Improving Care Transitions in Healthcare: A Human Factors/Ergonomics (HFE) Approach

2018 ◽  
Vol 62 (1) ◽  
pp. 551-555 ◽  
Author(s):  
Patrick Waterson ◽  
Abigail Wooldridge ◽  
Abigail Wooldridge ◽  
Mary Sesto ◽  
Ayse Gurses ◽  
...  
Keyword(s):  
Patient Safety ◽  
Elderly Patients ◽  
Medication Management ◽  
Care Transitions ◽  
Pediatric Trauma ◽  
Marrow Transplant ◽  
Different Types ◽  
Hospital To Home ◽  
Orthopedic Patients

Delivering safe healthcare often involves multi-disciplinary teams working across multiple locations. Care transitions are required to provide continuity of care and are often fail due to this type of complexity. Care transitions occur in numerous settings, for example: during shift changes, transfer between wards, or during discharge to the patient’s home (WHO Collaborating Centre for Patient Safety Solutions 2007). The aim of the panel will be to discuss different types of care transitions and how HFE can assist in improving patient safety and efficiency of the process. The panel will discuss and share lessons learnt from a range of projects involving care transitions for pediatric trauma care (Woolridge), and barriers and facilitators to follow-up care for bone marrow transplant survivors (Sesto). In addition, the work system elements for care transitions for elective orthopedic patients (Carman), elderly patients after heart failure hospitalization (Holden) and risks to elderly patients’ safe medication management (Gurses) when transitioning from hospital to home will be discussed.

scholarly journals Team Cognition as a Barrier and Facilitator in Care Transitions: Implications for Work System Design

2019 ◽  
Vol 63 (1) ◽  
pp. 648-652
Author(s):  
Abigail R. Wooldridge ◽  
Pascale Carayon ◽  
Peter Hoonakker ◽  
Bat-Zion Hose ◽  
Thomas B. Brazelton ◽  
...  
Keyword(s):  
Patient Safety ◽  
System Design ◽  
Systems Engineering ◽  
Care Transitions ◽  
Pediatric Trauma ◽  
Barriers And Facilitators ◽  
Distributed Teams ◽  
Future Research ◽  
Team Cognition ◽  
Work System

Inpatient care of pediatric trauma patients includes care transitions, including from emergency department (ED) to operating room (OR), OR to pediatric intensive care unit (PICU) and ED to PICU, which are important to patient safety and quality of care. Previous research identified work system barriers and facilitators in these transitions; the most common related to team cognition. We conducted interviews with 18 healthcare professionals to better understand how work system design influences team cognition barriers and facilitators. Using Systems Engineering Initiative for Patient Safety (SEIPS)-based process modeling, we identified when each barrier/facilitator occurred. The ED to OR transition had more barriers in transition preparation, while OR to PICU had more facilitators in the transition. Future research should explore solutions to support team cognition early in the ED to OR transition, such as designing a technology to be used by distributed teams.

scholarly journals Systems Barriers to Medication Management During Hospital to Home Transitions of Older Adults With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 228-228
Author(s):  
Maningbe Keita-Fakeye ◽  
Rhea Sharma ◽  
Sylvan Greyson ◽  
Quincy Samus ◽  
Ayse Gurses ◽  
...  
Keyword(s):  
Older Adults ◽  
Home Health Care ◽  
Medication Management ◽  
Care Transitions ◽  
Human Factors Engineering ◽  
Structured Interviews ◽  
Conflicting Information ◽  
Use Of Resources ◽  
Hospital To Home ◽  
Health Care Transitions

Abstract The hospital-to-home transition is a high-risk period for medication errors and adverse events for older adults living with dementia. Researchers conducted a qualitative study using semi-structured interviews and participant solicited diaries. Caregivers of adults ages 55 and older were recruited to understand barriers to medication management during hospital to skilled home health care transitions. We used a human factors engineering approach to guide our understanding of systems level barriers. At least two researchers independently coded each transcript using content analysis and the ATLAS.ti software. We interviewed 23 caregivers and identified five barrier types stemming from systems breakdowns related to: (1) knowledge and information, (2) access to and use of resources and tools, (3) caregiver burden, (4) pandemic concerns, and (5) health limitations. Caregivers grappled with receiving overwhelming, insufficient, incorrect, or conflicting information, and had difficulty managing information from different sources. Latinx caregivers encountered language barriers that impeded role and task clarity. Caregivers expressed mistrust in health systems elements and inability to access resources. Caregivers were in need of additional caregiving assistance, financial aid, and tools to manage medications. Balancing multiple medications and responsibilities left caregivers burdened. The health limitations of the older adult and COVID-19 concerns related to reduced access to resources and ability to deliver and receive in person care complicated task management. Altogether these barriers reflect systems level breakdowns impeding task understanding, execution, and overall management. These findings will inform the development of interdisciplinary strategies to ensure safer care transitions.

