Negotiating the transition from acute hospital care to home: perspectives of patients with traumatic brain injury, caregivers and healthcare providers

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Tolu O. Oyesanya ◽  
Gabrielle Harris ◽  
Callan Loflin ◽  
Prvu Bettger
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Financial Stability ◽  
Hospital Care ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Negotiation Process ◽  
Acute Hospital ◽  
Acute Hospital Care ◽  
Content Type

PurposeThe purpose is to explore experiences transitioning home from acute hospital care from perspectives of younger traumatic brain injury (TBI) patients, family caregivers and healthcare providers (HCPs).Design/methodology/approachThe authors conducted 54 qualitative interviews (N = 36: 12 patients, 8 caregivers, 16 HCPs) and analyzed data using conventional content analysis.FindingsThe transition from hospital to home was described as a negotiation, finding a way through these obstacles: (1) preparing for discharge home during acute hospital care; (2) navigating transitions in healthcare and health; (3) addressing recovery concerns, and (4) setting goals to return to normal. Factors influencing the negotiation process included social support, health-related knowledge or training, coping mechanisms, financial stability, and home environment stability.Originality/valueYounger TBI patients and caregivers have unique needs during the transition home from the hospital. Needed support from HCPs was inconsistently provided. Findings are foundational for integrated care research and practice with TBI.

“Just tell me in a simple way”: A qualitative study on opportunities to improve the transition from acute hospital care to home from the perspectives of patients with traumatic brain injury, families, and providers

2021 ◽  
pp. 026921552098867
Author(s):  
Tolu O Oyesanya ◽  
Callan Loflin ◽  
Gabrielle Harris ◽  
Janet Prvu Bettger
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Care ◽  
Transitional Care ◽  
Social Issues ◽  
Acute Hospital ◽  
Patient Navigator ◽  
Post Discharge ◽  
Acute Hospital Care

Objective: The purpose of this study was to identify areas to improve the transition from acute hospital care to home for patients with traumatic brain injury and their families. Design: Qualitative, descriptive. Setting: Level I trauma centered located in the Southeastern United States. Subjects: A total of 36 participants (12 patients with traumatic brain injury, 8 family caregivers, 16 providers). Main Measures: We conducted 55 semi-structured interviews with participants and used conventional content analysis to analyze the data. Results: Findings showed patients, families, and providers recommend three areas for improvement in the transition home from acute hospital care, described in three themes. Theme 1 was “improving patient and family education,” with the following sub-themes: (a) TBI-related information and (b) discharge preparation. Theme 2 was “additional provider guidance,” with the following sub-themes: (a) communication about patient’s recovery timeline and (b) recovery roadmap development. Theme 3 was “increasing systems-level support,” with the following sub-themes: (a) scheduling follow-up appointments, (b) using a patient navigator, (c) creating a provider follow-up structure, (d) linking pre-discharge care with post-discharge resources, and (e) addressing social issues. Conclusions: These findings delineate multiple areas where patients and families need additional support and education during the transition from acute hospital care to home in ways that are currently not being addressed. Findings may be used to improve education and support from providers and health systems given to patients with traumatic brain injury and families and to inform development and testing of transitional care interventions from acute hospital care to home.

scholarly journals A systematic review of interventions to improve acute hospital care for people with dementia

2021 ◽  
Vol 42 (3) ◽  
pp. 657-673
Author(s):  
Melanie Karrer ◽  
Angela Schnelli ◽  
Adelheid Zeller ◽  
Hanna Mayer
Keyword(s):  
Systematic Review ◽  
Hospital Care ◽  
Acute Hospital ◽  
Acute Hospital Care ◽  
People With Dementia

Flushing in relation to a possible rise in intracranial pressure: documentation of an unusual clinical sign

2000 ◽  
Vol 92 (6) ◽  
pp. 1040-1044 ◽  
Author(s):  
Gregory W. Hornig
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intraventricular Hemorrhage ◽  
Pneumococcal Meningitis ◽  
Clinical Importance ◽  
Neurological Deterioration ◽  
Content Type ◽  
Transient Nature ◽  
Fine Print

✓ This report documents clinical features in five children who developed transient reddening of the skin (epidermal flushing) in association with acute elevations in intracranial pressure (ICP). Four boys and one girl (ages 9–15 years) deteriorated acutely secondary to intracranial hypertension ranging from 30 to 80 mm Hg in the four documented cases. Two patients suffered from ventriculoperitoneal shunt malfunctions, one had diffuse cerebral edema secondary to traumatic brain injury, one was found to have pneumococcal meningitis and hydrocephalus, and one suffered an intraventricular hemorrhage and hydrocephalus intraoperatively. All patients were noted to have developed epidermal flushing involving either the upper chest, face, or arms during their period of neurological deterioration. The response was transient, typically lasting 5 to 15 minutes, and dissipated quickly. The flushing reaction is postulated to be a centrally mediated response to sudden elevations in ICP. Several potential mechanisms are discussed. Flushing has clinical importance because it may indicate significant elevations in ICP when it is associated with neurological deterioration. Because of its transient nature, the importance of epidermal flushing is often unrecognized; its presence confirms the need for urgent treatment.

