Staff perceptions of emergency and home-care telemedicine

1998 ◽  
Vol 4 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Risa P Hayes ◽  
Erin B Duffey ◽  
Jeffrey Dunbar ◽  
John W Wages ◽  
Stephen E Holbrook
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Patient Care ◽  
Pilot Trial ◽  
Health Agency ◽  
Home Health ◽  
Emergency Setting ◽  
Urban Hospital ◽  
Telemedicine System ◽  
System Utilization

The utilization of a low-bandwidth telemedicine system for emergency and for home-care patients was studied in a pilot trial. The emergency setting was the emergency department of a small urban hospital and its emergency medical service EMS ; the home-care setting was the home-health agency affiliated to the hospital. Utilization data were obtained through baseline and follow-up interviews with EMS technicians, emergency department and home-health nurses, and the project coordinator. The results indicated that initial enthusiasm for the use of the telemedicine system was not followed by a commitment to the system's utilization during the trial by the relevant administrations. Barriers to optimum utilization were identified, but the actual value of the system to patient care could not be determined. We conclude that the value of a telemedicine system to patient care cannot be realized unless there is an organizational commitment from the top to system utilization.

Home Health Agency Factors Associated With Acute Care Hospitalization and Emergency Department Use

2020 ◽  
Vol 38 (2) ◽  
pp. 92-97
Author(s):  
Zainab Toteh Osakwe ◽  
Olukayode Ayodeji Sosina ◽  
Ngozichukwuka Agu ◽  
Rose Saint Fleur-Calixte
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Health Agency ◽  
Home Health ◽  
Emergency Department Use ◽  
Factors Associated ◽  
Home Health Agency

OCM community oncology palliative care program: Sites of patient care in last 180 days before hospice or death by cancer types.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 69-69
Author(s):  
Adil Jamal Akhtar ◽  
Karna Sheth ◽  
Jeffrey H. Margolis ◽  
Karma Maxwell ◽  
Tammy Scott-Barney ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Patient Care ◽  
Care Setting ◽  
Care Home ◽  
Health Agency ◽  
Home Health ◽  
Average Difference ◽  
Community Oncology ◽  
At Home

69 Background: Michigan Health Professionals (MHP) participates in Oncology Care Model (OCM). A community oncology program for early and timely involvement of palliative care (PC) was launched in 2017 to achieve OCM goals of high quality, cost-effective, coordinated care. Previously, we showed that early enrollment in PC increased hospice utilization, decreased hospitalization and outpatient facility cost in last 30-days of death or end of OCM episode. PC improved quality of care in OCM patients. This study aims to see the effect of PC by patient care setting in the last 180-days before hospice or death. Methods: Retrospective claims review was performed with PC patients referred from September 2017 – December 2018. Last 180-days was defined by the entry into hospice, patient death, or OCM claim limit (12/31/2018), whichever was first to occur. OCM claims were analyzed by Integra Connect. Patient care setting utilization, in days (LOS), was identified for FACILITY: inpatient, skilled nursing, outpatient facility (ER, observation, etc.), physician office, and HOME HEALTH: home health agency visits. When no claim was found within the last 180-days, the patient was assumed to be at home or with no-care (HOME). Results: PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH care settings and more days at HOME vs PC declined or unable to reach (average difference of 14 days). PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH vs. matched PC-not referred patients who died or entered hospice (average difference of 26 days). In lung cancer, PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH vs. PC declined or unable to reach (average difference of 27 days). In pancreatic cancer, PC-Engaged patients had lower LOS in FACILITY + HOME HEALTH vs. PC declined or unable to reach (average difference of 17 days). Conclusions: Patients who are PC-Engaged spent more time at home and less time in facilities over the last 6 months before end-of-life. Patients who were referred to PC with advanced lung and pancreatic cancer showed the most opportunity for impact with PC engagement. Study was limited by OCM claims available as of June 2019. Results may be refreshed as more data becomes available.

Point of Care Technology: A Sociotechnical Approach to Home Health Implementation

2003 ◽  
Vol 42 (04) ◽  
pp. 463-470 ◽  
Author(s):  
C. M. Struk ◽  
M. L. V. Stricklin
Keyword(s):  
Home Care ◽  
Point Of Care ◽  
Management Strategies ◽  
Health Agency ◽  
Clinical Work ◽  
Evaluation Study ◽  
User Acceptance ◽  
Home Health ◽  
Factors Associated ◽  
Care Technology

Summary Objectives: This paper describes an ongoing evaluation study of the design and implementation of Point of Care (POC) technology in a home health agency. Methods: During the implementation of POC technology data about user acceptance were collected with the help of surveys and statistically analyzed. The survey also allowed for entering non-structured observations. A time series study was conducted to identify factors associated with technology change and its effect on professional competency. Results and Conclusions: Healthcare markets and consumers are demanding that providers use sophisticated information technology to document, transmit and access clinical and financial information across all delivery points. Newly adapted Patient Care Information Systems (PCIS) are available for clinical use in home care. The factors associated with home care nurses’ end user acceptance and use of the POC technology in clinical work are described. A sociotechnical approach with selected change management strategies appears to have positively influenced the nurse end users’ POC technology adoption and use in clinical work.

