scholarly journals Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery

2020 ◽  
Author(s):  
laura Allum ◽  
Chloe Apps ◽  
Nicholas Hart ◽  
Natalie Pattison ◽  
Bronwen Connolly ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Care Delivery ◽  
Cochrane Library ◽  
Future Research ◽  
Care Plans ◽  
Icu Stay ◽  
Structured Care ◽  
High Dependency ◽  
Prolonged Icu Stay

Abstract Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety, however these tools have not been designed for the specific needs of patients with prolonged ICU stay. The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice. Methods: We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational, and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings. Discussion: The findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research.Systematic Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE

scholarly journals Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery

2020 ◽  
Author(s):  
laura Allum ◽  
Chloe Apps ◽  
Nicholas Hart ◽  
Natalie Pattison ◽  
Bronwen Connolly ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Care Delivery ◽  
Cochrane Library ◽  
Future Research ◽  
Care Plans ◽  
Icu Stay ◽  
Structured Care ◽  
High Dependency ◽  
Prolonged Icu Stay

Abstract Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety, however these tools have not been designed for the specific needs of patients with prolonged ICU stay. Objectives: The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice. Methods: We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational, and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings. Discussion: The findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research.Systematic Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE

scholarly journals Standardising care in the ICU: a protocol for a scoping review of tools used to improve care delivery

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Laura Allum ◽  
Chloe Apps ◽  
Nicholas Hart ◽  
Natalie Pattison ◽  
Bronwen Connolly ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Care Delivery ◽  
Cochrane Library ◽  
Care Plans ◽  
Link Type ◽  
Icu Stay ◽  
Structured Care ◽  
High Dependency ◽  
Prolonged Icu Stay

Abstract Background Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety; however, these tools have not been designed for the specific needs of patients with prolonged ICU stay. The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice. Methods We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings. Discussion The findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research. Systematic review registration This protocol is registered on the Open Science Framework, https://osf.io/, DOI 10.17605/OSF.IO/Z8MRE

scholarly journals Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery

2019 ◽  
Author(s):  
laura Allum ◽  
Chloe Apps ◽  
Nicholas Hart ◽  
Natalie Pattison ◽  
Bronwen Connolly ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Delivery ◽  
Data Extraction ◽  
Healthcare Providers ◽  
Cochrane Library ◽  
Care Plans ◽  
Icu Stay ◽  
Structured Care ◽  
High Dependency ◽  
Prolonged Icu Stay

Abstract Background: Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families, and cost to health systems. Healthcare providers report dissatisfaction with provision of care for these longer stay patients due to competing demands from higher acuity patients. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety. However, these tools have not been designed for the specific needs of patients with prolonged ICU stay. The objective of this review is to generate data to inform development and implementation of quality improvement tools for patients with prolonged ICU stay, namely: the content, design and effect of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to understand how these tools were developed and implemented in clinical practice.Methods: We will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from 1999 to August 2019. We will include primary research studies recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement measures such as structured care plans or checklists designed to standardize more than one aspect of care delivery. Two authors will independently screen citations for eligible studies and perform data extraction. We will use a narrative synthesis to describe review findings.Discussion: The findings will be used to guide development of tools for use with prolonged ICU stay. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools for patients with prolonged ICU stay. Such tools are needed to standardise practice and thereby improve quality of care for patients with prolonged ICU stay and their families. Illustrating the development and implementation methods used for such tools will help to guide translation for similar tools in ICU and future research.Systematic Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/ , DOI 10.17605/OSF.IO/Z8MRE

scholarly journals Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery

2018 ◽  
Vol 36 (20) ◽  
pp. 2088-2100 ◽  
Author(s):  
Paul B. Jacobsen ◽  
Antonio P. DeRosa ◽  
Tara O. Henderson ◽  
Deborah K. Mayer ◽  
Chaya S. Moskowitz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Outcomes ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Cochrane Library ◽  
Survivorship Care Plan ◽  
Satisfaction With Care ◽  
Survivorship Care ◽  
Care Plans

Purpose Numerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers’ concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors. Methods Randomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis. Results Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care. Conclusion Existing research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.

scholarly journals Reporting of exercise descriptors and variables in resistance training interventions for lower limb tendinopathy: Protocol for a scoping review applying the Consensus on Exercise Reporting Template and Toigo and Boutellier Framework.