Acute Hospital Care

1990 ◽  
pp. 327-342
Author(s):  
Susan H. McDaniel ◽  
Thomas L. Campbell ◽  
David B. Seaburn
Keyword(s):  
Hospital Care ◽  
Acute Hospital ◽  
Acute Hospital Care

scholarly journals Predictors of discharge destination from acute care in patients with traumatic brain injury

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016694 ◽  
Author(s):  
Sareh Zarshenas ◽  
Laetitia Tam ◽  
Angela Colantonio ◽  
Seyed Mohammad Alavinia ◽  
Nora Cullen
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Acute Care ◽  
English Language ◽  
Healthcare Providers ◽  
Trial Registration ◽  
Future Research ◽  
Reference List ◽  
Registration Number

IntroductionMany studies have assessed the predictors of morbidity/mortality of patients with traumatic brain injury (TBI) in acute care. However, with the increasing rate of survival after TBI, more attention has been given to discharge destinations from acute care as an important measure of clinical priorities. This study describes the design of a systematic review compiling and synthesising studies on the prognostic factors of discharge settings from acute care in patients with TBI.Methods and analysisThis systematic review will be conducted on peer-reviewed studies using seven databases including Medline/Medline in-Process, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PsycINFO, CINAHL and Supplemental PubMed. The reference list of selected articles and Google Scholar will also be reviewed to determine other relevant articles. This study will include all English language observational studies that focus on adult patients with TBI in acute care settings. The quality of articles will be assessed by the Quality in Prognostic Studies tool.Ethics and disseminationThe results of this review will provide evidence that may guide healthcare providers in making more informed and timely discharge decisions to the next level of care for patient with TBI. Also, this study will provide valuable information to address the gaps in knowledge for future research.Trial registration numberTrial registration number (PROSPERO) is CRD42016033046.

Abstract WP276: Drag Reducing Polymers Based Resuscitation Fluid Improves Cerebral Microcirculation After Mild Traumatic Brain Injury and Hemorrhagic Shock

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Devon Lara ◽  
Gloria Statom ◽  
Olga A Bragina ◽  
Marina V Kameneva ◽  
Edwin M Nemoto ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Arterial Pressure ◽  
Hemorrhagic Shock ◽  
Hospital Care ◽  
Microvascular Perfusion ◽  
Arterial Hypotension ◽  
Cerebral Microcirculation ◽  
Neuronal Necrosis ◽  
Resuscitation Fluid

Introduction: Hemorrhagic shock (HS), causing arterial hypotension, often occurs after traumatic brain injury (TBI). Current resuscitation fluids do not ameliorate the impaired cerebral microvascular perfusion leading to hypoxia, neuronal death, increased mortality and poor neurological outcome. Nanomolar concentrations of intravascular blood soluble drag reducing polymers (DRP) were shown to increase tissue perfusion and oxygenation and decrease peripheral vascular resistance by rheological modulation of hemodynamics. We hypothesized that the resuscitation fluid with DRP would improve cerebral microcirculation, oxygenation and neuronal recovery after TBI combined with HS (TBI+HS). Methods: Mild TBI was induced in rats by fluid percussion pulse (1.5 ATA, 50 ms duration) followed by induced by phlebotomy arterial hypotension (40 mmHg). Resuscitation fluid (lactated Ringers, LR) with DRP (DRP/LR) or without (LR) was infused to restore mean arterial pressure (MAP) to 60 mmHg for one hour (pre-hospital care), followed by re-infusion of blood to a MAP of 100 mmHg (hospital care). Using in vivo 2-photon laser scanning microscopy over the parietal cortex we monitored changes in microvascular blood flow, tissue oxygenation (NADH) and neuronal necrosis (i.v. propidium Iodide) for 5 hr after TBI+HS. Doppler cortical flow, rectal and cranial temperatures, arterial pressure, blood gases and electrolytes were monitored. Results: TBI+HS compromised brain microvascular flow leading to tissue hypoxia followed by neuronal necrosis. Resuscitation with DRP/LR compared to LR better improved cerebral microvascular perfusion (82 ± 9.7% vs. 62 ± 9.7%, respectively from pre-TBI baseline, p<0.05, n=7), attenuated capillary microtrombi formation and re-recruited collapsed during HS capillaries. Improved microvascular perfusion increased cortical oxygenation reducing hypoxia (77 ± 8.2% vs. 60 ± 10.5%, by DRP-LR vs. LR, respectively from baseline, p<0.05) and decreased neuronal necrosis (21 ± 7.2% vs. 36 ± 7.3%, respectively as a percentage of total neurons, p<0.05). Conclusions: DRP/LR resuscitation fluid is superior in the restoration of the cerebral microcirculation and neuroprotection following TBI + HS compared to volume expansion with LR.