The Use and Effectiveness of Assistive Devices Possessed by Patients Seen in Home Care

1987 ◽  
Vol 7 (3) ◽  
pp. 181-191 ◽  
Author(s):  
Harriett S. Bynum ◽  
Joan C. Rogers
Keyword(s):  
Home Care ◽  
Medical Condition ◽  
Health Agency ◽  
Home Care Services ◽  
Home Health ◽  
Assistive Devices ◽  
Functional Improvement ◽  
Home Health Agency ◽  
Care Services ◽  
Common Medical Condition

The use and effectiveness of 54 selected assistive devices were studied in 30 recipients of home care services. Of these 54 devices, 82% were used and 69% were used routinely for the intended purpose. Twenty patients had bedside commodes and nine had bathtub benches or shower chairs. Only a few patients had long-handled shoe horns, reachers, raised toilet seats, sock aids, elastic shoelaces, commode armrests, or long-handled scrub sponges. No patient had a rocker knife, even though stroke was the most common medical condition. Device training, done inconsistently, generally took 30 minutes or less, spanned 1 to 2 sessions, occurred within 6 months of impairment or 1 year after onset, was carried out by a home health agency, and was judged adequate by the patient. Family members were as apt as not to be included in the training. No association was discerned between training and usage or timing of training in relation to length of impairment and usage. A substantive amount of human help was needed to complete the tasks involving the device. Device disuse was attributed to functional improvement, misprescription, and ineffectiveness.

scholarly journals Regular Home Health Care Visits Reduce Health Expenditure Among Home Care Patients: A Retrospective Cohort Study in a Community Hospital in Northern Taiwan

2021 ◽  
Author(s):  
Tzu-Jung Chou ◽  
Jen-Kuei Peng ◽  
You-Ling Chen ◽  
Hao-Hsiang Chang ◽  
Yi-Hsuan Lee ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cohort Study ◽  
Home Care ◽  
Home Health Care ◽  
Outpatient Clinic ◽  
Health Expenditure ◽  
Patient Characteristics ◽  
Home Health ◽  
Total Health Expenditure

Abstract Background: In response to the rapidly aging population with anticipated growth of chronic disabling diseases, the National Health Insurance program in Taiwan has established home health care services since 1995. Medically and functionally compromised elders with multiple chronic conditions, tend to have increased need for home health care (HHC) and higher medical costs. Our study aimed to identify health expenditure and its influencing factors among home care patients and to clarify whether regular HHC visits reduce health expenditure.Methods: A retrospective observational cohort study on individuals receiving HHC was conducted at National Taiwan University Hospital Bei-Hu Branch from 2010 to 2015. Patients aged < 20 years, did not receive HHC for at least 6 months, or did not receive regular hospital care at our healthcare system were excluded. The patient characteristics, health service utilization, and health expenditure were collected. Total health expenditure was defined as the sum of outpatient clinic, emergency department and hospitalization cost. Considering the distribution of costs data was highly skewed, a generalized linear model was applied to estimate the impact patient factors on healthcare expenditure.Results: A total of 1,285 home care patients, mean age 79.4±12.9 years and males 50.9%, were enrolled. The majority (85%) of the study population were totally dependent in daily activities with Barthel index 0-20, and had Charlson comorbidity index score≥4. The median monthly total expenditure per person was US$737 (IQR, 229-1,935), which broke down to US$414 (IQR,56-1,234) for hospitalization, US$170 (IQR,73-369) for outpatient clinic, and US$60 (IQR, 9-150) for emergency department. Home care patients with higher need for nursing services utilization (p<0.05), indwelling tracheostomy tube (p<0.05), underlying neoplasm (p<0.05), or registry of catastrophic illness certificate (p<0.001), had higher health expenditure. On the other hand, regular HHC visits significantly lowered total health expenditure (p<0.001).Conclusions: Patient characteristics that incurred higher health expenditure were identified, whereas regular HHC visits have a potential role to reduce expenditure in the disabled homebound population. The visit number and frequency of HHC should be taken into account when making reimbursement policy in order to provide a sustainable and cost-effective HHC program.

Clinical approbation of remote monitoring in treatment of patients in hospital and home care for patients with limited mobility

2020 ◽  
pp. 44-49
Author(s):  
A. A. Eryomenko ◽  
N. V. Rostunova ◽  
S. A. Budagyan ◽  
L. S. Sorokina
Keyword(s):  
High Risk ◽  
Home Care ◽  
Remote Monitoring ◽  
Emergency Situation ◽  
Home Treatment ◽  
Clinical Testing ◽  
Telemedicine System ◽  
Medical Supervision ◽  
Limited Mobility

The article describes the experience of clinical testing of the personal telemedicine system (PTS) ‘Obereg’ for remote monitoring of patients with the consequences of severe conditions in leading Russian clinics. It is shown that such patients are at high risk of complications when transferred from the ICU to a normal ward with limited medical supervision and lack of instrumentation. The use of remote monitoring using the personal telemedicine system ‘Obereg’ allows to solve this problem. The results of the use of PTS ‘Obereg’ for the organization of monitoring in the home patronage of patients with limited mobility are presented. It is indicated that such devices should be used in an emergency situation similar to a coronavirus pandemic to monitor patients who are in infectious boxes and on home treatment.

