scholarly journals Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eric D. Moyer ◽  
Erik B. Lehman ◽  
Matthew D. Bolton ◽  
Jennifer Goldstein ◽  
Ariana R. Pichardo-Lowden
Keyword(s):  
Blood Glucose ◽  
Continuity Of Care ◽  
Clinical Documentation ◽  
Stress Hyperglycemia ◽  
Optimal Care ◽  
Continuity Clinic ◽  
Altered Glucose ◽  
Discharge Summaries

AbstractStress hyperglycemia (SH) is a manifestation of altered glucose metabolism in acutely ill patients which worsens outcomes and may represent a risk factor for diabetes. Continuity of care can assess this risk, which depends on quality of hospital clinical documentation. We aimed to determine the incidence of SH and documentation tendencies in hospital discharge summaries and continuity notes. We retrospectively examined diagnoses during a 12-months period. A 3-months representative sample of discharge summaries and continuity clinic notes underwent manual abstraction. Over 12-months, 495 admissions had ≥ 2 blood glucose measurements ≥ 10 mmol/L (180 mg/dL), which provided a SH incidence of 3.3%. Considering other glucose states suggestive of SH, records showing ≥ 4 blood glucose measurements ≥ 7.8 mmol/L (140 mg/dL) totaled 521 admissions. The entire 3-months subset of 124 records lacked the diagnosis SH documentation in discharge summaries. Only two (1.6%) records documented SH in the narrative of hospital summaries. Documentation or assessment of SH was absent in all ambulatory continuity notes. Lack of documentation of SH contributes to lack of follow-up after discharge, representing a disruptor of optimal care. Activities focused on improving quality of hospital documentation need to be integral to the education and competency of providers within accountable health systems.

scholarly journals Factors related to perceived continuity of care in hospitalized cardiac patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Safstrom ◽  
T.J Jaarsma ◽  
L.N Nordgren ◽  
M.L Liljeroos ◽  
A.S Stomberg
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Perceived Control ◽  
Care Utilization ◽  
Funding Source ◽  
Patient Reported

Abstract Background Since healthcare systems are increasingly complex and often fragmented, continuity of care after hospitalization is a priority to increase patient safety and satisfaction. Aim Describe factors related to continuity of care in patients hospitalized due to cardiac conditions. Methods This cross-sectional multicenter study enrolled patients 6 weeks after hospitalization due to cardiac conditions. A total of 993 patients were included (mean age 72.2 (SD 10.4), males 66%) with AMI (35%), AF (25%), angina (21%) and HF (17.3%). Patients completed the Patient Continuity of Care Questionnaire, a questionnaire based on the definition that continuity of care is “the extent to which a series of health care services is experienced as connected and coherent and is consistent with a patient's health needs and personal circumstances”. The total score of the questionnaire ranges from 6 to 30, higher score indicating higher continuity and a score <24 indicating insufficient continuity. Cronbach's alpha on the total PCCQ was 0.94. Correlations between PCCQ and quality of life, depression, anxiety, perceived control and health care utilization were estimated using spearman rang correlation. Results Insufficient continuity of care ranged between 47% to 59% in the different diagnosis groups, which the highest continuity in the AMI group and lowest in patients with atrial fibrillation. In patients hospitalized due to AMI (n=355, mean age 71 (± 11), 70% men), continuity of care was related to higher perceived control, higher quality of life, a good financial situation, being a man, no symptoms of anxiety or depression (ᚹ range 0.17–0.26 p≤0.002). A low score on the PCCQ were associated with follow-up visit to a nurse in primary care after hospitalization (ᚹ −0.12 p=0.033). In patients hospitalized due to angina (n=210, mean age 73 (± 9), 74% men), continuity of care was related to higher perceived control, higher quality of life and no depressive symptoms (ᚹ range between 0.20 and 0.26 p=0.005). In patients with AF, (n=255, mean age 71 (± 10.), 58% men), continuity of care was related to having had contact by telephone with a nurse-led AF clinic, higher perceived control, higher quality of life and not being depressed (ᚹ range between 0.14–0.25 p=0.03). In patients with HF, (n=173, mean age 77 (±8) 59% men), continuity was related to male ender, younger age, follow-up in a nurse-led HF clinic and not being anxious (ᚹ range between 0.16 and 0.22 p=0.004–0.047). Low total score on PCCQ correlated to having had telephone contact with nurse in primary care (ᚹ −0.24 p=0.002). Conclusion Almost half of all patient reported insufficient continuity of care. Perceived control, quality of life, and symptoms of depression were related to higher continuity of care in all diagnose groups except heart failure. Further, there was a correlation between continuity and follow-up visits or contact by telephone with nurse-led clinics in all diagnose groups except angina. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council of Southeast Sweden, Centre for Clinical Research Sörmland

scholarly journals A Structured Workshop to Improve the Quality of Resident Discharge Summaries

