Disagreement Among Health Care Professionals About the Urgent Care Needs of Emergency Department Patients

Introduction: Some low acuity Emergency Department (ED) presentations are considered non-urgent or convenience visits and potentially avoidable with improved access to primary care. This study explored self-reported reasons why non-urgent patients presented to the ED. Methods: Patients, 17 years and older, were randomly selected from electronic registration records at three urban EDs in Edmonton, Alberta (AB), Canada during weekdays (0700 to 1900). A 47-item questionnaire was completed by each consenting patient, which included items on whether the patient believed the ED was their best care option and the rationale supporting their response. A thematic content analysis was performed on the responses, using previous experience and review of the literature to identify themes. Results: Of the 2144 eligible patients, 1408 (65.7%) questionnaires were returned, and 1402 (65.4%) were analyzed. For patients who felt the ED was their best option (n = 1234, 89.3%), rationales included: safety concerns (n = 309), effectiveness of ED care (n = 284), patient-centeredness of ED (n = 277), and access to health care professionals in the ED (n = 204). For patients who felt the ED was not their best care option (n = 148, 10.7%), rationales included a perception that: access to health professionals outside the ED was preferable (n = 39), patient-centeredness (particularly timeliness) was lacking in the ED (n = 26), and their health concern was not important enough to require ED care (n = 18). Conclusion: Even during times when alternative care options are available, the majority of non-urgent patients perceived the ED to be the most appropriate location for care. These results highlight that simple triage scores do not accurately reflect the appropriateness of care and that understanding the diverse and multi-faceted reasons for ED presentation are necessary to implement strategies to support non-urgent, low acuity care needs.

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Empowering Health Care Professionals: An Interprofessional Education Model Implementation and Evaluation

10.31219/osf.io/emz4c ◽

2019 ◽

Author(s):

Jessica Shank Coviello

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Interprofessional Education ◽

Healthcare Professionals ◽

The United States ◽

Healthcare Systems ◽

World Health ◽

Institute Of Medicine ◽

Care Needs ◽

Ensure Patient Safety

In 2016, the Institute of Medicine (IOM) reported medical error as the 3rd leading cause of death in healthcare systems in the United States. Effective communication of patient care needs across healthcare disciplines is critical to ensure patient safety, quality of care, and to improve operational efficiencies in healthcare systems. Ineffective collaboration and communication among healthcare professionals within the procedural areas increases the potential of harm as a patient moves from one healthcare professional to another. Health care systems are thus encouraged to train employees with a focus on interprofessional education (IPE) and collaborative practice. IOM and World Health Organization (WHO) recommend the use of IPE to help improve communication and collaboration. However the current educational structure in many institutions does not include IPE. As such, healthcare professionals work in silos, with little or no collaboration with one another, which may result in service duplication, increased service cost, and poor health outcomes for patients.

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Patient and family–centred care for pediatric patients in the emergency department

CJEM ◽

10.1017/s1481803500009994 ◽

2008 ◽

Vol 10 (01) ◽

pp. 38-43 ◽

Cited By ~ 11

Author(s):

Kathleen Brown ◽

Sharon E. Mace ◽

Ann M. Dietrich ◽

Stephen Knazik ◽

Neil E. Schamban

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Professionals ◽

Pediatric Population ◽

Quality Care ◽

Medical Decision ◽

Care Integration ◽

The Family ◽

Integral Role

ABSTRACT Patient and family–centred care (PFCC) is an approach to health care that recognizes the integral role of the family and encourages mutually beneficial collaboration between the patient, family and health care professionals. Specific to the pediatric population, the literature indicates that the majority of families wish to be present for all aspects of their child's care and be involved in medical decision-making. Families who are provided with PFCC are more satisfied with their care. Integration of these processes is an essential component of quality care. This article reviews the principles of PFCC and their applicability to the pediatric patient in the emergency department; and it discusses a model for integrating PFCC that is modifiable based on existing resources.

