scholarly journals Conceptual modelling of the flow of frail elderly through acute-care hospitals

2018 ◽  
Vol 56 (10) ◽  
pp. 2101-2124 ◽  
Author(s):  
Silvia Bruzzi ◽  
Paolo Landa ◽  
Elena Tànfani ◽  
Angela Testi
Keyword(s):  
Elderly Patients ◽  
Conceptual Model ◽  
Acute Care ◽  
Frail Elderly ◽  
Current Practice ◽  
Acute Care Hospitals ◽  
Management Approach ◽  
Content Type ◽  
Frail Patients ◽  
The Impact

Purpose The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, the purpose of this paper is to propose a conceptual model to facilitate the pathway of frail elderly patients across acute care hospitals, focussed on avoiding improper wait times and treatment during the process. Design/methodology/approach The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient’s stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly’s pathways, providing proper information that can validate the model when applied in current practice. Findings The paper proposes a design of the clinical path of frail patients in acute care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. The authors can, therefore, expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients. Research limitations/implications The framework proposed is a conceptual model to manage frail elderly patients in acute care wards. The research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings. Practical implications The paper includes suggestions for re-engineering the management of frail elderly patients in hospitals, when a reduction of lengths of stay and the improvement of clinical outcomes is required. Originality/value This paper fulfils an identified need to study and provide solutions for the management of frail elderly patients in acute care hospitals, and generally to produce value in a patient-centred model.

scholarly journals The characteristics of frail elderly patients in acute care hospitals

2018 ◽  
Vol 55 (1) ◽  
pp. 124-130
Author(s):  
Koki Yamaguchi ◽  
Tatsuya Hirase ◽  
Tetsuji Koizumi ◽  
Sigeru Inoguchi
Keyword(s):  
Elderly Patients ◽  
Acute Care ◽  
Frail Elderly ◽  
Acute Care Hospitals

Quality improvement in hospitals: barriers and facilitators

2017 ◽  
Vol 30 (1) ◽  
pp. 16-24 ◽  
Author(s):  
Dick E. Zoutman ◽  
B. Douglas Ford
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Patient Care ◽  
Acute Care ◽  
Medical Staff ◽  
Acute Care Hospitals ◽  
Content Type ◽  
Active Involvement ◽  
Staff Engagement ◽  
Positive Impacts

Purpose The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety. Design/methodology/approach An extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives. Findings The response rate was 37 percent, 46 surveys were completed from 125 acute care hospitals. QI initiatives had positive impacts on patient safety and care. Staff in all hospitals reported conducting past or present hand-hygiene QI projects and C. difficile and surgical site infection were the next most frequent foci. Hospital staff not having time and problems with staff prioritizing QI with other duties were identified as important QI barriers. All respondents reported hospital leadership support, data utilization and internal champions as important QI facilitators. Multiple regression models identified nurses’ active involvement and medical staff engagement in QI with improved patient care and physicians’ active involvement and medical staff engagement with greater patient safety. Practical implications There is the need to study how best to support and encourage physicians and nurses to become more engaged in QI. Originality/value QI initiatives were shown to have positive impacts on patient safety and patient care and barriers and facilitating factors were identified. The results indicated patient care and safety would benefit from increased physician and nurse engagement in QI initiatives.

scholarly journals The Impact of a Massachusetts State-Sponsored Educational Program on Antimicrobial Stewardship in Acute Care Hospitals

2013 ◽  
Vol 34 (4) ◽  
pp. 437-439 ◽  
Author(s):  
Adam Weston ◽  
Lauren Epstein ◽  
Lisa E. Davidson ◽  
Alfred DeMaria ◽  
Shira Doron
Keyword(s):  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Educational Program ◽  
Business Models ◽  
National Level ◽  
State Level ◽  
Acute Care Hospitals ◽  
The State ◽  
Team Approach ◽  
The Impact

Antimicrobial stewardship programs (ASPs) are critically important for combating the emergence of antimicrobial resistance. Despite this, there are no regulatory requirements at a national level, which makes initiatives at the state level critical. The objectives of this study were to identify existing antimicrobial stewardship practices, characterize barriers to antimicrobial stewardship implementation in acute care hospitals throughout Massachusetts, and evaluate the impact on these hospitals of a state-sponsored educational conference on antimicrobial stewardship.In September 2011, a state-sponsored educational program entitled “Building Stewardship: A Team Approach Enhancing Antibiotic Stewardship in Acute Care Hospitals” was offered to interested practitioners from throughout the state. The program consisted of 2 audio conferences, reading materials, and a 1-day conference consisting of lectures focusing on the importance of ASPs, strategies for implementation, improvement strategies for existing programs, and panel discussions highlighting successful practices. Smaller breakout sessions focused on operational issues, including understanding of pharmacodynamics, business models, and electronic surveillance.

Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

2018 ◽  
Vol 39 (8) ◽  
pp. 941-946 ◽  
Author(s):  
Bradley J. Langford ◽  
Julie Hui-Chih Wu ◽  
Kevin A. Brown ◽  
Xuesong Wang ◽  
Valerie Leung ◽  
...  
Keyword(s):  
Observational Study ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Defined Daily Doses ◽  
Prospective Audit And Feedback ◽  
The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

Abstract 2301: Frail Elderly Patients at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Dana H Lee ◽  
Billie Jean Martin ◽  
Alexandra M Yip ◽  
Karen J Buth ◽  
Gregory M Hirsch
Keyword(s):  
Renal Failure ◽  
Cardiac Surgery ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Frail Elderly ◽  
Independent Predictor ◽  
Institutional Care ◽  
Biological Age ◽  
Younger Patients ◽  
Frail Patients

Patients referred for cardiac surgery are increasingly older, but chronological age does not always capture biological age. This study assessed frailty, as a functional parameter of biological age, as a predictor of mortality or prolonged institutional care. Functional measures of frailty and clinical preoperative data were collected for all cardiac surgery patients at a single center (2004 –2007). Based on the Katz Index of Activities of Daily Living, frailty was defined as any impairment in feeding, bathing, dressing, transferring, toileting, continence, or ambulation, or dementia. The impact of frailty on in-hospital mortality or institutional discharge (other hospital or nursing facility) was assessed with multivariate logistic regression. The interaction of frailty and age was examined, with non-frail patients age<70 as the referent group. Results: Of 3096 patients, 133 (4.3%) were frail. Frail patients were older, more likely to be female, have COPD, CHF, EF<40%, recent MI, pre-operative renal failure, cerebrovascular disease, greater acuity, and more complex operations (p<0.05). Frail patients experienced higher rates of mortality, sepsis, delirium, post-operative renal failure, and transfusion (p<0.001). A greater proportion of frail patients than non-frail patients (49% vs. 9%) were discharged to a setting other than home. In the risk-adjusted models, frailty was an independent predictor of mortality (OR 1.8, 95% CI 1.0 –3.2) or institutional discharge (OR 6.4, 95% CI 4.1–9.9). Furthermore, frail elderly (age≥70) patients had greater risk of institutional discharge (OR 22.7, CI 12.4 – 41.7) than frail younger patients (OR 6.5, CI 3.4 –12.5) or non-frail elderly patients (OR 3.5, CI 2.6 – 4.6). Similarly, frail elderly patients had greater risk of mortality (OR 4.0, CI 1.9 – 8.1) than frail younger patients (OR 1.9, CI 0.8 – 4.7) or non-frail elderly patients (OR 2.4, CI 1.7–3.5). Frailty was an independent predictor of in-hospital mortality and prolonged institutional care. Frailty combined with older age further discriminated those at highest risk. Special consideration should be given to the management of frail elderly patients who have surgical cardiac disease.

How fashion influencers contribute to consumers' purchase intention

2020 ◽  
Vol 24 (3) ◽  
pp. 361-380 ◽  
Author(s):  
Youssef Chetioui ◽  
Hikma Benlafqih ◽  
Hind Lebdaoui
Keyword(s):  
Conceptual Model ◽  
Purchase Intention ◽  
Behavioral Control ◽  
Brand Attitude ◽  
Perceived Behavioral Control ◽  
Fashion Industry ◽  
Content Type ◽  
Factors Affecting ◽  
Consumer Purchase Intention ◽  
The Impact