2021 ◽  
Author(s):  
Ian Burton
Keyword(s):  
Clinical Practice ◽  
Resistance Training ◽  
Scoping Review ◽  
Lower Limb ◽  
Evidence Synthesis ◽  
Cochrane Library ◽  
Future Research ◽  
Exercise Interventions ◽  
Training Interventions ◽  
Current Resistance

Introduction: Musculoskeletal disorders have a significant global burden, with tendinopathies of the lower limb having a high prevalence. Although the use of resistance training interventions as treatment for tendinopathies has become widespread, the reporting and description of these interventions is often poor, preventing translation to clinical practice. Specific exercise description and intervention variables must be reported in order to translate research findings into clinical practice. This scoping review aims to summarise reporting of current resistance training interventions as assessed by the Consensus on Exercise Reporting Template and Toigo and Boutellier Framework.Methods and analysis: The recommended methodological framework described by the Joanna Briggs Institute will be used to structure this review, with reporting in accordance with the PRISMA-ScR. Databases to be searched include MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), JBI Evidence Synthesis, and five trial registries. Two independent reviewers will screen studies at title/abstract and full text. Following screening, data will be extracted and charted, then presented as figures and table alongside a narrative synthesis. Dissemination: This scoping review will evaluate current resistance training exercise descriptors and program variables in lower limb tendinopathy using recommended frameworks for the first time in the literature. The results will allow dissemination of the parameters of research exercise interventions to clinical practitioners through peer-reviewed publication and social media outlets, allowing implementation in clinical practice. The review will also outline future research and exercise reporting needs within tendinopathy resistance training interventions.

Providers' concordance with survivorship clinical algorithms.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20645-e20645
Author(s):  
Frances Ann Zandstra ◽  
Guadalupe R. Palos ◽  
Ludivine Russell ◽  
Katherine R. Gilmore ◽  
Jacklyn J. Flores ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Disease Surveillance ◽  
Clinical Care ◽  
Future Research ◽  
X Rays ◽  
Care Plans ◽  
Minimum Standards ◽  
Life Style Changes ◽  
Late Treatment ◽  
The Impact

e20645 Background: The utility of algorithms to guide clinical practice related to long-term survivorship care is unclear. In 2012, lymphoma survivorship algorithms for Hodgkin’s and Large B-Cell were developed as part of an institutional clinical practice initiative to enhance survivors’ outcomes. Here we describe providers’ concordance with minimum standards recommended in survivorship lymphoma algorithms. Methods: Concordance, the primary outcome, was defined as whether minimum recommendations, summarized in lymphoma algorithms, were provided during a survivorship visit. Concordance was measured using a “yes/no” response format assessing whether a provider’s recommendations were consistent with algorithms’ minimum standards including: 1) physical examination, 2) laboratory and imaging testing, 3) cancer screening procedures, and 4) health promotion education. Data were abstracted from electronic medical records and Passports (summary care plans). Secondary outcomes were number of survivors seen and Passports issued. All data included in these analyses were de-identified. Results: From 05/01 to 09/30/2012, all 63 survivors seen in the Lymphoma Survivorship Clinic received a Passport. Providers individualized Passports based on a survivor’s needs relevant to disease surveillance, life-style changes, screening recommendations, and specific procedures to assess for a recurrence or late treatment effects. Results indicated 100% of survivors received a physical exam, adult vaccinations, and cardiovascular screening. Similar rates were achieved for CBC testing, chest X-rays, assessing survivors’ psychosocial distress, and counseling survivors on screening recommendations specific to breast, cervical, colorectal and prostate cancers. Additionally, rates for skin exam recommendations were 97%. Conclusions: Based on concordance results, providers met the minimum recommendations listed in the lymphoma algorithms. Future research is needed to assess the impact of providers’ use of algorithms on survivors’ outcomes and feasibility of replicating concordance analyses in other clinical care settings.

