Comparing subspecialty and intensive care providers perspectives on pediatric complex chronic patients: A survey study

2021 ◽  
pp. 205343452110680
Author(s):  
Taylor A Kobussen ◽  
Gregory Hansen ◽  
Tanya R Holt
Keyword(s):  
Acute Care ◽  
Chronic Care ◽  
Tertiary Care ◽  
Likert Scale ◽  
Survey Study ◽  
Complex Care ◽  
Care Providers ◽  
Short Answer ◽  
Provider Perspectives ◽  
Short Answer Questions

Introduction Pediatric complex chronic care patients present unique challenges regarding healthcare provision: complex medical regimes, complicated family/provider dynamics, and multiple healthcare teams that can result in inconsistent care. This study examined subspecialty providers’ perspectives regarding pediatric complex chronic care patients and compared them with acute care providers while exploring opportunities to better facilitate care provided to pediatric complex chronic care patients. Methods This survey study occurring within a Canadian tertiary care pediatric center, utilized REDCap to deploy surveys involving Likert Scale and short answer questions. The Kruskal–Wallis test compared subspecialty provider perspectives when providing care to pediatric complex chronic care patients versus non-pediatric complex chronic care patients; and perspectives between subspecialty and acute care providers. Results Survey response rate was 24/46 (52.2%). Eight overarching themes emerged from Likert scale questions. Short answer questions revealed factors that may facilitate care provided to pediatric complex chronic care patients: access to funding; discharge planning; communication methods between specialists; and healthcare provider continuity. Several differences were identified when working with pediatric complex chronic care patients, compared to non-pediatric complex chronic care patients: increased time/resource burden; managing expectations of patients/families; navigating discrepancies in goals of care; complexity of coordination between services; increased efforts in coordinating discharge from hospital and working with medicalized patients/families. Discussion Exploring pediatric subspecialty provider perspectives of pediatric complex chronic care patients revealed opportunities to enhance care provided: increased resources to ease the strain of care provision for parents, implementation of a discharge coordinator, complex care clinics with a pediatrician to “quarterback” care, and co-management between the complex care pediatrician and acute care physician when admitted to an acute care service. Implementation of these initiatives may improve the care provided to pediatric complex chronic care patients.

scholarly journals P022: Geriatrics care in the ED: Acute care use after the introduction of an interdisciplinary care program in Sunnybrook Health Sciences Centre's Emergency Department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S85-S85
Author(s):  
N. Khatib ◽  
J. Charles ◽  
J.S. Lee
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Acute Care ◽  
Community Care ◽  
Complex Care ◽  
Care Providers ◽  
Care Coordinator ◽  
Efficiency Measures ◽  
Complex Patients ◽  
Emergency Doctors

Introduction: Currently the top 5% of complex patients consume 84% of Ontario’s Hospital and Home Care costs. There is a critical need for a dynamic, person-centred care planning process for medically complex patients with real time dialogue between ED/acute care and community care providers at care transitions. A care pathway was developed in the Sunnybrook Health Science Centre’s Emergency Department using quality improvement methodology and team. The purpose of this study is to evaluate the impact of the emergency room huddle for complex care patients on emergency doctors’ perceptions of patient safety and ED efficiency measures such as department flow and delays. Methods: Intervention - Medically complex patients with frequent ED use are now automatically flagged upon registration in the Emergency Department (ED) and an ED Care Coordination team is notified by secure email: GEM nurse, ED CCAC Care Coordinator, SW, OT/PT. The GEM nurse initiates a comprehensive patient assessment in the Emergency Department right after triage and the CCAC Care Coordinator initiates a teleconference with the patient’s family physician and community Care Coordinator with the patient’s consent. Usual physician assessment is preceded and followed by an inter-professional huddle (including the EM doctor, GEM nurse, CCAC nurse and SW, OT, PT) to ensure patient's needs, goals and team recommendations are clear. Emergency doctors who have participated in an inter-professional huddle for complex care patients are contacted via a semi-structured interview and Qualtrics surveys evaluating perceptions of patient safety and ED efficiency measures such as department flow and delays. Results: Qualitative analysis of the results will be conducted and results updated at a later date. Conclusion: Safety is enhanced through better communication between ED providers, patients, their family physicians and community care providers. It is essential that the inter-professional huddle is recognized by emergency physicians as an important element of patient safety and care. An evaluation of ED doctor’s perception of the huddle will help us understand enablers and barriers to the process and inspire further quality improvements to enhance patient care.

