Implications for COVID-19: A systematic review of nurses’ experiences of working in acute care hospital settings during a respiratory pandemic

Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

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Predicting the need for supportive services after discharged from hospital: a systematic review

10.21203/rs.2.10543/v4 ◽

2020 ◽

Author(s):

Daniel Kobewka ◽

Sunita Mulpuru ◽

Michaël Chassé ◽

Kednapa Thavorn ◽

Luke Lavallée ◽

...

Keyword(s):

Systematic Review ◽

Activities Of Daily Living ◽

Physical Function ◽

Acute Care ◽

Daily Living ◽

Acute Care Hospital ◽

Risk Of Bias ◽

Care Hospital ◽

Care Giver ◽

Supportive Services

Abstract Background Some patients admitted to acute care hospital require supportive services after discharge. The objective of our review was to identify models and variables that predict the need for supportive services after discharge from acute care hospital. Methods We performed a systematic review searching the MEDLINE, CINAHL, EMBASE, and COCHRANE databases from inception to May 1st 2017. We selected studies that derived and validated a prediction model for the need for supportive services after hospital discharge for patients admitted non-electively to a medical ward. We extracted cohort characteristics, model characteristics and variables screened and included in final predictive models. Risk of bias was assessed using the Quality in Prognostic Studies tool. Results Our search identified 3362 unique references. Full text review identified 6 models. Models had good discrimination in derivation (c-statistics >0.75) and validation (c-statistics >0.70) cohorts. There was high quality evidence that age, impaired physical function, disabilities in performing activities of daily living, absence of an informal care giver and frailty predict the need for supportive services after discharge. Stroke was the only unique diagnosis with at least moderate evidence of an independent effect on the outcome. No models were externally validated, and all were at moderate or higher risk of bias. Conclusions Deficits in physical function and activities of daily living, age, absence of an informal care giver and frailty have the strongest evidence as determinants of the need for support services after hospital discharge. Trial Registration: This review was registered with PROSPERO #CRD42016037144

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A core outcome set for studies evaluating interventions to prevent and/or treat delirium for adults requiring an acute care hospital admission: an international key stakeholder informed consensus study

BMC Medicine ◽

10.1186/s12916-021-02015-3 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Louise Rose ◽

Lisa Burry ◽

Meera Agar ◽

Bronagh Blackwood ◽

Noll L. Campbell ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care Unit ◽

Acute Care ◽

Qualitative Interviews ◽

Core Outcome Set ◽

Family Members ◽

Acute Care Hospital ◽

Care Hospital ◽

Core Outcome ◽

Outcome Set

Abstract Background Trials of interventions to prevent or treat delirium in adults in an acute hospital setting report heterogeneous outcomes. Our objective was to develop international consensus among key stakeholders for a core outcome set (COS) for future trials of interventions to prevent and/or treat delirium in adults with an acute care hospital admission and not admitted to an intensive care unit. Methods A rigorous COS development process was used including a systematic review, qualitative interviews, modified Delphi consensus process, and in-person consensus using nominal group technique (registration http://www.comet- initiative.org/studies/details/796). Participants in qualitative interviews were delirium survivors or family members. Participants in consensus methods comprised international representatives from three stakeholder groups: researchers, clinicians, and delirium survivors and family members. Results Item generation identified 8 delirium-specific outcomes and 71 other outcomes from 183 studies, and 30 outcomes from 18 qualitative interviews, including 2 that were not extracted from the systematic review. De-duplication of outcomes and formal consensus processes involving 110 experts including researchers (N = 32), clinicians (N = 63), and delirium survivors and family members (N = 15) resulted in a COS comprising 6 outcomes: delirium occurrence and reoccurrence, delirium severity, delirium duration, cognition, emotional distress, and health-related quality of life. Study limitations included exclusion of non-English studies and stakeholders and small representation of delirium survivors/family at the in-person consensus meeting. Conclusions This COS, endorsed by the American and Australian Delirium Societies and European Delirium Association, is recommended for future clinical trials evaluating delirium prevention or treatment interventions in adults presenting to an acute care hospital and not admitted to an intensive care unit.