Epidemiology and Costs of Acute Hospital Care for Cerebrovascular Disease in Diabetic and Nondiabetic Populations

Stroke ◽  
1997 ◽  
Vol 28 (6) ◽  
pp. 1142-1146 ◽  
Author(s):  
Craig J. Currie ◽  
Christopher L. Morgan ◽  
Leicester Gill ◽  
Nigel C. H. Stott ◽  
John R. Peters
Keyword(s):  
Cerebrovascular Disease ◽  
Hospital Care ◽  
Acute Hospital ◽  
Acute Hospital Care

Exploring strategic execution

2016 ◽  
Vol 9 (4) ◽  
pp. 406-428 ◽  
Author(s):  
Meabh Smith ◽  
John Loonam
Keyword(s):  
Balanced Scorecard ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Healthcare Sector ◽  
Healthcare Organisation ◽  
Content Type ◽  
The Balanced Scorecard ◽  
Irish Hospital ◽  
Improved Performance ◽  
Strategic Execution

Purpose Globally and particularly in Ireland, reduced expenditure on healthcare along with increasing pressure to increase patient throughput and improved performance against standards, is forcing healthcare providers to adopt tools from the business sector and apply them in the healthcare sector to bring about improved performance. The paper aims to discuss these issues. Design/methodology/approach This study is interpretivist in nature, specifically focussing on exploring how the balanced scorecard can support improved service delivery within a hospital department. The research will conduct an exploratory case study of a single hospital site within the Irish republic. This research is based on qualitative interviews with corroboration from document review and direct observation. This study provides a snap-shot of the Cath Lab service at a moment in time. Findings The development of a strategy map and proposed balanced scorecard for an Irish hospital unit. Originality/value The development of a balanced scorecard for a healthcare organisation.

scholarly journals ALTERNATIVES TO ACUTE HOSPITAL CARE FOR THE OVER 65S AT RISK OF UNPLANNED ADMISSION

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 599-600
Author(s):  
A. Huntley ◽  
M. Chalder ◽  
A. Heawood ◽  
C. Metcalfe ◽  
W. Hollingworth ◽  
...  
Keyword(s):  
At Risk ◽  
Hospital Care ◽  
Acute Hospital ◽  
Unplanned Admission ◽  
Acute Hospital Care

Experimental and computational investigations of the potential improvement in helmet blast-protection through the use of a polyurea-based external coating

2016 ◽  
Vol 12 (1) ◽  
pp. 33-72 ◽  
Author(s):  
M. Grujicic ◽  
S. Ramaswami ◽  
J. S. Snipes ◽  
R. Yavari ◽  
P. Dudt
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Computational Study ◽  
Element Analysis ◽  
Content Type ◽  
Ballistic Impacts ◽  
Blast Protection ◽  
Protection Efficacy ◽  
Potential Improvement ◽  
External Coating

Purpose – The design of the Advanced Combat Helmet (ACH) currently in use was optimized by its designers in order to attain maximum protection against ballistic impacts (fragments, shrapnel, etc.) and hard-surface/head collisions. Since traumatic brain injury experienced by a significant fraction of the soldiers returning from the recent conflicts is associated with their exposure to blast, the ACH should be redesigned in order to provide the necessary level of protection against blast loads. The paper aims to discuss this issue. Design/methodology/approach – In the present work, an augmentation of the ACH for improved blast protection is considered. This augmentation includes the use of a polyurea (a nano-segregated elastomeric copolymer) based ACH external coating. To demonstrate the efficacy of this approach, blast experiments are carried out on instrumented head-mannequins (without protection, protected using a standard ACH, and protected using an ACH augmented by a polyurea explosive-resistant coating (ERC)). These experimental efforts are complemented with the appropriate combined Eulerian/Lagrangian transient non-linear dynamics computational fluid/solid interaction finite-element analysis. Findings – The results obtained clearly demonstrated that the use of an ERC on an ACH affects (generally in a beneficial way) head-mannequin dynamic loading and kinematic response as quantified by the intracranial pressure, impulse, acceleration and jolt. Originality/value – To the authors’ knowledge, the present work is the first reported combined experimental/computational study of the blast-protection efficacy and the mild traumatic brain-injury mitigation potential of polyurea when used as an external coating on a helmet.

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