Implementation of an emergency department–based clinical pharmacist transitions-of-care program

2016 ◽  
Vol 73 (15) ◽  
pp. 1180-1187 ◽  
Author(s):  
Elizabeth Hohner ◽  
Melinda Ortmann ◽  
Umbreen Murtaza ◽  
Sheeva Chopra ◽  
Patricia A. Ross ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ambulatory Care ◽  
Clinical Pharmacist ◽  
Intervention Program ◽  
Transitions Of Care ◽  
Patient Specific ◽  
Chronic Obstructive ◽  
Ambulatory Care Setting ◽  
Home Based

Abstract Purpose The implementation of an emergency department (ED)–based clinical pharmacist transitions-of-care (TOC) program is described. Summary The intervention program consisted of collaboration between ED and ambulatory care pharmacists to provide patient-specific comprehensive medication review and education in the ED setting and to help ensure a coordinated transition to the ambulatory care setting by scheduling an ambulatory pharmacy clinic or home-based visit. Patients who sought care at an adult ED for an exacerbation of asthma, chronic obstructive pulmonary disease (COPD), or congestive heart failure (CHF) were assessed for issues with medication adherence or administration technique, patient-specific concerns regarding medication use, access to medications at discharge, the need for modification of chronic therapy, contraindicated medications, and vaccination status, if applicable. The pharmacist then referred the patient to follow up in an ambulatory care pharmacy clinic or with the home-based medication management (HBMM) program. Of the 18 program participants who were referred to follow-up care, 5 successfully followed up with a pharmacist after ED discharge. The mean time from the ED visit to follow-up for these 5 patients was 16.6 ± 8.6 days. In addition, 5 patients followed up with their primary care provider within 30 days of the initial ED visit; 2 of these patients also followed up with a pharmacist. Within 30 days of the initial ED encounter, 4 patients had ED revisits. Conclusion A TOC pharmacist-led program targeting patients who arrived at the ED with the chief complaint of asthma exacerbation, COPD, or CHF provided interventions from an ED or ambulatory care pharmacist as well as follow-up opportunities at outpatient clinics or an HBMM program.

Tracking the Rise of Geriatric Emergency Departments in the United States

2018 ◽  
Vol 39 (8) ◽  
pp. 871-879 ◽  
Author(s):  
John G. Schumacher ◽  
Jon Mark Hirshon ◽  
Phillip Magidson ◽  
Marilyn Chrisman ◽  
Terisita Hogan
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Emergency Departments ◽  
The United States ◽  
Transitions Of Care ◽  
Emergency Department Care ◽  
Equipment And Supplies ◽  
Care Services ◽  
Physical Environments

The traditional model of emergency care no longer fits the growing needs of the over 20 million older adults annually seeking emergency department care. In 2007 a tailored “geriatric emergency department” model was introduced and rapidly replicated among hospitals, rising steeply over the past 5 years. This survey examined all U.S. emergency departments self-identifying themselves as Geriatric Emergency Departments (GEDs) and providing enhanced geriatric emergency care services. It was guided by the recently adopted Geriatric Emergency Department Guidelines and examined domains including, GED identity, staffing, and administration; education, equipment, and supplies; policies, procedures, and protocols; follow-up and transitions of care; and quality improvement. Results reveal a heterogeneous mix of GED staffing, procedures, physical environments and that GEDs’ familiarity with the GED Guidelines is low. Findings will inform emergency departments and gerontologists nationwide about key GED model elements and will help hospitals to improve ED services for their older adult patients.

