Abstract WP329: Video Conferencing is the Preferred Method for Follow-up Communication for Post-hospital Stroke Patients

Introduction: Close communication with a stroke patient after discharge from a comprehensive stroke center has been shown to be crucial for medication compliance, follow up care and improving patient satisfaction. We aimed to improve post-hospitalization compliance and patient satisfaction by assessing if a video call as a routine follow-up communication modality would be the preferred method of communication. Methods: Admitted stroke patients were asked for their preference in post-hospitalization communications with their attending physician. Results: A total of 52 stroke patients were interviewed, 30 (57.7%) requested a video call, 22 (42.3%) requested a phone call. 100% (14/14) ages 55 and younger requested a video call. 70.3% (19/27) of patients 65 years old and younger requested a video call. Conclusion: There is evidently a strong demand for video conferencing as a method of follow-up communication among the post hospitalized stroke population. Although age appears to influence the demand, the majority of patients expressed greater enthusiasm with the concept of video conferencing. Follow-up video communication could improve patient medication, treatment compliance, risk factor reduction and ultimately improve patient care and satisfaction. Video calls will also provide additional visual information that a routine phone call would miss, potentially reducing readmissions. Therefore, with advancing technology and the strong desire for video conferencing, one should begin to think of ways to provide this service.

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Abstract WP394: Needs of Stroke Survivors Post Hospital Discharge Stroke Follow-up Call

Stroke ◽

10.1161/str.48.suppl_1.wp394 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Joseph Mojares ◽

Sherydahn Aldrich ◽

Maria Novales-Fiel

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Hospital Readmissions ◽

Primary Care Providers ◽

Phone Call ◽

Care Providers ◽

Stroke Patients ◽

Post Discharge ◽

Stroke Education

Background: This project attempts to discover the subjective response needs of 30-day post-acute stroke patients and their family members that were treated in two Northern California hospitals. The goal is to determine the functional level of the Stroke Survivor (SS) as measured by the Modified Rankin Scale (mRS) and to identify post-discharge needs. Purpose: The objective of this project is to identify the patient’s mRS score and post-discharge needs. The study includes stroke education reinforcement, primary care physician follow-up, ancillary services follow-up, discern hospital readmissions rates, and increase patient satisfaction. Methods: A list of discharged acute ischemic stroke patients over a three month period was provided to the Stroke Nurse Champion (SNC). A stroke phone call template was created to elicit the patient’s history, diagnosis, and mRS score. Patients with intracranial hemorrhage diagnosis, patients discharged to Skilled Nursing Facilities, and deceased patients were excluded from the study. The SNC performed chart review to determine patient course of hospitalization and stroke care management; places follow-up phone call to patient or family member; and identify the SS needs. When needs were discovered, they were addressed using electronic in-house messaging to patient’s primary care providers and ancillary staff. Results: Of the 63 participants, nine required stroke resource follow-up. The average mRS score of 1.84 revealed the patient’s knowledge of self-management to be 100%. There were 13 cases that needed outpatient therapy and Home Health therapy with mRS >2. The study outcome includes readmission rate of 0.03% (n=2) and stroke patient satisfaction >12.5%. Conclusions: Based on the mRS score, the SS appropriately met the level of care including rehabilitation needs at home. Post discharge needs of SS included psychosocial support, medication modification and appropriate durable medical equipment. Overall, the SS were satisfied with their care with low incidence of hospital readmission due to their stroke education provided during their hospitalization. Further plans for each hospital facility to consider continuing this project or to change the focus to outpatient support services as well.

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984 Changing the Management of Epistaxis in the Covid-19 Era

British Journal of Surgery ◽

10.1093/bjs/znab258.059 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

B Kerr ◽

J Dalton ◽

R Stewart ◽

D McGahey

Keyword(s):