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Optimising Hand Surgery during COVID-19 Pandemic

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835521500132 ◽

2021 ◽

Vol 26 (01) ◽

pp. 84-91

Author(s):

Shivangi Saha ◽

Suvashis Dash ◽

Mohammed Tahir Ansari ◽

Ashish Dhanraj Bichupuriya ◽

Amit Kumar Gupta ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Hand Surgery ◽

Patient Characteristics ◽

Operative Management ◽

Hand Injuries ◽

Care Needs ◽

Use Of Resources ◽

Flap Cover

Background: With the emergence of the COVID-19 pandemic, most health-care personnel and resources are redirected to prioritize care for seriously-ill COVID patients. This situation may poorly impact our capacity to care for critically injured patients. We need to devise a strategy to provide rational and essential care to hand trauma victims whilst the access to theatres and anaesthetic support is limited. Our center is a level 1 trauma center, where the pandemic preparedness required reorganization of the trauma services. We aim to summarise the clinical profile and management of these patients and highlight, how we modified our practice to optimize their care. Methods: This is a single-centre retrospective observational study of all patients with hand injuries visiting the Department of Plastic Surgery from 22nd March to 31st May 2020. Patient characteristics, management details, and outcomes were analysed. Results: A total of 102 hand injuries were encountered. Five patients were COVID-19 positive. The mean age was 28.9 ± 14.8 years and eighty-two (80.4%) were males. Thirty-one injuries involved fractures/dislocations, of which 23 (74.2%) were managed non-operatively. Seventy-five (73.5%) patients underwent wound wash or procedure under local anaesthetic and were discharged as soon as they were comfortable. Seventeen cases performed under brachial-plexus block, were discharged within 24 hours except four cases of finger replantation/ revascularisation and one flap cover which were discharged after monitoring for four days. At mean follow-up of 54.4 ± 21.8 days, the rates of early complication and loss to follow-up were 6.9% and 12.7% respectively. Conclusions: Essential trauma care needs to continue keeping in mind, rational use of resources while ensuring safety of the patients and health-care professionals. We need to be flexible and dynamic in our approach, by utilising teleconsultation, non-operative management, and regional anaesthesia wherever feasible.

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Keeping people with epilepsy safe during the COVID-19 pandemic

Neurology ◽

10.1212/wnl.0000000000009632 ◽

2020 ◽

Vol 94 (23) ◽

pp. 1032-1037 ◽

Cited By ~ 47

Author(s):

Jacqueline A. French ◽

Martin J. Brodie ◽

Roberto Caraballo ◽

Orrin Devinsky ◽

Ding Ding ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Care Pathway ◽

Clinical Care ◽

Health Care Facilities ◽

Urgent Care ◽

Consensus Recommendations ◽

Consensus Statements ◽

Care Facilities ◽

Strongly Agree

ObjectivesTo provide information on the effect of the coronavirus disease of 2019 (COVID-19) pandemic on people with epilepsy and provide consensus recommendations on how to provide the best possible care for people with epilepsy while avoiding visits to urgent care facilities and hospitalizations during the novel coronavirus pandemic.MethodsThe authors developed consensus statements in 2 sections. The first was “How should we/clinicians modify our clinical care pathway for people with epilepsy during the COVID-19 pandemic?” The second was “What general advice should we give to people with epilepsy during this crisis? The authors individually scored statements on a scale of −10 (strongly disagree) to +10 (strongly agree). Five of 11 recommendations for physicians and 3/5 recommendations for individuals/families were rated by all the authors as 7 or above (strongly agree) on the first round of rating. Subsequently, a teleconference was held where statements for which there was a lack of strong consensus were revised.ResultsAfter revision, all consensus recommendations received a score of 7 or above. The recommendations focus on administration of as much care as possible at home to keep people with epilepsy out of health care facilities, where they are likely to encounter COVID-19 (including strategies for rescue therapy), as well as minimization of risk of seizure exacerbation through adherence, and through ensuring a regular supply of medication. We also provide helpful links to additional helpful information for people with epilepsy and health providers.ConclusionThese recommendations may help health care professionals provide optimal care to people with epilepsy during the coronavirus pandemic.

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Emerging Pharmacotherapy and Health Care Needs of Patients in the Age of Artificial Intelligence and Digitalization

Annals of Pharmacotherapy ◽

10.1177/1060028020919383 ◽

2020 ◽

Vol 54 (10) ◽

pp. 1038-1046

Author(s):

Barbara J. Zarowitz

Keyword(s):

Artificial Intelligence ◽

Health Care ◽

Ethnic Diversity ◽

Health Care Professionals ◽

Large Data ◽

The United States ◽

Wearable Devices ◽

Data Sets ◽

Care Needs ◽

Clinician Training

Advances in the application of artificial intelligence, digitization, technology, iCloud computing, and wearable devices in health care predict an exciting future for health care professionals and our patients. Projections suggest an older, generally healthier, better-informed but financially less secure patient population of wider cultural and ethnic diversity that live throughout the United States. A pragmatic yet structured approach is recommended to prepare health care professionals and patients for emerging pharmacotherapy needs. Clinician training should include genomics, cloud computing, use of large data sets, implementation science, and cultural competence. Patients will need support for wearable devices and reassurance regarding digital medicine.

