Estimated Annual Number of US Acute-Care Hospital Inpatients Meeting ACCP Criteria for Venous Thromboembolism (VTE) Prophylaxis.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 903-903 ◽  
Author(s):  
Frederick A. Anderson ◽  
Max Zayaruzny ◽  
John A. Heit ◽  
Alexander T. Cohen ◽  
Keyword(s):  
Acute Care ◽  
Operative Procedure ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Care Quality ◽  
Major Surgery ◽  
Medical Illness ◽  
Care Hospital ◽  
Vte Prophylaxis ◽  
Hospital Inpatients

Abstract Background While consensus guidelines regarding VTE prophylaxis for hospital inpatients have been available for more than 15 years, the number of US inpatients who are potentially eligible for prophylaxis is unknown. Such data are required for estimating the potential costs and benefits of prophylaxis in reducing VTE incidence. Objective To estimate the number of Y2002 US acute-care hospital inpatients who are potentially eligible for VTE prophylaxis. Methods We applied the 7th (2004) American College of Chest Physician (ACCP) Consensus Conference VTE prophylaxis guidelines (Geerts et al. Chest2004;126:338S–400S) to inpatients with hospital discharge International Classification of Disease (ICD-9) codes for major surgery or medical illness identified from the Healthcare Utilization and Cost Database (HCUP), a national acute-care hospital database supported by the US Agency for Health Care Quality Research. Results Of a total of 37.8 million inpatients discharged from US acute-care hospitals in Y2002, 13.4 million (35%) met ACCP guideline criteria for VTE prophylaxis (Table). Table. Inpatients Discharged from US Acute-Care Hospitals with ACCP Guideline Defined Risk of VTE in Y2002 Surgical VTE Risk N Highest risk surgery 744,465 High risk surgery 3,031,318 Moderate risk surgery 2,019,696 Surgical subtotal 5,795,479 Medical VTE Risk N Heart failure 1,867,576 Cancer 1,017,356 Stroke 515,370 Other medical conditions 4,196,343 Medical subtotal 7,596,645 Grand Total 13,392,124 Among the 37.8 million Y2002 discharged inpatinets, 7.7 million were defined by HCUP criteria as having had a major operative procedure. When ACCP surgical risk criteria were applied to this population, 1.9 (25%) were at low VTE risk, while 5.8 million (75%) were at moderate (26%), high (39%) or highest (10%) VTE risk. Among the patients without a major operative procedure, 7.6 million met the ACCP criteria for VTE prophylaxis based on medical illness risk factors. Conclusions In total, 13.4 million US residents meet ACCP criteria for VTE prophylaxis annually due to hospitalization for either major surgery or medical illness. Given that almost 60% of all VTE events occurring in the community are related to recent acute-care hospitalization, providing universal, safe and effective VTE prophylaxis to this population affords an important opportunity to significantly reduce the incidence of VTE. These data provide support for developing and monitoring compliance with hospital-wide guidelines for VTE prevention.

scholarly journals Communication behavior of cognitively impaired older inpatients

2019 ◽  
Vol 52 (S4) ◽  
pp. 264-272
Author(s):  
Eva-Luisa Schnabel ◽  
Hans-Werner Wahl ◽  
Susanne Penger ◽  
Julia Haberstroh
Keyword(s):  
Cognitive Impairment ◽  
Psychometric Properties ◽  
Acute Care ◽  
Older Patients ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Well Being ◽  
Communication Behavior ◽  
Care Hospital

Abstract Background and objective Acutely ill older patients with cognitive impairment represent a major subgroup in acute care hospitals. In this context, communication plays a crucial role for patients’ well-being, healthcare decisions, and medical outcomes. As validated measures are lacking, we tested the psychometric properties of an observational instrument to assess Communication Behavior in Dementia (CODEM) in the acute care hospital setting. As a novel feature, we were also able to incorporate linguistic and social-contextual measures. Material and methods Data were drawn from a cross-sectional mixed methods study that focused on the occurrence of elderspeak during care interactions in two German acute care hospitals. A total of 43 acutely ill older patients with severe cognitive impairment (CI group, Mage ± SD = 83.6 ± 5.7 years) and 50 without cognitive impairment (CU group, Mage ± SD = 82.1 ± 6.3 years) were observed by trained research assistants during a standardized interview situation and rated afterwards by use of CODEM. Results Factor analysis supported the expected two-factor solution for the CI group, i.e., a verbal content and a nonverbal relationship aspect. Findings of the current study indicated sound psychometric properties of the CODEM instrument including internal consistency, convergent, divergent, and criterion validity. Conclusion CODEM represents a reliable and valid tool to examine the communication behavior of older patients with CI in the acute care hospital setting. Thus, CODEM might serve as an important instrument for researcher and healthcare professionals to describe and improve communication patterns in this environment.

