform the usual tracheotomy and insert two single-lumen tubes under bronchoscopic guidance into the main bronchus of each lung. We tie the two single-lumen tubes together and suture them directly to the skin. The described technique was successfully performed in all five patients. Pulmonary oxygenation improved rapidly after DLV induction in all cases, and the three patients with thoracic trauma were managed by DLV without undergoing surgery. Tube displacement was not observed during DLV management. No airway complications occured in either the acute or late phase regardless of the length of DLV management (range 2-23 days. Conclusions This novel DLV technique appears to be efficacious and safe in the critical care setting.

  6. Rehabilitation of medical and acute care patients. (United States)

    Dunning, Dianne; Halling, Krista B; Ehrhart, Nicole


    Cancer and serious systemic illness result in several physiologic changes that involve multiple body systems. While the primary conditions are addressed with traditional modalities of medicine, the side effects, secondary changes, and complications can be ameliorated or even prevented with rehabilitation and supportive care. This article reviews problems facing the oncologic and critically ill animal, discusses basic techniques in the management of these animals, and highlights the essential role of rehabilitation in obtaining maximal functional capacity in the critically ill patient.

  7. Clinical productivity of primary care nurse practitioners in ambulatory settings. (United States)

    Xue, Ying; Tuttle, Jane

    Nurse practitioners are increasingly being integrated into primary care delivery to help meet the growing demand for primary care. It is therefore important to understand nurse practitioners' productivity in primary care practice. We examined nurse practitioners' clinical productivity in regard to number of patients seen per week, whether they had a patient panel, and patient panel size. We further investigated practice characteristics associated with their clinical productivity. We conducted cross-sectional analysis of the 2012 National Sample Survey of Nurse Practitioners. The sample included full-time primary care nurse practitioners in ambulatory settings. Multivariable survey regression analyses were performed to examine the relationship between practice characteristics and nurse practitioners' clinical productivity. Primary care nurse practitioners in ambulatory settings saw an average of 80 patients per week (95% confidence interval [CI]: 79-82), and 64% of them had their own patient panel. The average patient panel size was 567 (95% CI: 522-612). Nurse practitioners who had their own patient panel spent a similar percent of time on patient care and documentation as those who did not. However, those with a patient panel were more likely to provide a range of clinical services to most patients. Nurse practitioners' clinical productivity was associated with several modifiable practice characteristics such as practice autonomy and billing and payment policies. The estimated number of patients seen in a typical week by nurse practitioners is comparable to that by primary care physicians reported in the literature. However, they had a significantly smaller patient panel. Nurse practitioners' clinical productivity can be further improved. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Senile anorexia in acute-ward and rehabilitations settings. (United States)

    Donini, L M; Savina, C; Piredda, M; Cucinotta, D; Fiorito, A; Inelmen, E M; Sergi, G; Domiguez, L J; Barbagallo, M; Cannella, C


    The most common pathological change in eating behaviour among older persons is anorexia, which accounts for a large percent of undernutrition in older adults. The main research aims are to determine, in a sample of acute and rehabilitation elderly subjects, the prevalence of anorexia of aging and the causes most impacting on senile anorexia. four different Units cooperated to this research study. Patients were recruited from geriatric acute and rehabilitation wards in Italy. Each Research Unit, for the estimation of the prevalence of anorexia in elderly subjects evaluated all the patients aged over 65 recruited from April 2006 to June 2007. Nutritional status, depression, social, functional and cognitive status, quality of life, health status, chewing, swallowing, sensorial functions were evaluated in anorexic patients and in a sample of "normal eating" elderly subjects. 96 anorexic subjects were selected in acute and rehabilitation wards (66 women; 81.5 +/- 7 years; 30 men: 81.8 +/- 8 years. The prevalence of anorexia in the sample was 33.3% in women and 26.7% in men. Anorexic subjects were older and more frequently needed help for shopping and cooking. A higher (although not statistically significant) level of comorbidity was present in anorexic subjects. These subjects reported constipation and epigastrium pain more frequently. Nutritional status parameters (MNA, anthropometry, blood parameters) were significantly worst in anorexic subjects whereas CRP was higher. Chewing and swallowing efficiencies were significantly impaired and eating patterns were different for anorexic subjects with a significant reduction of protein rich foods. consequences of anorexia can be extremely serious and deeply affect both patient's mobility, mortality and quality of life. Therefore, it is of utmost importance to perform a special evaluation of the nutritional risk, to constantly evaluate the nutritional status and feeding intake of older patients, to identify and treat the

  9. Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

    Directory of Open Access Journals (Sweden)

    Liza Van Eenoo


    Full Text Available Introduction: Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. Aim: This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Methods: Data on elements at the macro-level (policy, meso-level (care organisations and micro-level (clients are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. Conclusions and Discussion: These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.

  10. Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol. (United States)

    Van Eenoo, Liza; van der Roest, Henriëtte; van Hout, Hein; Declercq, Anja


    Since the European population is ageing, a growing number of elderly will need home care. Consequently, high quality home care for the elderly remains an important challenge. Job satisfaction among care professionals is regarded as an important aspect of the quality of home care. This paper describes a research protocol to identify elements that have an impact on job satisfaction among care professionals and on quality of care for older people in the home care setting of six European countries. Data on elements at the macro-level (policy), meso-level (care organisations) and micro-level (clients) are of importance in determining job satisfaction and quality of care. Macro-level indicators will be identified in a previously published literature review. At meso- and micro-level, data will be collected by means of two questionnaires utilsed with both care organisations and care professionals, and by means of interRAI Home Care assessments of clients. The client assessments will be used to calculate quality of care indicators. Subsequently, data will be analysed by means of linear and stepwise multiple regression analyses, correlations and multilevel techniques. These results can guide health care policy makers in their decision making process in order to increase the quality of home care in their organisation, in their country or in Europe.

  11. Implementing goals of care conversations with veterans in VA long-term care setting: a mixed methods protocol. (United States)

    Sales, Anne E; Ersek, Mary; Intrator, Orna K; Levy, Cari; Carpenter, Joan G; Hogikyan, Robert; Kales, Helen C; Landis-Lewis, Zach; Olsan, Tobie; Miller, Susan C; Montagnini, Marcos; Periyakoil, Vyjeyanthi S; Reder, Sheri


    The program "Implementing Goals of Care Conversations with Veterans in VA LTC Settings" is proposed in partnership with the US Veterans Health Administration (VA) National Center for Ethics in Health Care and the Geriatrics and Extended Care Program Offices, together with the VA Office of Nursing Services. The three projects in this program are designed to support a new system-wide mandate requiring providers to conduct and systematically record conversations with veterans about their preferences for care, particularly life-sustaining treatments. These treatments include cardiac resuscitation, mechanical ventilation, and other forms of life support. However, veteran preferences for care go beyond whether or not they receive life-sustaining treatments to include issues such as whether or not they want to be hospitalized if they are acutely ill, and what kinds of comfort care they would like to receive. Three projects, all focused on improving the provision of veteran-centered care, are proposed. The projects will be conducted in Community Living Centers (VA-owned nursing homes) and VA Home-Based Primary Care programs in five regional networks in the Veterans Health Administration. In all the projects, we will use data from context and barrier and facilitator assessments to design feedback reports for staff to help them understand how well they are meeting the requirement to have conversations with veterans about their preferences and to document them appropriately. We will also use learning collaboratives-meetings in which staff teams come together and problem-solve issues they encounter in how to get veterans' preferences expressed and documented, and acted on-to support action planning to improve performance. We will use data over time to track implementation success, measured as the proportions of veterans in Community Living Centers (CLCs) and Home-Based Primary Care (HBPC) who have a documented goals of care conversation soon after admission. We will work with

  12. Rapid research and implementation priority setting for wound care uncertainties.

    Directory of Open Access Journals (Sweden)

    Trish A Gray

    Full Text Available People with complex wounds are more likely to be elderly, living with multimorbidity and wound related symptoms. A variety of products are available for managing complex wounds and a range of healthcare professionals are involved in wound care, yet there is a lack of good evidence to guide practice and services. These factors create uncertainty for those who deliver and those who manage wound care. Formal priority setting for research and implementation topics is needed to more accurately target the gaps in treatment and services. We solicited practitioner and manager uncertainties in wound care and held a priority setting workshop to facilitate a collaborative approach to prioritising wound care-related uncertainties.We recruited healthcare professionals who regularly cared for patients with complex wounds, were wound care specialists or managed wound care services. Participants submitted up to five wound care uncertainties in consultation with their colleagues, via an on-line survey and attended a priority setting workshop. Submitted uncertainties were collated, sorted and categorised according professional group. On the day of the workshop, participants were divided into four groups depending on their profession. Uncertainties submitted by their professional group were viewed, discussed and amended, prior to the first of three individual voting rounds. Participants cast up to ten votes for the uncertainties they judged as being high priority. Continuing in the professional groups, the top 10 uncertainties from each group were displayed, and the process was repeated. Groups were then brought together for a plenary session in which the final priorities were individually scored on a scale of 0-10 by participants. Priorities were ranked and results presented. Nominal group technique was used for generating the final uncertainties, voting and discussions.Thirty-three participants attended the workshop comprising; 10 specialist nurses, 10 district

  13. Blood Product Administration in the Critical Care and Perioperative Settings. (United States)

    Rygård, Sofie Louise; Holst, Lars Broksø; Perner, Anders


    The critical care and perioperative settings are high consumers of blood products, with multiple units and different products often given to an individual patient. The recommendation of this review is always to consider the risks and benefits for a specific blood product for a specific patient in a specific clinical setting. Optimize patient status by treating anemia and preventing the need for red blood cell transfusion. Consider other options for correction of anemia and coagulation disorders and use an imperative non-overtransfusion policy for all blood products. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Predictors of job satisfaction for rural acute care registered nurses in Canada. (United States)

    Penz, Kelly; Stewart, Norma J; D'Arcy, Carl; Morgan, Debra


    This study examines predictors of job satisfaction among rural acute care registered nurses. The data are from a cross-sectional national survey, which was part of a larger project, The Nature of Nursing Practice in Rural and Remote Canada. This analysis suggests that a combination of individual, workplace, and community characteristics are interrelated predictors of job satisfaction for rural acute care nurses. There were nine variables that accounted for 38% of the total variance in job satisfaction. Four variables alone (available and up-to-date equipment and supplies, satisfaction with scheduling and shifts, lower psychological job demands, and home community satisfaction) explained 33% of the variance. Recruitment and retention strategies in rural areas must acknowledge that rural nurses' work lives and community lives are inextricably intertwined. Attention to these issues will help ensure high-quality working environments and a continued commitment to quality nursing care in the rural hospital settings in Canada.

  15. Factors contributing to nursing team work in an acute care tertiary hospital. (United States)

    Polis, Suzanne; Higgs, Megan; Manning, Vicki; Netto, Gayle; Fernandez, Ritin

    Effective nursing teamwork is an essential component of quality health care and patient safety. Understanding which factors foster team work ensures teamwork qualities are cultivated and sustained. This study aims to investigate which factors are associated with team work in an Australian acute care tertiary hospital across all inpatient and outpatient settings. All nurses and midwives rostered to inpatient and outpatient wards in an acute care 600 bed hospital in Sydney Australia were invited to participate in a cross sectional survey between September to October 2013. Data were collected, collated, checked and analysed using Statistical Package for the Social Sciences (SPSS) Version 21. Factors reporting a significant correlation with where p team leadership were 3.6 (S.D. 0.57) and 3.8 (SD 0.6) respectively. Leadership and communication between nurses were significant predictors of team work p team work.

  16. The use of echocardiography in acute cardiovascular care: recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association. (United States)

    Lancellotti, Patrizio; Price, Susanna; Edvardsen, Thor; Cosyns, Bernard; Neskovic, Aleksandar N; Dulgheru, Raluca; Flachskampf, Frank A; Hassager, Christian; Pasquet, Agnes; Gargani, Luna; Galderisi, Maurizio; Cardim, Nuno; Haugaa, Kristina H; Ancion, Arnaud; Zamorano, Jose-Luis; Donal, Erwan; Bueno, Héctor; Habib, Gilbert


    Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiac care scenarios are also described. © The European Society of Cardiology 2015.

  17. Cervical cancer screening in primary health care setting in Sudan

    DEFF Research Database (Denmark)

    Ibrahim, Ahmed; Aro, Arja R.; Rasch, Vibeke


    OBJECTIVE: To determine the feasibility of visual inspection with the use of acetic acid (VIA) as a screening method for cervical cancer, an alternative to the Pap smear used in primary health care setting in Sudan, and to compare sensitivity, specificity, positive and negative predictive values......, and histological diagnosis of positive cases of both tests. METHODS: A cross-sectional study of 934 asymptomatic women living in Khartoum, Sudan, was conducted during 2009-2010. A semi-structured questionnaire containing socio-economic and reproductive variables was used to collect data from each participant...... of this study showed that VIA has higher sensitivity and lower specificity compared to Pap smear, but a combination of both tests has greater sensitivity and specificity than each test independently. It indicates that VIA is useful for screening of cervical cancer in the primary health care setting in Sudan...

  18. Relatives' perceived quality of palliative care: comparisons between care settings in which patients die. (United States)

    de Boer, Dolf; Hofstede, Jolien M; de Veer, Anke J E; Raijmakers, Natasja J H; Francke, Anneke L


    Dying in the preferred setting is an indicator of good palliative care quality. Most people prefer to die at home. But does the quality of care as perceived by their relatives vary depending on the care setting that is the place of death? The aim is to compare (from the relatives perspective) whether there are perceived differences in the quality of palliative care between the settings in which people die. Multivariate linear regression analyses have been carried out using an existing dataset containing information collected using the relatives' version of the Consumer Quality Index (CQ-index) Palliative Care. The dataset includes 1368 relatives of patients with a wide variety of conditions who died in various locations: at home, in hospital, in residential care for the elderly, a hospice, palliative care unit or in another institution (e.g. institutions for people with intellectual disabilities or mental healthcare institutions). The relatives were the first contacts (family members or other people close to the patient) and they received the survey between 6 weeks and 6 months after the bereavement. Based on the raw data, differences between locations in terms of the perceived quality of care initially appeared inconsistent. The multivariate regression analyses however showed that relatives of people who died at home were generally the most positive about the palliative care that the patient and they themselves received when the patient was dying. The care provided by hospices also received a relatively good rating. In hospitals and in residential settings for care of the elderly, the care was rated less highly by the relatives. The quality of palliative care as experienced from the relatives' perspective is highest when the patient dies at home or in a hospice. This is an argument for letting people die at home, if they so wish, as far as possible and feasible.

  19. Antimicrobial Stewardship in Acute Care Centres: A Survey of 68 Hospitals in Quebec

    Directory of Open Access Journals (Sweden)

    Vincent Nault


    Full Text Available BACKGROUND: Antimicrobial stewardship programs (ASPs and quantitative monitoring of antimicrobial use are required to ensure that antimicrobials are used appropriately in the acute care setting, and have the potential to reduce costs and limit the spread of antimicrobial-resistant organisms and Clostridium difficile. Currently, it is not known what proportion of Quebec hospitals have an ASP and/or monitor antimicrobial use.

  20. Ethical issues for nurses providing perinatal care in community settings. (United States)

    Moore, M L


    Ethical issues in perinatal nursing are complex in that two patients--mother and fetus--are considered. This work considers six areas of potential ethical conflict: conflict between the mother and fetus, informed consent, confidentiality, cultural conflicts, conflicts associated with managed care, and conflicts in childbirth education. Ethical principles of autonomy, beneficence, and justice are included. Strategies for resolving ethical conflicts in community practice settings are suggested.

  1. Reliability of the Knee Smartphone-Application Goniometer in the Acute Orthopedic Setting. (United States)

    Pereira, Luís Carlos; Rwakabayiza, Sylvia; Lécureux, Estelle; Jolles, Brigitte M


    The standard goniometer (SG) is the most commonly used tool to assess range of motion (ROM) in patients with knee restrictions. Several medical applications have been designed to measure joint ROM. Little data are available on their reliability in the postoperative clinical setting. The purpose of this study was to assess whether a smartphone accelerometer-based knee goniometer application (App) is as reliable as the SG to measure knee ROM in clinical settings. A total of 60 subjects were included in this cross-sectional reliability trial. Overall, 20 healthy subjects (HS) and 20 acute postoperative patients (PO) underwent three active and three passive measurements in knee flexion and extension, using the SG and the smartphone knee goniometer App. To determine the fatigability of postoperative patients, a third group of 20 patients underwent a single active measurement in knee flexion and extension (PO1). Measurements were performed by three clinicians. For intraobserver reliability, mean intraclass correlation coefficient (ICC) values were higher for the App in all circumstances (overall mean SG 0.85, App 0.91), indicating an excellent correlation. For interobserver reliability, the highest ICC scores were in the PO1 group, with the App more consistent than the SG in all movements. Interobserver reliability was lower in the PO group versus PO1. Interobserver reliability was better for active ROM than for passive measurements. The overall concordance coefficient was very good to excellent with active measurements (range, 0.60-0.97). In conclusion, the App is a reliable tool for use in acute orthopedic care and offers better intra- and interobserver correlation scores for a single active measurement. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Implementing culture change in long-term dementia care settings. (United States)

    McGreevy, Jessica


    The approach to nursing in long-term care settings for people living with dementia continues to evolve from a traditional, task-oriented culture to one that is person-centred. Such change can be difficult to manage and may encounter considerable opposition; having an understanding of change management and leadership styles may help to make this transition easier. This article discusses the differences between task-oriented and person-centred care, theories of management, motivation and leadership styles, and focuses on those that are most appropriate for this type of change. An improved understanding of these theories will enable nurses to support others in the delivery of person-centred care.

  3. Implementing a resident acute care surgery service: Improving resident education and patient care. (United States)

    Kantor, Olga; Schneider, Andrew B; Rojnica, Marko; Benjamin, Andrew J; Schindler, Nancy; Posner, Mitchell C; Matthews, Jeffrey B; Roggin, Kevin K


    To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation. Outcomes were recorded prospectively and reviewed at weekly quality improvement conferences. The following information was collected: (1) teaching assistant case logs for senior residents preimplentation (n = 10) and postimplementation (n = 5) of the resident acute care surgery service; (2) data on the proportion of each case performed independently by residents; (3) resident evaluations of the resident acute care surgery versus other general operative services; (4) consult time for the first 12 months of the service (June 2014 to June 2015). During the first year after implementation, the number of total teaching assistant cases logged among graduating chief residents increased from a mean of 13.4 ± 13.0 (range 4-44) for preresident acute care surgery residents to 30.8 ± 8.8 (range 27-36) for postresident acute care surgery residents (P surgery (n = 27) in comparison with other general operative services (n = 127). In addition, creation of a 1-team consult service resulted in a more streamlined consult process with average consult time of 22 minutes for operative consults and 25 minutes for nonoperative consults (range 5-90 minutes). The implementation of a resident acute care surgery service has increased resident autonomy, teaching assistant cases, and satisfaction with operative case variety, as well as the efficiency of operative consultation at our institution. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Identification of human trafficking victims in health care settings. (United States)

    Baldwin, Susie B; Eisenman, David P; Sayles, Jennifer N; Ryan, Gery; Chuang, Kenneth S


    An estimated 18,000 individuals are trafficked into the United States each year from all over the world, and are forced into hard labor or commercial sex work. Despite their invisibility, some victims are known to have received medical care while under traffickers' control. Our project aimed to characterize trafficking victims' encounters in US health care settings. The study consisted of semi-structured interviews with six Key Informants who work closely with trafficking victims (Phase I) and 12 female trafficking survivors (Phase II). All survivors were recruited through the Coalition to Abolish Slavery and Trafficking, an NGO in Los Angeles, and all were trafficked into Los Angeles. Interviews were conducted in English and six other languages, with the assistance of professional interpreters. Using a framework analysis approach that focused on victims' encounters in health care settings, we assessed interview transcript content and coded for themes. We used an exploratory pile-sorting technique to aggregate similar ideas and identify overarching domains. The survivors came from 10 countries. Eight had experienced domestic servitude, three had survived sex trafficking, and one had experienced both. Half the survivors reported that they had visited a physician while in their traffickers' control, and another worked in a health care facility. All Key Informants described other victims who had received medical care. For domestic servants, medical visits were triggered by injury and respiratory or systemic illness, while sex trafficking victims were seen by health professionals for sexually transmitted infections and abortion. Trafficking victims were prevented from disclosing their status to health care providers by fear, shame, language barriers, and limited interaction with medical personnel, among other obstacles. This exploration of survivors' experiences in health care settings supports anecdotal reports that US health care providers may unwittingly encounter

  5. Lack of Needs Assessment in Cancer Survivorship Care and Rehabilitation in Hospitals and Primary Care Settings

    DEFF Research Database (Denmark)

    Handberg, Charlotte; Jensen, Charlotte Maria; Maribo, Thomas


    the aim of this study was to describe specific survivorship care and rehabilitation needs and plans as stated by patients with cancer at hospitals when diagnosed and when primary care survivorship care and rehabilitation begins. Methods: Needs assessment forms from cancer patients at two hospitals and two...... primary care settings were analyzed. The forms included stated needs and survivorship care and rehabilitation plans. All data were categorized using the International Classification of Functioning, Disability and Health (ICF). Results: Eighty-nine patients at hospitals and 99 in primary care, stated...... their needs. Around 50% of the patients completed a survivorship care and rehabilitation plan. In total, 666 (mean 7.5) needs were stated by hospital patients and 836 (mean 8.0) by those in primary care. The needs stated were primarily within the ICF component “body functions and structure”, and the most...

  6. Self-rated worry in acute care telephone triage

    DEFF Research Database (Denmark)

    Gamst-Jensen, Hejdi; Huibers, Linda; Pedersen, Kristoffer


    BACKGROUND: Telephone triage is used to assess acute illness or injury. Clinical decision making is often assisted by triage tools that lack callers' perspectives. This study analysed callers' perception of urgency, defined as degree of worry in acute care telephone calls. AIM: To explore...... emotions of feeling bothered to feeling distressed. Callers provided more contextual information when asked about their degree of worry. CONCLUSION: Callers were able to rate their degree of worry. The degree of worry scale is feasible for larger-scale studies if incorporating a patient-centred approach...

  7. Chronic obstructive pulmonary disease: Emergency care in acute exacerbation

    Directory of Open Access Journals (Sweden)

    Tedd J. Welniak


    The purpose of this paper is to outline the current state of research and international guidelines surrounding the management of acute exacerbation of COPD in the emergency centre. Strict adherence to international guidelines for management of acute exacerbation of COPD may be difficult for many African providers given factors affecting diagnosis, treatment, and access to care for many Africans suffering from COPD. Research looking into the role of the African EM practitioner in providing more cost-effective means of diagnosis and treatment of COPD is limited.

  8. Creating positive practice environments in a primary health care setting. (United States)

    Rabie, Tinda; Klopper, Hester C; Coetzee, Siedine K


    The aim of this study was to explore and describe the perceptions of nurse managers, nurses, and a physician in the community health centre with the most positive practice environment in a province of South Africa. Ten (N = 10) semistructured individual interviews were conducted with personnel of the community health centre with the most positive practice environment. Personnel cited the following as the most important characteristics of a positive practice environment in a primary health care setting: support, leadership and governance, collegial nurse-physician relationships, and quality of care. In a primary health care setting, it is important to train, appoint, and support managers who in turn will be able to train and support their personnel. Furthermore, reciprocal community involvement must be encouraged between personnel of the community health centre and stakeholders in the community to improve the health status of the community. Finally, group cohesions between all health care workers and managers at different organisational levels should be encouraged, as this enhances teamwork and a culture of teaching-learning and improves the competence of all staff. © 2017 John Wiley & Sons Australia, Ltd.

  9. Quality indicators for integrated care of dysphagia in hospital settings. (United States)

    Moraes, Danielle Pedroni; Andrade, Claudia Regina Furquim de


    This article proposes a panel of quality indicators for the management of swallowing rehabilitation (SR) therapy in a hospital setting. There were four stages in developing these indicators: identifying procedures to be managed; generating indicators and standardizing data collection; identifying the correlation among indicators; and formulating the panel of indicators. The following 12 quality indicators were developed: swallowing evaluation index; individual care index; speech-language pathologist (SLP) care index; number of assisted patients index; severity rate; swallowing diagnosis rate per hospital unit; swallowing rehabilitation demand index; time until first swallowing evaluation; SLP index per hospital bed; time until removal of feeding tube; time until reintroduction of oral feeding; and time until decannulation. The proposed indicators were designed to improve the management of dysphagia in a hospital setting. Measuring these indicators is essential to understanding the patient's needs and providing quality care. Managing care using these indicators will make it easier to track the patient's rehabilitation process, measure the effectiveness of new therapeutic processes and technologies, and evaluate the performance of hospital units relative to other providers in the area. The management of SR using quality indicators allows the effectiveness and efficiency of rehabilitation programs to be clearly evaluated.

  10. Evaluation of ceiling lifts in health care settings: patient outcome and perceptions. (United States)

    Alamgir, Hasanat; Li, Olivia Wei; Gorman, Erin; Fast, Catherine; Yu, Shicheng; Kidd, Catherine


    Ceiling lifts have been introduced into health care settings to reduce manual patient lifting and thus occupational injuries. Although growing evidence supports the effectiveness of ceiling lifts, a paucity of research links indicators, such as quality of patient care or patient perceptions, to the use of these transfer devices. This study explored the relationship between ceiling lift coverage rates and measures of patient care quality (e.g., incidence of facility-acquired pressure ulcers, falls, urinary infections, urinary incontinence, and assaults [patient to staff] in acute and long-term care facilities), as well as patient perceptions of satisfaction with care received while using ceiling lifts in a complex care facility. Qualitative semi-structured interviews were used to generate data. A significant inverse relationship was found between pressure ulcer rates and ceiling lift coverage; however, this effect was attenuated by year. No significant relationships existed between ceiling lift coverage and patient outcome indicators after adding the "year" variable to the model. Patients generally approved of the use of ceiling lifts and recognized many of the benefits. Ceiling lifts are not detrimental to the quality of care received by patients, and patients prefer being transferred by ceiling lifts. The relationship between ceiling lift coverage and pressure ulcer rates warrants further investigation. Copyright (c) 2009, SLACK Incorporated.