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Current Research Status of Palliative Care in Mainland China

Journal of Palliative Care ◽

10.1177/0825859718773949 ◽

2018 ◽

Vol 33 (4) ◽

pp. 215-241 ◽

Cited By ~ 6

Author(s):

Tao Wang ◽

Alex Molassiotis ◽

Betty Pui Man Chung ◽

Jing-Yu Tan

Keyword(s):

Health Care ◽

Decision Making ◽

Palliative Care ◽

Health Care Professionals ◽

Mainland China ◽

Education And Training ◽

Care Needs ◽

Research Status ◽

Palliative Care Services ◽

And Training

Objectives: This study aimed to obtain an overview of the current research status of palliative care in Mainland China and identify research directions for future studies by characterizing palliative care studies conducted among patients with any life-limiting illness in Mainland China and published in a peer-reviewed journal before November 2016. Methods: A review guide with 7 categories was initially developed based on existing international palliative care definitions and guidelines through content analysis. Ten databases were used to identify relevant studies from the inception of online cataloging to November 2016. Studies conducted in Mainland China and their research topic that fell within one of the categories of the review guide were included for further analysis. Descriptive analysis was adopted to summarize the relevant findings. Results: 54 studies found to be relevant were included for the analysis. Three studies on “palliative care education and training” (category 1) asserted that education and training programs were scant in Mainland China and that only 1 program had been devised within the health-care context of Shanghai. Five studies on “palliative care screening and timely identification” (category 2) highlighted the absence of early screening criteria or checklists and referral procedures for palliative care. Thirty-one studies on “palliative care needs assessment (n = 12/31) and implementation (n = 19/31)” (category 3) were identified, and various methodological flaws were observed in most of these included studies. Twelve studies on “advanced decision-making” (category 4) were identified, all of which focused on investigating the attitudes of patients with cancer, their families, and/or health-care professionals toward advanced decision-making only. The percentage of patients, family members, and health-care professionals who held positive attitudes toward advanced decision-making were varied and suboptimal, particularly for family members (51.4%-58.0%). Five studies on “caring for patients at the end of life” (category 5) were identified, and the experience of health-care professionals in caring for those patients was explored. No studies relating to “death and bereavement care” (Category 6) and “psychological support for palliative care providers” (Category 7) were identified. Conclusion: The current research status of palliative care in Mainland China remains at an early stage with minimal palliative care services used. Although several knowledge gaps were identified, the first step, which should be addressed, is assessing the palliative care needs. An appropriate and ongoing needs assessment could provide important information for constructing comprehensive education and training programs of palliative care, identifying prognostic factors of timely palliative care referral, and developing evidence-based and tailored palliative care services.

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PEER TO PEER SUPPORT AND HEALTH CARE UTILIZATION AMONG COMMUNITY-DWELLING OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3151 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S857-S857

Author(s):

Elizabeth A Jacobs ◽

Rebecca Schwei ◽

Scott Hetzel ◽

Jane Mahoney ◽

KyungMann Kim

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Department ◽

Health Care Utilization ◽

Peer Support ◽

Peer Group ◽

Peer To Peer ◽

Emergency Department Visits ◽

Urgent Care ◽

Care Utilization

Abstract The majority of older adults want to live and age in their communities. Some community-based organizations (CBOs) have initiated peer-to-peer support services to promote aging in place but the effectiveness of these programs is not clear. Our objective was to compare the effectiveness of a community-designed and implemented peer-to-peer support program vs. access to standard community services, in promoting health and wellness in vulnerable older adult populations. We partnered with three CBOs, one each in California, Florida, and New York, to enroll adults 65 > years of age who received peer support and matched control participants (on age, gender, and race/ethnicity) in an observational study. We followed participants over 12 months, collecting data on self-reported urgent care and emergency department visits and hospitalizations. In order to account for the lack of randomization, we used a propensity score method to compare outcomes between the two groups. We enrolled 222 older adults in the peer-to-peer group and 234 in the control group. After adjustment, we found no differences between the groups in the incidence of hospitalization, urgent and emergency department visits, and composite outcome of any health care utilization. The incidence of urgent care visits was statistically significantly greater in the standard community service group than in the peer-to-peer group. Given that the majority of older adults and their families want them to age in place, the question of how to do this is highly relevant. Peer-to-peer services may provide some benefit to older adults in regard to their health care utilization.

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