Acute Emergence of Elizabethkingia meningoseptica Infection among Mechanically Ventilated Patients in a Long-Term Acute Care Facility

2010 ◽  
Vol 31 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Kingsley N. Weaver ◽  
Roderick C. Jones ◽  
Rosemary Albright ◽  
Yolanda Thomas ◽  
Carlos H. Zambrano ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Acute Care Hospitals ◽  
Care Hospital ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Elizabethkingia Meningoseptica ◽  
Ventilated Patients

Objective.To describe an outbreak of infection associated with an infrequently implicated pathogen, Elizabethkingia meningoseptica, in an increasingly prominent setting for health care of severely ill patients, the long-term acute care hospital.Design.Outbreak investigation.Setting.Long-term acute care hospital with 55 patients, most of whom were mechanically ventilated.Methods.We defined a case as E. meningoseptica isolated from any patient specimen source from December 2007 through April 2008, conducted an investigation of case patients, obtained environmental specimens, and performed microbiologic testing.Results.Nineteen patients had E. meningoseptica infection, and 8 died. All case patients had been admitted with respiratory failure that required mechanical ventilation. Among the 8 individuals who died, the time from collection of the first specimen positive for E. meningoseptica to death ranged from 6 to 43 days (median, 16 days). Environmental sampling was performed on 106 surfaces; E. meningoseptica was isolated from only one swab. Three related pulsed-field gel electrophoresis patterns were identified in patient isolates; the environmental isolate yielded a fourth, unrelated pattern.Conclusion.Long-term acute care hospitals with mechanically ventilated patients could serve as an important transmission setting for E. meningoseptica. This multidrug-resistant bacterium could pose additional risk when patients are transferred between long-term acute care hospitals and acute care hospitals.

scholarly journals Long-term acute care hospitals and Georgia Medicaid: Utilization, outcomes, and cost

2016 ◽  
Vol 4 ◽  
pp. 205031211667092
Author(s):  
Evan S. Cole ◽  
Carla Willis ◽  
William C Rencher ◽  
Mei Zhou
Keyword(s):  
Acute Care ◽  
Diagnosis Related Groups ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Risk Scores ◽  
Average Risk ◽  
Care Hospital ◽  
Hospital Patients ◽  
Medicaid Population

Objectives: Because most research on long-term acute care hospitals has focused on Medicare, the objective of this research is to describe the Georgia Medicaid population who received care at a long-term acute care hospital, the type and volume of services provided by these long-term acute care hospitals, and the costs and outcomes of these services. For those with select respiratory conditions, we descriptively compare costs and outcomes to those of patients who received care for the same services in acute care hospitals. Methods: We describe Georgia Medicaid recipients admitted to a long-term acute care hospital between 2011 and 2012. We compare them to a population of Georgia Medicaid recipients admitted to an acute care hospital for one of five respiratory diagnosis-related groups. Measurements used include patient descriptive information, admissions, diagnosis-related groups, length of stay, place of discharge, 90-day episode costs, readmissions, and patient risk scores. Results: We found that long-term acute care hospital admissions for Medicaid patients were fairly low (470 90-day episodes) and restricted to complex cases. We also found that the majority of long-term acute care hospital patients were blind or disabled (71.2%). Compared to patients who stayed at an acute care hospital, long-term acute care hospital patients had higher average risk scores (13.1 versus 9.0), lengths of stay (61 versus 38 days), costs (US$143,898 versus US$115,056), but fewer discharges to the community (28.4% versus 51.8%). Conclusion: We found that the Medicaid population seeking care at long-term acute care hospitals is markedly different than the Medicare populations described in other long-term acute care hospital studies. In addition, our study revealed that Medicaid patients receiving select respiratory care at a long-term acute care hospital were distinct from Medicaid patients receiving similar care at an acute care hospital. Our findings suggest that state Medicaid programs should carefully consider reimbursement policies for long-term acute care hospitals, including bundled payments that cover both the original hospitalization and long-term acute care hospital admission.