  11. Better interprofessional teamwork, higher level of organized care, and lower risk of burnout in acute health care teams using care pathways: a cluster randomized controlled trial. (United States)

    Deneckere, Svin; Euwema, Martin; Lodewijckx, Cathy; Panella, Massimiliano; Mutsvari, Timothy; Sermeus, Walter; Vanhaecht, Kris


    Effective interprofessional teamwork is an essential component for the delivery of high-quality patient care in an increasingly complex medical environment. The objective is to evaluate whether the implementation of care pathways (CPs) improves teamwork in an acute hospital setting. A posttest-only cluster randomized controlled trial was performed in Belgian acute hospitals. Teams caring for patients hospitalized with a proximal femur fracture and those hospitalized with an exacerbation of chronic obstructive pulmonary disease, were randomized into intervention and control groups. The intervention group implemented a CP. The control group provided usual care. A set of team input, process, and output indicators were used as effect measures. To analyze the results, we performed multilevel statistical analysis. Thirty teams and a total of 581 individual team members participated. The intervention teams scored significantly better in conflict management [β=0.30 (0.11); 95% confidence interval (CI), 0.08 to 0.53]; team climate for innovation [β=0.29 (0.10); 95% CI, 0.09 to 0.49]; and level of organized care [β=5.56 (2.05); 95% CI, 1.35 to 9.76]. They also showed lower risk of burnout as they scored significantly lower in emotional exhaustion [β=-0.57 (0.21); 95% CI, -1.00 to -0.14] and higher in the level of competence (β=0.39; 95% CI, 0.15 to 0.64). No significant effect was found on relational coordination. CPs are effective interventions for improving teamwork, increasing the organizational level of care processes, and decreasing risk of burnout for health care teams in an acute hospital setting. Through this, high-performance teams can be built.

  12. Palliative care case management in primary care settings: A nationwide survey

    NARCIS (Netherlands)

    Plas, A.G. van der; Deliens, L.; Watering, M. van de; Jansen, W.J.; Vissers, K.C.P.; Onwuteaka-Philipsen, B.D.


    BACKGROUND: In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the

  13. Palliative care case management in primary care settings: A nationwide survey

    NARCIS (Netherlands)

    van der Plas, A.G.M.; Deliens, L.; van de Watering, M.; Jansen, W.J.J.; Vissers, K.C.; Onwuteaka-Philipsen, B.D.


    Background: In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the

  14. Decision Making in Different Care Settings: Do Undergraduate Students Already Care?

    Directory of Open Access Journals (Sweden)

    Ralf M. Jendyk


    Discussion: As decision making in medical care is an essential part of a physicians׳ daily routine and has tremendous impact on all parties involved, the results stress the need for addressing the different care settings as an influencing factor in undergraduate and continuing medical education.

  15. Malpractice litigation in acute stroke care - where are we now? (United States)

    Leung, Gilberto Kk; Porter, Gerard


    Acute stroke care has undergone momentous changes in recent years with the introduction of intravenous thrombolysis, mechanical thrombectomy and integrated stroke services. While these are welcome developments, they also carry unique medico-legal challenges. In 2015, a patient from Greater Manchester was awarded over £1 million in compensation after ambulance paramedics failed to admit her to a specialist unit. This paper explores the medico-legal implications of this first but over looked thrombolysis-related claim in the United Kingdom. It is submitted that the highly time-dependent and multidisciplinary nature of acute stroke care may expose a host of healthcare personnel, both medical and non-medical, to risks of legal pursuit for failing to provide appropriate care, and that available scientific evidence will likely support such claims. The situation calls for an urgent and concerted effort at implementing improvement measures at national levels. A reminder of the legal consequences of substandard acute stroke care is timely and necessary.

  16. Hospital medicine (Part 2): what would improve acute hospital care?

    LENUS (Irish Health Repository)

    Kellett, John


    There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

  17. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Jensen, Jens Ulrik Stæhr; Jørgensen, Karsten Juhl


    BACKGROUND: Acute respiratory infections (ARIs) are by far the most common reason for prescribing an antibiotic in primary care, even though the majority of ARIs are of viral or non-severe bacterial aetiology. Unnecessary antibiotic use will, in many cases, not be beneficial to the patients...... the benefits and harms of point-of-care biomarker tests of infection to guide antibiotic treatment in patients presenting with symptoms of acute respiratory infections in primary care settings regardless of age. SEARCH METHODS: We searched CENTRAL (2013, Issue 12), MEDLINE (1946 to January 2014), EMBASE (2010...... forms part of the acute phase response to acute tissue injury regardless of the aetiology (infection, trauma and inflammation) and may in the correct clinical context be used as a surrogate marker of infection, possibly assisting the doctor in the clinical management of ARIs. OBJECTIVES: To assess...

  18. Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit. (United States)

    Fu, Jack B; Lee, Jay; Shin, Ben C; Silver, Julie K; Smith, Dennis W; Shah, Jatin J; Bruera, Eduardo


    Pancytopenia, immunosuppression, and other factors may place patients with multiple myeloma at risk for medical complications. These patients often require inpatient rehabilitation. No previous studies have looked at risk factors for return to the primary acute care service of this patient population. To determine the percentage of and factors associated with return to the primary acute care service of multiple myeloma rehabilitation inpatients. Retrospective review. Acute inpatient rehabilitation unit within a National Cancer Institute Comprehensive Cancer Center. All patients with multiple myeloma admitted to the inpatient rehabilitation unit between March 1, 2004, and February 28, 2015. Return to the primary acute care service was analyzed with demographic information, multiple myeloma characteristics, medications, laboratory values, and hospital admission characteristics. One hundred forty-three inpatient rehabilitation admissions were found during the study period. After we removed multiple admissions of the same patients and planned transfers to the primary acute care service, 122 admissions were analyzed. Thirty-two (26%) patients transferred back to the primary acute care service for unplanned reasons. Multivariate analysis revealed male gender and thrombocytopenia as significantly associated with return to the primary acute care service. The median survival of patients who transferred back to the inpatient primary acute care service was 180 days versus 550 days for those who did not (P service. Factors associated with an increased risk of transfer back to the primary acute care service include male gender and thrombocytopenia. IV. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  19. Priority Setting, Cost-Effectiveness, and the Affordable Care Act. (United States)

    Persad, Govind


    The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

  20. A web-based and mobile patient-centered ''microblog'' messaging platform to improve care team communication in acute care. (United States)

    Dalal, Anuj K; Schnipper, Jeffrey; Massaro, Anthony; Hanna, John; Mlaver, Eli; McNally, Kelly; Stade, Diana; Morrison, Constance; Bates, David W


    Communication in acute care settings is fragmented and occurs asynchronously via a variety of electronic modalities. Providers are often not on the same page with regard to the plan of care. We designed and developed a secure, patient-centered "microblog" messaging platform that identifies care team members by synchronizing with the electronic health record, and directs providers to a single forum where they can communicate about the plan of care. The system was used for 35% of patients admitted to a medical intensive care unit over a 6-month period. Major themes in messages included care coordination (49%), clinical summarization (29%), and care team collaboration (27%). Message transparency and persistence were seen as useful features by 83% and 62% of respondents, respectively. Availability of alternative messaging tools and variable use by non-unit providers were seen as main barriers to adoption by 83% and 62% of respondents, respectively. This approach has much potential to improve communication across settings once barriers are addressed. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

  1. The induction of acute psychosis in a group setting. (United States)

    Powell, C


    The case histories of two patients are described, each of whom suffered a severe psychotic decompensation, one apparently schizophreniform and the other affective, after attending a seven day marathon group conducted by a charismatic, aggressive leader. The work of Yalom and Lieberman is reviewed, with regard to leader and participant characteristics in encounter group casualties. Drawing upon the work of Bion and Kernberg, a specific means for the induction of psychosis is suggested, involving primitive splitting and the projection of "all bad" self-object constellations within a group setting.

  2. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

    Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M


    /unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving......Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient...... clinical outcomes. Changes in structure and processes to deliver high-level quality care need to be regularly audited to ensure translation into better outcomes. QIs can help drive this process by providing an indicator of current levels of performance. In addition, outcomes QIs can be used to benchmark...

  3. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

    Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M


    /unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving......Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient...... clinical outcomes. Changes in structure and processes to deliver high-level quality care need to be regularly audited to ensure translation into better outcomes. QIs can help drive this process by providing an indicator of current levels of performance. In addition, outcomes QIs can be used to benchmark...

  4. Care mapping in clinical neuroscience settings: Cognitive impairment and dependency. (United States)

    Leigh, Andrew James; O'Hanlon, Katie; Sheldrick, Russell; Surr, Claire; Hare, Dougal Julian


    Person-centred care can improve the well-being of patients and is therefore a key driver in healthcare developments in the UK. The current study aims to investigate the complex relationship between cognitive impairment, dependency and well-being in people with a wide range of acquired brain and spinal injuries. Sixty-five participants, with varied acquired brain and spinal injuries, were selected by convenience sampling from six inpatient clinical neuroscience settings. Participants were observed using Dementia Care Mapping - Neurorehabilitation (DCM-NR) and categorised based on severity of cognitive impairment. A significant difference in the behaviours participants engaged in, their well-being and dependency was found between the severe cognitive impairment group and the mild, moderate or no cognitive impairment groups. Dependency and cognitive impairment accounted for 23.9% of the variance in well-ill-being scores and 17.2% of the variance in potential for positive engagement. The current study highlights the impact of severe cognitive impairment and dependency on the behaviours patients engaged in and their well-being. It also affirms the utility of DCM-NR in providing insights into patient experience. Consideration is given to developing DCM-NR as a process that may improve person-centred care in neuroscience settings.

  5. Ventilatory strategies and supportive care in acute respiratory distress syndrome. (United States)

    Luks, Andrew M


    While antiviral therapy is an important component of care in patients with the acute respiratory distress syndrome (ARDS) following influenza infection, it is not sufficient to ensure good outcomes, and additional measures are usually necessary. Patients usually receive high levels of supplemental oxygen to counteract the hypoxemia resulting from severe gas exchange abnormalities. Many patients also receive invasive mechanical ventilation for support for oxygenation, while in resource-poor settings, supplemental oxygen via face mask may be the only available intervention. Patients with ARDS receiving mechanical ventilation should receive lung-protective ventilation, whereby tidal volume is decreased to 6 ml/kg of their predicted weight and distending pressures are maintained ≤ 30 cm H2 O, as well as increased inspired oxygen concentrations and positive end-expiratory pressure (PEEP) to prevent atelectasis and support oxygenation. While these measures are sufficient in most patients, a minority develop refractory hypoxemia and may receive additional therapies, including prone positioning, inhaled vasodilators, extracorporeal membrane oxygenation, recruitment maneuvers followed by high PEEP, and neuromuscular blockade, although recent data suggest that this last option may be warranted earlier in the clinical course before development of refractory hypoxemia. Application of these "rescue strategies" is complicated by the lack of guidance in the literature regarding implementation. While much attention is devoted to these strategies, clinicians must not lose sight of simple interventions that affect patient outcomes including head of bed elevation, prophylaxis against venous thromboembolism and gastrointestinal bleeding, judicious use of fluids in the post-resuscitative phase, and a protocol-based approach to sedation and spontaneous breathing trials. © 2013 Blackwell Publishing Ltd.

  6. Variability in antibiotic use across Ontario acute care hospitals. (United States)

    Tan, Charlie; Vermeulen, Marian; Wang, Xuesong; Zvonar, Rosemary; Garber, Gary; Daneman, Nick


    Antibiotic stewardship is a required organizational practice for Canadian acute care hospitals, yet data are scarce regarding the quantity and composition of antibiotic use across facilities. We sought to examine the variability, and risk-adjusted variability, in antibiotic use across acute care hospitals in Ontario, Canada's most populous province. Antibiotic purchasing data from IMS Health, previously demonstrated to correlate strongly with internal antibiotic dispensing data, were acquired for 129 Ontario hospitals from January to December 2014 and linked to patient day (PD) denominator data from administrative datasets. Hospital variation in DDDs/1000 PDs was determined for overall antibiotic use, class-specific use and six practices of clinical or ecological significance. Multivariable risk adjustment for hospital and patient characteristics was used to compare observed versus expected utilization. There was 7.4-fold variability in the quantity of antibiotic use across the 129 acute care hospitals, from 253 to 1873 DDDs/1000 PDs. Variation was evident within hospital subtypes, exceeded that explained by hospital and patient characteristics, and included wide variability in proportion of broad-spectrum antibiotics (IQR 36%-48%), proportion of fluoroquinolones among respiratory antibiotics (IQR 40%-62%), proportion of ciprofloxacin among urinary anti-infectives (IQR 44%-60%), proportion of antibiotics with highest risk for Clostridium difficile (IQR 29%-40%), proportion of 'reserved-use' antibiotics (IQR 0.8%-3.5%) and proportion of anti-pseudomonal antibiotics among antibiotics with Gram-negative coverage (IQR 26%-40%). There is extensive variability in antibiotic use, and risk-adjusted use, across acute care hospitals. This could motivate, focus and benchmark antibiotic stewardship efforts. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email

  7. Attitude of resident doctors towards intensive care units′ alarm settings

    Directory of Open Access Journals (Sweden)

    Rakesh Garg


    Full Text Available Intensive care unit (ICU monitors have alarm options to intimate the staff of critical incidents but these alarms needs to be adjusted in every patient. With this objective in mind, this study was done among resident doctors, with the aim of assessing the existing attitude among resident doctors towards ICU alarm settings. This study was conducted among residents working at ICU of a multispeciality centre, with the help of a printed questionnaire. The study involved 80 residents. All residents were in full agreement on routine use of ECG, pulse oximeter, capnograph and NIBP monitoring. 86% residents realised the necessity of monitoring oxygen concentration, apnoea monitoring and expired minute ventilation monitoring. 87% PGs and 70% SRs routinely checked alarm limits for various parameters. 50% PGs and 46.6% SRs set these alarm limits. The initial response to an alarm among all the residents was to disable the alarm temporarily and try to look for a cause. 92% of PGs and 98% of SRs were aware of alarms priority and colour coding. 55% residents believed that the alarm occurred due to patient disturbance, 15% believed that alarm was due to technical problem with monitor/sensor and 30% thought it was truly related to patient′s clinical status. 82% residents set the alarms by themselves, 10% believed that alarms should be adjusted by nurse, 4% believed the technical staff should take responsibility of setting alarm limits and 4% believed that alarm levels should be pre-adjusted by the manufacturer. We conclude that although alarms are an important, indispensable, and lifesaving feature, they can be a nuisance and can compromise quality and safety of care by frequent false positive alarms. We should be familiar of the alarm modes, check and reset the alarm settings at regular interval or after a change in clinical status of the patient.

  8. Delegation: what it means to acute care nurses. (United States)

    Standing, Theresa S; Anthony, Mary K


    As health care costs rise, nurses are increasingly delegating tasks to unlicensed assistive personnel (UAP). The purpose of this phenomenologic study was to describe delegation from the perspective of the acute care nurse. We analyzed interviews with staff nurses, and a description of the meaning of delegation was developed using Donabedian's structure, process, outcome model to organize the findings. The process of delegation centered on communication and on nurse-UAP relationship and was shaped by the structural themes. The outcomes of delegation included nursing and patient outcomes. An enhanced content on communication and interpersonal relations is needed in nursing education.

  9. The lived experiences of acute-care bedside registered nurses caring for patients and their families with limited English proficiency: A silent shift. (United States)

    Coleman, Jami-Sue; Angosta, Alona D


    To explore the lived experiences of acute-care bedside nurses caring for patients and their families with limited English proficiency. Approximately 8.6% of the total US population is considered limited English proficient. In the hospital setting, registered nurses provide the most direct contact with patients and their families. Effective communication between patients and healthcare professionals is essential when providing quality health care. There are only few published studies about registered nurses' experiences caring for patients with language barriers, but studies among nurses' experiences on patients with limited English proficiency and their families in an acute-care setting have not been explored. A qualitative exploratory study was performed. The phenomenology research approach provides the most meaningful ways to describe and understand the entirety of the bedside nurses' experiences. A convenience, purposive sample of 40 registered nurses who work in bedside care in a 380-bed hospital in the western USA were interviewed. Each nurse had a minimum of three years of acute-care experience. The sample size was determined by data saturation. Four themes emerged from the data of this research including: Desire to Communicate; Desire to Connect; Desire to Provide Care; and Desire to Provide Cultural Respect and Understanding. Care of patients with limited English proficiency is a challenge to many nurses and other healthcare providers. This study reinforces the need to give acute-care nurses a voice to share their experiences and ideas for solutions to the challenges they face in the care they provide. Findings from this study have the potential to identify clinically relevant concerns, barriers to communication, resources for effective communication, and needs or concerns of the bedside nurses when providing care. A look at the process and organisational system may suggest opportunities for improvement in support of the nurses' expressed desires to provide

  10. The US emergency care system: meeting everyday acute care needs while being ready for disasters. (United States)

    Lurie, Nicole; Margolis, Gregg S; Rising, Kristin L


    The emergency care system is an essential part of the US health care system. In addition to providing acute resuscitation and life- and limb-saving care, the emergency care system provides considerable support to physicians outside the emergency department and serves as an important safety-net provider. In times of disaster, the emergency care system must be able to surge rapidly to accommodate a massive influx of patients, sometimes with little or no notice. Extreme daily demands on the system can promote innovations and adaptations that are invaluable in responding to disasters. However, excessive and inappropriate utilization is wasteful and can diminish "surge capacity" when it is most needed. Certain features of the US health care system have imposed strains on the emergency care system. We explore policy issues related to moving toward an emergency care system that can more effectively meet both individuals' needs for acute care and the broader needs of the community in times of disaster. Strategies for the redesign of the emergency care system must include the active engagement of both patients and the community and a close look at how to align incentives to reward quality and efficiency throughout the health care system.

  11. Managing low back pain in the primary care setting: the know-do gap. (United States)

    Scott, N Ann; Moga, Carmen; Harstall, Christa


    To ascertain knowledge gaps in the diagnosis and treatment of acute and chronic low back pain (LBP) in the primary care setting to prepare a scoping survey for identifying knowledge gaps in LBP management among Alberta's primary care practitioners, and to identify potential barriers to implementing a multidisciplinary LBP guideline. English language studies, published from 1996 to 2008, comparing the clinical practice patterns of primary care practitioners with guideline recommendations were identified by systematically searching literature databases, the websites of various health technology assessment agencies and libraries, and the Internet. Data were synthesized qualitatively. The literature search identified 14 relevant studies. Knowledge gaps were reported among various primary care practitioner groups in the assessment of red flags, use of diagnostic imaging, provision of advice regarding sick leave and continuing activity, administration of some medications (muscle relaxants, oral steroids and opioids) and recommendation of particular treatments (acupuncture, physiotherapy, spinal manipulation, traction, ultrasound, transcutaneous electrical nerve stimulation and spinal mobilization). A know-do gap clearly exists among primary care practitioners with respect to the diagnosis and treatment of LBP. The information on know-do gaps will be used to construct a survey tool for unearthing the local knowledge gaps extant among Alberta's primary care practitioners, and to develop a dissemination strategy for a locally produced multidisciplinary LBP guideline, with the aim of ensuring that the know-do gaps inherent within each primary practice discipline are specifically targeted.

  12. The outcomes of the elderly in acute care general surgery. (United States)

    St-Louis, E; Sudarshan, M; Al-Habboubi, M; El-Husseini Hassan, M; Deckelbaum, D L; Razek, T S; Feldman, L S; Khwaja, K


    Elderly patients form a growing subset of the acute care surgery (ACS) population. Older age may be associated with poorer outcomes for some elective procedures, but there are few studies focusing on outcomes for the elderly ACS population. Our objective is to characterize differences in mortality and morbidity for acute care surgery patients >80 years old. A retrospective review of all ACS admissions at a large teaching hospital over 1 year was conducted. Patients were classified into non-elderly (4 days) hospital stay (p = 0.05), increased postoperative complications (p = 0.002), admission to the ICU (p = 0.002), and were more likely to receive a non-operative procedure (p = 0.003). No difference was found (p = NS) for patient flow factors such as time to consult general surgery, time to see consult by general surgery, and time to operative management and disposition. Compared to younger patients admitted to an acute care surgery service, patients over 80 years old have a higher risk of complications, are more likely to require ICU admission, and stay longer in the hospital.

  13. Designing Collaborative Healthcare Technology for the Acute Care Workflow

    Directory of Open Access Journals (Sweden)

    Michael Gonzales


    Full Text Available Preventable medical errors in hospitals are the third leading cause of death in the United States. Many of these are caused by poor situational awareness, especially in acute care resuscitation scenarios. While a number of checklists and technological interventions have been developed to reduce cognitive load and improve situational awareness, these tools often do not fit the clinical workflow. To better understand the challenges faced by clinicians in acute care codes, we conducted a qualitative study with interprofessional clinicians at three regional hospitals. Our key findings are: Current documentation processes are inadequate (with information recorded on paper towels; reference guides can serve as fixation points, reducing rather than enhancing situational awareness; the physical environment imposes significant constraints on workflow; homegrown solutions may be used often to solve unstandardized processes; simulation scenarios do not match real-world practice. We present a number of considerations for collaborative healthcare technology design and discuss the implications of our findings on current work for the development of more effective interventions for acute care resuscitation scenarios.

  14. Between chaos and care in a harm reduction setting

    DEFF Research Database (Denmark)

    Kappel, Nanna; Tegner, Jette; Toth, Eva Charlotte

    . DCR clients often face stressful living circumstances, like unstable housing as well as physical and mental health issues. Despite this, the staff establish relationships with clients and build bridge to health care facilities, social services and addiction therapy. Aim: The purpose of this study...... relationships and met clients in a non-judgmental, accepting and educational approach. Clients expressed feeling safe, socially accepted and seen as human beings. In this setting, between chaos and care, staff established rapport and positive referrals to both health and social sector as well as addiction...... therapy. Analysis from this study also showed, that DCRs provide a frame for harm reduction services in relation to hygiene, safer injection techniques and prevention of potential overdoses as well as interventions in overdose situations. Furthermore, the clients valued the staff's education and some...

  15. Feasibility of Implementing Chronic Care Model in the Malaysian Public Primary Care Setting. (United States)

    Ariffin, F; Ramli, A S; Daud, M H; Haniff, J; Abdul-Razak, S; Selvarajah, S; Lee, V K; Tong, S F; Bujang, M A


    Non-communicable diseases (NCD) is a global health threat. the Chronic Care Model (CCM) was proven effective in improving NCD management and outcomes in developed countries. Evidence from developing countries including Malaysia is limited and feasibility of CCM implementation has not been assessed. this study intends to assess the feasibility of public primary health care clinics (PHC) in providing care according to the CCM. A cross-sectional survey was conducted to assess the public PHC ability to implement the components of CCM. All public PHC with Family Medicine Specialist in Selangor and Kuala Lumpur were invited to participate. A site feasibility questionnaire was distributed to collect site investigator and clinic information as well as delivery of care for diabetes and hypertension. there were a total of 34 public PHC invited to participate with a response rate of 100%. there were 20 urban and 14 suburban clinics. the average number of patients seen per day ranged between 250-1000 patients. the clinic has a good mix of multidisciplinary team members. All clinics had a diabetic registry and 73.5% had a hypertensive registry. 23.5% had a dedicated diabetes and 26.5% had a dedicated hypertension clinic with most clinic implementing integrated care of acute and NCD cases. the implementation of the essential components of CCM is feasible in public PHCs, despite various constraints. Although variations in delivery of care exists, majority of the clinics have adequate staff that were willing to be trained and are committed to improving patient care.

  16. The Experience of Advanced Practice Nurses in US Emergency Care Settings. (United States)

    Wolf, Lisa A; Delao, Altair M; Perhats, Cydne; Moon, Michael D; Carman, Margaret J


    Little information has been published regarding the actual practice, training, and validation of basic skills and competencies needed by the advanced practice registered nurse (APRN) in the emergency care setting. The purpose of this study was to (1) identify skills being performed by APRNs practicing in emergency care settings (2); explore types of training; and (3) describe competency validation. Additionally, we explored frequency of skill use and facilitators and barriers to performing a skill to the full extent of training and education. An exploratory mixed-methods study was performed incorporating a self-report survey and focus group interviews. The educational path to advanced practice nursing in emergency care settings is not standardized. Few programs incorporate or address the need for APRNs to receive acute care training across the life span, which is the hallmark of emergency nursing practice. Similarly, training is reported as fragmented, and validation of skills for both nurse practitioners and clinical nurse specialists can vary. APRN practice autonomy is affected by the presence of other providers (specifically physicians), institutional culture, and state boards of nursing that regulate practice. Integrated educational and orientation programs are needed that address high-acuity patients across the life span. Additionally, a more nuanced approach to assessing APRN capabilities as a combination of hard (clinical emergency) and soft (communication and organizational) skills may be an appropriate framework within which to examine the advanced practice role. Future research should continue to evaluate training, competency assessment, and outcomes for APRNs in the emergency care setting. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  17. Noncontingent reinforcement of disruptive behaviors in personal care home settings. (United States)

    Yury, Craig A


    The purpose of this case study was to examine the potential of using noncontingent reinforcement (NCR) to reduce the frequency of disruptive behaviors of three elderly persons in personal care home (PCH) settings. Assessment indicated that participants were engaging in the disruptive behaviors to obtain social attention from PCH staff. Social attention, up to 1 min of staff making eye contact with the participant and directing positive verbal statements toward the participant, was given on a fixed time interval (from morning through early evening) beginning every 20 min and fading to every 30 min. Results indicate that NCR reduced the frequency of the disruptive behaviors.

  18. Role of central venous pressure monitoring in critical care settings. (United States)

    Thomas Hill, Barry


    Central venous pressure (CVP) monitoring is used to assess the fluid status of patients in critical care settings. This article explains CVP monitoring, discussing the rationale for its use, the ways CVP can be measured, and the physiological factors that can affect the reliability and validity of CVP measurement. It also discusses the complications associated with CVP monitoring and the nursing responsibilities in relation to this activity. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  19. Critical care nursing in acute postoperative neurosurgical patients. (United States)

    Brooks, Christin


    The nursing discipline is vital throughout patients' hospital progression. One of the most critical moments in the hospital stay is the postoperative period. Neurosurgical patients require a high level of nursing care and vigilance and additional postoperative monitoring in intensive care units designed specifically for this demographic. In the postoperative setting, patient care must be transferred from anesthesia to nursing in a manner that is continuous and safe. This article focuses on neurosurgical patients in the postoperative period, the assessment of these patients, and critical care nursing, with emphasis on common issues and interventions for this dynamic patient population. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Implementation of a competency assessment tool for agency nurses working in an acute paediatric setting.

