scholarly journals Hospital@Home: a proof of concept

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Umans ◽  
J Van Ramshorst ◽  
S.P.M De Boer ◽  
A.J.C.M Bos-Schaap ◽  
S Walburg
Keyword(s):  
Patient Satisfaction ◽  
Home Care ◽  
Nurse Practitioners ◽  
Nursing Staff ◽  
Care Home ◽  
Care Group ◽  
Proof Of Concept ◽  
Patient Satisfaction Score ◽  
Home Care Nursing ◽  
Model Combining

Abstract Background Expenditure in healthcare in the Netherlands is so increasing that currently 1 in 7 employees are working in the health care/cure. Future expansion is under constrain given the 10% of GDP use and shortage of working force.Dutch healthcare consists of a cure section (mostly hospitals) and nursing care@home. Both entities have different national budgets (€25 + €20bln) Methods In a proof of concept, we explored a new Hospital@Home (H@H) model combining hospital cure and home-care budgets in a 800 mi2 district with 850,000 inhabitants. The objective comprises 4 proofs: (1)provide hospital care@home, (2) combine financial budgets (3) increasing working forces by combining teams, (4) increased satisfaction of pts and nursing staff. Results We proofed a joining budgets of the hospital and home-care group for cardiology. The homecare-budget was sufficient to hire 3 nurse practitioners who are trained by the cardiologists and work with 16 home-care cardiovascular nurses for H@H treatment. The hospital budget provided a virtual EHR cardiology ward and supplied the home care-nurses with a nursing app to assess the patients EHR. Budgets were sufficient to obtain the home-heartfailure monitoring application. The cardiology-group developed the H@H program for endocarditis treatment and heartfailure telemonitoring. Clinically, in the first 6 months, 50% of hospitalized endocarditis pts were treated with iv antibiotics@home with an average 16.5 days per pt shorter admission days without complications. 33% of eligible hospitalized heartfailure pts consented for telemonitoring@home while up-titrated on medication. Video-consulting reduced outpatient visits with 75%. Patient satisfaction was 75/100. Conclusion In this proof of concept, the H@H program provided hospital cure at home by merging hospital and home-care nursing staff and ICT budgets. Patient satisfaction score were driven by shorter admissions and less hospital visits. We call for further exploration of efforts to facilitate combined home-care and hospital-cure transmural budgets to confirm this proof of concept. Funding Acknowledgement Type of funding source: None

scholarly journals Connected care for endocarditis and heart failure patients: a hospital-at-home programme

2021 ◽  
Author(s):  
J. van Ramshorst ◽  
M. Duffels ◽  
S. P. M de Boer ◽  
A. Bos-Schaap ◽  
O. Drexhage ◽  
...  
Keyword(s):  
Heart Failure ◽  
Home Care ◽  
Nurse Practitioners ◽  
Care Group ◽  
Proof Of Concept ◽  
Home Setting ◽  
Curative Care ◽  
Care At Home ◽  
Hospital At Home ◽  
At Home

Abstract Background Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) Aim In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction. Results We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record. Conclusion The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

Home-care nursing staff in self-directed teams are more satisfied with their job and feel they have more autonomy over patient care: a nationwide survey

2017 ◽  
Vol 73 (10) ◽  
pp. 2430-2440 ◽  
Author(s):  
Erica E.M. Maurits ◽  
Anke J.E. de Veer ◽  
Peter P. Groenewegen ◽  
Anneke L. Francke
Keyword(s):  
Home Care ◽  
Patient Care ◽  
Nursing Staff ◽  
Nationwide Survey ◽  
Home Care Nursing ◽  
Care Nursing

Introduction of Wireless Buzzer to Improve Efficiency in Gynecology Triage (Preprint)