scholarly journals Implementing a Pharmacist-Led Medication Management Pilot to Improve Care Transitions

2012 ◽  
Vol 3 (2) ◽  
Author(s):  
Rachel Root ◽  
Pamela Phelps ◽  
Amanda Brummel ◽  
Craig Else
Keyword(s):  
Primary Care ◽  
Drug Therapy ◽  
Health System ◽  
Medication Management ◽  
Care Transitions ◽  
Care Visit ◽  
Discharge Medication ◽  
Drug Therapy Problems ◽  
The Continuum

Purpose: The purpose of this project was to design and pilot a pharmacist-led process to address medication management across the continuum of care within a large integrated health-system. Summary: A care transitions pilot took place within a health-system which included a 150-bed community hospital. The pilot process expanded the pharmacist's medication management responsibilities to include providing discharge medication reconciliation, a patient-friendly discharge medication list, discharge medication education, and medication therapy management (MTM) follow-up. Adult patients with a predicted diagnosis-related group (DRG) of congestive heart failure or chronic obstructive pulmonary disease admitted to the medical-surgical and intensive care units who utilized a primary care provider within the health-system were included in the pilot. Forty patients met the inclusion criteria and thirty-four (85%) received an intervention from an inpatient or MTM pharmacist. Within this group of patients, 88 drug therapy problems (2.6 per patient) were identified and 75% of the drug therapy recommendations made by the pharmacist were accepted by the care provider. The 30-day all-cause readmission rates for the intervention and comparison groups were 30.5% and 35.9%, respectively. The number of patients receiving follow-up care varied with 10 (25%) receiving MTM follow-up, 26 (65%) completing a primary care visit after their first hospital discharge, and 23 (58%) receiving a home care visit. Conclusion: Implementation of a pharmacist-led medication management pilot across the continuum of care resulted in an improvement in the quality of care transitions within the health-system through increased identification and resolution of drug therapy problems and MTM follow-up. The lessons learned from the implementation of this pilot will be used to further refine pharmacy care transitions programs across the health-system.   Type: Original Research

Abstract 96: Facilitation of the VA Hospital To Home (H2H) Initiative to Reduce Readmissions for Heart Failure: CHF QUERI

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Anju Sahay ◽  
Parisa Gholami ◽  
Nancy Oliva ◽  
Paul A Heidenreich
Keyword(s):  
Heart Failure ◽  
Diffusion Of Innovation ◽  
Symptom Management ◽  
Medication Management ◽  
Conference Calls ◽  
Provider Network ◽  
National Quality ◽  
Hospital To Home

Objective: Reducing readmission rates for heart failure (HF) patients is the primary goal of the VA and its' Chronic Heart Failure (CHF) QUERI. It is also the goal of Hospital to Home (H2H) national quality improvement (QI) which has 3 key focus areas: (a) medication management; (b) symptom management; and (c) early follow-up after discharge. According to Rogers’ Diffusion of Innovation Theory (2003) social networks significantly affect performance and innovation. Additionally, the Promoting Action on Research Implementation in Health Services(PARIHS, 2008) framework emphasizes the function of dynamic relationships among evidence, context and facilitation. The CHF QUERI formed the HF Provider Network consisting of 720+ providers (members) from 150 VA facilities to improve the quality of HF care. In January 2010 through the HF Network the “VA H2H” QI initiative was launched to facilitate the implementation of the national H2H initiative at the VA facilities with focus on H2H's 3 key focus areas. Through e-mails, web-based meetings and conference calls members were encouraged to (1) enroll own facility on national H2H website and (2) initiate and/or plan new projects focusing on the VA H2H initiative. Methods: A total of 122 VA facilities were identified with >100 discharges during 2007-2008. In Spring 2010 and then Spring 2011 members at all facilities were asked to complete surveys to find out (1) enrollment status and (2) number and description of projects initiated and/or planned for the VA H2H initiative, and other ongoing projects focusing on reducing HF readmissions. Results: Altogether 77 (63%) facilities enrolled on the national H2H website. With a survey response rate of 75% (92 facilities) altogether 529 projects were reported focusing on: Medication management=150 (29%); Symptom management=148 (27%); Early follow up=155 (30%); and Other areas=34 (14%). A total of 120 (22%) projects were initiated and another 93 (18%) are being planned based on the VA H2H initiative, and 316 (60%) are ongoing projects to reduce HF readmissions. Conclusions: Supporting the Rogers (2003) and PARIHS (2008) frameworks, these findings demonstrate the successful facilitation of the VA H2H initiative by the CHF QUERI through its HF Provider Network in terms of increased enrollment and significant number of initiated and/or planned VA H2H projects. Impact: Facilitation of non-mandated QI initiatives is crucial to improve the quality of care for HF patients.