2012 ◽  
Vol 4 (1) ◽  
pp. 87-91 ◽  
Author(s):  
Jaideep S. Talwalkar ◽  
Jason R. Ouellette ◽  
Shawnette Alston ◽  
Gregory K. Buller ◽  
Daniel Cottrell ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Discharge Summary ◽  
Faculty Members ◽  
Evaluation Tool ◽  
Outpatient Physician ◽  
Hospital Discharge Summary ◽  
Structured Program ◽  
Discharge Summaries

Abstract Background Poor communication at hospital discharge can increase the risk of adverse events. The hospital discharge summary is the most common tool for detailing events related to hospitalization in preparation for postdischarge follow-up, yet deficiencies in discharge summaries have been widely reported. Resident physicians are expected to dictate discharge summaries but receive little formal training in this arena. We hypothesized that implementation of an educational program on chart documentation skills would result in improvements in the quality of hospital discharge summaries in a community hospital internal medicine residency program. Methods A monthly, 1-hour workshop was launched in August 2007 to provide consistent and ongoing instruction on chart documentation. Guided by a faculty moderator, residents reviewed 2 randomly selected peer chart notes per session using instruments developed for that purpose. After the workshop had been in place for 2 years, 4 faculty members reviewed 63 randomly selected discharge summaries from spring 2007, spring 2008, and spring 2009 using a 14-item evaluation tool. Results Mean scores for 10 of the 14 individual items improved in a stepwise manner during the 3 years of the study. Items related to overall quality of the discharge summary showed statistically significant improvement, as did the portion of the summaries “carbon copied” to the responsible outpatient physician. Conclusions The quality of hospital discharge summaries improved following the implementation of a novel, structured program to teach chart documentation skills. Ongoing improvement was seen 1 and 2 years into the program, suggesting that continuing instruction in those skills was beneficial.

scholarly journals STUDY OF ALTERED GLUCOSE LEVELS IN CASES OF ACUTE ISCHEMIC STROKE AND ITS EFFECT ON PROGNOSIS

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Dr. Sunil I Mathew
Keyword(s):  
Blood Glucose ◽  
Medical Condition ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Stress Hyperglycemia ◽  
Exact Test ◽  
Glucose Levels ◽  
Altered Glucose ◽  
One Year ◽  
Glucose Estimation

IntroductionGlobally about 20 million people suffer from stroke each year. Stroke is a medical condition in which poor blood flow to the brain results in cell death. The risk factors causing stroke are high blood pressure, high blood, tobacco smoking, obesity cholesterol, diabetes mellitus and previous Transient Ischemic Attack (TIA).Objectives: To determine the association of stress hyperglycemia at admission with outcome of acute ischemic strokeMaterials and Methods: A study was done at Thiruvalla, Kerala for a period of one year. All new cases of cerebral infarction admitted comprised of 70 cases, 35 each in Euglycemia and Stress hyperglycemia group who were classified at the time of admission based on random blood glucose estimation with the features of stroke. All necessary investigations for the work-up of case required were done. Glasgow Outcome Score for the assessment of recovery in patients was scored, based on National Institute of Health Stroke Scale (NIHSS) on day 1, at the time of discharge and then again on day 30 to assess the clinical outcome. Standard descriptive statistics were used to report the data. Fisher's exact test and Students t test were used to compare the two groups. Binary logistic regression analysis was done.Result: Patients with stress hyperglycemia were found to have increased NIHSS scores on admission and this was more prominent at time of discharge on compared to euglycemic group. Poor recovery was associated with small and medium infarct size in stress hyperglycemia. However, prognosis worsened if size of infarct increased in both groups.Conclusion: Adequate control of blood glucose levels should be maintained immediately during admission and during follow-up to improve prognosis.Keywords: Stroke, Glucose levels, Prognosis

Interdisciplinary Approach to the Management of Intestinal Transplant Recipients: Evaluation, Discharge, and Lifetime Management