2020 ◽  
Author(s):  
Nicholas Mark Stansbury ◽  
Erin Nelson
Keyword(s):  
Medical Students ◽  
Nurse Practitioners ◽  
Nursing Staff ◽  
Internal Control ◽  
Patient Flow ◽  
Low Cost ◽  
Work Flow ◽  
Optimal Time ◽  
Nursing Experience ◽  
Asking Questions

BACKGROUND Current workflow in GYN triage has medical students interviewing patients after triage by nursing staff. The optimal time to initiate patient contact is unclear. This confusion has led to duplication of questions to patients, interruptions for nurses and fewer patient encounters for students. OBJECTIVE Determine if a restaurant-style buzzer can streamline workflow in gynecology (GYN) triage. METHODS A Plan-Do-Study-Act approach was used. Stakeholders were medical students, nurses, Nurse Practitioners and physicians. Factors contributing to workflow slowdown: students re-asking questions of patients, interruption of nursing staff, confusion about optimal patient flow. The net result was fewer interviews completed by students. The project was introduced during clerkship orientation. Buzzers were provided on weeks 1, 3, 5 of the rotation. Weeks 2, 4, 6 no buzzers were provided as an internal control. After each clerkship, students received a survey assessing key areas of waste and workflow disruption. A focus group with ten nurses was also conducted. RESULTS From February-July 2019, 30/45 surveys were completed (66%) 1. Very difficult/difficult to know when to begin the encounter: 90% without; 21.4% with buzzer p<.001 2. Students re-asking questions: very often/often 96.7% without; 14.8% with buzzer p<.001 3. Nursing staff interruptions: 76.7% very often/often without; 18.5% with buzzer p<.001 4. The odds of interviewing 5 or more patients per shift are ~10X greater using the buzzer χ²=14.2; p<.001 CONCLUSIONS The 10 nurses interviewed unanimously favored the use of the buzzer. Introduction of a simple, low-cost restaurant-style buzzer improved triage work-flow, student and nursing experience.

scholarly journals Adverse Events in Home-Care Nursing Agencies and Related Factors: A Nationwide Survey in Japan

2021 ◽  
Vol 18 (5) ◽  
pp. 2546
Author(s):  
Noriko Morioka ◽  
Masayo Kashiwagi
Keyword(s):  
Adverse Event ◽  
Patient Safety ◽  
Adverse Events ◽  
Home Care ◽  
Process Of Care ◽  
Related Factors ◽  
Cross Sectional ◽  
Home Care Nursing ◽  
Number Of Patients ◽  
Care Nursing

Despite the importance of patient safety in home-care nursing provided by licensed nurses in patients’ homes, little is known about the nationwide incidence of adverse events in Japan. This article describes the incidence of adverse events among home-care nursing agencies in Japan and investigates the characteristics of agencies that were associated with adverse events. A cross-sectional nationwide self-administrative questionnaire survey was conducted in March 2020. The questionnaire included the number of adverse event occurrences in three months, the process of care for patient safety, and other agency characteristics. Of 9979 agencies, 580 questionnaires were returned and 400 were included in the analysis. The number of adverse events in each agency ranged from 0 to 47, and 26.5% of the agencies did not report any adverse event cases. The median occurrence of adverse events was three. In total, 1937 adverse events occurred over three months, of which pressure ulcers were the most frequent (80.5%). Adjusting for the number of patients in a month, the percentage of patients with care-need level 3 or higher was statistically significant. Adverse events occurring in home-care nursing agencies were rare and varied widely across agencies. The patients’ higher care-need levels affected the higher number of adverse events in home-care nursing agencies.

scholarly journals Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

2020 ◽  
pp. 084456212094942
Author(s):  
Connie Schumacher ◽  
Aaron Jones ◽  
Andrew P. Costa
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Service Use ◽  
Urinary Catheter ◽  
Community Dwelling ◽  
Care Needs ◽  
Home Care Nursing ◽  
Nursing Visit ◽  
Ed Visits ◽  
Care Nursing

Background Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. Purpose The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. Methods A case-crossover design within a retrospective cohort of adult home care patients in Ontario. Results A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15–1.60) vs. 1.21 (95% CI 1.15–1.28)). No other clinical indicator modified the association. Conclusions The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.