    LENUS (Irish Health Repository)

    Hennerby, Cathy


    AIM: This paper reports on the implementation of a competency assessment tool for registered general agency nurses working in an acute paediatric setting, using a change management framework. BACKGROUND: The increased number of registered general agency nurses working in an acute children\\'s hospital alerted concerns around their competency in working with children. These concerns were initially raised via informal complaints about \\'near misses\\

  1. Acute hospital dementia care: results from a national audit. (United States)

    Timmons, Suzanne; O'Shea, Emma; O'Neill, Desmond; Gallagher, Paul; de Siún, Anna; McArdle, Denise; Gibbons, Patricia; Kennelly, Sean


    Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days. Most patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001). Dementia care relating to assessment, access to certain specialist services

  2. CD-Based Microfluidics for Primary Care in Extreme Point-of-Care Settings

    Directory of Open Access Journals (Sweden)

    Suzanne Smith


    Full Text Available We review the utility of centrifugal microfluidic technologies applied to point-of-care diagnosis in extremely under-resourced environments. The various challenges faced in these settings are showcased, using areas in India and Africa as examples. Measures for the ability of integrated devices to effectively address point-of-care challenges are highlighted, and centrifugal, often termed CD-based microfluidic technologies, technologies are presented as a promising platform to address these challenges. We describe the advantages of centrifugal liquid handling, as well as the ability of a standard CD player to perform a number of common laboratory tests, fulfilling the role of an integrated lab-on-a-CD. Innovative centrifugal approaches for point-of-care in extremely resource-poor settings are highlighted, including sensing and detection strategies, smart power sources and biomimetic inspiration for environmental control. The evolution of centrifugal microfluidics, along with examples of commercial and advanced prototype centrifugal microfluidic systems, is presented, illustrating the success of deployment at the point-of-care. A close fit of emerging centrifugal systems to address a critical panel of tests for under-resourced clinic settings, formulated by medical experts, is demonstrated. This emphasizes the potential of centrifugal microfluidic technologies to be applied effectively to extremely challenging point-of-care scenarios and in playing a role in improving primary care in resource-limited settings across the developing world.

  3. Palliative care case management in primary care settings: a nationwide survey. (United States)

    van der Plas, Annicka G M; Deliens, Luc; van de Watering, Marlies; Jansen, Wim J J; Vissers, Kris C; Onwuteaka-Philipsen, Bregje D


    In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the content of care and organisational characteristics of case management in palliative care is needed. To investigate how many case management initiatives for palliative care there are in the Netherlands for patients living at home; to describe the characteristics of these initiatives with regard to content and organisation of care. Primary care. A nationwide survey of all 50 coordinators of networks in palliative care in the Netherlands was conducted. Additional respondents were found through snowball sampling. We looked at 33 possible initiatives using interviews (n=33) and questionnaires (n=30). We identified 20 initiatives for case management. All stated that case management is supplemental to other care. In all initiatives the case managers are registered nurses and most possess higher vocational education and/or further training. All initiatives seek to identify the multidimensional care needs of the patients and the relatives and friends who care for them. Almost all provide information and support and refer patients who need care. Differences are found between the organisations offering the case management, their target groups, the names of the initiatives and whether direct patient care is provided by the case manager. In the Netherlands, case management in palliative care is new. Several models of delivery were identified. Research is needed to gain insight into the best way to deliver case management. By describing characteristics of case management in palliative care, an important first step is made in identifying effective elements of case management. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Shared care requires a shared vision: communities of clinical practice in a primary care setting. (United States)

    Young, Jessica; Egan, Tony; Jaye, Chrystal; Williamson, Martyn; Askerud, Anna; Radue, Peter; Penese, Maree


    To understand how a vision of care is formed and shared by patients and the primary care professionals involved in their care. To achieve the best health outcomes, it is important for patients and those who care for them to have a mutual understanding about what is important to the patient in their everyday life and why, and what care is necessary to realise this vision. Shared or team care does not necessarily translate to a consistent and integrated approach to a patient's care. An individual patient's care network of clinical and lay participants can be conceptualised as the patient's own 'Community of Clinical Practice' of which they are the central member. Working alongside a long-term conditions nursing team, we conducted a focused ethnography of nine 'Communities of Clinical Practice' in one general practice setting. Participant observation, in-depth qualitative interviews with 24 participants including nine patients, and the patients' medical records. Data were analysed using a template organising style. Primary care professionals' insight into a patient's vision of care evolves through a deep knowing of the patient over time; this is shared between 'Community of Clinical Practice' members, frequently through informal communication and realised through respectful dialogue. These common values - respect, authenticity, autonomy, compassion, trust, care ethics, holism - underpin the development of a shared vision of care. A patient's vision of care, if shared, provides a focus around which 'Community of Clinical Practice' members cohere. Nurses play an important role in sharing the patient's vision of care with other participants. A shared vision of care is an aspirational concept which is difficult to articulate but with attentiveness, sustained authentic engagement and being driven by values, it should evolve amongst the core participants of a 'Community of Clinical Practice'. © 2017 John Wiley & Sons Ltd.

  5. Setting priorities in primary health care - on whose conditions? A questionnaire study

    Directory of Open Access Journals (Sweden)

    Arvidsson Eva


    Full Text Available Abstract Background In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1 GPs', nurses', and patients' prioritising in routine primary care 2 The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients. Methods Paired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected. Results Compared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness. Conclusions The challenge for primary care providers is to balance the patients' demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.

  6. Defining NP scope of practice and associated regulations: focus on acute care. (United States)

    Kleinpell, Ruth M; Hudspeth, Randall; Scordo, Kristine Anne; Magdic, Kathy


    Although the nurse practitioner (NP) role has been in existence for over 40 years, there continues to be uncertainty about the essential components that define NP scope of practice. The purpose of this article is to review definitions and concepts related to NP scope of practice with an emphasis on NPs working in acute care. A synthesis literature review was conducted on defining NP scope of practice. Simultaneous review of authoritative resources including National Council of State Board of Nursing, individual state board of nursing language, and NP scope and standards of practice documents was conducted. Scope of practice is a legal term used by states to define what activities an individual professional can undertake. The Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation outlines that licensure and scope of practice are based on graduate education within a defined patient population for the APRN role. The APRN Consensus Model further identifies that the services provided by APRNs are not defined or limited by setting but rather by patient care needs. For the acute care NP, this is especially significant, as patient acuity and care requirements can vary across settings. When implemented, the Consensus Model will help to standardize regulation for APRNs as well as ensure congruence between licensure, accreditation, certification, and education. Providing clarification of the NP scope of practice, especially as it pertains to NPs working in acute care settings, remains needed to support practice based on educational preparation, licensure, certification, and focus of practice. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  7. Decision making for health care professionals: use of decision trees within the community mental health setting. (United States)

    Bonner, G


    To examine the application of the decision tree approach to collaborative clinical decision-making in mental health care in the United Kingdom (UK). While this approach to decision-making has been examined in the acute care setting, there is little published evidence of its use in clinical decision-making within the mental health setting. The complexities of dual diagnosis (schizophrenia and substance misuse in this case example) and the varied viewpoints of different professionals often hamper the decision-making process. This paper highlights how the approach was used successfully as a multiprofessional collaborative approach to decision-making in the context of British community mental health care. A selective review of the relevant literature and a case study application of the decision tree framework. The process of applying the decision tree framework to clinical decision-making in mental health practice can be time consuming and client inclusion within the process is not always appropriate. The approach offers a method of assigning numerical values to support complex multiprofessional decision-making as well as considering underpinning literature to inform the final decision. Use of the decision tree offers a common framework that can assist professionals to examine the options available to them in depth, while considering the complex variables that influence decision-making in collaborative mental health practice. Use of the decision tree warrants further consideration in mental health care in terms of practice and education.

  8. Design Considerations for Post-Acute Care mHealth: Patient Perspectives. (United States)

    Sanger, Patrick; Hartzler, Andrea; Lober, William B; Evans, Heather L; Pratt, Wanda


    Many current mobile health applications ("apps") and most previous research have been directed at management of chronic illnesses. However, little is known about patient preferences and design considerations for apps intended to help in a post-acute setting. Our team is developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Post-discharge SSIs are a major source of morbidity and expense, and occur at a critical care transition when patients are physically and emotionally stressed. Through interviews with surgical patients who experienced SSI, we derived design considerations for such a post-acute care app. Key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. We illustrate our application of these guiding design considerations and propose a new framework for mHealth design based on illness duration and intensity.

  9. Internet and technology transfer in acute care hospitals in the United States: survey-2000. (United States)

    Hatcher, M


    This paper provides the results of the survey-2000 measuring technology transfer and, specifically, Internet usage. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business-to-business and customers. These results are compared with responses to the same questions in survey-1997. Changes in response are noted and discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the third of three articles based upon the results of the survey-2000. Readers are referred to prior articles by the author, which discuss the survey design and provide a tutorial on technology transfer in acute care hospitals. (1) Thefirst article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes. (2)

  10. [Detection of palliative care needs in an acute care hospital unit. Pilot study]. (United States)

    Rodríguez-Calero, Miguel Ángel; Julià-Mora, Joana María; Prieto-Alomar, Araceli


    Previous to wider prevalence studies, we designed the present pilot study to assess concordance and time invested in patient evaluations using a palliative care needs assessment tool. We also sought to estimate the prevalence of palliative care needs in an acute care hospital unit. A cross-sectional study was carried out, 4 researchers (2 doctors and 2 nurses) independently assessed all inpatients in an acute care hospital unit in Manacor Hospital, Mallorca (Spain), using the validated tool NECPAL CCOMS-ICO©, measuring time invested in every case. Another researcher revised clinical recordings to analise the sample profile. Every researcher assessed 29 patients, 15 men and 14 women, mean age 74,03 ± 10.25 years. 4-observer concordance was moderate (Kappa 0,5043), tuning out to be higher between nurses. Mean time per patient evaluation was 1.9 to 7.72 minutes, depending on researcher. Prevalence of palliative care needs was 23,28%. Moderate concordance lean us towards multidisciplinary shared assessments as a method for future research. Avarage of time invested in evaluations was less than 8 minutes, no previous publications were identified regarding this variable. More than 20% of inpatients of the acute care unit were in need of palliative care. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  11. The effectiveness of interventions in the prevention and management of aggressive behaviours in patients admitted to an acute hospital setting: a systematic review. (United States)

    Kynoch, Kate; Wu, Chiung-Jung Jo; Chang, Anne M


    Violence in healthcare has been widely reported and healthcare workers, particularly nurses in the acute care setting, are ill-equipped to manage patients who exhibit aggressive traits. An initial search of the Cochrane Library and the Joanna Briggs Institute did not reveal any published systematic reviews recommending strategies to manage aggressive and/or violent behaviours in patients admitted to an acute hospital setting. This systematic review aims to establish best practice in the prevention and management of aggressive behaviours in patients admitted to an acute hospital setting. A three-step search strategy was utilised during this review. Major databases searched included: MEDLINE, CINAHL, PsycINFO, Health source, Web of science, EMBASE, the Cochrane library and Database of abstracts of reviews of effects (DARE) as well as PubMed. The search included published and unpublished studies and papers in English from 1990-2007. This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions in the prevention and management of patients who exhibit aggressive behaviours in an acute hospital setting. In the absence of RCT's, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for preventing and managing patient aggression in acute care areas. Each included study was assessed by two independent reviewers using the appropriate appraisal checklist developed by the Joanna Briggs Institute. Data was extracted from the papers included in this review using the standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics: Assessment and Review Instrument (JBI-MAStARI) package. The studies included in this review were not suitable for meta-analysis and therefore the results are presented in narrative form. Twelve

  12. Dementia Care Mapping in long-term care settings: a systematic review of the evidence. (United States)

    Barbosa, Ana; Lord, Kathryn; Blighe, Alan; Mountain, Gail


    This systematic review identifies and reports the extent and nature of evidence to support the use of Dementia Care Mapping as an intervention in care settings. The review was limited to studies that used Dementia Care Mapping as an intervention and included outcomes involving either care workers and/or people living with dementia. Searches were conducted in PubMed, Web of Knowledge, CINAHL, PsychINFO, EBSCO, and Scopus and manually from identified articles reference lists. Studies published up to January 2017 were included. Initial screening of identified papers was based on abstracts read by one author; full-text papers were further evaluated by a second author. The quality of the identified papers was assessed independently by two authors using the Cochrane Risk of Bias Tool. A narrative synthesis of quantitative findings was conducted. We identified six papers fulfilling predefined criteria. Studies consist of recent, large scale, good quality trials that had some positive impacts upon care workers' stress and burnout and benefit people with dementia in terms of agitated behaviors, neuropsychiatric symptoms, falls, and quality of life. Available research provides preliminary evidence that Dementia Care Mapping may benefit care workers and people living with dementia in care settings. Future research should build on the successful studies to date and use other outcomes to better understand the benefits of this intervention.

  13. Shared Vision Among Acute Care Magnet® Hospital Nurses: Ordinal Confirmatory Factor Analysis. (United States)

    Liu, Wen; Johantgen, Meg; Newhouse, Robin


    Psychometric testing of the Shared Vision (SV) scale that measures team efforts toward common patient-centered goals was initially estimated among rural hospital nurse executives. The purpose of this study was to estimate the scale's reliability (internal consistency), convergent validity (Pearson correlation with Practice Environment Scale), and structural validity (ordinal confirmatory factor analysis) among acute care Magnet(®) hospital nurses. The study sample included 289 nurses from 27 acute care Magnet® hospitals. The scale demonstrated acceptable estimates for internal consistency (Cronbach's α = .902, 95% confidence interval [CI] = [0.883, 0.919]), convergent validity (r = .720, p < .001), and structural validity with a one-factor structure. The findings of this study supported the reliability and validity of the SV scale as a unidimensional construct in measuring SV among nurses in acute care Magnet® hospitals. Further testing among different nursing providers and health care settings is needed to accumulate evidence and expand use of the instrument. © The Author(s) 2016.

  14. Consensus for improving the comprehensive care of patients with acute heart failure: summarised version. (United States)

    Manito Lorite, N; Manzano Espinosa, L; Llorens Soriano, P; Masip Utset, J; Comín Colet, J; Formiga Pérez, F; Herrero Puente, P; Delgado Jiménez, J; Montero-Pérez-Barquero, M; Jacob Rodríguez, J; López de Sá Areses, E; Pérez Calvo, J I; Martín-Sánchez, F J; Miró Andreu, Ò


    The purpose of this consensus document was to reach an agreement among experts on the multidisciplinary care of patients with acute heart failure. Starting with a narrative review of the care provided to these patients and a critical analysis of the healthcare procedures, we identified potential shortcomings and improvements and formalised a document on recommendations for optimising the clinical and therapeutic approach for acute heart failure. This document was validated through an in-person group session guided using participatory techniques. The process resulted in a set of 36 recommendations formulated by experts of the Spanish Society of Cardiology, the Spanish Society of Internal Medicine and the Spanish Society of Urgent and Emergency Care. The recommendations are designed to optimise the healthcare challenge presented by the care of patients with acute heart failure in the context of Spain's current National Health System. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  15. [Effect of Silencing SET Gene on Acute Promyelocytic Leukemia NB4-R1 Cells]. (United States)

    Wang, Yuan; Zhang, Mei; He, Peng-Cheng; Qi, Jun; Liu, Yan-Feng; Zhu, Hua-Chao


    To investigate the effect of silencing SET gene on the biological characteristics of acute promyelocytic leukemia NB4-R1 cells. The expression vector of pGCSIL containing SET-shRNA were transfected into 293T cells by using other packaging plasmids. The supernatant of the 293T cells was harvested for lentivirus. The SET-shRNA lentiviral vector was transfected into acute promyelocytic leukemia NB4-R1 cells and a stably transfected cell line was established. Real-time quantitative PCR and Western blot were used to assay the silencing efficiency on SET gene and the expression of PP2A. The cell cycle distribution was tested by flow cytometry. The expression of SET in experimental group statistically decreased as compared with that of the control group. The expression of PP2A was obviously raised at the level of mRNA and protein. The percentage of NB4-R1 cells in G0/G1 phase significantly increased, while the percentage of cells in S phase significantly decreased. The silencing gene in acute promyelocytic leukemia NB4-R1 cells using SET-shRNA lentiviral vector can increase the expression of PP2A and interfere of the cell cycle in NB4-R1 cells. This study has laid a experimental base for targed therapy of patients with acute promyelocytic leukemia.

  16. Carbapenem-resistant Enterobacteriaceae carriers in acute care hospitals and postacute-care facilities: The effect of organizational culture on staff attitudes, knowledge, practices, and infection acquisition rates. (United States)

    Fedorowsky, Rina; Peles-Bortz, Anat; Masarwa, Samira; Liberman, Dvora; Rubinovitch, Bina; Lipkin, Valentina


    Carbapenem-resistant Enterobacteriaceae (CRE) carriers are frequently transferred between acute care hospitals (ACHs) and postacute-care facilities (PACFs). Compliance of health care workers with infection prevention guidelines in both care settings may be influenced by the institution's organizational culture. To assess the association between organizational culture and health care workers' attitudes, knowledge, practices, and CRE acquisition rate and to identify differences between different care settings and health care workers' sectors. Cross-sectional descriptive design. Self-administered questionnaires were distributed to a sample of 420 health care workers from 1 ACH and 1 PACF belonging to the same health maintenance organization located in central Israel. The organizational culture factor known as staff engagement was positively correlated with infection prevention attitudes and compliance with contact precaution protocols and negatively correlated with CRE acquisition rate. In the 2 care settings, health care workers' attitudes, knowledge, and practices were found to be similar, but CRE acquisition rate was lower in PACFs. Compliance with contact precaution protocols by physicians was lower than compliance reported by other health care workers. Auxiliary staff reported lower knowledge. In a setting of endemic CRE where a multifaceted intervention is already being implemented, organizational culture variables can predict health care workers' attitudes, knowledge, and practices and in turn can affect CRE acquisition rates. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  17. Hospital ethical climate and teamwork in acute care: the moderating role of leaders. (United States)

    Rathert, Cheryl; Fleming, David A


    Health care delivery teams have received much attention in recent years from researchers and practitioners. Recent empirical research has demonstrated that objective and subjective outcomes tend to be improved when care teams function smoothly and efficiently. However, little is known about how the work environment, or care context, influences team processes that lead to better outcomes. The purposes of this study were to explore acute care staff's perceptions of how two components of the work environment, the ethical climate and continuous quality improvement leadership, influence teamwork and to begin to identify actionable approaches for improving teamwork. Although ethical climate influences have been studied in several sectors, research is lacking in health care. A cross-sectional field study explored how the ethical climate impacted teamwork in an acute care setting and how continuous quality improvement leadership behaviors moderated the relationship between the ethical climate and teamwork. Results indicated that clinicians who perceived the ethical climate to be benevolent were significantly more likely to say that teamwork was better. Furthermore, we found that continuous quality improvement leadership styles moderated the relationship between the ethical climate and teamwork. Although a benevolent ethical climate appears to be associated with effective teamwork, it appears that the proximate continuous quality improvement behaviors exhibited by leaders have a significant impact as well, above and beyond the climate. Implications for research and practice are discussed.

  18. Leadership support for ward managers in acute mental health inpatient settings. (United States)

    Bonner, Gwen; McLaughlin, Sue


    This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused.

  19. [Children's and Adolescents' Mental Health in Residential Youth Care Settings]. (United States)

    Niemann, Katrin; Häßler, Frank


    Children's and Adolescents' Mental Health in Residential Youth Care Settings Young people in residential youth care show a higher prevalence of mental problems than other children. This study gives an overview about the current situation of children and young people in the residential youth welfare service in Rostock (Mecklenburg-Western Pomerania, Germany). In 2008 a similar study for the rural district Bad Doberan (Mecklenburg-Western Pomerania, Germany) was conducted by Engel, Pätow, and Häßler (2009). This research was carried out with two measuring times over a period of eight months starting 2010. 48 young people and their keyworker as well as teachers answered Achenbach's self- and third-party-assessment forms for mental problems. Furthermore the Barrat-Impulsiveness Scale (BIS-11) and the Youth-Psychopathic Inventory were used to get information about traits of Psychopathy. The result showed that 51 % of the young people rated themselves as clinical relevant. Female probands reached higher scores than the male. The third-party assessment displayed 45 % in clinical scores. These scores, presented by a dimensional assessment, confirm the higher prevalence of mental problems in residential youthcare settings. A long term improvement of the life situation of psychological stressed children and adolescents, who are living in residential care homes, can only be achieved by an intensive cooperation of all the involved institutions and professions. The basis for this is the realisation of this necessity as well as the deduction and implementation of appropriate curricula, which imparts the required abilities needed for the conversion in the respective professions.

  20. Agenda-setting revisited: When and how do primary-care physicians solicit patients' additional concerns? (United States)

    Robinson, Jeffrey D; Tate, Alexandra; Heritage, John


    Soliciting patients' complete agendas of concerns (aka. 'agenda setting') can improve patients' health outcomes and satisfaction, and physicians' time management. We assess the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions. We coded videotapes/transcripts of 407 primary-, acute-care visits between adults and 85 general-practice physicians operating in 46 community-based clinics in two states representing urban and rural care. Measures are the incidence of physicians' questions, their linguistic format, position within visits, likelihood of being responded to, and the nature of such responses. Physicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits (pagenda item (Chi(2) (1, N=131)=11.96, p=.001), and to do so more frequently when positioned 'early' vs. 'late' during visits (Chi(2) (1, N=73)=4.99, p=.025). Agenda setting is comparatively infrequent. The communication format and position of physicians' questions affects patients' provision of additional concerns/questions. Physicians should increase use of optimized forms of agenda setting. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Therapeutic bronchoscopy vs. standard of care in acute respiratory failure

    DEFF Research Database (Denmark)

    Ellekjaer, K L; Meyhoff, T S; Møller, M H


    BACKGROUND: We aimed to assess patient-important benefits and harms of therapeutic bronchoscopy vs. standard of care (no bronchoscopy) in critically ill patients with acute respiratory failure (ARF). METHODS: We conducted a systematic review with meta-analysis and trial sequential analysis (TSA......) according to the Cochrane Handbook and GRADE methodology, including a predefined protocol (PROSPERO no. CRD42016046235). We included randomized clinical trials (RCTs) comparing therapeutic bronchoscopy to standard of care in critically ill patients with ARF. Two reviewers independently assessed trials...... judged as having high risk of bias. There was no difference in all-cause mortality between therapeutic bronchoscopy and standard of care (TSA adjusted RR 0.39; 95% CI 0.14 to 1.07; I(2) 0%), and only 3% of the required information size had been accrued. There was no difference in ICU length of stay...

  2. Respect in the care of older patients in acute hospitals. (United States)

    Koskenniemi, Jaana; Leino-Kilpi, Helena; Suhonen, Riitta


    The aim of this study was to describe the experiences of older patients and their next of kin with regards to respect in the care given in an acute hospital. The data were collected using tape-recorded interviews (10 patients and 10 next of kin) and analysed via inductive content analysis. Based on the analysis, the concept of respect can be defined by the actions taken by nurses (polite behaviour, the patience to listen, reassurance, response to information needs, assistance in basic needs, provision of pain relief, response to wishes and time management) and next of kin (support, assistance and advocacy) and by factors related to the environment (appreciation of older people in society, management of health-care organizations, the nursing culture, the flow of information and patient placement). The information will be used to develop an instrument for assessing how well respect is maintained in the care of older patients.

  3. The transition from acute care to home: a review of issues in discharge teaching and a framework for better practice. (United States)

    McBride, Meghan; Andrews, Gavin J


    Patients are often sent home with complex discharge plans that can become overwhelming and difficult to follow. By contrast, implementing effective teaching at the time of discharge can lead to a decrease in the rate of hospital readmissions and mortality for patients post discharge (Koelling, Johnson, Cody, & Aaronson, 2005). Unfortunately, many of the discharge teaching practices and programs used in health care settings have been criticized as being ineffective. Ensuring that patients are prepared for the transition from hospital to home after a cardiac event will require a fundamental shift in how teaching is performed in acute care settings. In this paper, the authors identify and examine models and concepts relevant to improving the process of providing discharge education in acute care settings. This includes attention to adult education, self-management and patient-centred care. A practical framework was developed: Important Elements of Effective Discharge Teaching. This framework can be used by frontline staff to initiate realistic practice change and promote the use of evidence-based strategies related to discharge teaching in acute care settings. The Important Elements of Effective Discharge Teaching framework provides health care practitioners with a tool to evaluate and reflect on their current professional practice and provides examples of teaching strategies that are based on best evidence. Nurses can incorporate elements of this framework while providing health teaching to patients after a cardiac event.

  4. 'I'm only dealing with the acute issues': How medical ward 'busyness' constrains care of the dying. (United States)

    Chan, Lisa S; Macdonald, Mary Ellen; Carnevale, Franco A; Cohen, S Robin


    Acute hospital units are a common location of death. Curative characteristics of the acute medical setting make it difficult to provide adequate palliative care; these characteristics include an orientation to life-prolonging treatment, an emphasis on routine or task-oriented care and a lack of priority on emotional engagement with patients. Indeed, research shows that dying patients in acute medical units often experience unmet needs at the end of life, including uncontrolled symptoms (e.g. pain, breathlessness), inadequate emotional support and poor communication. A focused ethnography was conducted on an acute medical ward in Canada to better understand how this curative/life-prolonging care environment shapes the care of dying patients. Fieldwork was conducted over a period of 10 months and included participant-observation and interviews with patients, family members and staff. On the acute medical ward, a 'logic of care' driven by discourses of limited resources and the demanding medical unit created a context of busyness. Staff experienced an overwhelming workload and felt compelled to create priorities, which reflected taken-for-granted values regarding the importance of curative/life-prolonging care over palliative care. This could be seen through the way staff prioritized life-prolonging practices and rationalized inconsistent and less attentive care for dying patients. These values influenced care of the dying through delaying a palliative approach to care, limiting palliative care to those with cancer and providing highly interventive end-of-life care. Awareness of these taken-for-granted values compels a reflective and critical approach to current practice and how to stimulate change.