Self-management, self-management support needs and interventions in advanced cancer: a scoping review

2018 ◽  
Vol 9 (1) ◽  
pp. 12-25 ◽  
Author(s):  
Suman Budhwani ◽  
Walter P Wodchis ◽  
Camilla Zimmermann ◽  
Rahim Moineddin ◽  
Doris Howell
Keyword(s):  
Advanced Cancer ◽  
Scoping Review ◽  
Patient Population ◽  
Care Delivery ◽  
Models Of Care ◽  
Self Management ◽  
Cochrane Library ◽  
Future Research ◽  
Management Support ◽  
Wide Range

Patients with advanced cancer can experience illness trajectories similar to other progressive chronic disease conditions where undertaking self-management (SM) and provision of self-management support (SMS) becomes important. The main objectives of this study were to map the literature of SM strategies and SMS needs of patients with advanced cancer and to describe SMS interventions tested in this patient population. A scoping review of all literature published between 2002 and 2016 was conducted. A total of 11 094 articles were generated for screening from MEDLINE, Embase, PsychINFO, CINAHL and Cochrane Library databases. A final 55 articles were extracted for inclusion in the review. Included studies identified a wide variety of SM behaviours used by patients with advanced cancer including controlling and coping with the physical components of the disease and facilitating emotional and psychosocial adjustments to a life-limiting illness. Studies also described a wide range of SMS needs, SMS interventions and their effectiveness in this patient population. Findings suggest that SMS interventions addressing SMS needs should be based on a sound understanding of the core skills required for effective SM and theoretical and conceptual frameworks. Future research should examine how a patient-oriented SMS approach can be incorporated into existing models of care delivery and the effects of SMS on quality of life and health system utilisation in this population.

Providers' concordance with survivorship clinical algorithms.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 243-243
Author(s):  
Frances Ann Zandstra ◽  
Guadalupe R. Palos ◽  
Ludivine Russell ◽  
Katherine Ramsey Gilmore ◽  
Jacklyn J. Flores ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Disease Surveillance ◽  
Clinical Care ◽  
Future Research ◽  
X Rays ◽  
Care Plans ◽  
Minimum Standards ◽  
Life Style Changes ◽  
Late Treatment ◽  
The Impact

243 Background: The utility of algorithms to guide clinical practice related to long-term survivorship care is unclear. In 2012, lymphoma survivorship algorithms for Hodgkin’s and Large B-Cell were developed as part of an institutional clinical practice initiative to enhance survivors’ outcomes. Here we describe providers’ concordance with minimum standards recommended in the survivorship lymphoma algorithm. Methods: Concordance, the primary outcome, was defined as whether minimum recommendations, summarized in the lymphoma algorithms, were provided during a survivorship visit. Concordance was measured using a “yes/no” response format assessing whether a provider’s recommendations were consistent with algorithms’ minimum standards including: 1) physical examination, 2) laboratory and imaging testing, 3) cancer screening procedures, and 4) health promotion education. Data were abstracted from electronic medical records and Passports (summary care plans). Secondary outcomes were number of survivors seen and Passports issued. All data included in these analyses were de-identified. Results: 63 survivors were seen in the Lymphoma Survivorship Clinic from 05/01 to 09/30/2012 and all received Passports. A provider tailored the plan to each survivor’s needs and counseled the individual on disease surveillance, life-style changes, screening recommendations, and specific procedures to assess for recurrence/late treatment effects. Results indicated 100% of survivors received a physical exam, including cardiovascular screening. Similar rates were also achieved for CBC testing, chest X-rays, and counseling survivors on screening recommendations relevant to: breast, cervical, colorectal and prostate cancers. Other counseling rates included 97% for skin exam recommendations and 100% for maintaining adult vaccinations. Finally, providers’ concordance with assessment of survivors’ psychosocial distress was 100%. Conclusions: Based on concordance results, providers met the minimum recommendations listed in the lymphoma algorithms. Future research is needed to assess the impact of providers’ use of algorithms on survivors’ outcomes and feasibility of replicating concordance analyses in other clinical care settings.