scholarly journals Treatment of Unstable Intertrochanteric Fractures in Elderly Patients Using a New Technique of Wire Tension Band Ventral Compression Wiring Combined With Artificial Femoral Head Replacement

2021 ◽  
Author(s):  
Jiajing Ye ◽  
Zhong Zhu ◽  
Lingjun Jiang ◽  
Haizhao Wu ◽  
Shouli Wang ◽  
...  
Keyword(s):  
Femoral Head ◽  
Elderly Patients ◽  
Tension Band ◽  
Fracture Line ◽  
Intertrochanteric Fractures ◽  
Greater Trochanter ◽  
Wire Tension ◽  
Different Types ◽  
Hip Function

Abstract Background: This study evaluates the effects of wire tension band ventral compression wiring technology paired with artificial femoral head replacement according to the different types of intertrochanteric fractures of the greater trochanter in elderly patients. Methods: Thirty-eight patients with unstable intertrochanteric fractures of the femur treated with artificial femoral head replacement between January 2015 and August 2019 were included. According to the fracture line of the greater trochanter, a new classification system was proposed. Type A fractures include transverse fractures from the greater trochanter tip to the base (2 patients). Type B fractures include oblique fractures from the greater trochanter tip to the base (according to the fracture line direction, type B was further divided into types B1 [4 patients], and B2 [24 patients]). the fracture line of type C fractures runs from the greater trochanter to near the femur end (8 patients). Different wire tension belt ventral compression wiring technologies were used for each fracture type. The Harris hip function score, Parker activity score, and hip pain were evaluated during the follow-up period. Fracture healing and prosthesis positioning, loosening, and dislocation were evaluated using radiographs. Results: The average follow-up period was 28.6 ± 5.8 months. Deep vein embolism was noted in one patient, heterotopic ossification in another, and steel wire fractures in another. All patients had satisfactory fracture healing and femoral prosthesis positioning and no chronic pain. The mean Harris hip function score was 7.21 ± 2.58 preoperatively and 84.74 ± 3.82 at the final follow-up (F = -48.13, P < 0.001).Conclusion: The use of different wire tension band ventral compression wiring technology based on different types of femoral rotation fractures combined with artificial femoral head replacement in elderly patients with unstable intertrochanteric fractures results in favorable clinical outcomes.

Evaluation of R-CHOP and R-CVP in the treatment of elderly patient with non-Hodgkin lymphoma

MedPharmRes ◽  
2019 ◽  
Vol 3 (3) ◽  
pp. 1-6
Author(s):  
Truc Phan ◽  
Tram Huynh ◽  
Tuan Q. Tran ◽  
Dung Co ◽  
Khoi M. Tran
Keyword(s):  
Elderly Patients ◽  
Hodgkin Lymphoma ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
The Elderly ◽  
Free Survival ◽  
Non Hodgkin Lymphoma ◽  
Common Sign ◽  
Related Mortality

Introduction: Little information is available on the outcomes of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine and prednisone) and R-CVP (rituximab with cyclophosphamide, vincristine and prednisone) in treatment of the elderly patients with non-Hodgkin lymphoma (NHL), especially in Vietnam. Material and methods: All patients were newly diagnosed with CD20-positive non-Hodgkin lymphoma (NHL) at Blood Transfusion and Hematology Hospital, Ho Chi Minh city (BTH) between 01/2013 and 01/2018 who were age 60 years or older at diagnosis. A retrospective analysis of these patients was perfomed. Results: Twenty-one Vietnamese patients (6 males and 15 females) were identified and the median age was 68.9 (range 60-80). Most of patients have comorbidities and intermediate-risk. The most common sign was lymphadenopathy (over 95%). The proportion of diffuse large B cell lymphoma (DLBCL) was highest (71%). The percentage of patients reaching complete response (CR) after six cycle of chemotherapy was 76.2%. The median follow-up was 26 months, event-free survival (EFS) was 60% and overall survival (OS) was 75%. Adverse effects of rituximab were unremarkable, treatment-related mortality accounted for less than 10%. There was no difference in drug toxicity between two regimens. Conclusions: R-CHOP, R-CVP yielded a good result and acceptable toxicity in treatment of elderly patients with non-Hodgkin lymphoma. In patients with known cardiac history, omission of anthracyclines is reasonable and R-CVP provides a competitive complete response rate.