  5. Health and Functioning of Families of Children With Special Health Care Needs Cared for in Home Care, Long-term Care, and Medical Day Care Settings. (United States)

    Caicedo, Carmen


    To examine and compare child and parent or guardian physical and mental health outcomes in families with children with special health care needs who have medically complex technology-dependent needs in home care, long-term care (LTC), and medical day care (MDC) settings. The number of children requiring medically complex technology-dependent care has grown exponentially. In this study, options for their care are home care, LTC, or MDC. Comparison of child and parent/guardian health outcomes is unknown. Using repeated measures data were collected from 84 dyads (parent/guardian, medically complex technology-dependent child) for 5 months using Pediatric Quality of Life Inventory Generic Core Module 4.0 and Family Impact Module Data analysis: χ(2), RM-ANCOVA. There were no significant differences in overall physical health, mental health, and functioning of children by care setting. Most severely disabled children were in home care; moderately disabled in MDC; children in vegetative state LTC; however, parents perceived children's health across care setting as good to excellent. Parents/guardians from home care reported the poorest physical health including being tired during the day, too tired to do the things they like to do, feeling physically weak, or feeling sick and had cognitive difficulties, difficulties with worry, communication, and daily activities. Parents/guardians from LTC reported the best physical health with time and energy for a social life and employment. Trends in health care policy indicate a movement away from LTC care to care in the family home where data indicate these parents/guardians are already mentally and functionally challenged.

  6. Health-Related Quality of Life in Elderly Patients With Pressure Ulcers in Different Care Settings. (United States)

    Sebba Tosta de Souza, Diba Maria; Veiga, Daniela Francescato; Santos, Ivan Dunshee de Abranches Oliveira; Abla, Luiz Eduardo Felipe; Juliano, Yara; Ferreira, Lydia Masako


    The purpose of this study was to measure and compare health-related quality of life in elderly patients with pressure ulcers in different health care settings (home care acute care facility, and long-term care facility [LTCF]). Cross-sectional comparative study. One hundred ten elderly patients with (n = 36) and without (n = 74) pressure ulcers living in LTCFs, hospitals, or at home. The research setting included 1 tertiary and 2 community-based hospitals, 10 LTCFs, and 18 community health centers in Brazil. The Mini-Mental State Examination, Braden Scale for Predicting Pressure Sore Risk, and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were used to assess cognitive status, pressure ulcer risk, and health-related quality of life, respectively. Compared with those without pressure ulcers, elderly patients with pressure ulcers reported significantly lower (worse) SF-36 scores on physical functioning (P ulcers scored significantly higher (better) SF-36 scores on mental health (P = .046) and vitality (P = .009). Hospitalized patients without pressure ulcers had lower SF-36 scores on bodily pain (P = .007) and general health (P = .026) than those living in LTCFs or at home. Patients without pressure ulcers in LTCFs had significantly lower Mini-Mental State Examination scores (lower cognitive status) than those living in other settings (P = .001). Elderly patients with pressure ulcers who were hospitalized and living at home or in LTCFs reported low scores on physical functioning and role physical, and LTCF residents also reported low scores on social functioning and role emotional. This shows the need for an environment that includes health care professionals prepared to implement strategies for pressure ulcer prevention.

  7. Will sacubitril-valsartan diminish the clinical utility of B-type natriuretic peptide testing in acute cardiac care?

    DEFF Research Database (Denmark)

    Mair, Johannes; Lindahl, Bertil; Giannitsis, Evangelos


    application of B-type natriuretic peptide testing in acute cardiac care is and will be the rapid rule-out of suspected acute heart failure there is no significant impairment to be expected for B-type natriuretic peptide testing in the acute setting. However, monitoring of chronic heart failure patients...... on sacubitril-valsartan treatment with B-type natriuretic peptide testing may be impaired. In contrast to N-terminal-proBNP, the current concept that the lower the B-type natriuretic peptide result in chronic heart failure patients, the better the prognosis during treatment monitoring, may no longer be true....

  8. Care priorities- Registered Nurses' clinical daily work in municipal elderly care settings. (United States)

    Norell, Margaretha; Ziegert, Kristina; Kihlgren, Annica


    Common in Swedish elderly home care is that Registered Nurses work independently, and lead the care team without being a part of it. People involved in the care of the patient can be social services, physician, Registered Nurse (RN), nurses in inpatient care and family. In according to current model for nursing documentation RNs interventions is described as participation, information/education, support, environment, general care, training, observation/surveillance, special care drug administration and coordination. Time pressure is perceived as high, but the nurses have the opportunity to influence their daily work situation and make priorities. The purpose of this study was to investigate how RNs prioritise interventions in municipal elderly care settings. A quantitative descriptive method was used for the study. Data were collected during the months of April and October 2004 - 2008, using a web-based form. The nurses filled in patient's type of housing, performed interventions, and if the interventions were delegated. Interventions were described as keywords and were attributed a certain amount of time, calculated in previous time studies. The inclusion criteria were: all patients 80 years of age and older, in a municipality in south-western Sweden, who received some form of health care from a RN, or performed by non-certified staff by delegation. Results indicate that differences in priority could be observed, depending on the patient's gender, or whether the patient was living in independent or sheltered housing. Drug administration was prioritised for female patients, while coordination became a priority for patients living in ordinary housing. Support received the highest priority, regardless if the patient lived in ordinary or sheltered housing. However, it is not entirely clear what support signifies in municipal health care settings, and this issue would therefore require further investigation. © 2012 Nordic College of Caring Science.

  9. Examining guideline-concordant care for acute myocardial infarction (AMI): the case of hospitalized post-acute and long-term care (PAC/LTC) residents. (United States)

    Radcliff, Tiffany A; Levy, Cari R


    Previous studies have examined differences in care for acute myocardial infarction (AMI) according to patient characteristics such as age, gender, or insurance, but little attention has been given to whether admission source is related to guideline adherence. To investigate: (1) the use of aspirin and reperfusion in the care of post-acute/long-term care (PAC/LTC) patients who are hospitalized for AMI, and (2) 30-day mortality associated with these treatments. Secondary examination of data from the Cooperative Cardiovascular Project (CCP) national baseline data. A total of 4013 U.S. hospitals. Patients hospitalized with a confirmed AMI admitted from PAC/LTC (n = 8151) or community-dwelling (n = 120,032) settings. Early administration of aspirin and reperfusion via either thrombolysis or percutaneous intervention. PAC/LTC patients were less likely to receive treatment for AMI, even after adjustment for multiple variables associated with treatment choice. Differences persisted with additional econometric adjustment using seemingly-unrelated regression. Multivariable logistic regression results indicated that aspirin was related to improved 30-day survival for both PAC/LTC and community admissions (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.43-0.58 for PAC/LTC, and OR, 0.57; 95% CI, 0.54-0.60 for community). Reperfusion was associated with higher ORs for mortality for eligible patients admitted from community setting (OR, 1.24; 95% CI, 1.13-1.35), but ideally-eligible candidates had lower ORs for mortality (OR, 0.58; 95% CI, 0.35-0.95 for PAC/LTC, and OR, 0.74; 95% CI, 0.68-0.81 for community). Patients transferred from PAC/LTC settings were less likely to receive early treatment for AMI than other patients. Future trials should inform which guidelines are applicable to PAC/LTC patients.

  10. The bulldozer and the ballet dancer: aspects of nurses' caring approaches in acute psychiatric intensive care. (United States)

    Björkdahl, A; Palmstierna, T; Hansebo, G


    Demanding conditions in acute psychiatric wards inhibit provision of safe, therapeutic care and leave nurses torn between humanistic ideals and the harsh reality of their daily work. The aim of this study was to describe nurses' caring approaches within this context. Data were collected from interviews with nurses working in acute psychiatric intensive care. Data were analysed using qualitative analysis, based on interpretive description. Results revealed a caring-approach continuum on which two approaches formed the main themes: the bulldozer and the ballet dancer. The bulldozer approach functioned as a shield of power that protected the ward from chaos. The ballet dancer approach functioned as a means of initiating relationships with patients. When examining the data from a theoretical perspective of caring and uncaring encounters in nursing, the ballet dancer approach was consistent with a caring approach, while the bulldozer approach was more complex and somewhat aligned with uncaring approaches. Conclusions drawn from the study are that although the bulldozer approach involves a risk for uncaring and harming actions, it also brings a potential for caring. This potential needs to be further explored and nurses should be encouraged to reflect on how they integrate paternalistic nursing styles with person-centred care.

  11. Acute Bacterial Parotitis in Intensive Care Patients: Four Case Reports

    Directory of Open Access Journals (Sweden)

    Cetin Kursad Akpinar


    Full Text Available Acute Bacterial Parotitis (ABP is an infection seen in very early and old ages. The infection can be prevented by sufficient fluid support, mouth hygiene, oral feeding and avoiding multiple medication use. Parotis ultrasonography can be used for diagnosis. Acute Bacterial Parotitis can be treated in a short time and free of problems with early diagnosis and appropriate antibiotics. Mortality can be seen in cases which are late diagnosed and which are resistant to antibiotic treatment. This article presents four case reports over the age of 65 with a diagnosis of ABP, who are monitored in the intensive care. It is thought that the first case developed ABP because of multiple medication use, liquid restriction and oral feeding difficulty, the second case because of oral feeding difficulty, the third case because of bad mouth hygiene, dementia and not getting enough liquid and the fourth case because of oral feeding difficulty. If the cases with the stated risk factors are carefully followed, intensive care hospitalization period will not be prolonged and mortality rates will not increase.

  12. Continuous Care Provided Through Comprehensive Medication Management in an Acute Care Practice Model. (United States)

    Marr, T David; Pinelli, Nicole R; Jarmul, Jamie A; Waldron, Kayla M; Eckel, Stephen F; Cicci, Jonathan D; Bates, Jill S; Amerine, Lindsey B


    Pharmacy practice models that foster pharmacists' accountability for medication-related outcomes are imperative for the profession. Comprehensive medication management (CMM) is an opportunity to advance patient care. The objective of this study was to evaluate the impact of a CMM practice model in the acute care setting on organizational, patient, and financial outcomes. Three adult service lines focused on at-risk patients identified using internal risk stratification methodology were implemented. Core CMM elements included medication reconciliation, differentiated clinical pharmacy services, inpatient MTM consultations, discharge services, and documentation. Mixed methods compared the effect of the CMM model before and after implementation. Historical patients served as comparative controls in an observational design. Pharmacists completed a 60-minute interview regarding their experiences. Qualitative data were analyzed using thematic coding to characterize perception of the model. Three pharmacists implemented the model on cardiology, hematology/oncology, and surgery transplant services and provided services to 75 patients during the study. A total of 145 medication-related problems were identified and resolved. CMM was associated with a nonsignificant reduction of 8.8% in 30-day hospital readmission rates ( P = 0.64) and a 24.9% reduction in 30-day hospital utilization ( P = 0.41) as well as a significant reduction of 86.5% in emergency department visits ( P = 0.02). Patients receiving discharge prescriptions from our outpatient pharmacies increased by 21.4%, resulting in an 11.3% increase in discharge prescription capture and additional revenue of $5780. Themes identified from qualitative interviews included CMM structure, challenges, value, and resources. This study demonstrated successful implementation of a CMM model that positively affected organizational, patient, and financial outcomes.

  13. Northern nursing practice in a primary health care setting. (United States)

    Vukic, Adele; Keddy, Barbara


    This paper explicates the nature of outpost nursing work, and/or the day-to-day realities of northern nursing practice in a primary health care setting in Canada. The study was carried out to systematically explore the work of nurses in an indigenous setting. Institutional ethnography, pioneered by Dorothy Smith was the methodology used to guide this research. The theoretical perspective of this methodology does not seek causes or links but intends to explicate visible practices. It is intended to explicate the social organization of specific discourses that inform work processes of nurses working in remote indigenous communities. The data originated from various sources including spending 2 weeks in a northern remote community shadowing experienced nurses, taking field notes and audio taping interviews with these nurses. One of the two researchers was a northern practice nurse for many years and has had taught in an outpost nursing programme. As part of the process, texts were obtained from the site as data to be incorporated in the analysis. The lived experiences have added to the analytical understanding of the work of nurses in remote areas. Data uncovered documentary practices inherent to the work setting which were then analysed along with the transcribed interviews and field notes derived from the on-site visit. Identifying disjuncture in the discourse of northern nursing and the lived experience of the nurses in this study was central to the research process. The results indicated that the social organization of northern community nursing work required a broad generalist knowledge base for decision making to work effectively within this primary health care setting. The nurse as 'other' and the invisibility of nurses' work of building a trusting relationship with the community is not reflected in the discourse of northern nursing. Trust cannot be quantified or measured yet it is fundamental to working effectively with the community. The nurses in this study

  14. Bundling Post-Acute Care Services into MS-DRG Payments (United States)

    U.S. Department of Health & Human Services — A bundled hospital payment system that encompasses both acute and post-acute care has been proposed as a means of creating financial incentives in the Medicare...

  15. Measuring the context of care in an Australian acute care hospital: a nurse survey. (United States)

    Schultz, Timothy J; Kitson, Alison L


    This study set out to achieve three objectives: to test the application of a context assessment tool in an acute hospital in South Australia; to use the tool to compare context in wards that had undergone an evidence implementation process with control wards; and finally to test for relationships between demographic variables (in particular experience) of nurses being studied (n = 422) with the dimensions of context. The Alberta Context Tool (ACT) was administered to all nursing staff on six control and six intervention wards. A total of 217 (62%) were returned (67% from the intervention wards and 56% from control wards). Data were analysed using Stata (v9). The effect of the intervention was analysed using nested (hierarchical) analysis of variance; relationships between nurses' experience and context was examined using canonical correlation analysis. Results confirmed the adaptation and fit of the ACT to one acute care setting in South Australia. There was no difference in context scores between control and intervention wards. However, the tool identified significant variation between wards in many of the dimensions of context. Though significant, the relationship between nurses' experience and context was weak, suggesting that at the level of the individual nurse, few factors are related to context. Variables operating at the level of the individual showed little relationship with context. However, the study indicated that some dimensions of context (e.g., leadership, culture) vary at the ward level, whereas others (e.g., structural and electronic resources) do not. The ACT also raised a number of interesting speculative hypotheses around the relationship between a measure of context and the capability and capacity of staff to influence it.We propose that context be considered to be dependent on ward- and hospital-level factors. Additionally, questions need to be considered about the unit of measurement of context in studies of knowledge implementation

  16. Measuring the context of care in an Australian acute care hospital: a nurse survey

    Directory of Open Access Journals (Sweden)

    Schultz Timothy J


    Full Text Available Abstract Background This study set out to achieve three objectives: to test the application of a context assessment tool in an acute hospital in South Australia; to use the tool to compare context in wards that had undergone an evidence implementation process with control wards; and finally to test for relationships between demographic variables (in particular experience of nurses being studied (n = 422 with the dimensions of context. Methods The Alberta Context Tool (ACT was administered to all nursing staff on six control and six intervention wards. A total of 217 (62% were returned (67% from the intervention wards and 56% from control wards. Data were analysed using Stata (v9. The effect of the intervention was analysed using nested (hierarchical analysis of variance; relationships between nurses' experience and context was examined using canonical correlation analysis. Results Results confirmed the adaptation and fit of the ACT to one acute care setting in South Australia. There was no difference in context scores between control and intervention wards. However, the tool identified significant variation between wards in many of the dimensions of context. Though significant, the relationship between nurses' experience and context was weak, suggesting that at the level of the individual nurse, few factors are related to context. Conclusions Variables operating at the level of the individual showed little relationship with context. However, the study indicated that some dimensions of context (e.g., leadership, culture vary at the ward level, whereas others (e.g., structural and electronic resources do not. The ACT also raised a number of interesting speculative hypotheses around the relationship between a measure of context and the capability and capacity of staff to influence it. We propose that context be considered to be dependent on ward- and hospital-level factors. Additionally, questions need to be considered about the unit of measurement

  17. Acute Kidney Injury in the Intensive Care Unit

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    Petar Kes


    Full Text Available Acute kidney injury (AKI is a common clinical syndrome with a broad aetiological profile. It complicates about 5% of hospital admissions and 30% of admissions to intensive care units (ICU. During last 20 years has been a significant change in the spectrum of severe AKI such that it is no longer mostly a single organ phenomenon but rather a complex multisystem clinical problem. Despite great advances in renal replacement technique (RRT, mortality from AKI, when part of MOF, remains over 50%. The changing nature of AKI requires a new approach using the new advanced technology. Clinicians can provide therapies tailored to time constraints (intermittent, continuous, or extended intermittent, haemodynamic, and metabolic requirements and aimed at molecules of variable molecular weight. Peritoneal dialysis (PD is technically the simplest form of RRT and is still commonly used worldwide. The problems include difficulty in maintaining dialysate flow, peritoneal infection, leakage, protein losses, and restricted ability to clear fluid and uraemic wastes. PD is the preferred treatment modality for AKI in pediatric practice. Patients that are hemodynamically stable can be managed with intermittent hemodyalisis (IHD, whereby relatively short (3 to 4 h dialysis sessions may be performed every day or every other day. Patients who are haemodynamically unstable are best managed using continuous renal replacement therapies (CRRT, which allow for continuous fine-tuning of intravascular volume, easier correction of hypervolemia, better solute removal, more accurately correction of metabolic acidosis, and offers possibilities for unlimited energy support. Recently, “hybrid” or sustained low-efficiency dialysis (SLED was introduced as a method which combines the advantages of IHD with those of CRRT. In this technique, classic dialysis hardware is used at low blood and dialysate flow rates, for prolonged period of time (6 to 12 h/day. SLED offers more haemodynamic

  18. Lean and Six Sigma in acute care: a systematic review of reviews. (United States)

    Deblois, Simon; Lepanto, Luigi


    The purpose of this paper is to present a systematic review of literature reviews, summarizing how Lean and Six Sigma management techniques have been implemented in acute care settings to date, and assessing their impact. To aid decision makers who wish to use these techniques by identifying the sectors of activity most often targeted, the main results of the interventions, as well as barriers and facilitators involved. To identify areas of future research. A literature search was conducted, using eight databases. The methodological quality of the selected reviews was appraised with AMSTAR. A narrative synthesis was performed according to the guidelines proposed by Popay et al. (2006). Data were reported according to PRISMA. The literature search identified 149 publications published from 1999 to January 2015. Seven literature reviews were included into the systematic review, upon appraisal. The overall quality of the evidence was poor to fair. The clinical settings most described were specialized health care services, including operating suites, intensive care units and emergency departments. The outcomes most often appraised related to processes and quality. The evidence suggests that Lean and Six Sigma are better adapted to settings where processes involve a linear sequence of events. There is a need for more studies of high methodological quality to better understand the effects of these approaches as well as the factors of success and barriers to their implementation. Field studies comparing the effects of Lean and Six Sigma to those of other process redesign or quality improvement efforts would bring a significant contribution to the body of knowledge. Lean and Six Sigma can be considered valuable process optimization approaches in acute health care settings. The success of their implementation requires significant participation of clinical personnel from the frontline as well as clinical leaders and managers. More research is needed to better understand the

  19. Shared Caregiving: Comparisons between Home and Child-Care Settings. (United States)

    Ahnert, Lieselotte; Rickert, Heike; Lamb, Michael E.


    Described experiences of 84 German toddlers enrolled or not enrolled in child care. Found total amount of care per weekday did not differ by child-care status; child-care toddlers received lower care levels from center providers; their mothers engaged in more social interactions during nonworking hours than did mothers of home-only toddlers; and…

  20. Application of physiologically based pharmacokinetic modeling in setting acute exposure guideline levels for methylene chloride.

    NARCIS (Netherlands)

    Bos, Peter Martinus Jozef; Zeilmaker, Marco Jacob; Eijkeren, Jan Cornelis Henri van


    Acute exposure guideline levels (AEGLs) are derived to protect the human population from adverse health effects in case of single exposure due to an accidental release of chemicals into the atmosphere. AEGLs are set at three different levels of increasing toxicity for exposure durations ranging from

  1. Guidance document for setting an Acute Reference Dose in Dutch national pesticide evaluations

    NARCIS (Netherlands)

    Raaij MTM van; CSR


    This report describes a proposal for the procedures for setting an Acute Reference Dose (ARfD) for pesticides evaluated in the Netherlands. This deals with both evaluations on the national level (on behalf of the Dutch Board for the Authorisation of Pesticides (CTB)) and evaluations at the European

  2. [Collaboration with specialists and regional primary care physicians in emergency care at acute hospitals provided by generalists]. (United States)

    Imura, Hiroshi


    A role of acute hospitals providing emergency care is becoming important more and more in regional comprehensive care system led by the Ministry of Health, Labour and Welfare. Given few number of emergent care specialists in Japan, generalists specializing in both general internal medicine and family practice need to take part in the emergency care. In the way collaboration with specialists and regional primary care physicians is a key role in improving the quality of emergency care at acute hospitals. A pattern of collaborating function by generalists taking part in emergency care is categorized into four types.

  3. Patient Safety Culture Survey in Pediatric Complex Care Settings: A Factor Analysis. (United States)

    Hessels, Amanda J; Murray, Meghan; Cohen, Bevin; Larson, Elaine L


    Children with complex medical needs are increasing in number and demanding the services of pediatric long-term care facilities (pLTC), which require a focus on patient safety culture (PSC). However, no tool to measure PSC has been tested in this unique hybrid acute care-residential setting. The objective of this study was to evaluate the psychometric properties of the Nursing Home Survey on Patient Safety Culture tool slightly modified for use in the pLTC setting. Factor analyses were performed on data collected from 239 staff at 3 pLTC in 2012. Items were screened by principal axis factoring, and the original structure was tested using confirmatory factor analysis. Exploratory factor analysis was conducted to identify the best model fit for the pLTC data, and factor reliability was assessed by Cronbach alpha. The extracted, rotated factor solution suggested items in 4 (staffing, nonpunitive response to mistakes, communication openness, and organizational learning) of the original 12 dimensions may not be a good fit for this population. Nevertheless, in the pLTC setting, both the original and the modified factor solutions demonstrated similar reliabilities to the published consistencies of the survey when tested in adult nursing homes and the items factored nearly identically as theorized. This study demonstrates that the Nursing Home Survey on Patient Safety Culture with minimal modification may be an appropriate instrument to measure PSC in pLTC settings. Additional psychometric testing is recommended to further validate the use of this instrument in this setting, including examining the relationship to safety outcomes. Increased use will yield data for benchmarking purposes across these specialized settings to inform frontline workers and organizational leaders of areas of strength and opportunity for improvement.

  4. Practitioner Perspectives on Delivering Integrative Medicine in a Large, Acute Care Hospital

    Directory of Open Access Journals (Sweden)

    Kent C. Nate


    Full Text Available Background. We describe the process and challenges of delivering integrative medicine (IM at a large, acute care hospital, from the perspectives of IM practitioners. To date, minimal literature that addresses the delivery of IM care in an inpatient setting from this perspective exists. Methods. Fifteen IM practitioners were interviewed about their experience delivering IM services at Abbott Northwestern Hospital (ANW, a 630-bed tertiary care hospital. Themes were drawn from codes developed through analysis of the data. Results. Analysis of interview transcripts highlighted challenges of ensuring efficient use of IM practitioner resources across a large hospital, the IM practitioner role in affecting patient experiences, and the ways practitioners navigated differences in IM and conventional medicine cultures in an inpatient setting. Conclusions. IM practitioners favorably viewed their role in patient care, but this work existed within the context of challenges related to balancing supply and demand for services and to integrating an IM program into the established culture of a large hospital. Hospitals planning IM programs should carefully assess the supply and demand dynamics of offering IM in a hospital, advocate for the unique IM practitioner role in patient care, and actively support integration of conventional and complementary approaches.

  5. Decision support systems for robotic surgery and acute care (United States)

    Kazanzides, Peter


    Doctors must frequently make decisions during medical treatment, whether in an acute care facility, such as an Intensive Care Unit (ICU), or in an operating room. These decisions rely on a various information sources, such as the patient's medical history, preoperative images, and general medical knowledge. Decision support systems can assist by facilitating access to this information when and where it is needed. This paper presents some research eorts that address the integration of information with clinical practice. The example systems include a clinical decision support system (CDSS) for pediatric traumatic brain injury, an augmented reality head- mounted display for neurosurgery, and an augmented reality telerobotic system for minimally-invasive surgery. While these are dierent systems and applications, they share the common theme of providing information to support clinical decisions and actions, whether the actions are performed with the surgeon's own hands or with robotic assistance.

  6. Management of Acute Pancreatitis in Critical Care Unit

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    Güniz Meyancı Köksal


    Full Text Available Pancreatitis is characterized by an inflammation occuring due to digestion of pancreatic self tissues and other organs after activation of digestive enzymes which are stable under normal conditions . For all the pancreatitis cases, the mortality rate is <%15. In the acute pancreatitis cases, the monitorization of the inspiration system, cardiovascular system and the metabolic status are needed. There is no primary therapy for the pancreatitis. All the therapy protocols are support therapy. The basic support therapy methods are: Liquid replacement, respiration support, pain management, pancreas secretion inhibition, metabolic support, intra-abdominal monitoring and decompression, nutrition, antibiotherapy, immunomodulation, coagulation mechanism monitoring. In the acute pancreatitis, the causes of early deaths are pancreatic shock and acute pulmonary thrombohemorrhage, within the first 7 days the causes of the 75% deaths are pulmonary shock and congestion and after 7 days the causes of the 77% are pancreas abscess, MOF (multiple organ failure, purulent peritonitis and erosive hemorrhage. (Journal of the Turkish Society of Intensive Care 2010; 8: 85-9

  7. Rational drug use for acute bronchiolitis in emergency care. (United States)

    Uysalol, Metin; Haşlak, Fatih; Özünal, Zeynep Güneş; Vehid, Hayriye; Uzel, Nedret


    Uysalol M, Haşlak F, Özünal ZG, Vehid H, Uzel N. Rational drug use for acute bronchiolitis in emergency care. Turk J Pediatr 2017; 59: 155-161. Despite the large variety of inhaled treatment options of acute bronchiolitis, there is no generally agreed treatment regime. This study aimed to determine the most appropriate treatment option. This was a double-blind randomized prospective clinical trial and has been performed in emergency department. The mean age of the 378 infants included in the study was 7.63 ± 4.6 months, and 54.8% (207) were boys. Patients were randomized by using the lottery method for simple random sample into 5 different treatment options; 3% hypertonic saline, nebulized adrenaline, nebulized adrenaline mixed with 3% hypertonic saline, nebulized salbutamol, and as control group; normal saline (0.9% NaCl). From the first treatment time until discharge time; treatment durations, adverse events and readmission rates within the first fifteen days were recorded for each patient. Nebulized adrenaline mixed with 3% hypertonic saline, as compared with other options, were associated with a significantly higher discharge rate at 4th hours (p hypertonic saline, was evaluated as `better acute response` and can be helpful to reduce hospitalization needs. Additionally, this option seems to be more effective to reduce length of hospital stay.