scholarly journals Care Coordination of Multimorbidity: A Scoping Study

2015 ◽  
Vol 5 (1) ◽  
pp. 15-28 ◽  
Author(s):  
Anne Doessing ◽  
Viola Burau
Keyword(s):  
Care Coordination ◽  
Healthcare Professionals ◽  
Care Delivery ◽  
Cochrane Library ◽  
Future Research ◽  
Scoping Study ◽  
Hand Search ◽  
Qualitative Thematic Analysis ◽  
Number Of Patients ◽  
Wide Range

Background A key challenge in healthcare systems worldwide is the large number of patients who suffer from multimorbidity; despite this, most systems are organized within a single-disease framework. Objective The present study addresses two issues: the characteristics and preconditions of care coordination for patients with multimorbidity; and the factors that promote or inhibit care coordination at the levels of provider organizations and healthcare professionals. Design The analysis is based on a scoping study, which combines a systematic literature search with a qualitative thematic analysis. The search was conducted in November 2013 and included the PubMed, CINAHL, and Web of Science databases, as well as the Cochrane Library, websites of relevant organizations and a hand-search of reference lists. The analysis included studies with a wide range of designs, from industrialized countries, in English, German and the Scandinavian languages, which focused on both multimorbidity/comorbidity and coordination of integrated care. Results The analysis included 47 of the 226 identified studies. The central theme emerging was complexity. This related to both specific medical conditions of patients with multimorbidity (case complexity) and the organization of care delivery at the levels of provider organizations and healthcare professionals (care complexity). Conclusions In terms of how to approach care coordination, one approach is to reduce complexity and the other is to embrace complexity. Either way, future research must take a more explicit stance on complexity and also gain a better understanding of the role of professionals as a prerequisite for the development of new care coordination interventions.

Impact of cancer survivorship care plans (SCPs) on health outcomes and health care delivery: A systematic review.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 2-2 ◽  
Author(s):  
Paul B. Jacobsen ◽  
Antonio P. Derosa ◽  
Tara O. Henderson ◽  
Deborah Mayer ◽  
Chaya S. Moskowitz ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Care Delivery ◽  
Well Being ◽  
Cochrane Library ◽  
Satisfaction With Care ◽  
Survivorship Care ◽  
Care Plans ◽  
Randomized Studies ◽  
Patient Reported ◽  
The Impact

2 Background: In 2006, the Institute of Medicine recommended that patients at or near completion of active treatment be provided with a SCP (treatment summary, relevant health information, and follow-up care plan) to improve care delivery and outcomes in the post-treatment period. We systematically reviewed published research to determine if SCPs have a positive impact on health outcomes and healthcare delivery. Methods: Randomized and nonrandomized studies evaluating patient-reported outcomes, healthcare utilization, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, and Cochrane Library. Data were extracted by independent raters and summarized based on qualitative synthesis. Results: Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer diagnoses, timing of SCP delivery in relation to treatment completion, SCP delivery method and recipients, SCP content, SCP-related counseling, and outcomes assessed. Findings from nonrandomized studies yielded descriptive information only on outcomes such as satisfaction with care and reactions to SCPs. Among randomized studies, findings were near uniformly negative for the impact of SCPs on the most commonly assessed outcomes (physical, functional, and psychological well-being); findings were positive in single studies for other outcomes including amount of information received, satisfaction with care, and physician implementation of recommended survivorship care. Conclusions: Existing research provides minimal evidence that SCPs improve quality of life in cancer survivors. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal health outcomes. Findings are very limited but more positive for proximal outcomes (e.g., information received) and for care delivery, especially when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. In light of current findings, future research should focus to a greater extent on evaluating ways to ensure SCP recommendations are subsequently implemented as part of ongoing care.

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