scholarly journals Introducing virtual reality therapy for inpatients with dementia admitted to an acute care hospital: learnings from a pilot to pave the way to a randomized controlled trial

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Lora Appel ◽  
Erika Kisonas ◽  
Eva Appel ◽  
Jennifer Klein ◽  
Deanna Bartlett ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Virtual Reality ◽  
Acute Care ◽  
Controlled Trial ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Pharmacological Intervention ◽  
Care Hospital ◽  
Randomized Controlled ◽  
Prospective Longitudinal

Abstract Background Behavioural and psychological symptoms of dementia (BPSD) are difficult to manage, particularly in acute care settings. As virtual reality (VR) technology becomes increasingly accessible and affordable, there is growing interest among clinicians to evaluate VR therapy in hospitalized patients, as an alternative to administering antipsychotics/sedatives or using physical restraints associated with negative side effects. Objectives Validate and refine the proposed research protocol for a randomized controlled trial (RCT) that evaluates the impact of VR therapy on managing BPSD in acute care hospitals. Special attention was given to ascertain the processes of introducing non-pharmacological interventions in acute care hospitals. Methods Ten patients 65 years or older (mean = 87) previously diagnosed with dementia, admitted to an acute care hospital, were recruited over 3-month period into a prospective longitudinal pilot study. The intervention consisted of viewing 20-min of immersive 360° VR using a head-mounted display. Baseline and outcomes data were collected from the hospital electronic medical records, pre/post mood-state questionnaires, Neuropsychiatric Inventory (NPI) score, and standardized qualitative observations. Comprehensive process data and workflow were documented, including timestamps for each study task and detailed notes on personnel requirements and challenges encountered. Results Of 516 patients admitted during the study, 67 met the inclusion/exclusion criteria. In total, 234 calls were initiated to substitute decision makers (SDM) of the 67 patients for the consenting process. Nearly half (45.6%) of SDMs declined participation, and 40% could not be reached in time before patients being discharged, resulting in 57 eligible patients not being enrolled. Ten consented participants were enrolled and completed the study. The initial VR session averaged 53.6 min, largely due to the administration of NPI (mean = 19.5 min). Only four participants were able to respond reliably to questions. Seven participants opted for additional VR therapy sessions; of those providing feedback regarding the VR content, they wanted more varied scenery (animals, fields of flowers, holiday themes). Few sessions (4/18) encountered technical difficulties. Conclusion The pilot was instrumental in identifying issues and providing recommendations for the RCT. Screening, inclusion criteria, consenting, data collection, and interaction with SDMs and hospital staff were all processes requiring changes and optimizations. Overall, patients with dementia appear to tolerate immersive VR, and with suggested protocol alterations, it is feasible to evaluate this non-pharmacological intervention in acute care hospitals.

scholarly journals Palliative care for cancer patients near end of life in acute-care hospitals across Canada: a look at the inpatient palliative care code

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
J. Tung ◽  
J. Chadder ◽  
D. Dudgeon ◽  
C. Louzado ◽  
J. Niu ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Acute Care ◽  
Care Delivery ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Administrative Databases ◽  
Care Hospital ◽  
Care Needs ◽  
Patients With Cancer

Hospitals play an important role in the care of patients with advanced cancer: nearly half of all cancer deaths occur in acute-care settings. The need for increasing access to palliative care and related support services for patients with cancer in acute-care hospitals is therefore growing. Here, we examine how often and how early in their illness patients with cancer might be receiving palliative care services in the 2 years before their death in an acute-care hospital in Canada. The palliative care code from inpatient administrative databases was used as a proxy for receiving, or being referred for, palliative care. Currently, the palliative care code is the only data element routinely collected from patient charts that allows for the tracking of palliative care activity at a pan-Canadian level.     Our findings suggest that most patients with cancer who die in an acute-care hospital receive a palliative designation; however, many of those patients are identified as palliative only in their final admission before death. Of the patients who received a palliative designation before their final admission, nearly half were identified as palliative less than 2 months before death. Findings signal that delivery of services within and between jurisdictions is not consistent, that the palliative care needs of some patients are being missed by physicians, and that palliative care is still largely seen as end-of-life care and is not recognized as an integral component of cancer care.     Measuring the provision of system-wide palliative care remains a challenge because comprehensive national data about palliative care are not currently reported from all sectors. To advance measurement and reporting of palliative care in Canada, attention should be focused on collecting comparable data from regional and provincial palliative care programs that individually capture data about palliative care delivery in all health care sectors.