Low-Income Senior Housing Residents’ Emergency Department Use and Care Transition Problems

2017 ◽  
Vol 31 (6) ◽  
pp. 610-616 ◽  
Author(s):  
Antoinette B. Coe ◽  
Leticia R. Moczygemba ◽  
Kelechi C. Ogbonna ◽  
Pamela L. Parsons ◽  
Patricia W. Slattum ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Personal Health Record ◽  
Primary Care Providers ◽  
Adverse Outcomes ◽  
Transitions Of Care ◽  
Care Providers ◽  
Senior Housing ◽  
Follow Up Care

Older adults may be at risk of adverse outcomes after emergency department (ED) visits due to ineffective transitions of care. Semi-structured interviews were employed to identify and categorize reasons for ED use and problems that occur during transition from the ED back to home among 14 residents of low-income senior housing. Qualitative thematic and descriptive analyses were used. Ambulance use, timely ED use or a wait-and-see approach, and lack of health-care provider contact before ED visit were emergent themes. Delayed medication receipt, no current medication list, and medication knowledge gaps were identified. Lack of a personal health record, follow-up care instruction, and worsening symptoms education emerged as transition problems from ED to home. After an ED visit, education opportunities exist around seeing primary care providers for nonurgent conditions, follow-up care, medications, and worsening condition symptoms. Timely receipt of discharge medications and medication education may improve medication-related transition problems.

Pharmacy Services in a Hypertension Clinic

1992 ◽  
Vol 5 (1) ◽  
pp. 7-11
Author(s):  
Douglas F. Covey ◽  
Diane D. Shackelford ◽  
Wallace E. Geck
Keyword(s):  
Quality Assurance ◽  
Ambulatory Care ◽  
Nurse Practitioner ◽  
Clinical Pharmacist ◽  
Care Setting ◽  
Outpatient Setting ◽  
Pharmacy Services ◽  
Ambulatory Care Setting ◽  
Hypertension Clinic

Roles for pharmacists are evolving rapidly in the ambulatory care setting. This is primarily due to increasing inpatient costs with a resultant shifting of costs to the outpatient section. This shift has subsequently presented larger numbers of patients and sicker patients to the outpatient setting. This article describes the involvement of a clinical pharmacist in a multidisciplinary hypertension clinic. Detailed are the procedures used to evaluate a patient from consult to discharge, and the responsibilities of the clinical pharmacist, the clinic physician, and the nurse practitioner are reviewed. Finally, methods of documentation and quality assurance are outlined.

Evaluation of Early Versus Late Postdischarge Medication Reconciliation on Readmission Rates and Emergency Department Visits

2017 ◽  
Vol 31 (3) ◽  
pp. 279-283 ◽  
Author(s):  
Tina Joseph ◽  
Rebecca A. Barros ◽  
Elise Kim ◽  
Bupendra Shah
Keyword(s):  
Emergency Department ◽  
Clinical Pharmacist ◽  
Medication Reconciliation ◽  
Emergency Department Visits ◽  
Optimal Timing ◽  
Significant Difference ◽  
The Impact ◽  
Late Group ◽  
Hospital Use

Background: The current literature speculates ideal postdischarge follow-up focusing on transitions from hospital to home can range anywhere between 48 hours and 2 weeks. However, there is a lack of evidence regarding the optimal timing of follow-up visit to prevent readmissions. Objective: The purpose of this study is to evaluate the impact of early (<48 hours) versus late (48 hours-14 days) postdischarge medication reconciliation on readmissions and emergency department (ED) use. Methods: In this retrospective study, data for patients who had a clinic visit with a primary care provider (PCP), clinical pharmacist, or both for postdischarge medication reconciliation were reviewed. Primary outcome included hospital use rate at 30 days. Secondary outcomes included hospital use rate at 90 days and hospital use rate with a postdischarge PCP follow-up visit, clinical pharmacist, or both at 30 days. Results: One hundred sixty patients were included in the analysis: 31 early group patients and 129 late group patients. There was no significant difference on hospital use at 30 days in patients who received early or late groups (32.3% vs 21.8%, P = .947). There was also no significant difference on hospital use at 90 days in patients in early versus late group (51.6% vs 50.3%, P = .842). The type of provider (PCP vs pharmacists) conducting postdischarge medication reconciliation did not show significance on hospital use at 30 days (19.9% vs 21.4%, P = .731). Conclusion: Results from this study suggest patients can be seen up to 14 days postdischarge for medication reconciliation with no significant difference on hospital use.