2005 ◽  
Vol 15 (1) ◽  
pp. 54-59
Author(s):  
Kate Samela ◽  
Erin Fennelly ◽  
Mary Brosnan ◽  
Jill Robinson
Keyword(s):  
Intestinal Failure ◽  
Interdisciplinary Approach ◽  
Open Communication ◽  
Optimal Care ◽  
Team Members ◽  
Close Relationship ◽  
Transplant Team ◽  
Intestinal Transplant

Patients suffering from intestinal failure present unique and difficult challenges to the transplant team. Augmenting the need for interdisciplinary teamwork is the higher incidence of death on the intestinal transplant waiting list. Successful management of this population requires an interdisciplinary approach at each stage of care, beginning with evaluation and continuing through discharge and lifetime management. A close relationship between patients, their caregivers, and all members of the transplant team is an essential component to successful lifetime management. Open communication between team members and unlimited accessibility to each other enables work flow to be managed efficiently, and enables the provision of optimal care. In this article, we describe the functions of the nonphysician clinical personnel needed to manage the intestinal transplant patient—beginning at the evaluation through lifetime follow-up care. The goal of each professional is the same: to restore the patient to the best quality of life possible.

scholarly journals Home health monitoring during the COVID pandemic: Results from a feasibility study in Alberta primary care

2021 ◽  
pp. 084047042110419
Author(s):  
Jodi Thesenvitz ◽  
Shelby Corley ◽  
Lana Solberg ◽  
Chris Carvalho
Keyword(s):  
Primary Care ◽  
Health Monitoring ◽  
Phase 1 ◽  
Home Health ◽  
Chronic Obstructive ◽  
Optimal Care ◽  
Obstructive Pulmonary Disease ◽  
Home Health Monitoring

The expansive geography of Central Alberta presents many barriers to optimal care, including limited resources and access issues. In response to the COVID-19 pandemic, primary care networks (PCNs) within Central Alberta partnered with a technology provider to rapidly implement home health monitoring (HHM) for patients with chronic diseases. In the 37 patients evaluated in phase 1 (90 days), diabetes was most common (73%), followed by hypertension (38%), chronic obstructive pulmonary disease (27%), and heart failure (11%). Overall, patients were comfortable using the HHM technology, and >60% reported improved quality of life after follow-up. Patients also made fewer visits to their family physician/emergency department compared with the pre-enrolment period. In January 2021, the HHM initiative was expanded to a larger patient cohort (phase 2; n = 500). Interim results for 90 patients from eight PCNs up to the end of May 2021 show similar findings to phase 1.

scholarly journals Patient Follow-up in an Urban Resident Continuity Clinic: An Initiative to Improve Scheduling Practices

2011 ◽  
Vol 3 (2) ◽  
pp. 256-260 ◽  
Author(s):  
David W. Dowdy ◽  
Claire K. Horton ◽  
Ben Lau ◽  
Rosaly Ferrer ◽  
Alice H. Chen
Keyword(s):  
Core Competencies ◽  
Continuity Clinic ◽  
Clinical Supervisors ◽  
Implementation Evaluation ◽  
Outpatient Scheduling ◽  
Low Health Literacy ◽  
Resident Continuity Clinic ◽  
Problem Solving Process

Abstract Introduction Failure to schedule timely follow-up appointments may impair continuity and quality of care, especially for patients with low health literacy and unstable living situations. Resident continuity clinics face particular challenges in scheduling patient follow-up because of residents' complex schedules and limited time in clinic. Methods As part of a structured quality-improvement curriculum, residents initiated discussions with clinical supervisors and clerical staff to evaluate and improve scheduling practices in an urban continuity clinic. The problem-solving process emphasized feasibility (rapid implementation/evaluation cycle, low time/resource burden) and measurable outcomes. These discussions led to design of a new scheduling form. We evaluated the short-term impact of awareness raising by comparing scheduling rates before (month 1) versus after (months 2–3) implementation, and of the form itself by randomly selecting 2 afternoon clinics to implement the new form, with a third serving as control. Results We analyzed all patient encounters over a 3-month period (n  =  910), excluding patients with a recommended follow-up interval of greater than 4 months. The proportion of appointments “never scheduled” (at 1 month after provider-requested follow-up date) declined from 18.8% (95% confidence interval [CI], 14.5%–23.9%) in month 1 to 11.4% (CI, 8.1%–15.5%) in month 3. This proportion was significantly higher before than after implementation of the form (multivariable relative risk, 1.49; 95% CI, 1.08–2.03; P  =  .02), both in clinics that used and did not use the form (P  =  .93 for difference). Conclusions We describe a model resident-led, team-based intervention that addressed core competencies in graduate medical education while improving outpatient scheduling practices.