  8. Low-value care for acute sinusitis encounters: who's choosing wisely? (United States)

    Sharp, Adam L; Klau, Marc H; Keschner, David; Macy, Eric; Tang, Tania; Shen, Ernest; Munoz-Plaza, Corrine; Kanter, Michael; Silver, Matthew A; Gould, Michael K


    To assess acute sinusitis (AS) encounters in primary care (PC), urgent care (UC), and emergency department (ED) settings for adherence to recommendations to avoid low-value care. A retrospective, observational study of adult AS encounters (2010-2012) within a large integrated healthcare system. We compared ED and UC encounters with PC visits, adjusting for differences in patient characteristics. adherence to recommendations to avoid antibiotics and a computed tomography (CT) scan of the face, head, or sinuses. length of symptoms and adherence with AS recommendations. Of 152,774 AS encounters, 89.2% resulted in antibiotics and 1.1% resulted in a CT scan. Compared with PC encounters, ED encounters were less likely to result in antibiotics (adjusted odds ratio [AOR], 0.57; 95% CI, 0.50-0.65) but more likely to result in a CT scan (AOR, 59.4; 95% CI, 51.3-68.7), while UC encounters were more likely to result in both antibiotics (AOR, 1.12; 95% CI, 1.08-1.17) and CT imaging (AOR, 2.4; 95% CI, 2.1-2.7). Chart review of encounters resulting in antibiotics found that 50% were inappropriately prescribed for symptoms of ≤7 days' duration (95% CI, 41%-58%), while 35% were appropriately prescribed for symptoms of ≥14 days' duration (95% CI, 27%-44%). Only 29% (95% CI, 22%-36%) of encounters were consistent with guideline-adherent care. AS encounters in an integrated health system infrequently result in CT imaging, but antibiotic treatment is common. Differences exist across acute care settings, but improved antibiotic stewardship is needed in all settings.

  9. Transition between care settings at end of life in the Netherlands: results from a nationwide study.

    NARCIS (Netherlands)

    Abarshi, E.; Echteld, M.; Block, L. van den; Donker, G.; Deliens, L.; Onwuteaka-Philipsen, B.


    Background: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Objective: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to

  10. Transition between care settings at end of life in the Netherlands: results from a nationwide study.

    NARCIS (Netherlands)

    Abarshi, E.; Echteld, M.; Block, L. van den; Donker, G.; Deliens, L.; Onwuteaka-Philipsen, B.


    Issue/problem: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Aim: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to

  11. Developing a Policy for Delegation of Nursing Care in the School Setting (United States)

    Spriggle, Melinda


    School nurses are in a unique position to provide care for students with special health care needs in the school setting. The incidence of chronic conditions and improved technology necessitate care of complex health care needs that had formerly been managed in inpatient settings. Delegation is a tool that may be used by registered nurses to allow…

  12. Nursing Education Interventions for Managing Acute Pain in Hospital Settings: A Systematic Review of Clinical Outcomes and Teaching Methods. (United States)

    Drake, Gareth; de C Williams, Amanda C


    The objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  13. Innovation or rebranding, acute care surgery diffusion will continue. (United States)

    Collins, Courtney E; Pringle, Patricia L; Santry, Heena P


    Patterns of adoption of acute care surgery (ACS) as a strategy for emergency general surgery (EGS) care are unknown. We conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for ACS at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment (three practice types [community, public or charity, and university] in each of six geographic regions [Mid-Atlantic, Midwest, New England, Northeast, South, and West]). Interviews were recorded, transcribed, and analyzed using NVivo (QSR International, Melbourne, Australia). We applied the methods of investigator triangulation using an inductive approach to develop a final taxonomy of codes organized by themes related to respondents' views on the future of ACS as a strategy for EGS. We applied our findings to a conceptual model on diffusion of innovation. We found a paradox between ACS viewed as a health care delivery innovation versus a rebranding of comprehensive general surgery. Optimism for the future of ACS because of increased desirability for trauma and critical care careers as well as improved EGS outcomes was tempered by fear over lack of continuity, poor institutional resources, and uncertainty regarding financial viability. Our analysis suggests that the implementation of ACS, whether a true health care delivery innovation or an innovative rebranding, fits into the Rogers' diffusion of innovation theory. Despite concerns over resource allocation and the definition of the specialty, from the perspective of senior surgeons deeply entrenched in executing this care delivery model, ACS represents the new face of general surgery that will likely continue to diffuse from these early adopters. Published by Elsevier Inc.

  14. Disparities in Post-Acute Rehabilitation Care for Joint Replacement (United States)

    Freburger, Janet K.; Holmes, George M.; Ku, Li-Jung E.; Cutchin, Malcolm P.; Heatwole-Shank, Kendra; Edwards, Lloyd J.


    Objectives To determine the extent to which demographic and geographic disparities exist in the use of post-acute rehabilitation care (PARC) for joint replacement. Methods Cross-sectional analysis of two years (2005–2006) of population-based hospital discharge data from 392 hospitals in four states (AZ, FL, NJ, WI). 164,875 individuals 45 years and older admitted to the hospital for a hip or knee joint replacement and who survived their inpatient stay were identified. Three dichotomous dependent variables were examined: 1) discharge to home vs. institution (i.e., skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF)); 2) discharge to home with vs. without home health (HH); and 3) discharge to a SNF vs. IRF. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use, controlling for illness severity/comorbidities, hospital characteristics, and PARC supply. Interactions among race, socioeconomic, and geographic variables were explored. Results Considering PARC as a continuum from more to less intensive care in regard to hours of rehabilitation/day (e.g., IRF→SNF→HH→no HH), the uninsured received less intensive care in all three models. Individuals on Medicaid and those of lower SES received less intensive care in the HH/no HH and SNF/IRF models. Individuals living in rural areas received less intensive care in the institution/home and HH/no HH models. The effect of race was modified by insurance and by state. In most instances minorities received less intensive care. PARC use varied by hospital. Conclusions Efforts to further understand the reasons behind these disparities and their effect on outcomes are needed. PMID:21485020

  15. [Consensus on improving the care integrated of patients with acute heart failure]. (United States)

    Llorens, Pere; Manito Lorite, Nicolás; Manzano Espinosa, Luis; Martín-Sánchez, Francisco Javier; Comín Colet, Josep; Formiga, Francesc; Jacob, Javier; Delgado Jiménez, Juan; Montero-Pérez-Barquero, Manuel; Herrero, Pablo; López de Sá Areses, Esteban; Pérez Calvo, Juan Ignacio; Masip, Josep; Miró, Òscar


    Acute heart failure (AHF) requires considerable use of resources, is an economic burden, and is associated with high complication and mortality rates in emergency departments, on hospital wards, or outpatient care settings. Diagnosis, treatment, and continuity of care are variable at present, leading 3 medical associations (for cardiology, internal medicine, and emergency medicine) to undertake discussions and arrive at a consensus on clinical practice guidelines to support those who manage AHF and encourage standardized decision making. These guidelines, based on a review of the literature and clinical experience with AHF, focus on critical points in the care pathway. Regarding emergency care, the expert participants considered the initial evaluation of patients with signs and symptoms that suggest AHF, the initial diagnosis, first decisions about therapy, monitoring, assessment of prognosis, and referral criteria. For care of the hospitalized patient, the group developed a protocol for essential treatment. Objectives for the management and treatment of AHF on discharge were also covered through the creation or improvement of multidisciplinary care systems to provide continuity of care.

  16. Clinical pharmacy consultations provided by American and Kenyan pharmacy students during an acute care advanced pharmacy practice experience. (United States)

    Pastakia, Sonak D; Vincent, William R; Manji, Imran; Kamau, Evelyn; Schellhase, Ellen M


    To compare the clinical consultations provided by American and Kenyan pharmacy students in an acute care setting in a developing country. The documented pharmacy consultation recommendations made by American and Kenyan pharmacy students during patient care rounds on an advanced pharmacy practice experience at a referral hospital in Kenya were reviewed and classified according to type of intervention and therapeutic area. The Kenyan students documented more interventions than American students (16.7 vs. 12.0 interventions/day) and provided significantly more consultations regarding human immunodeficiency virus (HIV) and antibiotics. The top area of consultations provided by American students was cardiovascular diseases. American and Kenyan pharmacy students successfully providing clinical pharmacy consultations in a resource-constrained, acute-care practice setting suggests an important role for pharmacy students in the reconciliation of prescriber orders with medication administration records and in providing drug information.

  17. Comparing written programs and self-reported respiratory protection practices in acute care hospitals. (United States)

    Sietsema, Margaret; Conroy, Lorraine M; Brosseau, Lisa M


    Airborne biological hazards in hospitals require the use of respiratory protection. A well-implemented respiratory protection program can protect health care workers from these exposures. This study examines the relationship between written respiratory programs and reported practices in health care settings. Twenty-eight hospitals in Illinois and Minnesota were recruited to a study of respiratory protection programs and practices in acute care settings. Interviews were conducted with hospital managers, unit managers, and health care workers from departments where respirators are commonly required. Each hospital's written respiratory protection program was scored for the 11 elements required by the Occupational Safety and Health Administration (OSHA), using a standardized tool, for a maximum possible score of 22 (2 pts. per element). Twenty interview questions associated with program practices were also scored by percent correct responses. Written program scores ranged from 2-17 with an average of 9.2. Hospital and unit managers scored on average 82% and 81%, respectively, when compared to the OSHA standard; health care workers scored significantly lower, 71% (p respiratory protection programs in the study sites did not provide the level of detail required OSHA. Interview responses representing hospital practices surrounding respiratory protection indicated that hospitals were aware of and following regulatory guidelines.

  18. Health care priority setting in Norway a multicriteria decision analysis

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    Defechereux Thierry


    Full Text Available Abstract Background Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. Methods In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. Results The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Conclusions Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.

  19. Health care priority setting in Norway a multicriteria decision analysis. (United States)

    Defechereux, Thierry; Paolucci, Francesco; Mirelman, Andrew; Youngkong, Sitaporn; Botten, Grete; Hagen, Terje P; Niessen, Louis W


    Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and treatment. This study compares the values of the country's health policy makers with these three official principles. In total 34 policy makers participated in a discrete choice experiment, weighting the relative value of six policy criteria. We used multi-variate logistic regression with selection as dependent valuable to derive odds ratios for each criterion. Next, we constructed a composite league table - based on the sum score for the probability of selection - to rank potential interventions in five major disease areas. The group considered cost effectiveness, large individual benefits and severity of disease as the most important criteria in decision making. Priority interventions are those related to cardiovascular diseases and respiratory diseases. Less attractive interventions rank those related to mental health. Norwegian policy makers' values are in agreement with principles formulated in national health laws. Multi-criteria decision approaches may provide a tool to support explicit allocation decisions.

  20. Virtual Visits for Acute, Nonurgent Care: A Claims Analysis of Episode-Level Utilization. (United States)

    Gordon, Aliza S; Adamson, Wallace C; DeVries, Andrea R


    Expansion of virtual health care-real-time video consultation with a physician via the Internet-will continue as use of mobile devices and patient demand for immediate, convenient access to care grow. The objective of the study is to analyze the care provided and the cost of virtual visits over a 3-week episode compared with in-person visits to retail health clinics (RHC), urgent care centers (UCC), emergency departments (ED), or primary care physicians (PCP) for acute, nonurgent conditions. A cross-sectional, retrospective analysis of claims from a large commercial health insurer was performed to compare care and cost of patients receiving care via virtual visits for a condition of interest (sinusitis, upper respiratory infection, urinary tract infection, conjunctivitis, bronchitis, pharyngitis, influenza, cough, dermatitis, digestive symptom, or ear pain) matched to those receiving care for similar conditions in other settings. An episode was defined as the index visit plus 3 weeks following. Patients were children and adults younger than 65 years of age without serious chronic conditions. Visits were classified according to the setting where the visit occurred. Care provided was assessed by follow-up outpatient visits, ED visits, or hospitalizations; laboratory tests or imaging performed; and antibiotic use after the initial visit. Episode costs included the cost of the initial visit, subsequent medical care, and pharmacy. A total of 59,945 visits were included in the analysis (4635 virtual visits and 55,310 nonvirtual visits). Virtual visit episodes had similar follow-up outpatient visit rates (28.09%) as PCP (28.10%, P=.99) and RHC visits (28.59%, P=.51). During the episode, lab rates for virtual visits (12.56%) were lower than in-person locations (RHC: 36.79%, Pvirtual visits (6.62%) were typically lower than in-person locations (RHC: 5.97%, P=.11; UCC: 8.77%, Pvirtual visit episodes, respectively, including medical and pharmacy costs. Virtual care appears to

  1. Quality of care for people with dementia and professional caregivers' perspectives regarding palliative care in Japanese community care settings. (United States)

    Nakanishi, Miharu; Hirooka, Kayo; Morimoto, Yuko; Nishida, Atsushi


    Palliative care for dementia includes psychosocial interventions as first-line treatment for challenging behaviour. However, the national dementia plan in Japan contradicts recommendations for palliative care for dementia. This study aimed to examine the association between care quality for patients with dementia and professional caregivers' perspectives regarding palliative care for dementia in Japanese community care settings. In total, 2116 professional caregivers from 329 agencies (217 in-home long-term care support providers; 29 small-scale, multiple home-care providers; and 83 group homes) in Tokyo prefecture, Japan, completed cross-sectional, paper-based questionnaires about 3603 people diagnosed with dementia, in May 2016. Quality of care measures included physical restraint and antipsychotic medication use and quality of life. Patients' quality of life was assessed via the Japanese version of the Alzheimer's Disease Health-related Quality of Life scale. The Japanese version of the Questionnaire on Palliative Care for Advanced Dementia was used to assess professional caregivers' knowledge and attitudes regarding palliative care for dementia. Professional caregivers' knowledge and attitudes regarding palliative care for dementia were positively associated with quality of life in patients with dementia. Physical restraint and antipsychotic medication were used regardless of professional caregivers' knowledge and attitudes. Professional caregivers' perspectives regarding palliative care for dementia could have exerted a positive effect on quality of life in patients with dementia. A national strategy for advocacy and the protection of adults is required to integrate several laws and guidelines and prevent the use of antipsychotics as a form of chemical restraint. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Pre-hospital acute coronary syndrome care in Kerala, India: A qualitative analysis. (United States)

    Patel, Amisha; Mohanan, P P; Prabhakaran, Dorairaj; Huffman, Mark D

    Ischemic heart disease is the leading cause of death in India. Many of these deaths are due to acute coronary syndromes (ACS), which require prompt symptom recognition, care-seeking behavior, and transport to a treatment facility in the critical pre-hospital period. In India, little is known about pre-hospital management of individuals with ACS. We aim to understand the facilitators, barriers, and context of optimal pre-hospital ACS care to provide opportunities to reduce pre-hospital delays and improve acute cardiovascular care. We conducted a qualitative study using in-depth interviews and focus group discussions with 27 ACS providers in Kerala, India to understand facilitators, barriers, and context to pre-hospital ACS care. Six themes emerged from these interviews and discussions: (1) individuals with ACS misperceive their symptoms as non-cardiac in origin; (2) emergency medical services are infrequently used; (3) insufficient pre-hospital healthcare infrastructure contributes to pre-hospital delay; (4) multiple stops are made before arriving at a facility that can provide definitive diagnosis and treatment; (5) relatively high costs of treatment and lack of widespread health insurance coverage limits care delivery; and (6) novel mobile technologies may allow for faster diagnosis and initiation of treatment in the pre-hospital setting. Individualized patient-based factors (general knowledge of ACS symptoms, socioeconomic position) and broader systems-based factors (ambulance networks, coordination of transport) affect pre-hospital ACS care in Kerala. Improving public awareness of ACS symptoms, increasing appropriate use of emergency medical services, and building a infrastructure for rapid and coordinated transport may improve pre-hospital ACS care. Copyright © 2016. Published by Elsevier B.V.

  3. Acute medical assessment units: an efficient alternative to in-hospital acute medical care.

    LENUS (Irish Health Repository)

    Watts, M


    Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the \\'coal face" of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.

  4. A new assessment for elders admitted to acute care: reliability of the MDS-AC. (United States)

    Carpenter, G I; Teare, G F; Steel, K; Berg, K; Murphy, K; Bjornson, J; Jonsson, P V; Hirdes, J P


    Assessment of older people rarely includes functional domains critical for ensuring optimum outcome of treatment in acute hospital care. We report the development of a new assessment instrument, and illustrate how differences between pre-hospital and hospital admission status can be systematically evaluated using the Minimum Data Set for Acute Care (MDS-AC). Content was developed by literature review and consultation with professionals working in acute areas. Dual independent assessments were conducted on hospital in-patients in 4 countries. Inter-assessor reliability coefficients were calculated for each item. Kappa was calculated for all binary and multi-level nominal variables. Quadratically weighted Kappa was estimated for all ordinal multi-level variables. Where one level of the variable contained 90% or more of the subjects, total observed agreement is reported. Separate reliability estimates were calculated for pre-hospitalization and inpatient items. Subjects had a mean age of 78. Completion of pre-hospitalization and hospital period assessment (combined) required 20 and 30 minutes. Excluding items for which 90% or more of subjects were classified into a single scoring level, average inter-assessor reliability coefficient for the pre-hospital period items was 0.57 and for in hospital 0.58. Overall exact agreement was 83% for pre-hospitalization assessment items, and 79% for the in-hospital items. The reliability achieved in the highly unstable situation of the acute admission phase is sufficient for use in clinical care and research. Differences in pre-hospital and admission status necessary for case-mix adjusted comparison of outcomes were illustrated. Development of a means for systematically comparing changes in older people during the course of illness is of increasing importance when addressing questions of the appropriate and inappropriate use of medical technology.

  5. Activity in GEriatric acute CARe (AGECAR: rationale, design and methods

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    Fleck Steven J


    Full Text Available Abstract Background The Activity in GEriatric acute CARe (AGECAR is a randomised control trial to assess the effectiveness of an intrahospital strength and walk program during short hospital stays for improving functional capacity of patients aged 75 years or older. Methods/Design Patients aged 75 years or older admitted for a short hospital stay (≤14 days will be randomly assigned to either a usual care (control group or an intervention (training group. Participants allocated in the usual care group will receive normal hospital care and participants allocated in the intervention group will perform multiple sessions per day of lower limb strength training (standing from a seated position and walking (10 min bouts while hospitalized. The primary outcome to be assessed pre and post of the hospital stay will be functional capacity, using the Short Physical Performance Battery (SPPB, and time to walk 10 meters. Besides length of hospitalization, the secondary outcomes that will also be assessed at hospital admission and discharge will be pulmonary ventilation (forced expiratory volume in one second, FEV1 and peripheral oxygen saturation. The secondary outcomes that will be assessed by telephone interview three months after discharge will be mortality, number of falls since discharge, and ability to cope with activities of daily living (ADLs, using the Katz ADL score and Barthel ADL index. Discussion Results will help to better understand the potential of regular physical activity during a short hospital stay for improving functional capacity in old patients. The increase in life expectancy has resulted in a large segment of the population being over 75 years of age and an increase in hospitalization of this same age group. This calls attention to health care systems and public health policymakers to focus on promoting methods to improve the functional capacity of this population. Trial registration ID: NCT01374893.

  6. Nurse students learning acute care by simulation - Focus on observation and debriefing. (United States)

    Abelsson, Anna; Bisholt, Birgitta


    Simulation creates the possibility to experience acute situations during nursing education which cannot easily be achieved in clinical settings. To describe how nursing students learn acute care of patients through simulation exercises, based on observation and debriefing. The study was designed as an observational study inspired by an ethnographic approach. Data was collected through observations and interviews. Data was analyzed using an interpretive qualitative content analysis. Nursing students created space for reflection when needed. There was a positive learning situation when suitable patient scenarios were presented. Observations and discussions with peers gave the students opportunities to identify their own need for knowledge, while also identifying existing knowledge. Reflections could confirm or reject their preparedness for clinical practice. The importance of working in a structured manner in acute care situations became apparent. However, negative feedback to peers was avoided, which led to a loss of learning opportunity. High fidelity simulation training as a method plays an important part in the nursing students' learning. The teacher also plays a key role by asking difficult questions and guiding students towards accurate knowledge. This makes it possible for the students to close knowledge gaps, leading to improved patient safety. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. [Endovascular treatment in acute ischaemic stroke. A stroke care plan for the region of Madrid]. (United States)

    Alonso de Leciñana, M; Díaz-Guzmán, J; Egido, J A; García Pastor, A; Martínez-Sánchez, P; Vivancos, J; Díez-Tejedor, E


    Endovascular therapies (intra-arterial thrombolysis and mechanical thrombectomy) after acute ischaemic stroke are being implemented in the clinical setting even as they are still being researched. Since we lack sufficient data to establish accurate evidence-based recommendations for use of these treatments, we must develop clinical protocols based on current knowledge and carefully monitor all procedures. After review of the literature and holding work sessions to reach a consensus among experts, we developed a clinical protocol including indications and contraindications for endovascular therapies use in acute ischaemic stroke. The protocol includes methodology recommendations for diagnosing and selecting patients, performing revascularisation procedures, and for subsequent patient management. Its objective is to increase the likelihood of efficacy and treatment benefit and minimise risk of complications and ineffective recanalisation. Based on an analysis of healthcare needs and available resources, a cooperative inter-hospital care system has been developed. This helps to ensure availability of endovascular therapies to all patients, a fast response time, and a good cost-to-efficacy ratio. It includes also a prospective register which serves to monitor procedures in order to identify any opportunities for improvement. Implementation of endovascular techniques for treating acute ischaemic stroke requires the elaboration of evidence-based clinical protocols and the establishment of appropriate cooperative healthcare networks guaranteeing both the availability and the quality of these actions. Such procedures must be monitored in order to improve methodology. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  8. Occupational Therapy Predischarge Home Visits in Acute Hospital Care: A Randomized Trial. (United States)

    Clemson, Lindy; Lannin, Natasha A; Wales, Kylie; Salkeld, Glenn; Rubenstein, Laurence; Gitlin, Laura; Barris, Sarah; Mackenzie, Lynette; Cameron, Ian D


    To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. Randomized controlled trial. Acute and medical wards. Individuals aged 70 and older (N = 400). Primary outcomes: activities daily living (ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index (LLDI)). Occupational therapist recommendations differed significantly between groups (P occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  9. Internships in Nontraditional Health Care Settings: A Pilot Program. (United States)

    Kotarba, Joseph A.


    Addresses nontraditional health care issues by placing internship students in different health care agencies such as (1) workplace wellness programs; (2) centers for independent living for the physically handicapped; and (3) an Acquired Immune Deficiency Syndrome (AIDS) intervention program. Examines new problems in health care and the importance…

  10. Palliative Care Consults in Nursing Homes and Reductions in Acute Care Use and Potentially Burdensome End-of-Life Transitions (United States)

    Miller, Susan C.; Lima, Julie C.; Intrator, Orna; Martin, Edward; Bull, Janet; Hanson, Laura C.


    BACKGROUND/OBJECTIVES To evaluate how receipt and timing of nursing home (NH) palliative care consults (primarily by nurse practitioners with palliative care expertise) is associated with end-of-life care transitions and acute care use DESIGN A propensity-score (pscore) matched retrospective cohort study SETTING Forty-six NHs in two states PARTICIPANTS NH residents who died in 2006–2010 stratified by days between initial consult and death: ≤7, 8–30, 31–60 or 61–180. By strata, pscore matching identified three controls (n=1,174) for each consult recipient (n=477). MEASUREMENTS Outcomes were hospitalizations in the last 7, 30 and 60 days of life, emergency room visits in the last 30 and 60 days, and any potentially burdensome care transition defined as hospitalization or hospice admission within three days of death or two or more hospitalizations or emergency room visits within 30. Weighted multivariate logistic regression analyses evaluated outcomes. RESULTS Residents with consults (compared to controls) had lower rates of hospitalization, with rates lowest when initial consults were furthest from death. For instance, among residents with initial consults 8–30 days before death the adjusted hospitalization rate in the last seven days of life was 11.1% (95% CI, 9.79 to 12.43) compared to 22.0% (95% CI, 20.62 to 23.41) among controls; however, among those with initial consults 61–180 days before death, rates were 6.9% (95% CI, 5.47 to 8.37) compared to 22.9% (95% CI, 20.48 to 25.42). Potentially burdensome transition rates were lower when consults were 61–180 days before death (16.2% (95% CI, 13.74 to 18.57) compared to 28.2% (95% CI, 25.82 to 30.59)) for controls. CONCLUSION Findings suggest palliative care consults improve end-of-life NH care by reducing acute care use and potentially burdensome care transitions. PMID:27641157

  11. Through the lens of instructional design: appraisal of the Jeffries/National League for Nursing Simulation Framework for use in acute care. (United States)

    Wilson, Rebecca D; Hagler, Debra


    As human patient simulation becomes more prevalent in acute care settings, clinical experts are often asked to assist in developing scenarios. Although the Jeffries/National League for Nursing Simulation Framework has been used in academic settings to guide the instructional design of clinical simulations, its use in acute care settings is less known. This framework incorporates a consideration of contextual elements, design characteristics, and outcomes. An external validation study applying the framework within the context of acute care showed its overall strength as well as elements that were problematic. The implications derived from the study of the design characteristics in a hospital setting can be used by nurses who are considering either adopting or adapting this framework for their own practice. Copyright 2012, SLACK Incorporated.