scholarly journals Antimicrobial use trends, Israel, 2012 to 2017

2019 ◽  
Vol 24 (34) ◽  
Author(s):  
Yaakov Dickstein ◽  
Elizabeth Temkin ◽  
Debby Ben-David ◽  
Yehuda Carmeli ◽  
Mitchell J Schwaber
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Study Data ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Hospital Data ◽  
Surgical Intensive Care ◽  
Health Maintenance ◽  
Defined Daily Doses

Background In 2012, Israel’s National Center for Infection Control initiated a national stewardship programme that included mandatory annual reporting of antimicrobial use. Here we present nationwide Israeli data for the period 2012 to 2017. Aim The goal of this study was to detect trends in antimicrobial use in Israel following the introduction of the stewardship programme, as part of an assessment of the programme’s impact. Methods In this retrospective observational study, data were collected from Israel’s health maintenance organisations (HMOs), acute care hospitals and post-acute care hospitals (PACHs). Acute care hospital data were collected for general medical and surgical wards, and medical/surgical intensive care units (ICUs). Data were converted into defined daily doses (DDD), with use rates presented as DDD per 1,000 insured/day in the community and DDD per 100 patient-days in hospitals and PACHs. Trends were analysed using linear regression. Results Antimicrobial use decreased across sectors between 2012 and 2017. In the community, the decrease was modest, from 22.8 to 21.8 DDD per 1,000 insured per day (4.4%, p = 0.004). In acute care hospitals, antibiotic DDDs per 100 patient-days decreased from 100.0 to 84.0 (16.0%, p = 0.002) in medical wards, from 112.8 to 94.2 (16.5%, p = 0.004) in surgical wards and from 154.4 to 137.2 (11.1%, p = 0.04) in ICUs. Antimicrobial use decreased most markedly in PACHs, from 29.1 to 18.1 DDD per 100 patient-days (37.8%, p = 0.005). Conclusion Between 2012 and 2017, antimicrobial use decreased significantly in all types of healthcare institutions in Israel, following the introduction of the nationwide antimicrobial stewardship programme.

scholarly journals Administering Virtual Reality Therapy to Manage Behavioural and Psychological Symptoms in Patients with Dementia Admitted to an Acute-care Hospital: Results of a Pilot Study (Preprint)

2020 ◽  
Author(s):  
Lora Appel ◽  
Erika Kisonas ◽  
Eva Appel ◽  
Jennifer Klein ◽  
Deanna Bartlett ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Pilot Study ◽  
Acute Care ◽  
Psychological Symptoms ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Care Hospital ◽  
Behavioural And Psychological Symptoms ◽  
Prospective Longitudinal ◽  
The Impact

BACKGROUND As Virtual Reality (VR) technologies become increasingly accessible and affordable, clinicians are eager to try VR-therapy as a novel means to manage Behavioural and Psychological Symptoms of Dementia (BPSD) which are exacerbated during acute-care hospitalization, with the goal of reducing the use for antipsychotics, sedatives, and physical restraints, associated with negative side-effects, increased length of stay, and caregiver burden. To date no evaluations of immersive VR-therapy have been reported for patients with dementia in acute-care hospitals. OBJECTIVE Determine the feasibility (acceptance, comfort, safety) of using immersive VR-therapy for people living with dementia (mild, moderate, and advanced) during acute-care hospitalization, and explore its potential to manage BPSD. METHODS A prospective longitudinal pilot-study was conducted at a community teaching hospital in Toronto. Ten patients over 65 years (mean = 87) diagnosed with dementia, participated in one or more sessions of viewing immersive 360° VR-footage of nature scenes displayed on Samsung Gear-VR head-mounted-display. The mixed-methods study included patient chart review, standardized observations during intervention, and pre- and post-intervention semi-structured interviews about the VR experience. RESULTS All recruited participants completed the study. Seven out of ten participants displayed enjoyment or relaxation during a VR session, which averaged 6 minutes per viewing. One participant experienced dizziness; no interference between VR equipment and hearing aids or medical devices was reported. CONCLUSIONS It is feasible to expose older adults with various degrees of dementia admitted to an acute-care hospital, to immersive VR-therapy. This pilot provides the basis for conducting the first RCT to evaluate the impact of VR-therapy on managing BPSD in acute-care hospitals. CLINICALTRIAL Research Ethics Board ID: 748-1806-Mis-321 Clinical Trials.gov registration: NCT03941119