50 Using A Targeted Teaching Intervention to Drive up the Quality of Discharge Summaries. Shop 75+

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
R C Robey ◽  
A Danson ◽  
J Evans ◽  
J Froggatt ◽  
A Pederson ◽  
...  
Keyword(s):  
Patient Information ◽  
Poor Quality ◽  
Teaching Intervention ◽  
Intended Audience ◽  
Improvement Project ◽  
Group Settings ◽  
Questionnaire Surveys ◽  
Discharge Summaries

Abstract Background Quality improvement project examining discharge communication, and a targeted teaching intervention. Introduction Poor quality, incomplete or missing discharge summaries (DSs) are associated with avoidable/ameliorable adverse events after discharge [1]; preventable readmission [2,3]; failure to implement discharge plans [4]; and medication continuity errors [4,5]. Methods To review the quality of DSs produced, each month forty representative DSs are randomly selected from four clinical areas and qualitatively assessed (total > 1,000, August 2017—to date). Alongside this, in August 2018, incoming foundation doctors were surveyed on perceptions of the purpose/importance of DSs, and training provided on writing them. They were resurveyed after teaching delivery in November 2018 and April 2019. Interventions Data from QI review and survey were used to generate a teaching intervention, in the form of an interactive slide set for delivery in small group settings. This was delivered in weekly mandatory teaching sessions. PDSA cycles were completed for teaching sessions, and the slide set was developed accordingly. Results After the teaching sessions, we noted improvement in satisfaction with training provided on writing DSs (from 24% to 40%), as well as confidence in writing high-quality DSs (from 28% to 100%). We demonstrated increases in responses including the patient as an intended audience for the DS (from 51% to 84%), and rating “patient information in lay terms” of “high importance” (from 41% to 72%). These changes in perceptions were accompanied by improvement in the quality of DSs produced, particularly with respect to the quality of follow-up actions detailed and the quality of patient information provided in lay terminology. The average monthly proportion of DSs achieving a “great score” in these areas increased from 20% and 28% respectively (August 2017—June 2018), to 44% and 71% (August 2018—March 2019). Conclusions These data provide proof-of-principle that targeted teaching, constructed around prior questionnaire surveys, improves awareness of the purpose of DCs and leads to improvement in the quality of DSs produced and enhanced patient safety.

scholarly journals Communication with cancer survivors: Disparities by education level but not race in a majority-minority community

2021 ◽  
Author(s):  
Marci Chock ◽  
Sharon Tamashiro ◽  
Kristy Fujinaga ◽  
Ryon Nakasone ◽  
Jared Acoba
Keyword(s):  
High School ◽  
Cancer Survivors ◽  
Education Level ◽  
Response Scale ◽  
Optimal Care ◽  
Race And Education ◽  
Follow Up Care ◽  
The Impact

Abstract Purpose Patient-provider communication (PPC) is an important component of optimal patient care. Many factors influence the quality of PPC among cancer patients, however, there are conflicting data on the impact of patient race and education level on PPC. We sought to assess the effect of race and education level on PPC among a multiracial cohort of cancer survivors. Methods We conducted a survey of 360 cancer survivors. Data were collected on age, race, income, and education level. The survey assessed satisfaction with PPC and follow-up with cancer physician. Questions were answered on a 5-point response scale. We evaluated PPC using nonparametric analyses and built logistic regression models for satisfaction with follow-up care. Results Patients with a high school or lower education consistently rated questions of PPC more poorly than those who attained a higher level of education. No significant associations were detected between PPC and race. Results for perceived quality of care showed a similar disparity by education level. High school educated patients reported significantly lower satisfaction with quality of follow-up care compared with patients who attained Graduate level education (OR 3.50, 95% CI 1.37-8.94). Conclusion Our study demonstrated that education level, but not race, is associated with perception of communication and satisfaction with follow-up care. Patients who attained higher levels of education had higher PPC ratings and satisfaction with follow-up care. Our findings identify an opportunity for improvement in PPC through individualizing the delivery of health-related information with the goal of achieving optimal care of long-term cancer survivors.

scholarly journals Acceptance of home blood glucose monitoring by owners of recently diagnosed diabetic cats and impact on quality of life changes in cat and owner