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Quality Improvement: Developing and Implementing a Quality Improvement Plan in an Acute Care Hospital Setting

Perspectives on Administration and Supervision ◽

10.1044/aas9.3.7 ◽

1999 ◽

Vol 9 (3) ◽

pp. 7-11

Author(s):

Carole R. Roth

Keyword(s):

Quality Improvement ◽

Acute Care ◽

Hospital Setting ◽

Acute Care Hospital ◽

Care Hospital ◽

Improvement Plan

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Comparative Evaluation of Malnutrition Screening in Oncology Patients in an Acute Care Hospital: A Pilot Study

Journal of Human Nutrition ◽

10.36959/487/276 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Sinha Chandni Sen ◽

LaSalle Colette ◽

Argabright Debra ◽

Hollenbeck Clarie B

Keyword(s):

Pilot Study ◽

Acute Care ◽

Comparative Evaluation ◽

Acute Care Hospital ◽

Care Hospital ◽

Oncology Patients

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A Taxonomy for Psycho-Oncological Intervention Techniques in an Acute Care Hospital in Germany

Oncology Research and Treatment ◽

10.1159/000517532 ◽

2021 ◽

pp. 1-7

Author(s):

Martina Madl ◽

Marietta Lieb ◽

Katharina Schieber ◽

Tobias Hepp ◽

Yesim Erim

Keyword(s):

Acute Care ◽

Interrater Reliability ◽

Acute Care Hospital ◽

Future Research ◽

Systematic Research ◽

Care Hospital ◽

Certification System ◽

Stepwise Procedure ◽

Further Development

Background: Due to the establishment of a nationwide certification system for cancer centers in Germany, the availability of psycho-oncological services for cancer patients has increased substantially. However, little is known about the specific intervention techniques that are applied during sessions in an acute care hospital, since a standardized taxonomy is lacking. With this study, we aimed at the investigation of psycho-oncological intervention techniques and the development of a comprehensive and structured taxonomy thereof. Methods: In a stepwise procedure, a team of psycho-oncologists generated a data pool of interventions and definitions that were tested in clinical practice during a pilot phase. After an adaptation of intervention techniques, interrater reliability (IRR) was attained by rating 10 previously recorded psycho-oncological sessions. A classification of interventions into superordinate categories was performed, supported by cluster analysis. Results: Between April and June 2017, 980 psycho-oncological sessions took place. The experts agreed on a total number of 22 intervention techniques. An IRR of 89% for 2 independent psycho-oncological raters was reached. The 22 techniques were classified into 5 superordinate categories. Discussion/Conclusion: We developed a comprehensive and structured taxonomy of psycho-oncological intervention techniques in an acute care hospital that provides a standardized basis for systematic research and applied care. We expect our work to be continuously subjected to further development: future research should evaluate and expand our taxonomy to other contexts and care settings.

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Cognitive and Functional Impairment of Hospitalized Patients over 65 Years of Age

European Journal of Investigation in Health, Psychology and Education ◽

10.3390/ejihpe4010001 ◽

2013 ◽

Vol 4 (1) ◽

pp. 5-18

Author(s):

Mª José Calero-García ◽

Alfonso J. Cruz Lendínez

Keyword(s):

Cognitive Impairment ◽

Marital Status ◽

Acute Care ◽

Functional Impairment ◽

Acute Care Hospital ◽

Education Level ◽

Care Hospital ◽

Elderly Men ◽

Time Of Admission ◽

The Relationship

The first objective of this research is to establish and study how the different stages of cognitive impairment and the levels of dependence evolve in patients over 65 years of age, admitted to an acute care hospital, as well as the relationship between these factors and the different social and demographical variables. The results show that the level of dependence decreases suddenly at the time of admission and undergoes a slight recovery at the time of discharge. Although this recovery continues at home after discharge, patients do not get the same level of independence that they used to have before admission. In addition, significant differences in terms of age, marital status and education level were found. In general, our results show that elderly men over 80 years of age, without no education and widowers are more likely to suffer from severe cognitive impairment and be more functionally dependent when admitted to hospital.

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