  12. Antibiotic use and clinical outcomes in the acute setting under management by an infectious diseases acute physician versus other clinical teams: a cohort study. (United States)

    Fawcett, Nicola Jk; Jones, Nicola; Quan, T Phuong; Mistry, Vikash; Crook, Derrick; Peto, Tim; Walker, A Sarah


    To assess the magnitude of difference in antibiotic use between clinical teams in the acute setting and assess evidence for any adverse consequences to patient safety or healthcare delivery. Prospective cohort study (1 week) and analysis of linked electronic health records (3 years). UK tertiary care centre. All patients admitted sequentially to the acute medical service under an infectious diseases acute physician (IDP) and other medical teams during 1 week in 2013 (n=297), and 3 years 2012-2014 (n=47 585). Antibiotic use in days of therapy (DOT): raw group metrics and regression analysis adjusted for case mix. 30-day all-cause mortality, treatment failure and length of stay. Antibiotic use was 173 vs 282 DOT/100 admissions in the IDP versus non-IDP group. Using case mix-adjusted zero-inflated Poisson regression, IDP patients were significantly less likely to receive an antibiotic (adjusted OR=0.25 (95% CI 0.07 to 0.84), p=0.03) and received shorter courses (adjusted rate ratio (RR)=0.71 (95% CI 0.54 to 0.93), p=0.01). Clinically stable IDP patients of uncertain diagnosis were more likely to have antibiotics held (87% vs 55%; p=0.02). There was no significant difference in treatment failure or mortality (adjusted p>0.5; also in the 3-year data set), but IDP patients were more likely to be admitted overnight (adjusted OR=3.53 (95% CI 1.24 to 10.03), p=0.03) and have longer length of stay (adjusted RR=1.19 (95% CI 1.05 to 1.36), p=0.007). The IDP-led group used 30% less antibiotic therapy with no adverse clinical outcome, suggesting antibiotic use can be reduced safely in the acute setting. This may be achieved in part by holding antibiotics and admitting the patient for observation rather than prescribing, which has implications for costs and hospital occupancy. More information is needed to indicate whether any such longer admission will increase or decrease risk of antibiotic-resistant infections. Published by the BMJ Publishing Group Limited. For

  13. Assessment of quality of care in acute postoperative pain management

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    Milutinović Dragana


    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p

  14. Acute care to prevent back disability. Ten years of progress. (United States)

    Bigos, S J; Battié, M C


    Efforts to curb back problems through preemployment screening, safety measures, and educational programs have had little effect on this most expensive musculoskeletal malady. Present knowledge raises doubts about the possibility of preventing back pain. However, recent scientific investigations indicate that chronic back pain disability, which accounts for 80% of the costs for back problems, can be prevented. In Gothenburg, Sweden, the collective use of proven treatment methods during the acute stage of back symptoms markedly reduced the period of time patients were disabled from back problems. Effective early intervention centers around: teaching patients about back care, including how to control symptoms through improved body mechanics; applying these educational principles, specifically to the patient's livelihood; avoiding the debilitation that results from overusing bed rest and medication; recommendations to increase cardiovascular fitness; and the judicious use of orthopedic surgery. This approach targets the few patients who tend to be disabled the longest, suffer the most, and become the most costly to society.

  15. Symptoms of posttraumatic stress disorder among pediatric acute care nurses. (United States)

    Czaja, Angela S; Moss, Marc; Mealer, Meredith


    In their work, pediatric acute care nurses may encounter traumatic events and be at risk for posttraumatic stress disorder (PTSD). This survey-based study examines the potential diagnosis of PTSD among nurses at a tertiary children's hospital with a Level 1 trauma center. Twenty-one percent of respondents had strong PTSD symptoms without significant difference between units. Nurses with potential PTSD had more comorbid symptoms of anxiety, depression, and burnout and were more often considering a career change. Furthermore, symptoms affected not only their work but also their personal lives. Future research should focus upon identifying pediatric nurses with PTSD to provide therapeutic interventions and reducing high-risk events and their potential impact. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Demographic diversity, value congruence, and workplace outcomes in acute care. (United States)

    Gates, Michael G; Mark, Barbara A


    Nursing scholars and healthcare administrators often assume that a more diverse nursing workforce will lead to better patient and nurse outcomes, but this assumption has not been subject to rigorous empirical testing. In a study of nursing units in acute care hospitals, the influence of age, gender, education, race/ethnicity, and perceived value diversity on nurse job satisfaction, nurse intent to stay, and patient satisfaction were examined. Support was found for a negative relationship between perceived value diversity and all outcomes and for a negative relationship between education diversity and intent to stay. Additionally, positive relationships were found between race/ethnicity diversity and nurse job satisfaction as well as between age diversity and intent to stay. From a practice perspective, the findings suggest that implementing retention, recruitment, and management practices that foster a strong shared value system among nurses may lead to better workplace outcomes. Copyright © 2012 Wiley Periodicals, Inc.

  17. Epidemiology of Acute Kidney Injury in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    James Case


    Full Text Available The incidence of acute kidney injury (AKI in the intensive care unit (ICU has increased during the past decade due to increased acuity as well as increased recognition. Early epidemiology studies were confounded by erratic definitions of AKI until recent consensus guidelines (RIFLE and AKIN standardized its definition. This paper discusses the incidence of AKI in the ICU with focuses on specific patient populations. The overall incidence of AKI in ICU patients ranges from 20% to 50% with lower incidence seen in elective surgical patients and higher incidence in sepsis patients. The incidence of contrast-induced AKI is less (11.5%–19% of all admissions than seen in the ICU population at large. AKI represents a significant risk factor for mortality and can be associated with mortality greater than 50%.

  18. Identification of cerebral perfusion using arterial spin labeling in patients with seizures in acute settings.

    Directory of Open Access Journals (Sweden)

    Roh-Eul Yoo

    Full Text Available This study aimed to explore the utility of arterial spin labeling perfusion-weighted imaging (ASL-PWI in patients with suspected seizures in acute settings. A total of 164 patients who underwent ASL-PWI for suspected seizures in acute settings (with final diagnoses of seizure [n = 129], poststroke seizure [n = 18], and seizure mimickers [n = 17], were included in this retrospective study. Perfusion abnormality was analyzed for: (1 pattern, (2 multifocality, and (3 atypical distribution against vascular territories. Perfusion abnormality was detected in 39% (50/129 of the seizure patients, most (94%, 47/50 being the hyperperfusion pattern. Of the patients with perfusion abnormality, multifocality or hemispheric involvement and atypical distribution against vascular territory were revealed in 46% (23/50 and 98% (49/50, respectively. In addition, seizures showed characteristic features including hyperperfusion (with or without non-territorial distribution on ASL-PWI, thus differentiating them from poststroke seizures or seizure mimickers. In patients in whom seizure focus could be localized on both EEG and ASL-PWI, the concordance rate was 77%. The present study demonstrates that ASL-PWI can provide information regarding cerebral perfusion status in patients with seizures in acute settings and has the potential to be used as a non-invasive imaging tool to identify the cerebral perfusion in patients with seizures.

  19. Spectrum of vaginal discharge in a tertiary care setting (United States)

    Sivaranjini, R; Jaisankar, TJ; Thappa, Devinder Mohan; Kumari, Rashmi; Chandrasekhar, Laxmisha; Malathi, M; Parija, SC; Habeebullah, S


    Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies. PMID:24470998

  20. Admission, management and outcomes of acute pancreatitis in intensive care. (United States)

    Russell, Peter S; Mittal, Anhubav; Brown, Lisa; McArthur, Colin; Phillips, Anthony J R; Petrov, Max; Windsor, John A


    A review of the management of acute pancreatitis (AP) at a tertiary intensive care unit (ICU) in Auckland, New Zealand, was published in 2004. This paper aims to update this series and identify changes in admission criteria, management and outcomes. A retrospective review of patients admitted to the Department of Critical Care Medicine, Auckland City Hospital, with AP from 2003 to 2014 was undertaken and data compared with the previous study (1988-2001). Eighty-four patients (male 53, mean ± SD age = 56.9 ± 15 years) with 85 admissions to ICU from 2003 to 2014 were compared with 112 patients in the previous study. Maori were over-represented. Median duration of symptoms prior to admission to ICU decreased from 7 to 3 days. The proportion of total AP patients admitted to ICU halved and the mean Acute Physiology and Chronic Health Evaluation II score on admission decreased from mean 19.9 ± 8.2 SD to 15.4 ± 7.3 (P < 0.001). Two thirds of patients had persistent organ failure. The use of enteral feeding doubled from 46/112 (41%) to 71/85 (84%) (P < 0.001). The use of primary percutaneous drainage increased from 14/112 (13%) to 24/85 (28%) (P = 0.007). Rate of necrosectomy was similar (36/112 (32%) versus 20/85 (24%), P = 0.205), although minimally invasive necrosectomy was introduced. Overall hospital mortality decreased by 29% (P = 0.198). There have been changes to the admission criteria and management in line with evolving guidelines and, overall, outcomes have improved. © 2016 Royal Australasian College of Surgeons.

  1. Disseminating hypnosis to health care settings: Applying the RE-AIM framework (United States)

    Yeh, Vivian M.; Schnur, Julie B.; Montgomery, Guy H.


    Hypnosis is a brief intervention ready for wider dissemination in medical contexts. Overall, hypnosis remains underused despite evidence supporting its beneficial clinical impact. This review will evaluate the evidence supporting hypnosis for dissemination using guidelines formulated by Glasgow and colleagues (1999). Five dissemination dimensions will be considered: Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Reach In medical settings, hypnosis is capable of helping a diverse range of individuals with a wide variety of problems. Efficacy There is evidence supporting the use of hypnosis for chronic pain, acute pain and emotional distress arising from medical procedures and conditions, cancer treatment-related side-effects and irritable bowel syndrome. Adoption Although hypnosis is currently not a part of mainstream clinical practices, evidence suggests that patients and healthcare providers are open to trying hypnosis, and may become more so when educated about what hypnosis can do. Implementation Hypnosis is a brief intervention capable of being administered effectively by healthcare providers. Maintenance Given the low resource needs of hypnosis, opportunities for reimbursement, and the ability of the intervention to potentially help medical settings reduce costs, the intervention has the qualities necessary to be integrated into routine care in a self-sustaining way in medical settings. In sum, hypnosis is a promising candidate for further dissemination. PMID:25267941

  2. Impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care. (United States)

    Ballard, David J; Ogola, Gerald; Fleming, Neil S; Stauffer, Brett D; Leonard, Bradley M; Khetan, Rainer; Yancy, Clyde W


    To determine the impact of a standardized heart failure order set on mortality, readmission, and quality and costs of care. Observational study. Eight acute care hospitals and two specialty heart hospitals. All adults (>18 years) discharged from one of the included hospitals between December 2007 and March 2009 with a diagnosis of heart failure, who had not undergone heart transplant, did not have a left ventricular assistive device, and with a length of stay of 120 or less days. A standardized heart failure order set was developed internally, with content driven by the prevailing American College of Cardiology/American Heart Association clinical practice guidelines, and deployed systemwide via an intranet physician portal. Publicly reported process of care measures, in-patient mortality, 30-day mortality, 30-day readmission, length of stay, and direct cost of care were compared for heart failure patients treated with and without the order set. Order set used reached 73.1% in March 2009. After propensity score adjustment, order set use was associated with significantly increased core measures compliance [odds ratio (95% confidence interval) = 1.51(1.08; 2.12)] and reduced in-patient mortality [odds ratio (95% confidence interval) = 0.49(0.28; 0.88)]. Reductions in 30-day mortality and readmission approached significance. Direct cost for initial admissions alone and in combination with readmissions were significantly lower with order set use. Implementing an evidence-based standardized order set may help improve outcomes, reduce costs of care and increase adherence to evidence-based processes of care.

  3. Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients - results of a pragmatic intervention. (United States)

    Bell, Jack J; Bauer, Judith D; Capra, Sandra; Pulle, Ranjeev Chrys


    Malnutrition is highly prevalent and resistant to intervention following hip fracture. This study investigated the impact of individualised versus multidisciplinary nutritional care on nutrition intake and outcomes in patients admitted to a metropolitan hospital acute hip fracture unit. A prospective, controlled before and after comparative interventional study aligning to the CONSORT guidelines for pragmatic clinical trials. Randomly selected patients receiving individualised nutritional care (baseline) were compared with post-interventional patients receiving a new model of nutritional care promoting nutrition as a medicine, multidisciplinary nutritional care, foodservice enhancements, and improved nutrition knowledge and awareness. Malnutrition was diagnosed using the Academy of Nutrition and Dietetics criteria. Fifty-eight weighed food records were available for each group across a total of 82 patients (n = 44, n = 38). Group demographics were not significantly different with predominantly community dwelling (72%), elderly (82.2 years), female (70%), malnourished (51.0%) patients prone to co-morbidities (median 5) receiving early surgical intervention (median D1). Multidisciplinary nutritional care reduced intake barriers and increased total 24-h energy (6224 vs. 2957 kJ; p nutritional deterioration over admission (5.4 vs. 20.5%; p = 0.049), and increased discharge directly back to the community setting (48.0 vs. 17.6%; p = 0.012). Trends suggested a reduction in median length of stay (D13 vs. D14). Inpatient mortality remained low across groups (5.2%, 2.3%). Multidisciplinary nutritional care improves nutrition intake and outcomes in acute hip fracture inpatients. Similar pragmatic study designs should be considered in other elderly inpatient populations perceived resistant to nutritional intervention. Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  4. Innovation or rebranding, acute care surgery diffusion will continue (United States)

    Collins, Courtney E.; Pringle, Patricia L.; Santry, Heena P.


    Background Patterns of adoption of acute care surgery (ACS) as a strategy for emergency general surgery (EGS) care are unknown. Methods We conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for ACS at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment (three practice types [community, public/charity, university] in each of six geographic regions [Mid-Atlantic, Midwest, New England, Northeast, South, West]). Interviews were recorded, transcribed, and analyzed using NVivo (QSR International, Melbourne, Australia). We applied the methods of investigator triangulation using an inductive approach to develop a final taxonomy of codes organized by themes related to respondents’ views on the future of ACS as a strategy for EGS. We applied our findings to a conceptual model on diffusion of innovation. Results We found a paradox between ACS viewed as a healthcare delivery innovation versus a rebranding of comprehensive general surgery. Optimism for the future of ACS due to increased desirability for trauma/critical care careers and improved outcomes for EGS was tempered by fear over lack of continuity, poor institutional resources and uncertainty regarding financial viability. Our analysis suggests that the implementation of ACS, whether a true healthcare delivery innovation or an innovative rebranding, fits into the Rogers’ Diffusion of Innovation Theory. Conclusions Despite concerns over resource allocation and the definition of the specialty, from the perspective of senior surgeons deeply entrenched in executing this care-delivery model, ACS represents the new face of general surgery that will likely continue to diffuse from these early adopters. PMID:25891673

  5. The Experience of Witnessing Patients' Trauma and Suffering among Acute Care Nurses (United States)

    Walsh, Mary E.; Buchanan, Marla J.


    A large body of research provides evidence of workplace injuries to those in the nursing profession. Research on workplace stress and burnout among medical professionals is also well known; however, the profession of acute care nursing has not been examined with regards to work-related stress. This qualitative study focused on acute care nurses'…

  6. Applying lean Six Sigma to reduce linen loss in an acute care hospital

    African Journals Online (AJOL)

    Applying lean Six Sigma to reduce linen loss in an acute care hospital. ... International Journal of Engineering, Science and Technology ... This paper describes a case study in an acute care hospital that formed a cross-functional team to apply the Lean Six Sigma problem solving methodology and tools to improve the linen ...

  7. What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis. (United States)

    Clarke, David; Jones, Fiona; Harris, Ruth; Robert, Glenn


    Co-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality is increasing. In the acute healthcare context, co-production is promoted as harnessing the knowledge of patients, carers and staff to make changes about which they care most. However, little is known regarding the impact of co-production on patient, staff or organisational outcomes in these settings. To identify and appraise reported outcomes of co-production as an intervention to improve quality of services in acute healthcare settings. Rapid evidence synthesis. Medline, Cinahl, Web of Science, Embase, HMIC, Cochrane Database of Systematic Reviews, SCIE, Proquest Dissertation and Theses, EThOS, OpenGrey; CoDesign; The Design Journal; Design Issues. Studies reporting patient, staff or organisational outcomes associated with using co-production in an acute healthcare setting. 712 titles and abstracts were screened; 24 papers underwent full-text review, and 11 papers were included in the evidence synthesis. One study was a feasibility randomised controlled trial, three were process evaluations and seven used descriptive qualitative approaches. Reported outcomes related to (a) the value of patient and staff involvement in co-production processes; (b) the generation of ideas for changes to processes, practices and clinical environments; and (c) tangible service changes and impacts on patient experiences. Only one study included cost analysis; none reported an economic evaluation. No studies assessed the sustainability of any changes made. Despite increasing interest in and advocacy for co-production, there is a lack of rigorous evaluation in acute healthcare settings. Future studies should evaluate clinical and service outcomes as well as the cost-effectiveness of co-production relative to other forms of quality improvement. Potentially broader

  8. Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.

    Directory of Open Access Journals (Sweden)

    Payal Modi

    Full Text Available Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy.To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b. Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity.850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60, sensitivity (67%, and specificity (49%, for predicting severe dehydration were all poor.Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.

  9. Dissociative Spectrum Disorders in the Primary Care Setting


    Elmore, James L.


    Dissociative disorders have a lifetime prevalence of about 10%. Dissociative symptoms may occur in acute stress disorder, posttraumatic stress disorder, somatization disorder, substance abuse, trance and possession trance, Ganser's syndrome, and dissociative identity disorder, as well as in mood disorders, psychoses, and personality disorders. Dissociative symptoms and disorders are observed frequently among patients attending our rural South Carolina community mental health center. Given the...

  10. Cost and care of patients with Alzheimer's disease: clinical predictors in German health care settings. (United States)

    Reese, Jens Peter; Hessmann, Philipp; Seeberg, Greta; Henkel, Dajana; Hirzmann, Pamela; Rieke, Jürgen; Baum, Erika; Dannhoff, Frank; Müller, Matthias J; Jessen, Frank; Geldsetzer, Monika-Balzer; Dodel, Richard


    The study aims to report service use and costs for patients with Alzheimer's disease (AD) and to explore the incremental influence of sociodemographic and illness-related determinants in ambulatory and inpatient settings within the German health care system. 395 patients with dementia were recruited at the following sites: 1) University hospital, 2) general practitioners' offices, 3) office-based neurologists, 4) a regional psychiatric hospital, and 5) nursing homes. Sociodemographic, economic, and clinical parameters were assessed using a standardized questionnaire. Informal care was not evaluated. Disease severity was measured using the Mini-Mental Status Examination and the Alzheimer's Disease Assessment Scale - Cognitive Subscale. Neuropsychiatric status was assessed using the Geriatric Depression Scale, the Neuropsychiatric Inventory, and the Alzheimer's Disease Cooperative-Study-Activities of Daily Living. Annual total costs were estimated to be €13,080 per patient. The most important cost component was (long-term) care, constituting about 43% of total costs. Indirect costs comprised about 18% of total costs and were mainly due to reductions in working time of caregivers. Poorer functional status was associated with higher total and caregiving costs. In multivariate analyses, we identified younger age, female gender, and impaired activities of daily living as independent predictors of higher costs. Given that care for patients with AD is complex and expensive, our models were only able to explain about 17-43% of the variability in total costs. This suggests that further social and individual factors considerably influence the costs associated with AD. Direct medical care costs and long-term care costs related differently to the patient's clinical characteristics. Longitudinal and population-based studies are necessary for thoroughly evaluating the burden of disease.

  11. Finding new bearings: a qualitative study on the transition from inpatient to ambulatory care of patients with acute myeloid leukemia. (United States)

    Nissim, Rinat; Rodin, Gary; Schimmer, Aaron; Minden, Mark; Rydall, Anne; Yuen, Dora; Mischitelle, Ashley; Fitzgerald, Peter; Lo, Christopher; Gagliese, Lucia; Zimmermann, Camilla


    Treatment of adult acute myeloid leukemia (AML) is intensive, with induction treatment initiated in an inpatient setting and subsequent consolidation therapy often conducted in an outpatient setting. The purpose of the present qualitative paper is to provide insight into the experience of patients in the transition from inpatient to ambulatory care. Participants were 35 AML patients who were interviewed about their experience of the illness and treatment. Utilizing the grounded theory method, we describe the adjustment of participants to the transition to ambulatory care. As outpatients, participants described adjusting to the intensity of ambulatory treatment and to the need to assume greater responsibility for their care. They also expressed a growing desire to understand their long-term care plan, compared to their preference to focus on the present prior to discharge, and they were struggling to construct a new sense of identity. AML patients are now leaving acute care settings sicker and earlier. Considering their perceptions can inform interventions to facilitate adjustment during the transition to outpatient care.

  12. Interprofessional communication failures in acute care chains: How can we identify the causes? (United States)

    van Leijen-Zeelenberg, Janneke E; van Raak, Arno J A; Duimel-Peeters, Inge G P; Kroese, Mariëlle E A L; Brink, Peter R G; Vrijhoef, Hubertus J M


    Although communication failures between professionals in acute care delivery occur, explanations for these failures remain unclear. We aim to gain a deeper understanding of interprofessional communication failures by assessing two different explanations for them. A multiple case study containing six cases (i.e. acute care chains) was carried out in which semi-structured interviews, physical artifacts and archival records were used for data collection. Data were entered into matrices and the pattern-matching technique was used to examine the two complementary propositions. Based on the level of standardization and integration present in the acute care chains, the six acute care chains could be divided into two categories of care processes, with the care chains equally distributed among the categories. Failures in communication occurred in both groups. Communication routines were embedded within organizations and descriptions of communication routines in the entire acute care chain could not be found. Based on the results, failures in communication could not exclusively be explained by literature on process typology. Literature on organizational routines was useful to explain the occurrence of communication failures in the acute care chains. Organizational routines can be seen as repetitive action patterns and play an important role in organizations, as most processes are carried out by means of routines. The results of this study imply that it is useful to further explore the role of organizational routines on interprofessional communication in acute care chains to develop a solution for failures in handover practices.

  13. Functional Status Predicts Acute Care Readmissions from Inpatient Rehabilitation in the Stroke Population.

    Directory of Open Access Journals (Sweden)

    Chloe Slocum

    Full Text Available Acute care readmission risk is an increasingly recognized problem that has garnered significant attention, yet the reasons for acute care readmission in the inpatient rehabilitation population are complex and likely multifactorial. Information on both medical comorbidities and functional status is routinely collected for stroke patients participating in inpatient rehabilitation. We sought to determine whether functional status is a more robust predictor of acute care readmissions in the inpatient rehabilitation stroke population compared with medical comorbidities using a large, administrative data set.A retrospective analysis of data from the Uniform Data System for Medical Rehabilitation from the years 2002 to 2011 was performed examining stroke patients admitted to inpatient rehabilitation facilities. A Basic Model for predicting acute care readmission risk based on age and functional status was compared with models incorporating functional status and medical comorbidities (Basic-Plus or models including age and medical comorbidities alone (Age-Comorbidity. C-statistics were compared to evaluate model performance.There were a total of 803,124 patients: 88,187 (11% patients were transferred back to an acute hospital: 22,247 (2.8% within 3 days, 43,481 (5.4% within 7 days, and 85,431 (10.6% within 30 days. The C-statistics for the Basic Model were 0.701, 0.672, and 0.682 at days 3, 7, and 30 respectively. As compared to the Basic Model, the best-performing Basic-Plus model was the Basic+Elixhauser model with C-statistics differences of +0.011, +0.011, and + 0.012, and the best-performing Age-Comorbidity model was the Age+Elixhauser model with C-statistic differences of -0.124, -0.098, and -0.098 at days 3, 7, and 30 respectively.Readmission models for the inpatient rehabilitation stroke population based on functional status and age showed better predictive ability than models based on medical comorbidities.

  14. Assessing breast cancer risk in a primary care setting. (United States)

    Kiely, Deirdre; Schwartz, Shira


    Individuals who are given a preventive exam by a primary care provider are more likely to agree to cancer screening. The provider recommendation has been identified as the strongest factor associated with screening utilization. This article provides a framework for breast cancer risk assessment for an advanced practice registered nurse working in primary care practice.

  15. The Future of Family Engagement in Residential Care Settings (United States)

    Affronti, Melissa L.; Levison-Johnson, Jody


    Residential programs for children and youth are increasingly implementing engagement strategies to promote family-centered and family-driven models of care (Leichtman, 2008). The practice of engagement is a fairly new area of research, especially in residential care. Driven by their goal to increase the use of state-of-the-art family engagement…

  16. [Campylobacter and Salmonella acute gastroenteritis: epidemiology and health care utilization]. (United States)

    Sala Farré, Maria Rosa; Osorio Sánchez, Dimelza; Arias Varela, Cesar; Simó Sanahuja, Maria; Recasens Recasens, Assumpta; Pérez Jové, Josefa


    In Catalonia the current surveillance systems do not allow to know the true incidence or the health care utilization of acute gastroenteritis (AGE) caused by Campylobacter and Salmonella infections. The aim of this study is to analyze these characteristics. Descriptive study of Campylobacter and Salmonella infections reported in 2002 and 2012 in Catalonia, Spain. We included cases isolated and reported by the laboratory to a regional Surveillance Unit. The estimated incidence of Salmonella and Campylobacter AGE decreased by almost 50% and 20% respectively in 2012. Children between one and 4 years old were the most affected in both years. Significant differences in the clinical characteristics and disease duration were observed between Campylobacter and Salmonella. Visits to the Emergency Department and hospitalization rates were 63.7% and 15%, being more frequent among salmonellosis cases. The estimated incidence of Campylobacter and Salmonella infections has decreased, however rates are still important, as well as it is the health care utilization in both diseases. Current surveillance systems need appropriateness improvements to reach a better control of these infections. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  17. Optimal setting and care organization in the management of older adults with hip fracture: a narrative review

    Directory of Open Access Journals (Sweden)

    Andrea Giusti


    Full Text Available Hip fracture (HF is a common event in older adults and is associated with significant morbidity, mortality, reduction of quality of life and costs for the healthcare systems. The expected rise in the total number of HF worldwide, due to improvements in life expectancy, and the growing awareness of HF detrimental consequences have led to the development and implementation of models of care alternative to the traditional ones for the acute and post-acute management of HF older adults. These services were set to streamline hospital care, minimize inhospital complications, provide early discharge, improve short- and long-term functional and clinical outcomes, and reduce healthcare costs associated with hip and other fragility fractures. The main feature that distinguishes these models is the different healthcare professional that retains the responsibility and leadership during the acute and post-acute phases. This narrative review has been conceived to provide a brief description of the models implemented in the last twenty years, to describe their potential beneficial effects on the shortand long-term outcomes, and to define the strengths and limitations of these models. On the basis of available studies, it seems that the more complex and sophisticated services, characterized by a multidisciplinary approach with a co-leadership (geriatrician and orthopedic surgeon or a geriatrician leadership demonstrated to produce better outcomes compared to the traditional or simplest models.