An assessment of Chemical, Biological, Radiologic, Nuclear, and Explosive preparedness among emergency department healthcare providers in an inner city emergency department

2015 ◽  
Vol 13 (5) ◽  
pp. 431 ◽  
Author(s):  
Joseph G. Kotora, DO, MPH
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Online Survey ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Survey Study ◽  
Care Providers ◽  
Adequate Knowledge ◽  
Practice Experience ◽  
Midlevel Providers

Introduction: Emergency healthcare providers are required to care for victims of Chemical, Biological, Radiologic, Nuclear, and Explosive (CBRNE) agents. However, US emergency departments are often ill prepared to manage CBRNE casualties. Most providers lack adequate knowledge or experience in the areas of patient decontamination, hospital-specific disaster protocols, interagency familiarization, and available supply of necessary medical equipment and medications. This study evaluated the CBRNE preparedness of physicians, nurses, and midlevel providers in an urban tertiary care emergency department.Methods: This retrospective observational survey study used a previously constructed questionnaire instrument. A total of 205 e-mail invitations were sent to 191 eligible providers through an online survey distribution tool (Survey Monkey®). Respondents were enrolled from February 1, 2014 to March 15, 2014. Simple frequencies of correct answers were used to determine the level of preparedness of each group. Cronbach’s coefficient á was used to validate the precision of the study instrument. Finally, validity coefficients and analysis of variance ANOVA were used to determine the strength of correlation between demographic variables, as well as the variation betweenindividual responses. Results: Fifty-nine providers responded to the questionnaire (31.14 percent response rate). The overall frequency of correct answers was 66.26 percent, indicating a relatively poor level of CBRNE preparedness. The study instrument lacked precision and reliability (coefficient á 0.4050). Significant correlations were found between the frequency of correct answers and the respondents’ gender, practice experience, and previous experience with a CBRNE incident. Significant variance exists between how providers believe casualties should be decontaminated, which drugs should be administered, and the interpretation of facility-specific protocols.Conclusions: Emergency care providers are inadequately prepared to manage CBRNE incidents. Furthermore, a valid and precise instrument capable of measuring preparedness needs to be developed. Standardized educational curriculums that consider healthcare providers’ genders, occupations, and experience levels may assist in closing the knowledge gaps between providers and reinforce emergency departments’ CBRNE preparedness.

A survey of Instagram users with asthma to evaluate the acceptability of a planned clinical trial intervention (Preprint)

2020 ◽  
Author(s):  
Kerry Spitzer ◽  
Brent Heineman ◽  
Marcella Jewell ◽  
Michael Moran ◽  
Peter Lindenauer
Keyword(s):  
United States ◽  
Social Media ◽  
Health Care Providers ◽  
College Education ◽  
The United States ◽  
Survey Study ◽  
Care Providers ◽  
Healthy Behaviors ◽  
Social Media Platforms ◽  
Hispanic White

BACKGROUND Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. There is a need for more research into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. OBJECTIVE In this study, we assess the willingness of Instagram users with poorly controlled asthma to participate in a pilot study that uses Instagram as a means of providing social and informational support. In addition, we explore the potential for adapting photovoice and digital storytelling to social media. METHODS A survey study of Instagram users living with asthma in the United States, between the ages of 18 to 40. RESULTS Over 3 weeks of recruitment, 457 individuals completed the pre-survey screener; 347 were excluded. Of the 110 people who were eligible and agreed to participate in the study, 82 completed the study survey. Respondents mean age was 21(SD = 5.3). Respondents were 56% female (n=46), 65% (n=53) non-Hispanic white, and 72% (n=59) had at least some college education. The majority of respondents (n = 66, 81%) indicated that they would be willing to participate in the study. CONCLUSIONS Among young-adult Instagram users with asthma there is substantial interest in participating in a study that uses Instagram to connect participants with peers and a health coach in order to share information about self-management of asthma and build social connection.