Evaluation of the correlation between risk factors and mortality in elderly patients with femoral neck fracture with 5-year follow-up

2008 ◽  
Vol 149 (11) ◽  
pp. 493-503 ◽  
Author(s):  
Andor Sebestyén ◽  
Imre Boncz ◽  
Ferenc Tóth ◽  
Márta Péntek ◽  
József Nyárády ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Femoral Neck Fracture ◽  
Neck Fracture

A csípőtáji törésekhez idős korban magas halálozás társul. A szakirodalomban kevés a nagy beteganyagot feldolgozó, országos kiterjedésű ellátórendszer adatain alapuló feldolgozás. Célkitűzés: A tanulmány célja a 60 év feletti akut, monotraumás combnyaktöröttek primer ellátását követő halálozások vizsgálata havonta és évente ötéves utánkövetéssel, valamint a különböző rizikófaktoraik halálozásra gyakorolt hatásainak értékelése az egyes időperiódusokban. Módszer: Az adatok az Országos Egészségbiztosítási Pénztár adatbázisából származnak. Az értékelés bázisát a fekvőbeteg-ellátást végző intézményekből combnyaktörés primer műtéti ellátását követően 2000. évben emittált betegek képezik. Bemutatjuk az átlagos évenkénti, havonkénti és heti halálozási arányokat, valamint rizikótényezők szerinti alakulásukat havonként és évenként. A rizikótényezők és a halálozás kapcsolatának értékelése logisztikus és Cox-regressziós analízissel történik. Eredmények: A tanulmányban 3783 fő került elemzésre. Átlagéletkoruk 77,97 (SD 8,52) év. A halálozás az első héten 1,71%, 30 napon belül 8,99%, az első évben 30,74%, öt év alatt 61,88% volt. A halálozás havi szinten az első 5 hónapig mutat csökkenést, éves szinten az első év után stagnál. A rizikófaktorok közül a férfinem és a magasabb életkor öt évig, a kísérőbetegségek hatásai a negyedik évig, a laterális combnyaktöréstípus és a 12 órán túli ellátás két évig, a korai lokális szövődmények egy évig, a hétvégi ellátások az első hónapban eredményeznek magasabb halálozási kockázatot. Az országos és egyetemi ellátásokat követően az első évben alacsonyabb a halálozási kockázat. Következtetések: A csípőtáji törések managementjében a halálozások csökkentése érdekében hangsúlyozzuk a 12 órán belüli ellátás, a törési típusnak megfelelő módszerválasztás, a hét minden napján történő azonos ellátási feltételek biztosítása, az ellátások centrumokba történő szervezése, a beteg általános állapotának és kísérőbetegségeinek megfelelő akut ellátás és az utókezelések fontosságát.

Characteristics of Different Types of Childhood Violence and the Risk of Revictimization

2019 ◽  
Vol 25 (14) ◽  
pp. 1696-1716 ◽  
Author(s):  
Ida Frugaard Stroem ◽  
Helene Flood Aakvaag ◽  
Tore Wentzel-Larsen
Keyword(s):  
Childhood Abuse ◽  
Telephone Survey ◽  
Regression Analyses ◽  
Multiple Forms ◽  
Different Types ◽  
Children And Young Adults ◽  
Childhood Violence ◽  
Forms Of Violence ◽  
The Relationship

This study investigates the relationship between the characteristics of different types of childhood violence and adult victimization using two waves of data from a community telephone survey (T1) and a follow-up survey, including 505 cases and 506 controls, aged 17-35 years (T2). The logistic regression analyses showed that exposure to childhood abuse, regardless of type, was associated with adult victimization. Exposure to multiple types of abuse, victimization both in childhood and in young adulthood, and recency of abuse increased these odds. Our findings emphasize the importance of assessing multiple forms of violence when studying revictimization. Practitioners working with children and young adults should be attentive to the number of victimization types experienced and recent victimization to prevent further abuse.

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