Patient Satisfaction ◽

Severe Pain ◽

Community Hospital ◽

Phone Call ◽

Medical Assistance ◽

Safe Alternative ◽

Droplet Concentration ◽

Nasal Secretions ◽

Bed Days

Abstract Aim Epistaxis in the Covid pandemic is a concerning problem facing otolaryngologists due to high droplet concentration and increased virulence in nasal secretions. Furthermore, safe ambulation of patients reduces Covid exposure and preserves essential resources. This study assessed the implementation of ENT UK recommended altered epistaxis management during the Covid pandemic. Method Patients presenting to a medium-sized community hospital with unrelenting epistaxis had a rapid rhino (RR) inserted. Able patients were ambulated and given an appointment for RR removal. Previously all patients were admitted. A comparative retrospective analysis of patients referred with epistaxis was conducted using electronic care records from March – August 2019 versus the same period in 2020. Follow-up phone-call was also employed. Admissions, bed days, RR complications and patient satisfaction was assessed. Data was analysed student t-tests. Results A significant reduction in admissions (n = 91; P < 0.001) and bed days (n = 104; P < 0.001) was observed. Only 2 out of the 68 patients ambulated required medical assistance prior to their scheduled appointment (3%; P < 0.001). The majority of patients were satisfied (91%) and reported no bleeding (94%). No RR dislodgement occurred (0%) and most patients were pleased to avoid admission (92%). 70% of patients reported severe pain following RR insertion. Conclusions Ambulation of patients presenting to ED with unrelenting epistaxis managed with RR insertion is a safe alternative to previous practice with few complications. Furthermore, patients are largely satisfied although reported severe pain post RR insertion needs addressed. Finally, this altered management reduces contact and preserves resources as our hospitals face overwhelming pressures.

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Abstract TMP99: Farmalarm: App for Mobile Devices Improves Risk Factor Control After Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp99 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Marc Ribo ◽

Estefania montiel ◽

Estela Sanjuan ◽

Mireia Sanchis ◽

Marta Rubiera ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Medical Staff ◽

Healthy Lifestyle ◽

Medication Compliance ◽

Treatment Compliance ◽

Lifestyle Changes ◽

Stroke Patients ◽

Risk Factor Control ◽

Stroke Awareness

Risk factor control and treatment compliance in the following months after stroke are often poor. We aim to validate a digital platform for smartphones designed to raise awareness in patients about the need to perform healthy lifestyle changes, improve communication with medical staff and increase treatment compliance Methods: Farmalarm is an app for smartphones designed to increase stroke awareness by: medication visual alerts and compliance control, chat communication with medical staff, sharing didactic video files, exercise monitoring... Stroke patients discharged home were screened for participation and divided in two groups: to follow the FARMALARM program during 3-4 weeks or standard of care follow-up. We determined risk factor control goals at 90 days in all patients Results: During 16 months, from the 457 patients discharged home, 126 (27.6%) were included in the study: Farmalarm n=74; age 57±12, Control n=52, age 59±10. There were no significant differences in baseline characteristics between groups. Patients in Farmalarm group followed the program for 23±6 days after discharge. In Farmalarm group, mean number alarms due to medication intake failure dropped from 68.5% in the first week to 44.6% in the third week (p=0.03). At 90 days, achievement of risk factor control was higher in the FARMALARM group (table). The rate of patients with 4/4 risk factors under control was higher in the FARMALARM group (45.3% Vs 22.5%; p=0.02) (graph) and less patients dropped all medications at 3 months in the Farmalarm group (1.5% Vs 8.16%:p=0.05). A regression model adjusted for age and gender showed that the only variable independently associated with all risk factors under control at 90 days was the use of Farmalarm (OR: 4.7; 95% CI:1.1-6.9;p=0.03). Conclusion: In stroke patients discharged home the use of mobile applications to monitor medication compliance and increase stroke awareness is feasible and seems to improve the control of vascular risk factors.

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Abstract TP288: Overcoming Obstacles Making People Healthy (OOMPH): A Patient Centered Post Discharge Follow-up Program for Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.tp288 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jonathan Muller ◽

Barbara Gatton ◽

Linda Fox ◽

Joseph A Bove ◽

Johanna Donovan Turner ◽

...

