Essential information for transition of care for frail elderly patients in Japan: A qualitative study

Abstract Background: Information exchange between hospitals and primary care physicians is suboptimal. Most physicians are dissatisfied with the current referral process, and poor communication leads to negative care transition outcomes.Methods: To identify the key information needed in referral letters for successful transition of care. We conducted a qualitative study using consecutive, semi-structured in-person interviews and focus group sessions. We recruited 5 participants for individual interviews and 16 participants for focus groups. All participants were engaged in clinical work. We analyzed all data using qualitative thematic analysis. Interview transcripts were analyzed inductively and reflectively. All results were returned to the participants and modified based on their feedback. Results: The five individual interviews provided a general picture of the current referral process and a useful interview guide for the following focus group sessions. The focus group discussions were used to identify the essential care transition information needed at admission and discharge from the hospital. Essential information on hospital admission were: 1) Basic medical and care information, 2) Care resources available at home, 3) The purpose of admission and the goals of care during hospitalization, and 4) Status of advance care planning (ACP) and patient’s will in an emergency. Essential information on hospital discharge were: 1) Clinical course, 2) Explanation of medical condition during hospitalization, 3) Status of ACP and patient’s will in an emergency, and 4) Medical procedures to be continued at home. Conclusion: We identified the essential information needed for successful transition of care in Japan, particularly on admission to and discharge from acute hospitals. The clinical effectiveness of a template that contains the information identified in our study warrants investigation.

Download Full-text

Clinicians’ Perceptions of the Appropriateness of Neurocritical Care for Patients with Spontaneous Intracerebral Hemorrhage (ICH): A Qualitative Study

Neurocritical Care ◽

10.1007/s12028-020-01145-5 ◽

2020 ◽

Author(s):

Siobhan Mc Lernon ◽

David Werring ◽

Louise Terry

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Elderly Patients ◽

Frail Elderly ◽

Neurocritical Care ◽

Structured Interviews ◽

Mortality And Morbidity ◽

Tertiary Referral Center ◽

Inappropriate Care ◽

The Family

Abstract Background and Objective Clinicians working in intensive care frequently report perceptions of inappropriate care (PIC) situations. Intracerebral haemorrhage (ICH) is associated with high rates of mortality and morbidity. Prognosticating after ICH is complex and may be influenced by clinicians’ subjective impressions and biases, which may, in turn, influence decision making regarding the level of care provided. The aim of this study was to qualitatively explore perceptions of neurocritical care in relation to the expected functional outcome for ICH patients. Design Qualitative study using semi-structured interviews with neurocritical care doctors and nurses. Setting Neurocritical care (NCC) department in a UK neuroscience tertiary referral center. Subjects Eleven neurocritical care nurses, five consultant neurointensivists, two stroke physicians, three neurosurgeons. Intervention None. Measurements and Main Results We conducted 21 semi-structured interviews and identified five key themes: (1) prognostic uncertainty (2) subjectivity of good versus poor outcome (3) perceived inappropriate care (PIC) situations (including for frail elderly patients) (4) challenging nature of decision-making (5) clinician distress. Conclusions Caring for severely affected ICH patients in need of neurocritical care is challenging, particularly with frail elderly patients. Awareness of the challenges could facilitate interventions to improve decision-making for this group of stroke patients and their families, as well as measures to reduce the distress on clinicians who care for this patient group. Our findings highlight the need for effective interdisciplinary shared decision making involving the family, taking into account patients’ previously expressed values and preferences and incorporating these into bespoke care planning.

Download Full-text

Nurses’ experience of collaboration with relatives of frail elderly patients in acute hospital wards: A qualitative study

International Journal of Nursing Studies ◽

10.1016/j.ijnurstu.2007.01.010 ◽

2008 ◽

Vol 45 (5) ◽

pp. 668-681 ◽

Cited By ~ 38

Author(s):

Tove Lindhardt ◽

Ingalill Rahm Hallberg ◽

Ingrid Poulsen

Keyword(s):

Qualitative Study ◽

Elderly Patients ◽

Frail Elderly ◽

Acute Hospital ◽

Hospital Wards

Download Full-text

Association between preoperative evaluation with lung ultrasound and outcome in frail elderly patients undergoing orthopedic surgery for hip fractures: study protocol for an Italian multicenter observational prospective study (LUSHIP)

The Ultrasound Journal ◽

10.1186/s13089-021-00230-w ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Luigi Vetrugno ◽

Enrico Boero ◽

Elena Bignami ◽

Andrea Cortegiani ◽

Santi Maurizio Raineri ◽

...

Keyword(s):

Hip Fracture ◽

Postoperative Complications ◽

Observational Study ◽

Elderly Patients ◽

Fracture Fixation ◽

Frail Elderly ◽

Statistical Power ◽

Lung Ultrasound ◽

Preoperative Evaluation ◽

Cardiac Complications

Abstract Background Hip fracture is one of the most common orthopedic causes of hospital admission in frail elderly patients. Hip fracture fixation in this class of patients is considered a high-risk procedure. Preoperative physical examination, plasma natriuretic peptide levels (BNP, Pro-BNP), and cardiovascular scoring systems (ASA-PS, RCRI, NSQIP-MICA) have all been demonstrated to underestimate the risk of postoperative complications. We designed a prospective multicenter observational study to assess whether preoperative lung ultrasound examination can predict better postoperative events thanks to the additional information they provide in the form of “indirect” and “direct” cardiac and pulmonary lung ultrasound signs. Methods LUSHIP is an Italian multicenter prospective observational study. Patients will be recruited on a nation-wide scale in the 12 participating centers. Patients aged > 65 years undergoing spinal anesthesia for hip fracture fixation will be enrolled. A lung ultrasound score (LUS) will be generated based on the examination of six areas of each lung and ascribing to each area one of the four recognized aeration patterns—each of which is assigned a subscore of 0, 1, 2, or 3. Thus, the total score will have the potential to range from a minimum of 0 to a maximum of 36. The association between 30-day postoperative complications of cardiac and/or pulmonary origin and the overall mortality will be studied. Considering the fact that cardiac complications in patients undergoing hip surgery occur in approx. 30% of cases, to achieve 80% statistical power, we will need a sample size of 877 patients considering a relative risk of 1.5. Conclusions Lung ultrasound (LU), as a tool within the anesthesiologist’s armamentarium, is becoming increasingly widespread, and its use in the preoperative setting is also starting to become more common. Should the study demonstrate the ability of LU to predict postoperative cardiac and pulmonary complications in hip fracture patients, a randomized clinical trial will be designed with the scope of improving patient outcome. Trial registration ClinicalTrials.gov, NCT04074876. Registered on August 30, 2019.

Download Full-text