The healthcare delivery system: an overview

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Delivery System ◽  
Chronic Care ◽  
Tertiary Care ◽  
Healthcare Delivery ◽  
Healthcare Delivery System ◽  
Care Level ◽  
Primary Care Level ◽  
Internal Markets ◽  
System A ◽  
Policy Challenge

This chapter provides an overview of the healthcare delivery system. A figure illustrates how six different parts of the system relate to each other. The primary care level plays a key role in many countries by representing the gate, in which referrals to secondary care are being made. Tertiary care is principally of two types depending on patients’ prognosis: chronic care or rehabilitation. In addition to the three care levels, there are two parts with quite different roles: pharmacies provide pharmaceuticals, and sickness benefit schemes compensate the sick for their income losses. A recurrent policy challenge is to make each provider level take into account the resource implications of their isolated decisions outside of their own budgets. A brief discussion is included on the scope for ‘internal markets’.

scholarly journals How to foster the formation of STEM identity: studying diversity in an authentic learning environment

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Alison Singer ◽  
Georgina Montgomery ◽  
Shannon Schmoll
Keyword(s):  
Learning Environment ◽  
Identity Formation ◽  
Sense Of Belonging ◽  
Sociology Of Science ◽  
Authentic Learning ◽  
Learning Task ◽  
Short Answer ◽  
Diversity And Inclusion ◽  
Educational Challenge ◽  
Short Answer Questions

Abstract Background STEM identity has been shown to have a powerful role in an individual’s success in educational environments, as well as on their career goals and trajectories. Historically, however, STEM identity formation for underrepresented students has been hampered by the lack of representation of in STEM fields, which predominantly consist of white males. One educational challenge is diversifying STEM classrooms, both in terms of the students themselves and also in terms of the science and scientists they learn about. Methods We piloted a 4-credit History, Philosophy, and Sociology of Science course at Michigan State University. Students were tasked with creating exhibits focused on themes of diversity and inclusion in science for a real client. Using a STEM identity survey, we assessed students’ attitudes towards the sciences, issues of diversity in science, and their sense of belonging to their educational communities. We also had the students respond to various short-answer questions throughout the semester to better understand their experiences working on a collaborative authentic learning task. Results Our results suggest that authentic learning experiences based around ideas of diversity and inclusion can help students develop sense of belonging and positive STEM identities. Students demonstrated shifts in their self-identities as scientists, focusing more on the intersection between their gender, ethnicity, and self-perception as a scientist. Through qualitative analysis of short-answer questions, we were able to ascertain that working in groups in an authentic learning environment helped the students improve their communication and collaboration skills. Conclusions Students’ increased focus on gender and ethnicity suggests that they are thinking critically about how their personal identities intersect with their scientific identities. Additional research would help us better understand if the coupling of authentic learning and inclusive teaching practices have significant impacts on the formation of students’ STEM identities.

scholarly journals Impact of legalization of Medical Assistance in Dying on the Use of Palliative Sedation in a Tertiary Care Hospital: A Retrospective Chart Review

2021 ◽  
pp. 104990912110304
Author(s):  
Amy Nolen ◽  
Rawaa Olwi ◽  
Selby Debbie
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Care Hospital ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Before And After