Fractional carbon dioxide laser, platelet –rich plasma and narrow band ultraviolet B in the treatment of Vitiligo (A prospective randomized comparative trial)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abdullah Eshafi ◽  
Nehal Mohamed Zuelfakkar ◽  
Ahmed Abd Elfattah Afify
Keyword(s):  
Patient Satisfaction ◽  
Co2 Laser ◽  
Platelet Rich Plasma ◽  
Ultraviolet B ◽  
Treatment Modalities ◽  
Computer Assisted ◽  
Triple Combination ◽  
Patient Satisfaction Score ◽  
Triple Combination Therapy ◽  
Melanin Pigmentation

Abstract Vitiligo is a disease that causes the loss of skin color in patches due to loss of melanin pigmentation of specific areas of the skin. Although several hypotheses have been proposed, the leading theory is still the auto-immune etiology linked to specific genetic mutations. Vitiligo can also be associated with several autoimmune diseases. There is no curative treatment for vitiligo but, several treatment modalities are considered. Topical therapies like steroids and Calcineurin inhibitors are of popular use in clinical settings also, steroids can be administered systemically in vitiligo patients. Physical therapies as fractionated CO2 (Fr: CO2) laser and Narrowband-UV (NBUV) phototherapy represent a gold standard in treatment in clinical practice. Moreover, intralesional therapies are emerging, one of which is autologous platelet-rich plasma injection. Aim of the study This study aimed to evaluate and compare the efficacy and safety of Fr: CO2 laser, PRP, combined Fr: CO2 laser and PRP, combined Fr: CO2 laser and NB-UVB, combined Fr: CO2 laser, PRP and NB-UVB in the treatment of vitiligo as well as reporting the side effects. Patients and methods This study included 20 vitiligo patients with at least 6 patches of stable vitiligo (120 patches), the patches were divided into six groups according to the treatment modality. Assessment of treatment response was done through patient satisfaction score and Vitiligo analysis by computer-assisted grid (VACAG). Results Regarding surface area reduction in included patients, fractional CO2 laser achieved the best results followed by triple combination therapy (CO2 with PRP and NB-UVB), the least response was with CO2 with PRP treatment. Patient satisfaction in the current study had a different outcome, PRP treated patients exhibited the highest satisfaction scores while triple combination treated group showed the least satisfaction scores.

scholarly journals Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

2017 ◽  
Vol 6 (7) ◽  
pp. 2836
Author(s):  
Ashima Taneja ◽  
Kamaldeep Arora ◽  
Isha Chopra ◽  
Anju Grewal ◽  
Sushree Samiksha Naik ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
High Risk ◽  
Epidural Analgesia ◽  
Comparative Study ◽  
Satisfaction Score ◽  
Epidural Group ◽  
Patient Satisfaction Score ◽  
Vaginal Deliveries ◽  
Group A ◽  
Group B

Background: Labour analgesia has been recommended but sufficient data on use of labour epidural analgesia with ropivacaine and fentanyl combination during labour is not available.Methods: A comparative study was conducted on 40 high risk labouring partuirents, randomly allocated to group A (iv tramadol) and group B (epidural analgesia with ropivacaine plus fentanyl). Assessments were done for fetal heart rate abnormality, mode of delivery, duration of labour, and Apgar score. The VAS score, patient satisfaction score, and complications were recorded.Results: Group A had more number of instrumental deliveries compared to group B, the later had higher number of caesarean sections. No difference was observed in vaginal deliveries in both the groups. Pain relief was significant in patients of epidural group. The neonatal outcome was same in both the groups. Significant number of patients had a higher degree of satisfaction score in group B compared to group A.Conclusions: Tramadol and epidural analgesia in labour are safe and effective. Patient satisfaction is significantly higher in epidural group as compared to the tramadol group.

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