scholarly journals Status of Tuberculosis Infection Control Programs in Canadian Acute Care Hospitals, 1989 to 1993 – Part 1

1997 ◽  
Vol 8 (4) ◽  
pp. 188-194 ◽  
Author(s):  
Donna Holton ◽  
Shirley Paton ◽  
Helen Gibson ◽  
Geoffrey Taylor ◽  
Carol Whyman ◽  
...  
Keyword(s):  
Infection Control ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Respiratory Protection ◽  
Care Hospital ◽  
Screening Programs ◽  
Control Programs ◽  
Environmental Controls ◽  
Hospital Infection Control

OBJECTIVE: To document tuberculosis (TB) prevention and control activities in Canadian acute care hospitals from 1989 to 1993.DESIGN: Retrospective questionnaire.PARTICIPANTS: All members of the Community and Hospital Infection Control Association-Canada and l’Association des professionnels pour la prévention des infections who lived in Canada and worked in an acute care hospital received a questionnaire. One questionnaire per hospital was completed.OUTCOME: The study documented the number of respiratory TB cases admitted to the hospital, the type of engineering and environmental controls available, and the type of occupational tuberculin skin test (TST) screening programs offered by the hospital.RESULTS: Questionnaires were received from 319 hospitals. Ninety-nine (32%) hospitals did not admit a respiratory TB case during the study. Thirty-one (10%) hospitals averaged six or more TB cases per year. TST results were reported for 47,181 health care workers, and 819 (1.7%) were reported as TST converters; physicians had a significantly higher TST conversion rate than other occupational groups. Most hospitals did not have isolation rooms with air exhausted outside the building, negative air pressure and six or more air changes per hour. Surgical masks were used as respiratory protection by 74% of staff.CONCLUSIONS: Canadian hospitals can expect to admit TB patients. Participating hospitals did not meet TB engineering or environmental recommendations published in 1990 and 1991. In addition, occupational TB screening programs in 1989 to 1993 did not meet Canadian recommendations published in 1988.

A Prospective Registry on Venous Thromboembolic Events: Findings from PROVE.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1769-1769
Author(s):  
Alexander G.G. Turpie ◽  
Keyword(s):  
Acute Care ◽  
Chronic Care ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Care Hospital ◽  
Vte Prophylaxis ◽  
Patient Status ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Precipitating Factor