  18. Incidence and prevalence of inflammatory bowel diseases in gastroenterology primary care setting. (United States)

    Tursi, Antonio; Elisei, Walter; Picchio, Marcello


    The incidence of inflammatory bowel diseases (IBDs) has markedly increased over the last years, but no epidemiological study has been performed in gastroenterology primary care setting. We describe the epidemiology of IBD in a gastroenterology primary care unit using its records as the primary data source. Case finding used predefined read codes to systematically search computer diagnostic and prescribing records from January 2009 to December 2012. A specialist diagnosis of Ulcerative colitis (UC), Crohn's disease (CD), inflammatory bowel disease unclassified (IBDU) or segmental colitis associated with diverticulosis (SCAD), based on clinical, histological or radiological findings, was a prerequisite for the inclusion in the study. Secondary, infective and apparent acute self-limiting colitis were excluded. We identified 176 patients with IBD in a population of 94,000 with a prevalence 187.2/100,000 (95% CI: 160.6-217.0). Between 2009 and 2012 there were 61 new cases. In particular, there were 23 new cases of UC, 19 new cases of CD, 15 new cases of SCAD, and 4 new cases of IBDU. The incidence of IBD was 16.2/100,000 (95% CI 12.5-20.7) per year. The incidence per year was 6/100,000 (95% CI 3.8 to 8.9) for UC, 5/100,000 (95% CI 3.0-7.7) for CD, 4/100,000 (95% CI 2.3-6.5) for SCAD, and 1/100,000 (95% CI 0.3-2.6) for IBDU. We assessed for the first time which is the prevalence and incidence of IBD in a gastroenterology primary care unit. This confirms that specialist primary care unit is a key factor in providing early diagnosis of chronic diseases. Copyright © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  19. Latent Growth Modeling of nursing care dependency of acute neurological inpatients. (United States)

    Piredda, M; Ghezzi, V; De Marinis, M G; Palese, A


    Longitudinal three-time point study, addressing how neurological adult patient care dependency varies from the admission time to the 3rd day of acute hospitalization. Nursing care dependency was measured with the Care Dependency Scale (CDS) and a Latent Growth Modeling approach was used to analyse the CDS trend in 124 neurosurgical and stroke inpatients. Care dependence followed a decreasing linear trend. Results can help nurse-managers planning an appropriate amount of nursing care for acute neurological patients during their initial stage of hospitalization. Further studies are needed aimed at investigating the determinants of nursing care dependence during the entire in-hospital stay.

  20. Perspectives of Post-Acute Transition of Care for Cardiac Surgery Patients

    Directory of Open Access Journals (Sweden)

    Nicoleta Stoicea


    Full Text Available Post-acute care (PAC facilities improve patient recovery, as measured by activities of daily living, rehabilitation, hospital readmission, and survival rates. Seamless transitions between discharge and PAC settings continue to be challenges that hamper patient outcomes, specifically problems with effective communication and coordination between hospitals and PAC facilities at patient discharge, patient adherence and access to cardiac rehabilitation (CR services, caregiver burden, and the financial impact of care. The objective of this review is to examine existing models of cardiac transitional care, identify major challenges and social factors that affect PAC, and analyze the impact of current transitional care efforts and strategies implemented to improve health outcomes in this patient population. We intend to discuss successful methods to address the following aspects: hospital-PAC linkages, improved discharge planning, caregiver burden, and CR access and utilization through patient-centered programs. Regular home visits by healthcare providers result in decreased hospital readmission rates for patients utilizing home healthcare while improved hospital-PAC linkages reduced hospital readmissions by 25%. We conclude that widespread adoption of improvements in transitional care will play a key role in patient recovery and decrease hospital readmission, morbidity, and mortality.

  1. Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study

    Directory of Open Access Journals (Sweden)

    Lesley Baillie


    Full Text Available Introduction: Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. Theory and methods: The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n =17; focus groups (n = 9 with ward staff (n = 36; interviews with frail older people (n = 4. The data were analysed using the framework approach. Findings: Three themes are presented: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. Discussion and conclusions: A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other’s roles and build relationships and trust.

  2. Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study

    Directory of Open Access Journals (Sweden)

    Lesley Baillie


    Full Text Available Introduction: Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services.Theory and methods: The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n =17; focus groups (n = 9 with ward staff (n = 36; interviews with frail older people (n = 4. The data were analysed using the framework approach. Findings: Three themes are presented: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions.Discussion and conclusions: A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other’s roles and build relationships and trust.

  3. A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care

    DEFF Research Database (Denmark)

    Langhorn, Leanne; Sorensen, Jens C; Pedersen, Preben U


    A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care......A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care...

  4. Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care. (United States)

    Verbakel, Jan Y; Lemiengre, Marieke B; De Burghgraeve, Tine; De Sutter, An; Aertgeerts, Bert; Bullens, Dominique M A; Shinkins, Bethany; Van den Bruel, Ann; Buntinx, Frank


    Acute infection is the most common presentation of children in primary care with only few having a serious infection (eg, sepsis, meningitis, pneumonia). To avoid complications or death, early recognition and adequate referral are essential. Clinical prediction rules have the potential to improve diagnostic decision-making for rare but serious conditions. In this study, we aimed to validate a recently developed decision tree in a new but similar population. Diagnostic accuracy study validating a clinical prediction rule. Acutely ill children presenting to ambulatory care in Flanders, Belgium, consisting of general practice and paediatric assessment in outpatient clinics or the emergency department. Physicians were asked to score the decision tree in every child. The outcome of interest was hospital admission for at least 24 h with a serious infection within 5 days after initial presentation. We report the diagnostic accuracy of the decision tree in sensitivity, specificity, likelihood ratios and predictive values. In total, 8962 acute illness episodes were included, of which 283 lead to admission to hospital with a serious infection. Sensitivity of the decision tree was 100% (95% CI 71.5% to 100%) at a specificity of 83.6% (95% CI 82.3% to 84.9%) in the general practitioner setting with 17% of children testing positive. In the paediatric outpatient and emergency department setting, sensitivities were below 92%, with specificities below 44.8%. In an independent validation cohort, this clinical prediction rule has shown to be extremely sensitive to identify children at risk of hospital admission for a serious infection in general practice, making it suitable for ruling out. NCT02024282. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  5. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

    NARCIS (Netherlands)

    Bellani, Giacomo; Laffey, John G.; Pham, Tài; Fan, Eddy; Brochard, Laurent; Esteban, Andres; Gattinoni, Luciano; van Haren, Frank; Larsson, Anders; McAuley, Daniel F.; Ranieri, Marco; Rubenfeld, Gordon; Thompson, B. Taylor; Wrigge, Hermann; Slutsky, Arthur S.; Pesenti, Antonio; Francois, Guy M.; Rabboni, Francesca; Madotto, Fabiana; Conti, Sara; Sula, Hektor; Nunci, Lordian; Cani, Alma; Zazu, Alan; Dellera, Christian; Insaurralde, Carolina S.; Alejandro, Risso V.; Daldin, Julio; Vinzio, Mauricio; Fernandez, Ruben O.; Cardonnet, Luis P.; Bettini, Lisandro R.; Bisso, Mariano Carboni; Osman, Emilio M.; Setten, Mariano G.; Lovazzano, Pablo; Alvarez, Javier; Villar, Veronica; Pozo, Norberto C.; Grubissich, Nicolas; Plotnikow, Gustavo A.; Vasquez, Daniela N.; Ilutovich, Santiago; Tiribelli, Norberto; Chena, Ariel; Pellegrini, Carlos A.; Saenz, María G.; Estenssoro, Elisa; Brizuela, Matias; Gianinetto, Hernan; Gomez, Pablo E.; Cerrato, Valeria I.; Bezzi, Marco G.; Borello, Silvina A.; Loiacono, Flavia A.; Fernandez, Adriana M.; Knowles, Serena; Reynolds, Claire; Inskip, Deborah M.; Miller, Jennene J.; Kong, Jing; Whitehead, Christina; Bihari, Shailesh; Seven, Aylin; Krstevski, Amanda; Rodgers, Helen J.; Millar, Rebecca T.; Mckenna, Toni E.; Bailey, Irene M.; Hanlon, Gabrielle C.; Aneman, Anders; Lynch, Joan M.; Azad, Raman; Neal, John; Woods, Paul W.; Roberts, Brigit L.; Kol, Mark R.; Wong, Helen S.; Riss, Katharina C.; Staudinger, Thomas; Wittebole, Xavier; Berghe, Caroline; Bulpa, Pierre A.; Dive, Alain M.; Verstraete, Rik; Lebbinck, Herve; Depuydt, Pieter; Vermassen, Joris; Meersseman, Philippe; Ceunen, Helga; Rosa, Jonas I.; Beraldo, Daniel O.; Piras, Claudio; Rampinelli, Adenilton M.; Nassar, Antonio P.; Mataloun, Sergio; Moock, Marcelo; Thompson, Marlus M.; Gonçalves, Claudio H.; Antônio, Ana Carolina P.; Ascoli, Aline; Biondi, Rodrigo S.; Fontenele, Danielle C.; Nobrega, Danielle; Sales, Vanessa M.; Shindhe, Suresh; Ismail, Dk Maizatul Aiman B. Pg Hj; Laffey, John; Beloncle, Francois; Davies, Kyle G.; Cirone, Rob; Manoharan, Venika; Ismail, Mehvish; Goligher, Ewan C.; Jassal, Mandeep; Ferguson, Niall D.; Nishikawa, Erin; Javeed, Areej; Curley, Gerard; Rittayamai, Nuttapol; Parotto, Matteo; Mehta, Sangeeta; Knoll, Jenny; Pronovost, Antoine; Canestrini, Sergio; Bruhn, Alejandro R.; Garcia, Patricio H.; Aliaga, Felipe A.; Farías, Pamela A.; Yumha, Jacob S.; Ortiz, Claudia A.; Salas, Javier E.; Saez, Alejandro A.; Vega, Luis D.; Labarca, Eduardo F.; Martinez, Felipe T.; Carreño, Nicolás G.; Lora, Pilar; Liu, Haitao; Qiu, Haibo; Liu, Ling; Tang, Rui; Luo, Xiaoming; An, Youzhong; Zhao, Huiying; Gao, Yan; Zhai, Zhe; Ye, Zheng L.; Wang, Wei; Li, Wenwen; Li, Qingdong; Zheng, Ruiqiang; Yu, Wenkui; Shen, Juanhong; Li, Xinyu; Yu, Tao; Lu, Weihua; Wu, Ya Q.; Huang, Xiao B.; He, Zhenyang; Lu, Yuanhua; Han, Hui; Zhang, Fan; Sun, Renhua; Wang, Hua X.; Qin, Shu H.; Zhu, Bao H.; Zhao, Jun; Liu, Jian; Li, Bin; Liu, Jing L.; Zhou, Fa C.; Li, Qiong J.; Zhang, Xing Y.; Li-Xin, Zhou; Xin-Hua, Qiang; Jiang, Liangyan; Gao, Yuan N.; Zhao, Xian Y.; Li, Yuan Y.; Li, Xiao L.; Wang, Chunting; Yao, Qingchun; Yu, Rongguo; Chen, Kai; Shao, Huanzhang; Qin, Bingyu; Huang, Qing Q.; Zhu, Wei H.; Hang, Ai Y.; Hua, Ma X.; Li, Yimin; Xu, Yonghao; Di, Yu D.; Ling, Long L.; Qin, Tie H.; Wang, Shou H.; Qin, Junping; Han, Yi; Zhou, Suming; Vargas, Monica P.; Jimenez, Juan I. Silesky; Rojas, Manuel A. González; Solis-Quesada, Jaime E.; Ramirez-Alfaro, Christian M.; Máca, Jan; Sklienka, Peter; Gjedsted, Jakob; Christiansen, Aage; Nielsen, Jonas; Villamagua, Boris G.; Llano, Miguel; Burtin, Philippe; Buzancais, Gautier; Beuret, Pascal; Pelletier, Nicolas; Mortaza, Satar; Mercat, Alain; Chelly, Jonathan; Jochmans, Sébastien; Terzi, Nicolas; Daubin, Cédric; Carteaux, Guillaume; de Prost, Nicolas; Chiche, Jean-Daniel; Daviaud, Fabrice; Fartoukh, Muriel; Barberet, Guillaume; Biehler, Jerome; Dellamonica, Jean; Doyen, Denis; Arnal, Jean-Michel; Briquet, Anais; Klasen, Fanny; Papazian, Laurent; Follin, Arnaud; Roux, Damien; Messika, Jonathan; Kalaitzis, Evangelos; Dangers, Laurence; Combes, Alain; Au, Siu-Ming; Béduneau, Gaetan; Carpentier, Dorothée; Zogheib, Elie H.; Dupont, Herve; Ricome, Sylvie; Santoli, Francesco L.; Besset, Sebastien L.; Michel, Philippe; Gelée, Bruno; Danin, Pierre-Eric; Goubaux, Bernard; Crova, Philippe J.; Phan, Nga T.; Berkelmans, Frantz; Badie, Julio C.; Tapponnier, Romain; Gally, Josette; Khebbeb, Samy; Herbrecht, Jean-Etienne; Schneider, Francis; Declercq, Pierre-Louis M.; Rigaud, Jean-Philippe; Duranteau, Jacques; Harrois, Anatole; Chabanne, Russell; Marin, Julien; Constantin, Jean-Michel; Thibault, Sandrine; Ghazi, Mohammed; Boukhazna, Messabi; Zein, Salem Ould; Richecoeur, Jack R.; Combaux, Daniele M.; Grelon, Fabien; Le Moal, Charlene; Sauvadet, Elise P.; Robine, Adrien; Lemiale, Virginie; Reuter, Danielle; Dres, Martin; Demoule, Alexandre; Goldgran-Toledano, Dany; Baboi, Loredana; Guérin, Claude; Lohner, Ralph; Kraßler, Jens; Schäfer, Susanne; Zacharowski, Kai D.; Meybohm, Patrick; Reske, Andreas W.; Simon, Philipp; Hopf, Hans-Bernd F.; Schuetz, Michael; Baltus, Thomas; Papanikolaou, Metaxia N.; Papavasilopoulou, Theonymfi G.; Zacharas, Giannis A.; Ourailogloy, Vasilis; Mouloudi, Eleni K.; Massa, Eleni V.; Nagy, Eva O.; Stamou, Electra E.; Kiourtzieva, Ellada V.; Oikonomou, Marina A.; Avila, Luis E.; Cortez, Cesar A.; Citalán, Johanna E.; Jog, Sameer A.; Sable, Safal D.; Shah, Bhagyesh; Gurjar, Mohan; Baronia, Arvind K.; Memon, Mohammedfaruk; Muthuchellappan, Radhakrishnan; Ramesh, Venkatapura J.; Shenoy, Anitha; Unnikrishnan, Ramesh; Dixit, Subhal B.; Rhayakar, Rachana V.; Ramakrishnan, Nagarajan; Bhardwaj, Vallish K.; Mahto, Heera L.; Sagar, Sudha V.; Palaniswamy, Vijayanand; Ganesan, Deeban; Hashemian, Seyed Mohammadreza; Jamaati, Hamidreza; Heidari, Farshad; Meaney, Edel A.; Nichol, Alistair; Knapman, Karl M.; O'Croinin, Donall; Dunne, Eimhin S.; Breen, Dorothy M.; Clarkson, Kevin P.; Jaafar, Rola F.; Dwyer, Rory; Amir, Fahd; Ajetunmobi, Olaitan O.; O'Muircheartaigh, Aogan C.; Black, Colin S.; Treanor, Nuala; Collins, Daniel V.; Altaf, Wahid; Zani, Gianluca; Fusari, Maurizio; Spadaro, Savino; Volta, Carlo A.; Graziani, Romano; Brunettini, Barbara; Palmese, Salvatore; Formenti, Paolo; Umbrello, Michele; Lombardo, Andrea; Pecci, Elisabetta; Botteri, Marco; Savioli, Monica; Protti, Alessandro; Mattei, Alessia; Schiavoni, Lorenzo; Tinnirello, Andrea; Todeschini, Manuel; Giarratano, Antonino; Cortegiani, Andrea; Sher, Sara; Rossi, Anna; Antonelli, Massimo M.; Montini, Luca M.; Casalena, Paolo; Scafetti, Sergio; Panarello, Giovanna; Occhipinti, Giovanna; Patroniti, Nicolò; Pozzi, Matteo; Biscione, Roberto R.; Poli, Michela M.; Raimondi, Ferdinando; Albiero, Daniela; Crapelli, Giulia; Beck, Eduardo; Pota, Vincenzo; Schiavone, Vincenzo; Molin, Alexandre; Tarantino, Fabio; Monti, Giacomo; Frati, Elena; Mirabella, Lucia; Cinnella, Gilda; Fossali, Tommaso; Colombo, Riccardo; Pattarino, Pierpaolo Terragni Ilaria; Mojoli, Francesco; Braschi, Antonio; Borotto, Erika E.; Cracchiolo, Andrea N.; Palma, Daniela M.; Raponi, Francesco; Foti, Giuseppe; Vascotto, Ettore R.; Coppadoro, Andrea; Brazzi, Luca; Floris, Leda; Iotti, Giorgio A.; Venti, Aaron; Yamaguchi, Osamu; Takagi, Shunsuke; Maeyama, Hiroki N.; Watanabe, Eizo; Yamaji, Yoshihiro; Shimizu, Kazuyoshi; Shiozaki, Kyoko; Futami, Satoru; Ryosuke, Sekine; Saito, Koji; Kameyama, Yoshinobu; Ueno, Keiko; Izawa, Masayo; Okuda, Nao; Suzuki, Hiroyuki; Harasawa, Tomofumi; Nasu, Michitaka; Takada, Tadaaki; Ito, Fumihito; Nunomiya, Shin; Koyama, Kansuke; Abe, Toshikazu; Andoh, Kohkichi; Kusumoto, Kohei; Hirata, Akira; Takaba, Akihiro; Kimura, Hiroyasu; Matsumoto, Shuhei; Higashijima, Ushio; Honda, Hiroyuki; Aoki, Nobumasa; Imai, Hiroshi; Ogino, Yasuaki; Mizuguchi, Ichiko; Ichikado, Kazuya; Nitta, Kenichi; Mochizuki, Katsunori; Hashida, Tomoaki; Tanaka, Hiroyuki; Nakamura, Tomoyuki; Niimi, Daisuke; Ueda, Takeshi; Kashiwa, Yozo; Uchiyama, Akinori; Sabelnikovs, Olegs; Oss, Peteris; Haddad, Youssef; Liew, Kong Y.; Ñamendys-Silva, Silvio A.; Jarquin-Badiola, Yves D.; Sanchez-Hurtado, Luis A.; Gomez-Flores, Saira S.; Marin, Maria C.; Villagomez, Asisclo J.; Lemus, Jordana S.; Fierro, Jonathan M.; Cervantes, Mavy Ramirez; Mejia, Francisco Javier Flores; Dector, Dulce; Dector, Dulce M.; Gonzalez, Daniel R.; Estrella, Claudia R.; Sanchez-Medina, Jorge R.; Ramirez-Gutierrez, Alvaro; George, Fernando G.; Aguirre, Janet S.; Buensuseso, Juan A.; Poblano, Manuel; Dendane, Tarek; Zeggwagh, Amine Ali; Balkhi, Hicham; Elkhayari, Mina; Samkaoui, Nacer; Ezzouine, Hanane; Benslama, Abdellatif; Amor, Mourad; Maazouzi, Wajdi; Cimic, Nedim; Beck, Oliver; Bruns, Monique M.; Schouten, Jeroen A.; Rinia, Myra; Raaijmakers, Monique; Heunks, Leo M.; van Wezel, Hellen M.; Heines, Serge J.; Strauch, Ulrich; Buise, Marc P.; Simonis, Fabienne D.; Schultz, Marcus J.; Goodson, Jennifer C.; Browne, Troy S.; Navarra, Leanlove; Hunt, Anna; Hutchison, Robyn A.; Bailey, Mathew B.; Newby, Lynette; Mcarthur, Colin; Kalkoff, Michael; Mcleod, Alex; Casement, Jonathan; Hacking, Danielle J.; Andersen, Finn H.; Dolva, Merete S.; Laake, Jon H.; Barratt-Due, Andreas; Noremark, Kim Andre L.; Søreide, Eldar; Sjøbø, Brit Å; Guttormsen, Anne B.; Yoshido, Hector H. Leon; Aguilar, Ronald Zumaran; Oscanoa, Fredy A. Montes; Alisasis, Alain U.; Robles, Joanne B.; Pasanting-Lim, Rossini Abbie B.; Tan, Beatriz C.; Andruszkiewicz, Pawel; Jakubowska, Karina; Coxo, Cristina M.; Alvarez, António M.; Oliveira, Bruno S.; Montanha, Gustavo M.; Barros, Nelson C.; Pereira, Carlos S.; Messias, António M.; Monteiro, Jorge M.; Araujo, Ana M.; Catorze, Nuno T.; Marum, Susan M.; Bouw, Maria J.; Gomes, Rui M.; Brito, Vania A.; Castro, Silvia; Estilita, Joana M.; Barros, Filipa M.; Serra, Isabel M.; Martinho, Aurelia M.; Tomescu, Dana R.; Marcu, Alexandra; Bedreag, Ovidiu H.; Papurica, Marius; Corneci, Dan E.; Negoita, Silvius Ioan; Grigoriev, Evgeny; Gritsan, Alexey I.; Gazenkampf, Andrey A.; Almekhlafi, Ghaleb; Albarrak, Mohamad M.; Mustafa, Ghanem M.; Maghrabi, Khalid A.; Salahuddin, Nawal; Aisa, Tharwat M.; Al Jabbary, Ahmed S.; Tabhan, Edgardo; Arabi, Yaseen M.; Trinidad, Olivia A.; Al Dorzi, Hasan M.; Tabhan, Edgardo E.; Bolon, Stefan; Smith, Oliver; Mancebo, Jordi; Aguirre-Bermeo, Hernan; Lopez-Delgado, Juan C.; Esteve, Francisco; Rialp, Gemma; Forteza, Catalina; de Haro, Candelaria; Artigas, Antonio; Albaiceta, Guillermo M.; de Cima-Iglesias, Sara; Seoane-Quiroga, Leticia; Ceniceros-Barros, Alexandra; Ruiz-Aguilar, Antonio L.; Claraco-Vega, Luis M.; Soler, Juan Alfonso; Lorente, Maria del Carmen; Hermosa, Cecilia; Gordo, Federico; Prieto-González, Miryam; López-Messa, Juan B.; Perez, Manuel P.; Perez, Cesar P.; Allue, Raquel Montoiro; Roche-Campo, Ferran; Ibañez-Santacruz, Marcos; Temprano, Susana; Pintado, Maria C.; de Pablo, Raul; Gómez, Pilar Ricart Aroa; Ruiz, Silvia Rodriguez; Moles, Silvia Iglesias; Jurado, Ma Teresa; Arizmendi, Alfons; Piacentini, Enrique A.; Franco, Nieves; Honrubia, Teresa; Cheng, Meisy Perez; Losada, Elena Perez; Blanco, Javier; Yuste, Luis J.; Carbayo-Gorriz, Cecilia; Cazorla-Barranquero, Francisca G.; Alonso, Javier G.; Alda, Rosa S.; Algaba, Ángela; Navarro, Gonzalo; Cereijo, Enrique; Diaz-Rodriguez, Esther; Marcos, Diego Pastor; Montero, Laura Alvarez; Para, Luis Herrera; Sanchez, Roberto Jimenez; Navalpotro, Miguel Angel Blasco; Abad, Ricardo Diaz; González, Raquel Montiel; Toribio, Dácil Parrilla; Castro, Alejandro G.; Artiga, Maria Jose D.; Penuelas, Oscar; Roser, Tomas P.; Olga, Moreno F.; Curto, Elena Gallego; Sánchez, Rocío Manzano; Imma, Vallverdu P.; Elisabet, Garcia M.; Claverias, Laura; Magret, Monica; Pellicer, Ana M.; Rodriguez, Lucia L.; Sánchez-Ballesteros, Jesús; González-Salamanca, Ángela; Jimenez, Antonio G.; Huerta, Francisco P.; Diaz, Juan Carlos J. Sotillo; Lopez, Esther Bermejo; Moya, David D. Llinares; Alfonso, Alec A. Tallet; Luis, Palazon Sanchez Eugenio; Cesar, Palazon Sanchez; Rafael, Sánchez I.; Virgilio, Corcoles G.; Recio, Noelia N.; Adamsson, Richard O.; Rylander, Christian C.; Holzgraefe, Bernhard; Broman, Lars M.; Wessbergh, Joanna; Persson, Linnea; Schiöler, Fredrik; Kedelv, Hans; Tibblin, Anna Oscarsson; Appelberg, Henrik; Hedlund, Lars; Helleberg, Johan; Eriksson, Karin E.; Glietsch, Rita; Larsson, Niklas; Nygren, Ingela; Nunes, Silvia L.; Morin, Anna-Karin; Kander, Thomas; Adolfsson, Anne; Piquilloud, Lise; Zender, Hervé O.; Leemann-Refondini, Corinne; Elatrous, Souheil; Bouchoucha, Slaheddine; Chouchene, Imed; Ouanes, Islem; Ben Souissi, Asma; Kamoun, Salma; Demirkiran, Oktay; Aker, Mustafa; Erbabacan, Emre; Ceylan, Ilkay; Girgin, Nermin Kelebek; Ozcelik, Menekse; Ünal, Necmettin; Meco, Basak Ceyda; Akyol, Onat O.; Derman, Suleyman S.; Kennedy, Barry; Parhar, Ken; Srinivasa, Latha; McNamee, Lia; McAuley, Danny; Steinberg, Jack; Hopkins, Phil; Mellis, Clare; Kakar, Vivek; Hadfield, Dan; Vercueil, Andre; Bhowmick, Kaushik; Humphreys, Sally K.; Ferguson, Andrew; Mckee, Raymond; Raj, Ashok S.; Fawkes, Danielle A.; Watt, Philip; Twohey, Linda; Jha, Rajeev R.; Thomas, Matthew; Morton, Alex; Kadaba, Varsha; Smith, Mark J.; Hormis, Anil P.; Kannan, Santhana G.; Namih, Miriam; Reschreiter, Henrik; Camsooksai, Julie; Kumar, Alek; Rugonfalvi, Szabolcs; Nutt, Christopher; Oneill, Orla; Seasman, Colette; Dempsey, Ged; Scott, Christopher J.; Ellis, Helen E.; McKechnie, Stuart; Hutton, Paula J.; Di Tomasso, Nora N.; Vitale, Michela N.; Griffin, Ruth O.; Dean, Michael N.; Cranshaw, Julius H.; Willett, Emma L.; Ioannou, Nicholas; Gillis, Sarah; Csabi, Peter; Macfadyen, Rosaleen; Dawson, Heidi; Preez, Pieter D.; Williams, Alexandra J.; Boyd, Owen; de Gordoa, Laura Ortiz-Ruiz; Bramall, Jon; Symmonds, Sophie; Chau, Simon K.; Wenham, Tim; Szakmany, Tamas; Toth-Tarsoly, Piroska; Mccalman, Katie H.; Alexander, Peter; Stephenson, Lorraine; Collyer, Thomas; Chapman, Rhiannon; Cooper, Raphael; Allan, Russell M.; Sim, Malcolm; Wrathall, David W.; Irvine, Donald A.; Zantua, Kim S.; Adams, John C.; Burtenshaw, Andrew J.; Sellors, Gareth P.; Welters, Ingeborg D.; Williams, Karen E.; Hessell, Robert J.; Oldroyd, Matthew G.; Battle, Ceri E.; Pillai, Suresh; Kajtor, Istvan; Sivashanmugavel, Mageswaran; Okane, Sinead C.; Donnelly, Adrian; Frigyik, Aniko D.; Careless, Jon P.; May, Martin M.; Stewart, Richard; Trinder, T. John; Hagan, Samantha J.; Wise, Matt P.; Cole, Jade M.; MacFie, Caroline C.; Dowling, Anna T.; Hurtado, Javier; Nin, Nicolás; Nuñez, Edgardo; Pittini, Gustavo; Rodriguez, Ruben; Imperio, María C.; Santos, Cristina; França, Ana G.; Ebeid, Alejandro; Deicas, Alberto; Serra, Carolina; Uppalapati, Aditya; Kamel, Ghassan; Banner-Goodspeed, Valerie M.; Beitler, Jeremy R.; Mukkera, Satyanarayana Reddy; Kulkarni, Shreedhar; Lee, Jarone; Mesar, Tomaz; Shinn, John O.; Gomaa, Dina; Tainter, Christopher; Yeatts, Dale J.; Warren, Jessica; Lanspa, Michael J.; Miller, Russel R.; Grissom, Colin K.; Brown, Samuel M.; Bauer, Philippe R.; Gosselin, Ryan J.; Kitch, Barrett T.; Cohen, Jason E.; Beegle, Scott H.; Stoger, John H.; Gueret, Renaud M.; Tulaimat, Aiman; Choudry, Shazia; Stigler, William; Batra, Hitesh; Huff, Nidhi G.; Lamb, Keith D.; Oetting, Trevor W.; Mohr, Nicholas M.; Judy, Claine; Saito, Shigeki; Kheir, Fayez M.; Kheir, Fayez; Schlichting, Adam B.; Delsing, Angela; Crouch, Daniel R.; Elmasri, Mary; Ismail, Dina; Dreyer, Kyle R.; Blakeman, Thomas C.; Baron, Rebecca M.; Grijalba, Carolina Quintana; Hou, Peter C.; Seethala, Raghu; Aisiku, Imo; Henderson, Galen; Frendl, Gyorgy; Hou, Sen-Kuang; Owens, Robert L.; Schomer, Ashley; Bumbasirevic, Vesna; Jovanovic, Bojan; Surbatovic, Maja; Veljovic, Milic