Keyword(s):

Support Groups ◽

Medical Information ◽

Patient Adherence ◽

Hospital Readmissions ◽

Phone Call ◽

Stroke Patients ◽

Post Discharge ◽

Phone Calls ◽

Stroke Support Groups

Background and Purpose: At least 12% of stroke patients are readmitted to a hospital within 30 days of discharge. We know that patients hospitalized for other conditions are less likely to be readmitted within 30 days if they are seen by their PCP shortly after discharge. However, less than a third of patients in the New York metropolitan area admitted for heart failure, heart attacks, and pneumonia see their PCP within 14 days after discharge and nearly 40% of patients do not adhere to their prescribed regimen. In the case of cerebrovascular diseases, outpatient follow-up may prevent the majority of avoidable readmissions. The purpose of this project is to identify and reduce unnecessary, unplanned hospital readmissions after stroke. Our goal is to encourage patient adherence to prescribed medication and other therapies, as well as to ensure timely follow-up with their PCP. Methods: Stroke and transient ischemic attack (TIA) patients with a disposition of either home or short-term rehabilitation are visited and offered enrollment. Participants are given a kit which includes a personalized binder (to manage essential medical information) and a 28-slot pill box. Each patient then receives 3 phone call interviews at 7, 21 and 32 days after discharge. The aim of the phone calls is to identify obstacles to compliance with treatment regimen and follow-up care. Results: From January 2015 to June 2016, 247 patients were enrolled and followed up. Within 30 days of discharge, 10% were readmitted and 50% of all readmissions occurred within the first 7 days. Of those readmitted, 19% were due to an injury from physical therapy. Data from follow-up phone calls revealed that 83% were taking all prescribed medications, 89% had completed a follow-up with any physician, 69% were using the binder, and 61% had done all three. Conclusions: While we have not enrolled enough patients to see a statistically significant reduction in readmissions, our interviews showed that weather, depression, as well as a lack of insurance, family support, and a home health aide are all determinants on how patients will follow their prescribed regimen. The results of this study have allowed us to begin implementing stroke support groups and pre-discharge follow-up appointment scheduling.

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Patient Satisfaction With Extended International Normalized Ratio Follow-up Intervals in a Veteran Population

Annals of Pharmacotherapy ◽

10.1177/1060028019889414 ◽

2019 ◽

Vol 54 (5) ◽

pp. 442-449

Author(s):

Rebecca R. Schoen ◽

Michael W. Nagy ◽

Andrea L. Porter ◽

Amanda R. Margolis

Keyword(s):

Patient Satisfaction ◽

Focus Group ◽

International Normalized Ratio ◽

Limited Data ◽

Participant Satisfaction ◽

Small Effect Size ◽

The Mean ◽

The Impact ◽

Improve Patient

Background: For highly stable warfarin patients, limited data exists regarding patient satisfaction on extended international normalized ratio (INR) follow-up intervals and how this population compares with patients on a direct oral anticoagulant (DOAC). Objective: To assess the impact on patient satisfaction of extending INR follow-up intervals. Methods: Veterans on stable warfarin doses had extended INR follow-up intervals up to 12 weeks in a single-arm prospective cohort study for 2 years. This analysis included participants who completed at least 2 Duke Anticoagulation Satisfaction Scales (DASS). The primary outcome was the change in the DASS. A focus group described participant experiences. Participant satisfaction was compared to patients on a DOAC. Results: Of the 51 participants, 48 were included in the warfarin extended INR follow-up group. Compared with baseline, the mean DASS score (42.9 ± 12.08) was worse at 24 months (46.82 ± 15.2, P = 0.0266), with a small effect size (Cohen’s d = 0.29). The 8 participants in the focus group were satisfied with the extended INR follow-up interval but would be uncomfortable extending follow-up past 2 to 3 months. The extended INR follow-up interval study had similar DASS scores as the 33 participants included on DOAC therapy (46.8 ± 15.1, P = 0.9970) but may be limited by differing populations using DOACs. Conclusion and Relevance: For patients currently stable on warfarin therapy, extending the INR follow-up interval up to 12 weeks or changing to a DOAC does not appear to improve patient satisfaction.

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Caregiver’s Recall of Stroke Discharge Education Exceeds Patients and Is Associated With Greater Satisfaction

Journal of Patient Experience ◽

10.1177/2374373519893201 ◽

2019 ◽

Vol 7 (5) ◽

pp. 796-800

Author(s):

Caleb J Heiberger ◽

Clayton Busch ◽

John Chandler ◽

Kevin Rance ◽

Brett Montieth ◽

...