PurposeThis study examines the impact of attitudes toward fashion influencers (FIs) on brand attitude and consumer purchase intention. It also aims to identify factors affecting consumers' attitudes toward FIs.Design/methodology/approachTo achieve this goal, the authors propose a conceptual model that combines the theory of planned behavior (TPB) and theoretical outcomes of prior literature related to influencer marketing. Based on data collected from 610 Moroccan respondents, the authors empirically test the conceptual model using a partial least squares (PLS) estimation.FindingsThis study illustrates that attitudes toward FIs positively impact brand attitude and consumer purchase intention. The authors also demonstrate that perceived credibility, trust, perceived behavioral control, perceived subjective norms, perceived expertise and perceived congruence positively impact attitudes toward FIs.Practical implicationsThe study findings help marketers and advertisers in the fashion industry to understand how influencer marketing contributes to consumer purchase intention. They also allow marketers to understand factors explaining attitudes toward FIs and therefore better select influencers capable of creating purchase intentions among existing and potential customers.Originality/valueThe present paper bridges a gap pertaining to antecedents and factors that impact attitudes toward FIs and consumer purchase intention. To the authors’ knowledge, this study is the first of its kind to investigate the impact of attitudes toward influencers on both brand attitude and purchase intention in the fashion industry.

scholarly journals Finding the right management approach in independent hotels

2019 ◽  
Vol 31 (7) ◽  
pp. 2862-2883 ◽  
Author(s):  
Alireza Nazarian ◽  
Peter Atkinson ◽  
Pantea Foroudi ◽  
Karen Dennis
Keyword(s):  
Leadership Style ◽  
Structural Equation ◽  
Management Approach ◽  
Snowball Sampling ◽  
Content Type ◽  
Organisational Effectiveness ◽  
Independent Hotels ◽  
The Right ◽  
Reward Mechanism ◽  
The Impact

Purpose This study aims to identify factors that managers can influence to improve effectiveness by examining the relationship between leadership and effectiveness in small and medium-sized independent hotels. Design/methodology/approach In total, 272 valid questionnaires were collected from managers of 83 small and medium-sized independent hotels in the Netherlands by using selective and snowball sampling techniques. A two-stage structural equation modelling approach was used to test the hypotheses. Findings Surprisingly, in contradiction to previous studies, neither transactional nor transformational leadership had a direct effect on organisational effectiveness. Instead, the effect was through the intervening variables of ability to acquire resources and reward mechanisms. Research limitations/implications The contradiction between this and previous studies may be due to the fact that constructs used in this study do not have the universal applicability that is customarily assumed and further investigation is needed. Practical implications This study suggests that managers in this type of hotel, first, should be adaptable in their leadership style and not rely on transactional leadership alone; second, managers must pay attention to resource acquisition; and third, managers must retain staff by using the right reward mechanism. Originality/value This study contributes to the literature of leadership and effectiveness in small and medium-sized independent hotels by being the first to focus on the impact of ability to acquire resources and reward mechanism. It also makes an important contribution to the growing body of hospitality literature that probes the supposed universal validity of organisational studies’ constructs.

The consideration of building maintenance at design stage in public buildings

Facilities ◽  
2019 ◽  
Vol 37 (13/14) ◽  
pp. 942-960 ◽  
Author(s):  
Ellemy Iskandar Khalid ◽  
Shardy Abdullah ◽  
Mohd Hanizun Hanafi ◽  
Shahrul Yani Said ◽  
Mohamad Sufian Hasim
Keyword(s):  
Maintenance Management ◽  
Design Stage ◽  
Management Approach ◽  
Public Buildings ◽  
Content Type ◽  
Building Maintenance ◽  
Key Players ◽  
The Government ◽  
The Impact ◽  
Proactive Maintenance

Purpose Effective building maintenance management is vital for reducing the impact of building defects and costly building maintenance work. Such practice significantly contributes to the public sector in terms of cost reduction, improved effectiveness and efficiency in maintenance works, increasing safety and well-being of the occupants, expanding the life of building stocks and expanding the value of investment for the government building assets. The maintenance practice in Malaysia is still emerging in comparison to many developed nations. The purpose of this study is to determine the current scenario of the building maintenance approach at the design stage in public buildings in Malaysia. Design/methodology/approach An extensive questionnaire survey was held, involving 312 key players (38 per cent out of 820 predetermined participants) in Malaysia. Findings The analysis showed that building maintenance in public building in Malaysia still uses the reactive approach. Despite the Malaysian Government’s adoption of a proactive maintenance approach, unfortunately, there are some misunderstandings among the key players regarding the approach. The research results demonstrate that the key players had a lack of understanding on the concept of the proactive maintenance management approach and that they were either ignorant or had insufficient awareness of proactive maintenance approach. Originality/value The contribution of this study is useful for the government to adopt a more proactive building maintenance policy at the design stage, to give awareness on proactive building maintenance to the key players in their construction project and as a guide to the key players to adopt a maintenance plan at the design stage of work.