Abstract Introduction Venous thromboembolism (VTE) is a major health problem, especially in the elderly. A variety of intrinsic factors, acute medical illnesses and surgery have been shown to increase VTE risk. Despite this, VTE has not been adequately described in terms of clinical history, clinical risk factors and VTE prophylaxis. The objective of the Prospective Registry On Venous thromboembolic Events (PROVE) is to characterize the profile of patients with ultrasound-confirmed deep-vein thrombosis (DVT), the prior use and type of VTE prophylaxis and its relationship to demographic and comorbid factors. Methods PROVE is a multinational, multi-center, observational study. Patients were recruited during a 3 month period, beginning in February 2003, in centers possessing an ultrasound laboratory. Patients with ultrasound-confirmed DVT were consecutively enrolled. There were no exclusion criteria once DVT was diagnosed. Results Of 3527 enrolled patients in 254 centers in 19 countries (48% Asian and 52% non-Asian), data from 3508 (99%) were analyzable. Patients were: 51% male, mean age 53±18 years, mean BMI 26.0±5.1 kg/m2, 46.7% Caucasian, 47.1% Asian, 1.6% African and 4.4% other ethnicity. Patient status when DVT was diagnosed was: 59.7% home, 35.7% acute care hospital, 3.3% chronic care facility, 1.3% other. Locations of DVT were 25.0% calf only, 20.8% proximal without calf, and 58.9% proximal and calf. The incidences of idiopathic DVT, DVT following a precipitating factor, and recurrent DVT according to patient status at the time of diagnosis are shown in Table 1. Of patients who had a precipitating factor for DVT (see Table 2), 16% had received prior VTE prophylaxis. Types of VTE prophylaxis were: 53% low-molecular-weight heparin, 10% unfractionated heparin, 17% vitamin K antagonist, 29% elastic stockings, 2% venal caval filter, and 17% other. Conclusion Overall, the incidence of idiopathic DVT was similar to the incidence of DVT occurring after a precipitating event, as observed in other published studies. However, the incidence of idiopathic DVT was higher in patients at home at the time of diagnosis, while the incidence of DVT in patients with a precipitating factor was higher in acute care hospitals and chronic care facilities. The occurrence of DVT in patients who had received VTE prophylaxis may be due, at least in part, to the use of inadequate prophylaxis regimens. Table 1 Type of DVT according to patient status when DVT was diagnosed Patient status Idiopathic DVT,* n (%) DVT after a precipitating event,* n (%) Recurrent DVT,* n (%) * DVT was recorded as more than one type in some patients Home (N=2091) 1092 (52) 818 (39) 221 (11) Acute care hospital (N=1250) 396 (32) 807 (65) 74 (6) Chronic care facility (N=115) 35 (30) 64 (56) 16 (14) Other (N=45) 19 (42) 24 (53) 3 (7) Total 1542 (44) 1713 (49) 314 (9) Table 2 VTE prophylaxis received by patients with a precipitating factor for DVT (N=1715) Precipitating factor for DVT Patients with precipitating factor, n (%) Patients who had received VTE prophylaxis, n (%) Acute medical condition 775 (45) 92 (12) Surgery 498 (29) 124 (25) Trauma without surgery 239 (14) 44 (18) Pregnancy/postpartum 158 (5) 10 (6) Long airplane travel 56 (2) 3 (5)

scholarly journals When do Physicians and Nurses Start Communication about Advance Care Planning? A Qualitative Study at an Acute Care Hospital in Japan

2020 ◽  
Vol 12 (3) ◽  
pp. 289-305 ◽  
Author(s):  
Mari Tsuruwaka ◽  
Yoshiko Ikeguchi ◽  
Megumi Nakamura
Keyword(s):  
Qualitative Study ◽  
Acute Care ◽  
Advance Care Planning ◽  
Healthcare Professionals ◽  
Medical Condition ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Care Planning ◽  
Care Hospital ◽  
Advance Care

Abstract Although advance care planning (ACP) can lead to more patient-centered care, the communication around it can be challenging in acute care hospitals, where saving a life or shortening hospitalization is important priorities. Our qualitative study in an acute care hospital in Japan revealed when specifically physicians and nurses start communication to facilitate ACP. Seven physicians and 19 nurses responded to an interview request, explaining when ACP communication was initiated with 32 patients aged 65 or older. Our qualitative approach employed descriptive analysis to identify major themes, which included “initiation by patients” and “initiation by healthcare professionals.” In the latter case, seven specific triggers were identified: (1) when the patients’ medical condition changed in terms of symptom relief, (2) when the patients’ medical condition changed in terms of prognostic prediction, (3) when serious events occurred, (4) when a choice of treatment was presented, (5) when the location for end-of-life care was chosen, (6) when the patients’ cognitive function deteriorated, and (7) when serious events settled down. Within this group of healthcare professionals, physicians were more focused on changes in their patients’ medical condition, whereas nurses focused more on their patients’ desire for a long-term perspective. Nurses encouraged patients to consider ACP themselves, which developed into an approach to respect patients’ autonomy. In acute care hospitals, it appeared to be desirable to have an early discussion where patients could understand the significance ACP, which would matter even after their discharge from the hospital.

Sign in / Sign up

Export Citation Format

Share Document