Keyword(s):

Patient Satisfaction ◽

Categorical Data ◽

Stroke Patients ◽

Exact Test ◽

Perceived Utility ◽

Time Periods ◽

Fischer Exact Test ◽

Over Time ◽

Discharge Education

Stroke survivors and their caregivers report not receiving enough information at discharge. To identify strengths and weaknesses of stroke discharge education, we delivered questionnaires that assessed patient and caregiver recall, perceived utility, and satisfaction at discharge as well as 1- and 3-month follow-up. Categorical data of responses were compared between time periods using Fischer exact test. Recall significantly differed between discharge (86%) and 1-month follow-up (54%, P < .05), but not discharge and 3-month follow-up (69%). Patient perceived utility at both 1 month (69%) and 3 months (64%) was lower than at discharge (92%, P < .05). Patient satisfaction was lower at 1 month (69%) and 3 months (54%) than discharge (92%, P < .05). Caregiver recall declined from discharge (81%) to 1 month (65%) but improved from 1 to 3 months (82%, P < .05). Caregiver satisfaction and perceived utility remained positive through the study. The results suggest stroke patients and their caregivers suffer from education recall failure over time that is associated with worse satisfaction and perceived utility by patients. Reinforcement at 1 month may improve caregiver recall. We conclude that education for caregivers may be more reliably reinforced, suggesting a role in continued patient education.

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Patient satisfaction with patient-led follow-up for endometrial cancer

British Journal of Nursing ◽

10.12968/bjon.2020.29.17.s4 ◽

2020 ◽

Vol 29 (17) ◽

pp. s4-s10

Author(s):

Tanisha Sharma ◽

Sandeep Sharma ◽

Jodie Eastwood ◽

Ros Jackson ◽

Janey Wells

Keyword(s):

Endometrial Cancer ◽

Patient Satisfaction ◽

Uterine Cancer ◽

Cancer Recurrence ◽

Phone Call ◽

Satisfaction Survey ◽

Assess Patient Satisfaction ◽

Nursing Team ◽

Study Population

Background: The 5-year hospital follow-up after treatment for endometrial cancer can increase anxiety for patients and not directly pick up cancer recurrence. Aims: The aim of this study was to assess patient satisfaction with a patient-led follow-up and identify cancer recurrence. Methods: This study population was 104 women with early uterine cancer who had undergone surgery. They were given information regarding symptoms suspicious for recurrence and started on a patient-led follow-up, which included a yearly phone call from the nursing team, and a questionnaire was completed. Findings: Most patients (92%) scored ≥9 on the 10-point satisfaction survey. Nine women came back to the clinic for pain or bleeding. There was no recurrence of cancer in this study population. Conclusion: Patients are satisfied with a patient-led, telephone follow-up. This data has influenced a change in the regional Cancer Alliance guidance on cancer follow-up emphasising risk stratification.

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Abstract T P305: Fragmented Care Among Stroke Patients at 4 Chicago Hospitals

Stroke ◽

10.1161/str.45.suppl_1.tp305 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Carlos Corado ◽

John Cashy ◽

Abel Kho ◽

Shyam Prabhakaran

Keyword(s):

Acute Stroke ◽

Information Exchange ◽

Health Information Exchange ◽

Medication Compliance ◽

Stroke Patients ◽

Health Records ◽

Longitudinal Tracking ◽

A Site ◽

Fragmentation Of Care

Background/Objective: Stroke patients may be unable to provide medical history. Given the urgency of decision-making in acute stroke and importance of medication compliance post-stroke, prompt access to prior health records could reduce delays and errors. We hypothesized that stroke patients often have fragmented care in the Chicago Health Atlas. Methods: The Chicago Health Atlas encompasses clinical data on over 1 million unique patients within the 606xx ZIP codes of Chicago. A unique ID is created for each patient through the use of a secure one-way hash function. The creation of a unique ID enables longitudinal tracking of a patient’s care across participating sites. We identified all acute stroke admissions to any of 4 Chicago Health Atlas hospitals using ICD-9 codes (430-436) and searched for prior inpatient or outpatient encounters at any of those sites. Fragmented care was defined as having prior encounters at a site different from the site of stroke hospitalization. In the same cohort, we assessed post-hospitalization outpatient encounters within the Health Atlas. Results: There were 5,980 stroke patients with emergency department or inpatient visits between 2006 and 2010. Of these, 3,732 (62.4%, mean age 61.1 years, 47% black) had non-fragmented care prior to stroke while 2,066 (34.5%, mean age 58.1 years, 31% black) were completely new encounters (first-ever) in the Health Atlas and only 182 (3.0%, mean age 57.5 years, 59% black) had fragmented care. The percent with fragmented care increased from 1.3% in 2006 to 3.3% in 2010 (p<0.001 for trend). Rates of follow-up within following 12 months varied across the 3 groups (non-fragmented: 75% and fragmented: 64% vs. new: 51.4%; p<0.001). Conclusions: Two-thirds of stroke patients have previously accessed the health care system, with a majority having records at the same site of stroke hospitalization. However, 3% of patients have fragmented care, a rate that is increasing over time. Our estimate of fragmentation may be an underestimate since only 4 sites were included in this analysis. Having health information exchange may be valuable in reducing fragmentation of care for stroke patients.