A new model for assessing the impact of ICT and digital knowledge on students’ thoughts and beliefs

2019 ◽  
Vol 17 (5) ◽  
pp. 943-959 ◽  
Author(s):  
Lila Rajabion ◽  
Karzan Wakil ◽  
Arshad Badfar ◽  
Shahrzad Mojtabavi Naeini ◽  
Batool Zareie
Keyword(s):  
Technology Acceptance ◽  
Conceptual Model ◽  
Digital Technology ◽  
Focal Point ◽  
Vital Role ◽  
Content Type ◽  
Digital Education ◽  
Digital Knowledge ◽  
The Impact ◽  
Digital Training

PurposeThis study aimed to examine the impact of ICT and digital knowledge on students’ thoughts and beliefs. Using Information and Communication Technology (ICT) in learning and teaching processes can improve the interpretation of knowledge, not only in the learning process but also for thoughts and beliefs. Beliefs and thoughts as propositional content are understood to be a subjective manner of knowing and becoming a focal point of education process. In addition, ICT plays a vital role in enhancing the efficiency of the teaching process which can change the thoughts of learners. So, in this paper, the usage of ICT in education was considered as a key factor for improving students’ thoughts and beliefs. In addition, a conceptual model was proposed to evaluate this impact.Design/methodology/approachData were collected from 384 students from secondary schools in Iran. For assessing the elements of the model, a complete questionnaire was designed. For statistical analysis of questionnaires, SPSS 22 and SMART-PLS 3.2 software package was used.FindingsThe obtained results showed the high strength of the proposed model. The outcomes indicated that digital technology acceptance positively affects students’ thoughts and beliefs. In addition, the findings showed that the role of digital knowledge, digital training facilities and digital education content on students’ thoughts and beliefs was significant.Research limitations/implicationsThe authors deal with one experiment and so the results cannot be generalized. The trail should be repeated with many groups and in diverse contexts.Originality/valueDespite the importance of the investigating the impact of ICT and digital knowledge on the students’ thoughts and beliefs, the relationship among these factors was not examined well in previous research. Thus, the investigation of the impact of ICT and digital knowledge on the students’ thoughts and beliefs is the main originality of this research. For this goal, a new conceptual model is proposed, which has 11 sub-indicators within four variables: digital technology acceptance, digital knowledge, digital training facilities and digital education content.

Social distancing in a social therapy environment

2020 ◽  
Vol 41 (3/4) ◽  
pp. 113-127
Author(s):  
Geraldine Ann Akerman ◽  
Emily Jones ◽  
Harry Talbot ◽  
Gemma Grahame-Wright
Keyword(s):  
Social Isolation ◽  
Current Practice ◽  
Social Therapy ◽  
Content Type ◽  
Social Distancing ◽  
Emotional Environment ◽  
The Social ◽  
The Uk ◽  
The Impact

Purpose This paper aims to describe the impact of the COVID-19 pandemic on a prison-based therapeutic community (TC). Design/methodology/approach The paper takes the form of a case study where the authors reflect on their current practice, using the findings of research on social isolation and the overarching TC principles to explore the effect of the pandemic on the TC at HMP Grendon. The authors consider how the residents and staff adjusted to the change as the parameters changed when the social distancing rules were imposed and how they adapted to the prolonged break to therapy. Sections in the paper were written by a resident and an operational member of staff. The authors conclude with their thoughts on how to manage the consequences the lockdown has brought and start to think about what returning to “normality” might mean. Findings The paper describes the adjustments made by the residents and staff as the UK Government imposed the lockdown. The authors, including a resident and an operational member of staff comment on the psychological and practical impact these adjustments had. The thought is given to the idea of “recovery”, returning to “normality” and how this study can be best managed once restrictions are lifted. Research limitations/implications At the time of writing, there are no confirmed cases of COVID-19 at HMP Grendon. The measures and commitment from all staff and residents in the prison to keep the prison environment safe may in part account for this. This paper explores the effects of lockdown on the emotional environment in a TC and highlights the consequences that social isolation can have on any individual. To the authors’ knowledge, there is currently no research undertaken on the impact of lockdown/social isolation on a TC. This research would be useful, as the authors postulate from reflections on current practice that the effects of the lockdown will be greater in a social therapy environment. Originality/value HMP Grendon started in 1962, as this time there have been no significant events that have meant the suspension of therapy for such a sustained period. It is, therefore, important that the impact of such is considered and reflected upon.

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