Background: Patients approaching end of life may experience intractable symptoms managed with palliative sedation. The legalization of Medical Assistance in Dying (MAiD) in Canada in 2016 offers a new option for relief of intolerable suffering, and there is limited evidence examining how the use of palliative sedation has evolved with the introduction of MAiD. Objectives: To compare rates of palliative sedation at a tertiary care hospital before and after the legalization of MAiD. Methods: This study is a retrospective chart analysis of all deaths of patients followed by the palliative care consult team in acute care, or admitted to the palliative care unit. We compared the use of palliative sedation during 1-year periods before and after the legalization of MAiD, and screened charts for MAiD requests during the second time period. Results: 4.7% (n = 25) of patients who died in the palliative care unit pre-legalization of MAiD received palliative sedation compared to 14.6% (n = 82) post-MAiD, with no change in acute care. Post-MAiD, 4.1% of deaths were medically-assisted deaths in the palliative care unit (n = 23) and acute care (n = 14). For patients who requested MAiD but instead received palliative sedation, the primary reason was loss of decisional capacity to consent for MAiD. Conclusion: We believe that the mainstream presence of MAiD has resulted in an increased recognition of MAiD and palliative sedation as distinct entities, and rates of palliative sedation increased post-MAiD due to greater awareness about patient choice and increased comfort with end-of-life options.

scholarly journals Improving Communications With Patients and Families in Geriatric Care. The How, When, and What

2021 ◽  
Vol 8 ◽  
pp. 237437352110340
Author(s):  
Shirley Chien-Chieh Huang ◽  
Alden Morgan ◽  
Vanessa Peck ◽  
Lara Khoury
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Tertiary Care ◽  
Care Providers ◽  
Telephone Interviews ◽  
Written Information ◽  
Geriatric Unit ◽  
Patient Health

There has been little published literature examining the unique communication challenges older adults pose for health care providers. Using an explanatory mixed-methods design, this study explored patients’ and their family/caregivers’ experiences communicating with health care providers on a Canadian tertiary care, inpatient Geriatric unit between March and September 2018. In part 1, the modified patient–health care provider communication scale was used and responses scored using a 5-point scale. In part 2, one-on-one telephone interviews were conducted and responses transcribed, coded, and thematically analyzed. Thirteen patients and 7 family/caregivers completed part 1. Both groups scored items pertaining to adequacy of information sharing and involvement in decision-making in the lowest 25th percentile. Two patients and 4 family/caregivers participated in telephone interviews in part 2. Interview transcript analysis resulted in key themes that fit into the “How, When, and What” framework outlining the aspects of communication most important to the participants. Patients and family/caregivers identified strategic use of written information and predischarge family meetings as potentially valuable tools to improve communication and shared decision-making.

scholarly journals Patients’ moral attitudes toward electronic health records: Survey study with vignettes and statements

2021 ◽  
Vol 27 (1) ◽  
pp. 146045822098003
Author(s):  
Tania Moerenhout ◽  
Ignaas Devisch ◽  
Laetitia Cooreman ◽  
Jodie Bernaerdt ◽  
An De Sutter ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
De Novo ◽  
Information Access ◽  
Survey Study ◽  
Sensitive Information ◽  
Patient Portal ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health ◽  
Moral Attitudes

Patient access to electronic health records gives rise to ethical questions related to the patient-doctor-computer relationship. Our study aims to examine patients’ moral attitudes toward a shared EHR, with a focus on autonomy, information access, and responsibility. A de novo self-administered questionnaire containing three vignettes and 15 statements was distributed among patients in four different settings. A total of 1688 valid questionnaires were collected. Patients’ mean age was 51 years, 61% was female, 50% had a higher degree (college or university), and almost 50% suffered from a chronic illness. Respondents were hesitant to hide sensitive information electronically from their care providers. They also strongly believed hiding information could negatively affect the quality of care provided. Participants preferred to be informed about negative test results in a face-to-face conversation, or would have every patient decide individually how they want to receive results. Patients generally had little experience using patient portal systems and expressed a need for more information on EHRs in this survey. They tended to be hesitant to take up control over their medical data in the EHR and deemed patients share a responsibility for the accuracy of information in their record.

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