    IMPORTANCE Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation

  6. Effectiveness of a clinical pathway for acute stroke care in a district general hospital: an audit

    Directory of Open Access Journals (Sweden)

    Siegert Richard J


    Full Text Available Abstract Background Organised stroke care saves lives and reduces disability. A clinical pathway might be a form of organised stroke care, but the evidence for the effectiveness of this model of care is limited. Methods This study was a retrospective audit study of consecutive stroke admissions in the setting of an acute general medical unit in a district general hospital. The case-notes of patients admitted with stroke for a 6-month period before and after introduction of the pathway, were reviewed to determine data on length of stay, outcome, functional status, (Barthel Index, BI and Modified Rankin Scale, MRS, Oxfordshire Community Stroke Project (OCSP sub-type, use of investigations, specific management issues and secondary prevention strategies. Logistic regression was used to adjust for differences in case-mix. Results N = 77 (prior to the pathway and 76 (following the pathway. The median (interquartile range, IQR age was 78 years (67.75–84.25, 88% were European NZ and 37% were male. The median (IQR BI at admission for the pre-pathway group was less than the post-pathway group: 6 (0–13.5 vs. 10 (4–15.5, p = 0.018 but other baseline variables were statistically similar. There were no significant differences between any of the outcome or process of care variables, except that echocardiograms were done less frequently after the pathway was introduced. A good outcome (MRS Conclusion A clinical pathway for acute stroke management appeared to have no benefit for the outcome or processes of care and may even have been associated with worse outcomes. These data support the conclusions of a recent Cochrane review.

  7. Infection prevention and control measures for acute respiratory infections in healthcare settings: an update. (United States)

    Seto, W H; Conly, J M; Pessoa-Silva, C L; Malik, M; Eremin, S


    Viruses account for the majority of the acute respiratory tract infections (ARIs) globally with a mortality exceeding 4 million deaths per year. The most commonly encountered viruses, in order of frequency, include influenza, respiratory syncytial virus, parainfluenza and adenovirus. Current evidence suggests that the major mode of transmission of ARls is through large droplets, but transmission through contact (including hand contamination with subsequent self-inoculation) and infectious respiratory aerosols of various sizes and at short range (coined as "opportunistic" airborne transmission) may also occur for some pathogens. Opportunistic airborne transmission may occur when conducting highrisk aerosol generating procedures and airborne precautions will be required in this setting. General infection control measures effective for all respiratory viral infections are reviewed and followed by discussion on some of the common viruses, including severe acute respiratory syndrome (SARS) coronavirus and the recently discovered novel coronavirus.

  8. Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States. (United States)

    Hatcher, M


    This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

  9. Chemical Intolerance in Primary Care Settings: Prevalence, Comorbidity, and Outcomes (United States)

    Katerndahl, David A.; Bell, Iris R.; Palmer, Raymond F.; Miller, Claudia S.


    PURPOSE This study extends previous community-based studies on the prevalence and clinical characteristics of chemical intolerance in a sample of primary care clinic patients. We evaluated comorbid medical and psychiatric disorders, functional status, and rates of health care use. METHODS A total of 400 patients were recruited from 2 family medicine clinic waiting rooms in San Antonio, Texas. Patients completed the validated Quick Environmental Exposure and Sensitivity Inventory (QEESI) to assess chemical intolerance; the Primary Care Evaluation of Mental Disorders (PRIME-MD) screen for possible psychiatric disorders; the Dartmouth–Northern New England Primary Care Cooperative Information Project (Dartmouth COOP) charts for functional status; and the Healthcare Utilization Questionnaire. RESULTS Overall, 20.3% of the sample met criteria for chemical intolerance. The chemically intolerant group reported significantly higher rates of comorbid allergies and more often met screening criteria for possible major depressive disorder, panic disorder, generalized anxiety disorder, and alcohol abuse disorder, as well as somatization disorder. The total number of possible mental disorders was correlated with chemical intolerance scores (P intolerance were significantly more likely to have poorer functional status, with trends toward increased medical service use when compared with non–chemically intolerant patients. After controlling for comorbid psychiatric conditions, the groups differed significantly only regarding limitations of social activities. CONCLUSIONS Chemical intolerance occurs in 1 of 5 primary care patients yet is rarely diagnosed by busy practitioners. Psychiatric comorbidities contribute to functional limitations and increased health care use. Chemical intolerance offers an etiologic explanation. Symptoms may resolve or improve with the avoidance of salient chemical, dietary (including caffeine and alcohol), and drug triggers. Given greater medication


    Directory of Open Access Journals (Sweden)

    Heather Gordon


    Full Text Available Purpose: To describe and evaluate priority setting in an Acute Care hospital in Argentina, using Accountability for Reasonableness, an ethical framework for fair priority setting. Methods: Case Study involving key informant interviews and document review. Thirty respondents were identified using a snowball sampling strategy. A modified thematic approach was used in analyzing the data. Results: Priorities are primarily determined at the Department of Health. The committee which is supposed to set priorities within the hospital was thought not to have much influence. Decisions were based on government policies and objectives, personal relationships, economic, political, historical and arbitrary reasons. Decisions at the DOH were publicized through internet; however, apart from the tenders and a general budget, details of hospital decisions were not publicized. CATA provided an accessible but ineffective forum for appeals. There were no clear mechanisms for appeals and leadership to ensure adherence to a fair process. Conclusions: In spite of their efforts to ensure fairness, Priority setting in the study hospital did not meet all the four conditions of a fair process. Policy discussions on improving legitimacy and fairness provided an opportunity for improving fairness in the hospital and Accountability for Reasonableness might be a useful framework for analysis and for identifying and improving strategies.Propósito: Describir y evaluar el establecimiento de prioridades en un hospital de cuidados intensivos en Argentina, empleando la Administración Razonable como marco ético para una justa asignación. Métodos: Estudio de un Caso que incluía entrevistas a un informante y revisión de documentos. Se identificó a treinta participantes empleando la estrategia de muestras tipo "bola de nieve". Al analizar los datos, se empleó un enfoque temático modificado. Resultados: Las prioridades se determinan principalmente en el Departamento de Salud

  11. Spiritual Care in a Hospital Setting: Nurses’ and Patients’ Perspectives

    NARCIS (Netherlands)

    Vlasblom, J.P.; Steen, van der J.T.; Jochemsen, H.


    The Trent Universities Interprofessional Learning in Practice (TUILIP) project aimed to establish interprofessional learning (IPL) for healthcare students in clinical practice settings. Ten IPL facilitators were employed in eight varied practice setting pilot sites for up to a year to research,

  12. A narrative review of acute care nurses' experiences nursing patients with intellectual disability: underprepared, communication barriers and ambiguity about the role of caregivers. (United States)

    Lewis, Peter; Gaffney, Ryan J; Wilson, Nathan J


    To describe how nurses experience caring for people with intellectual disability in an acute care setting. Recent advances in the care of people with intellectual disability in hospital are primarily based upon the experiences of people with intellectual disability and their caregivers. Little is known about the experiences of registered nurses caring for people with intellectual disability, yet the experiences of nurses in delivering care largely determine the quality of care experienced by people with intellectual disability and their caregivers. A narrative literature review using electronic database searches was conducted using variants of the terms disability, nursing and acute care. Through our reading of the recent literature describing the experiences of nurses caring for people with intellectual disability in an acute care setting, we have identified three themes: (1) nurses feel underprepared when caring for patients with intellectual disability, (2) nurses experience challenges when communicating with people with intellectual disability and (3) nurses have ambiguous expectations of paid and unpaid caregivers. The enablers of and barriers to the delivery of nursing care in acute care settings need to be made explicit and researchers and nurses need to collaborate in the development, implementation and evaluation of care delivery strategies. Nurses need to be adequately prepared to care for people with intellectual disability. Preparation should include dealing with the complexities of communicating with people with intellectual disability and practical experience of doing so in clinical and educational environments that ensure the safety and dignity of nurses and people with intellectual disability. Nurses need supportive strategies for developing therapeutic relationships with a range of informal and formal caregivers. © 2016 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

  13. Feasibility of using the International Classification of Functioning, Disability and Health Core Set for evaluation of fall-related risk factors in acute rehabilitation settings. (United States)

    Huang, Shih W; Lin, Li F; Chou, Lin C; Wu, Mei J; Liao, Chun D; Liou, Tsan H


    Previously, we reported the use of an International Classification of Functioning (ICF) core set that can provide a holistic framework for evaluating the risk factors of falls; however, data on the feasibility of applying this core set are lacking. To investigate the feasibility of applying the fall-related ICF risk-factor core set in the case of patients in an acute-rehabilitation setting. A cross-sectional and descriptive correlational design. Acute-rehabilitation ward. A total of 273 patients who experienced fall at acute-rehabilitation ward. The data on falls were collected from the hospital's Nursing Information System (NIS) and the fall-reporting system (Adverse Event Reporting System, AERS) between 2010 and 2013. The relationship of both systems to the fall-related ICF core set was analyzed to assess the feasibility of their clinical application. We evaluated the feasibility of using the fall-related ICF risk-factor core set by using the frequency and the percentage of the fall patients in of the listed categories. The fall-related ICF risk-factor core set category b735 (muscle tone functions) exhibited a high feasibility (85.95%) for clinical application, and the category b730 (muscle power functions) covered 77.11% of the patients. The feasibility of application of the category d410 (change basic body position) was also high in the case of all fall patients (81.69%). In the acute-rehabilitation setting, the feasibility of application of the fall-related ICF risk-factor core set is high. The fall-related ICF risk-factor core set can help multidisciplinary teams develop fall-prevention strategies in acute rehabilitation wards.

  14. Duration of bed occupancy as calculated at a random chosen day in an acute care ward. Implications for the use of scarce resources in psychiatric care

    Directory of Open Access Journals (Sweden)

    Restan Asbjørn


    Full Text Available Abstract Background Psychiatric acute wards are obliged to admit patients without delay according to the Act on Compulsive Psychiatric Care. Residential long term treatment facilities and rehabilitation facilities may use a waiting list. Patients, who may not be discharged from the acute ward or should not wait there, then occupy acute ward beds. Materials and methods Bed occupancy in one acute ward at a random day in 2002 was registered (n = 23. Successively, the length of stay of all patients was registered, together with information on waiting time after a decision was made on further treatment needs. Eleven patients waited for further resident treatment. The running cost of stay was calculated for the acute ward and in the different resident follow-up facilities. Twenty-three patients consumed a total of 776 resident days. 425 (54.8% of these were waiting days. Patients waited up to 86 days. Results Total cost of treatment was 0.69 million Euro (0.90 mill. $, waiting costs were 54.8% of this, 0.38 million Euro (0.50 million $. The difference between acute care costs and the costs in the relevant secondary resident facility was defined as the imputed loss. Net loss by waiting was 0.20 million Euro (0.26 million $ or 28.8% of total cost. Discussion This point estimate study indicates that treating patients too sick to be released to anything less than some other intramural facility locks a sizable amount of the resources of a psychiatric acute ward. The method used minimized the chance of financially biased treatment decisions. Costs of frustration to staff and family members, and delayed effect of treatment was set to zero. Direct extrapolation to costs per year is not warranted, but it is suggested that our findings would be comparable to other acute wards as well. The study shows how participant observation and cost effectiveness analysis may be combined.

  15. Creating learning momentum through overt teaching interactions during real acute care episodes. (United States)

    Piquette, Dominique; Moulton, Carol-Anne; LeBlanc, Vicki R


    Clinical supervisors fulfill a dual responsibility towards patient care and learning during clinical activities. Assuming such roles in today's clinical environments may be challenging. Acute care environments present unique learning opportunities for medical trainees, as well as specific challenges. The goal of this paper was to better understand the specific contexts in which overt teaching interactions occurred in acute care environments. We conducted a naturalistic observational study based on constructivist grounded theory methodology. Using participant observation, we collected data on the teaching interactions occurring between clinical supervisors and medical trainees during 74 acute care episodes in the critical care unit of two academic centers, in Toronto, Canada. Three themes contributed to a better understanding of the conditions in which overt teaching interactions among trainees and clinical supervisors occurred during acute care episodes: seizing emergent learning opportunities, coming up against challenging conditions, and creating learning momentum. Our findings illustrate how overt learning opportunities emerged from certain clinical situations and how clinical supervisors and trainees could purposefully modify unfavorable learning conditions. None of the acute care episodes encountered in the critical care environment represented ideal conditions for learning. Yet, clinical supervisors and trainees succeeded in engaging in overt teaching interactions during many episodes. The educational value of these overt teaching interactions should be further explored, as well as the impact of interventions aimed at increasing their use in acute care environments.

  16. Oxygen in the Setting of Acute Myocardial Infarction: Is It Really a Breath of Fresh Air? (United States)

    Loomba, Rohit S; Nijhawan, Karan; Aggarwal, Saurabh; Arora, Rohit R


    Supplemental oxygen has been used in the setting of acute myocardial infarction (AMI). Once an official recommendation in the guidelines for the management of acute ST-segment elevation myocardial infarction, it is now mentioned as an intervention to be considered. Data for the use of supplemental oxygen or AMI are limited, and some data have suggested associated harm. We performed a systematic review of the literature and a subsequent meta-analysis of the data to determine the effect of high concentration oxygen versus titrated oxygen or room air in the setting of AMI. The following end points were studied: in-hospital mortality, opiate use, percentage of infarcted myocardium by magnetic resonance imaging (MRI), and mass of infarcted myocardium by MRI. No significant difference was noted with end points when comparing those randomized to high-concentration oxygen versus those randomized to titrated oxygen or room air in the setting of AMI. No significant publication bias was identified although this could not be assessed for all end points. High-concentration oxygen may not offer any benefit when compared to titrated oxygen or room air. A large, randomized trial is warranted to further delineate these differences with respect to multiple end points. © The Author(s) 2015.

  17. The impact of brief team communication, leadership and team behavior training on ad hoc team performance in trauma care settings. (United States)

    Roberts, Nicole K; Williams, Reed G; Schwind, Cathy J; Sutyak, John A; McDowell, Christopher; Griffen, David; Wall, Jarrod; Sanfey, Hilary; Chestnut, Audra; Meier, Andreas H; Wohltmann, Christopher; Clark, Ted R; Wetter, Nathan


    Communication breakdowns and care coordination problems often cause preventable adverse patient care events, which can be especially acute in the trauma setting, in which ad hoc teams have little time for advanced planning. Existing teamwork curricula do not address the particular issues associated with ad hoc emergency teams providing trauma care. Ad hoc trauma teams completed a preinstruction simulated trauma encounter and were provided with instruction on appropriate team behaviors and team communication. Teams completed a postinstruction simulated trauma encounter immediately afterward and 3 weeks later, then completed a questionnaire. Blinded raters rated videotapes of the simulations. Participants expressed high levels of satisfaction and intent to change practice after the intervention. Participants changed teamwork and communication behavior on the posttest, and changes were sustained after a 3-week interval, though there was some loss of retention. Brief training exercises can change teamwork and communication behaviors on ad hoc trauma teams. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Acute mental health care according to recent mental health legislation. Part III. Structuring space for acute mental health care. (United States)

    Janse van Rensburg, A; Janse van Rensburg, A B R


    This is the third of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). The study reviewed existing South African standards for mental health care facilities. Architectural principles and implications for the use of space were deducted from recent legislation. Objectives were to evaluate the use of space in the existing physical facilities, to identify appropriate architectural solutions considering identified human rights requirements and to provide provisional cost estimates to align the unit towards its designated functions. Personal interviews were conducted. An on-site assessment and survey was made of existing and potential new spaces. Spatial requirements for implementing the Mental Health Act, No. 17 of 2002 (MHCA) were explored. Principles for spatial design of acute facilities include that: - spaces should communicate clear individual identity; - space should be segregated into zones according to user functionality and privacy; - communal leisure spaces should open into safe contained outdoor spaces; - circulation routes should preferably be circular; - sufficient visual connection should exist between circulation space and group activities; and - open lines of sight should be provided to all access points. The potential options for extension included: - an extensive unused single storey structural shell for a potential office wing on the same floor; - a huge vacant double volume space which could be accessed across the existing flat roof for potential occupational therapy activities; and - the existing roof area could be altered and secured to become an adequate outside leisure and garden area. A proposed concept design in two phases - based on these principles - was submitted to hospital and provincial management. To implement the MHCA without violating the human rights of mental health care users at HJH will require specific adjustment and extension of the current use of space at HJH.

  19. Improving Ambulatory Care Resident Training: Preparing for Opportunities to Treat Mental Illness in the Primary Care Setting. (United States)

    Farhat, Nada M; Bostwick, Jolene R; Rockafellow, Stuart D


    The development of an outpatient psychiatry clinical practice learning experience for PGY2 ambulatory care pharmacy residents in preparation for the treatment of psychiatric disorders in the primary care setting is described. With the increased prevalence of psychiatric disorders, significant mortality, and limited access to care, integration of mental health treatment into the primary care setting is necessary to improve patient outcomes. Given the majority of mental health treatment occurs in the primary care setting, pharmacists in patient-centered medical homes (PCMHs) are in a unique position with direct access to patients to effectively manage these illnesses. However, the increased need for pharmacist education and training in psychiatry has prompted a large, Midwestern academic health system to develop an outpatient psychiatry learning experience for PGY2 (Postgraduate Year 2) ambulatory care pharmacy residents in 2015. The goal of this learning experience is to introduce the PGY2 ambulatory care residents to the role and impact of psychiatric clinical pharmacists and to orient the residents to the basics of psychiatric pharmacotherapy to be applied to their future practice in the primary care setting. The development of an outpatient psychiatry learning experience for PGY2 ambulatory care pharmacy residents will allow for more integrated and comprehensive care for patients with psychiatric conditions, many of whom are treated and managed in the PCMH setting.

  20. Predictors of effective de-escalation in acute inpatient psychiatric settings. (United States)

    Lavelle, Mary; Stewart, Duncan; James, Karen; Richardson, Michelle; Renwick, Laoise; Brennan, Geoffrey; Bowers, Len


    To explore the factors that influence the use of de-escalation and its success in halting conflict in acute psychiatric inpatient setting. De-escalation is the use of verbal and nonverbal communication to reduce or eliminate aggression and violence during the escalation phase of a patient's behaviour. Although de-escalation is a first-line intervention in aggression management in acute psychiatric settings, little is known about the use or effectiveness of this technique. A retrospective case note analysis. For each patient (n = 522), their involvement in conflict (e.g. aggression) or containment (e.g. coerced medication) during the first two weeks of their admission was recorded. The frequency and order of the conflict and containment events were identified during each shift. The sequences of events occurring in shifts involving de-escalation were analysed. Sequences where de-escalation ended the pattern of conflict or containment were categorised as 'successful', and all others were categorised as 'unsuccessful'. Over half of patients (53%) experienced de-escalation during the first two weeks of admission, with the majority of these (37%) experiencing multiple episodes. De-escalation was successful in approximately 60% of cases. Successful de-escalations were preceded by fewer, and less aggressive, conflict events, compared with unsuccessful de-escalations, which were most frequently followed by administration of pro re nata medication. Patients with a history of violence were more likely to experience de-escalation, and it was more likely to be unsuccessful. De-escalation is frequently effective in halting a sequence of conflict in acute inpatient settings, but patients with a history of violence may be specifically challenging. These findings provide support for de-escalation in practice but suggest that nurses may lack confidence in using the technique when the risk of violence is greater. Providing evidence-based staff training may improve staff confidence

  1. Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders' perceptions. (United States)

    Lind, S; Wallin, L; Brytting, T; Fürst, C J; Sandberg, J


    In high-income countries a large proportion of all deaths occur in hospitals. A common way to translate knowledge into clinical practice is developing guidelines for different levels of health care organisations. During 2012, national clinical guidelines for palliative care were published in Sweden. Later, guidance for palliative care was issued by the National Board of Health and Welfare. The aim of this study was two-fold: to investigate perceptions regarding these guidelines and identify obstacles and opportunities for implementation of them in acute care hospitals. Interviews were conducted with local politicians, chief medical officers and health professionals at acute care hospitals. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. The results showed little knowledge of the two documents at all levels of the health care organisation. Palliative care was primarily described as end of life care and only few of the participants talked about the opportunity to integrate palliative care early in a disease trajectory. The environment and culture at hospitals, characterised by quick decisions and actions, were perceived as obstacles to implementation. Health professionals' expressed need for palliative care training is an opportunity for implementation of clinical guidelines. There is a need for further implementation of palliative care in hospitals. One option for further research is to evaluate implementation strategies tailored to acute care. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. The value of registered nurses in ambulatory care settings: a survey. (United States)

    Mastal, Margaret; Levine, June


    Ambulatory care settings employ 25% of the three million registered nurses in the United States. The American Academy of Ambulatory Care Nursing (AAACN) is committed to improving the quality of health care in ambulatory settings, enhancing patient outcomes, and realizing greater health care efficiencies. A survey of ambulatory care registered nurses indicates they are well positioned to lead and facilitate health care reform activities with organizational colleagues. They are well schooled in critical thinking, triage, advocating for patients, educating patients and families, collaborating with medical staff and other professionals, and care coordination. The evolving medical home concept and other health care delivery models reinforces the critical need for registered nurses to provide chronic disease management, care coordination, health risk appraisal, care transitions, health promotion, and disease prevention services. Recommendations are offered for organizational leaders, registered nurses, and AAACN to utilize nursing knowledge and skills in the pursuit of leading change and advancing health.

  3. Palliative care for cancer patients in a primary health care setting:Bereaved relatives' experience, a qualitative group interview study

    DEFF Research Database (Denmark)

    Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde


    care setting to explore barriers and facilitators for delivery of good palliative home care. Methods: Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results: Three main categories of experience were identified: 1) The health professionals' management, where...... a need to optimize was found. 2) Shared care, which was lacking. 3) The relatives' role, which needs an extra focus. Conclusion: Relatives experience insufficient palliative care mainly due to organizational and cultural problems among professionals. Palliative care in primary care in general needs......Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary...

  4. First report of leprosy presenting as acute polyarthritis in the setting of type I downgrading lepra reaction. (United States)

    Al-Raqum, Haneen Adel; Uppal, S S; El Abdalghani, Rana Abdul Rahman; Lasheen, Ibrahim


    Leprosy is a rare cause of acute polyarthritis. We describe the occurrence of oedema of the hands and feet and acute polyarthritis in the setting of type I (downgrading) lepra reaction in an untreated patient with borderline leprosy. This case report further expands the range of articular manifestations that can occur in leprosy.

  5. Impact of a fall prevention programme in