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Comparative analysis of an innovative app versus conventional techniques to improve patient compliance after minor oral surgical procedures (Preprint)

10.2196/preprints.35997 ◽

2021 ◽

Author(s):

Deborah Sybil ◽

Meenakshi Krishna ◽

Priyanshu Kumar Shrivastava ◽

Shradha Singh ◽

Imran Khan

Keyword(s):

Tooth Extraction ◽

Compliance Rate ◽

Phone Call ◽

Oral Surgical Procedures ◽

Operative Care ◽

The Difference ◽

Complications Rate ◽

Study Participants ◽

Improve Patient

BACKGROUND Certain factors such as compliance, comprehension, retention of instructions, and other unaccounted elements impact the objectives of post-operative care. It is imperative that patients follow the instructions and prescribed regimen diligently for a smooth and placid healing. Keeping the same principles in view, ExoDont was designed by our team, an android-based mHealth app which ensures a smooth post-operative period for the patients after a dental extraction. Besides providing post-operative instructions at defined intervals, the app also sends out drug reminders as an added advantage over other available conventional modes. OBJECTIVE To compare the compliance rate of individuals with respect to the prescribed regimen, postoperative instructions, and additionally, assess any significant changes in post-operative complications rate under the three categories namely Verbal, Verbal plus Written, and ExoDont group. METHODS The patients after tooth extraction were randomly assigned to the aforementioned groups and a one week follow-up through a phone call was planned to obtain the responses from study participants. The result obtained from the three groups was then statistically analyzed. RESULTS The compliance rate in patients for post-operative instructions and prescribed drug adherence was statistically significant in the group using ExoDont app than in Verbal or Verbal plus Written group. However, the difference in the incidence of postoperative complication rate was not significant among the three groups. CONCLUSIONS As evident from the result, it is anticipated that the ExoDont app will be revolutionary in not only circumventing the unaccounted possibilities of missing the prescribed dose and post-operative instructions but also ensure a smooth post-operative phase and easy recovery for the patients.

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The Utility of Telehealth in the Recovery From the COVID-19 Pandemic

Surgical Technology Online ◽

10.52198/21.sti.39.os1445 ◽

2021 ◽

Vol 39 ◽

Author(s):

Zhongming Chen ◽

◽

John Tarazi ◽

Hytham Salem ◽

Giles Scuderi ◽

...

Keyword(s):

Infectious Disease ◽

Orthopaedic Surgery ◽

New Technologies ◽

Improve Patient Care ◽

Medical Community ◽

Technological Innovations ◽

Hospital System ◽

Exposure Risks ◽

Improve Patient

Telehealth has recently been used more often in an attempt to protect practitioners and patients during the 2019 coronavirus infectious disease (COVID-19) crisis. Despite telehealth’s existence, there was no prior need to fully realize its potential. Recently, technological innovations in orthopaedic surgery have assisted in making this modality more useful. However, it is important to continually educate the medical community regarding these technologies and their interplay to improve patient care. Therefore, our purpose is to provide information on telehealth by assessing: (1) steps the hospital/system are taking to reduce COVID-19 exposure for teams and patients; (2) new technologies allowing for the optimization of patient safety; and (3) use of telehealth for postoperative follow up. We will demonstrate that telehealth and its associated strategies can be used effectively to decrease COVID-19 exposure risks for both medical staff and patients during these rapidly changing and uncertain times.

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