2017 ◽  
Vol 20 (8) ◽  
pp. 711-720 ◽  
Author(s):  
Katarina Hazuchova ◽  
Ruth Gostelow ◽  
Christopher Scudder ◽  
Yaiza Forcada ◽  
David B Church ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Glucose ◽  
Glycaemic Control ◽  
Glucose Monitoring ◽  
Blood Glucose Monitoring ◽  
Control Parameters ◽  
Home Blood Glucose Monitoring ◽  
The Impact

Objectives This study aimed to evaluate the acceptance of home blood glucose monitoring (HBGM) by owners of recently diagnosed diabetic cats, and the impact of choosing HBGM on the quality of life (QoL) changes of cat and owner, in addition to glycaemic changes during 6 months of follow-up. Methods Owners of cats diagnosed with diabetes mellitus (DM) and treated with insulin for 6–20 weeks were divided into an HBGM group and a non-HBGM group, based on their ability and willingness to perform HBGM after a standardised instruction session. The HBGM acceptance level and reasons for acceptance failure were documented; a questionnaire evaluated owners’ experiences. For the following 6 months, changes in QoL, measured using the validated DIAQoL-pet quantification tool, and changes in glycaemic control parameters (clinical signs, serum fructosamine, blood glucose curve average/minimal/maximal/pre-insulin blood glucose) were compared between HBGM and non-HBGM groups at months 1, 3 and 6, as well as within the groups between baseline and months 1, 3 and 6. Results Thirty-eight cats were enrolled; 28 (74%) entered the HBGM group. There was no significant difference between groups in overall DIAQoL-pet score or glycaemic control parameters at any time point apart from the maximal blood glucose at month 6 (lower in the HBGM group). However, the DIAQoL-pet score, including indicators of owner worry about DM, worry about hypoglycaemia and costs, as well as glycaemic parameters, improved at all time points within the HBGM group but not within the non-HBGM group. Remission occurred in 9/28 (32%) HBGM group cats and 1/10 (10%) non-HBGM group cats ( P = 0.236). Conclusions and relevance HBGM was adopted successfully by most diabetic cat owners. Despite the extra task, positive changes in QoL parameters occurred in the HBGM group and not in the non-HBGM group. Although no difference was found in glycaemic control between the HBGM and non-HBGM groups during the 6 months of follow-up, significant glycaemic improvements were documented in the HBGM group.

scholarly journals The frequency and quality of delirium documentation in discharge summaries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Victoria L Chuen ◽  
Adrian C.H Chan ◽  
Jin Ma ◽  
Shabbir M.H Alibhai ◽  
Vicky Chau
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Discharge Summary ◽  
Medical Specialties ◽  
Surgical Services ◽  
Documentation Quality ◽  
Medication Changes ◽  
Discharge Summaries

Abstract Background The National Institute for Health and Care Excellence recommends documenting all delirium episodes in the discharge summary using the term “delirium”. Previous studies demonstrate poor delirium documentation rates in discharge summaries and no studies have assessed delirium documentation quality. The aim of this study was to determine the frequency and quality of delirium documentation in discharge summaries and explore differences between medical and surgical services. Methods This was a multi-center retrospective chart review. We included 110 patients aged ≥ 65 years identified to have delirium during their hospitalization using the Chart-based Delirium Identification Instrument (CHART-DEL). We assessed the frequency of any delirium documentation in discharge summaries, and more specifically, for the term “delirium”. We evaluated the quality of delirium discharge documentation using the Joint Commission on Accreditation of Healthcare Organization’s framework for quality discharge summaries. Comparisons were made between medical and surgical services. Secondary outcomes included assessing factors influencing the frequency of “delirium” being documented in the discharge summary. Results We identified 110 patients with sufficient chart documentation to identify delirium and 80.9 % of patients had delirium documented in their discharge summary (“delirium” or other acceptable term). The specific term “delirium” was reported in 63.6 % of all delirious patients and more often by surgical than medical specialties (76.5 % vs. 52.5 %, p = 0.02). Documentation quality was significantly lower by surgical specialties in reporting delirium as a diagnosis (23.5 % vs. 57.6 %, p < 0.001), documenting delirium workup (23.4 % vs. 57.6 %, p = 0.001), etiology (43.3 % vs. 70.4 %, p = 0.03), treatment (36.7 % vs. 66.7 %, p = 0.02), medication changes (44.4 % vs. 100 %, p = 0.002) and follow-up (36.4 % vs. 88.2 %, p = 0.01). Conclusions The frequency of delirium documentation is higher than previously reported but remains subpar. Medical services document delirium with higher quality, but surgical specialties document the term “delirium” more frequently. The documentation of delirium in discharge summaries must improve to meet quality standards.

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