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

2020 ◽  
Vol 51 (4) ◽  
pp. 550-570
Author(s):  
Cindy Luu ◽  
Thomas B. Talbot ◽  
Cha Chi Fung ◽  
Eyal Ben-Isaac ◽  
Juan Espinoza ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Patient Care ◽  
Skill Acquisition ◽  
Video Game ◽  
Rank Correlation ◽  
Fixed Time ◽  
Serious Game ◽  
Cross Sectional ◽  
Number Of Patients

Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.

Occupational Exposures in the Homecare Environment: Piloting an Observation Tool

2021 ◽  
pp. 108482232098691
Author(s):  
Elizabeth Bien ◽  
Kermit Davis ◽  
Susan Reutman ◽  
Gordon Gillespie
Keyword(s):  
Home Care ◽  
Patient Care ◽  
Occupational Safety ◽  
Occupational Exposures ◽  
Care Patient ◽  
Home Healthcare ◽  
Occupational Hazards ◽  
Cross Sectional ◽  
Direct Observations ◽  
Occupational Setting

The population of home healthcare workers (HHCWs) is rapidly expanding. Worker tasks and the unique home care environments place the worker at increased risks of occupational exposures, injury, and illness. Previous studies focusing on occupational exposures of HHCWs are limited to self-reports and would benefit from direct observations. The purpose of this study is to describe the occupational hazards observed in the unique work environment of home healthcare. HHCWs and home care patient participants were recruited from one home care agency in the Midwest to be observed during a routine home visit. This cross-sectional study used a trained occupational health nurse for direct observation of the occupational setting. Standardized observations and data collection were completed using the Home Healthcare Worker Observation Tool. The observer followed a registered nurse and occupational therapist into 9 patient homes observing visits ranging from 22 to 58 minutes. Hazards observed outside of and within the home include uneven pavements (n = 6, 67%), stairs without railings (n = 2, 22%), throw rugs (n = 7, 78%), unrestrained animals (n = 2, 22%), dust (n = 5, 56%), and mold (n = 2, 22%). Hand hygiene was observed prior to patient care 2 times (22%) and after patient care during 5 visits (56%). Observations have identified hazards that have the potential to impact workers’ and patients’ health. The direct observations of HHCWs provided opportunities for occupational safety professionals to understand the occupational exposures and challenges HHCWs encounter in the home care environment and begin to identify ways to mitigate occupational hazards.

scholarly journals Adolescents’ pain and distress during peripheral intravenous cannulation in a paediatric emergency setting

2021 ◽  
Author(s):  
Giorgio Cozzi ◽  
Marta Cognigni ◽  
Riccardo Busatto ◽  
Veronica Grigoletto ◽  
Manuela Giangreco ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Relief ◽  
Local Anaesthesia ◽  
Cross Sectional Study ◽  
Emergency Setting ◽  
Older Children ◽  
Cross Sectional ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Significant Difference

AbstractThe objective of the study is to investigate pain and distress experienced by a group of adolescents and children during peripheral intravenous cannulation in a paediatric emergency department. This cross-sectional study was performed between November 2019 and June 2020 at the paediatric emergency department of the Institute for Maternal and Child Health of Trieste, Italy. Eligible subjects were patients between 4 and 17 years old undergoing intravenous cannulation, split into three groups based on their age: adolescents (13–17 years), older children (8–12 years), and younger children (4–7 years). Procedural distress and pain scores were recorded through validated scales. Data on the use of topical anaesthesia, distraction techniques, and physical or verbal comfort during procedures were also collected. We recruited 136 patients: 63 adolescents, 48 older children, and 25 younger children. There was no statistically significant difference in the median self-reported procedural pain found in adolescents (4; IQR = 2–6) versus older and younger children (5; IQR = 2–8 and 6; IQR = 2–8, respectively). Furthermore, no significant difference was observed in the rate of distress between adolescents (79.4%), older (89.6%), and younger (92.0%) children. Adolescents received significantly fewer pain relief techniques.Conclusion: This study shows that adolescents experience similar pain and pre-procedural distress as younger children during peripheral intravenous cannulation. What is Known:• Topical and local anaesthesia, physical and verbal comfort, and distraction are useful interventions for pain and anxiety management during intravenous cannulation in paediatric settings. • No data is available on pain and distress experienced by adolescents in the specific setting of the emergency department. What is New:• Adolescents experienced high levels of pre-procedural distress in most cases and similar levels of pain and distress when compared to younger patients• The number of pain relief techniques employed during procedures was inversely proportional to patient’s age, topical or local anaesthesia were rarely used

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