scholarly journals Adherence of older emergency department patients to community-based specialized geriatric services

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 659-666
Author(s):  
Zachary MacDonald ◽  
Ian G. Stiell ◽  
Ioanna Genovezos ◽  
Debra Eagles
Keyword(s):  
Emergency Department ◽  
Patient Adherence ◽  
Cognitively Impaired ◽  
Study Participation ◽  
Convenience Sample ◽  
Home Based ◽  
Included Patient ◽  
Emergency Department Patients ◽  
Future Work

ABSTRACTObjectivesOur objective was to determine emergency department (ED) patient adherence to outpatient specialized geriatric services (SGS) following ED evaluation by the geriatric emergency management (GEM) nurse, and identify barriers and facilitators to attendance.MethodsWe conducted a prospective cohort study at two academic EDs between July and December 2016, enrolling a convenience sample of patients ≥ 65 years, seen by a GEM nurse, referred to outpatient SGS, and consented to study participation. We completed a chart review and a structured telephone follow-up at 6 weeks. Descriptive statistics were used.ResultsWe enrolled 103/285 eligible patients (86 eligible but not enrolled, 86 declined specialized geriatric referrals, and 10 declined study participation). Patients were mean age of 83.1 years, 59.2% female, and 73.2% cognitively impaired. Reasons for referral included mobility (86.4%), cognition (56.3%), pain (38.8%), mood (35.0%), medications (33.0%), and nutrition (31.1%). Referrals were to Geriatric Day Hospital (GDH) programs (50.5%), geriatric outreach (26.2%), falls clinic (12.6%), and geriatric psychiatry (8.7%). Adherence with follow-up was 59.2%. Barriers to attendance included patient did not feel SGS were needed (52.1%), inability to recall GEM consultation (53.4%), and dependence on family for transportation (72.6%). Home-based assessments had the highest adherence (81.5%).ConclusionAdherence of older ED patients referred by the GEM team to SGS is suboptimal, and a large proportion of patients decline these referrals in the ED. Future work should examine the efficacy of home-based assessments in a larger confirmatory setting and focus on interventions to increase referral acceptance and address barriers to attendance.

The next step: Parent Perspectives of Transition to Preschool of Children with Disabilities

1997 ◽  
Vol 22 (3) ◽  
pp. 30-34 ◽  
Author(s):  
Julie Campbell
Keyword(s):  
Information Needs ◽  
Intervention Program ◽  
Transition Process ◽  
Educational Goals ◽  
Disabled Children ◽  
Stepping Stones ◽  
Early Intervention Program ◽  
Inclusive Practice ◽  
Home Based

An innovative project was established to support the transition of young children from their home-based early intervention program to a neighbourhood preschool. The project, called Stepping Stones, provides specialist staff for a small group of severely disabled children with the aim of gradually introducing them to the on-site preschool. The participation of parents, consistent with a family-centred philosophy, was an important part of the transition process. Parents and staff were interviewed in the second week of the project to identify initial concerns and information needs. A follow-up interview was undertaken six weeks later. Results suggest that the parents were not really sure about the educational objectives for non-disabled children at the preschool and therefore were uncertain about what to expect in terms of developmental gains for their disabled children in spite of their strong commitment to the general principles of inclusive practice. In preparation for transition, more time needs to be given to familiarising parents with the implicit educational goals of preschool programs and making these more explicit where necessary.

scholarly journals Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits

2017 ◽  
Vol 49 (5) ◽  
pp. 1602129 ◽  
Author(s):  
Maroula Vasilopoulou ◽  
Andriana I. Papaioannou ◽  
Georgios Kaltsakas ◽  
Zafeiris Louvaris ◽  
Nikolaos Chynkiamis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Usual Care ◽  
Lower Risk ◽  
Controlled Trial ◽  
Emergency Department Visits ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Copd Exacerbations ◽  
Home Based ◽  
Ed Visits

Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits.Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based maintenance tele-rehabilitation (n=47) with 12 months of hospital-based, outpatient, maintenance rehabilitation (n=50) and also to 12 months of usual care treatment (n=50) without initial PR.In a multivariate analysis during the 12-month follow-up, both home-based tele-rehabilitation and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389–0.687, and IRR 0.635, 95% CI 0.473–0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100–0.358, and IRR 0.375, 95% CI 0.207–0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI 0.072–0.185).Home-based maintenance tele-rehabilitation is equally effective as hospital-based, outpatient, maintenance PR in reducing the risk for acute COPD exacerbation and hospitalisations. In addition, it encounters a lower risk for ED visits, thereby constituting a potentially effective alternative strategy to hospital-based, outpatient, maintenance PR.

scholarly journals Feasibility and acceptability of electronic administration of patient reported outcomes using mHealth platform in emergency department patients with non-medical opioid use

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kathryn Hawk ◽  
Caitlin Malicki ◽  
Jeremiah Kinsman ◽  
Gail D’Onofrio ◽  
Andrew Taylor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Reported Outcomes ◽  
Prescription Medication ◽  
Transitions Of Care ◽  
Opioid Use ◽  
Treatment Pathways ◽  
Implementation Challenges ◽  
Patient Reported ◽  
Electronic Health

Abstract Background The emergency department (ED) offers an important opportunity to identify patients with opioid use disorder (OUD) and initiate treatment. However, post-ED follow-up is challenging, and novel approaches to enhance care transitions are urgently needed. Outcomes following ED visits have traditionally focused on overdose, treatment engagement, and mortality with an absence of patient reported outcomes (PROs), for example patient ability to schedule follow-up OUD treatment appointments or pick up a prescription medication, that may better inform evaluation of treatment pathways and near-term outcomes after acute events. In the context of increasing novel secure mobile health (mHealth) platforms, we explored the feasibility and acceptability of electronically collecting PROs from ED patients with non-medical opioid use to enhance care in the ED and transitions of care. Methods ED patients with non-medical opioid use or opioid overdose who endorsed willingness and ability to complete electronic surveys after discharge were enrolled from a tertiary, urban academic ED. Participants were enrolled in an mHealth platform, shared electronic health records with researchers, and completed electronic surveys of PROs at baseline, three- and thirty-days post discharge from the hospital, including questions about ability to schedule a follow-up appointment, pick up a prescription medication and overdose risk behaviors. Primary outcomes were measures of feasibility and acceptability of electronic PRO collection among ED patients with non-medical opioid use. Results Among 1,808 patients assessed for eligibility between June-December 2019, 101 of 130 (78%) eligible adult patients consented to participate. Ninety-six (95%) of 101 patients completed registration in the mHealth platform, and 77/96 (80%) were successful in sharing their electronic health data. Completion rates for the baseline, three-day and thirty-day surveys were 97% (93/96), 49% (47/96) and 42% (40/96). Implementation challenges included short engagement window during ED visit, limited access to smartphones/computers, insufficient battery life of participant phone to access email and password, forgotten emails and passwords, multi-step verification processes for account set-up, and complaints about hospital care, most of which were effectively addressed by study personnel. Conclusions ED patients with OUD were willing to share electronic health information and PROs, although implementation challenges were common, and more than half of participants were lost-to-follow-up after hospital discharge at 30 days. Efforts to streamline communication and remove barriers to engagement are needed to improve the collection of PROs and pathways of care in ED patients with OUD. Clinical Trial Registration ClinicalTrials.gov (NCT03985163). Date of Registration: June 10, 2019, Retrospectively registered (First enrollment June 8, 2019). https://clinicaltrials.gov/ct2/show/record/NCT03985163

scholarly journals Defining Ambulatory Care Sensitive Conditions for adults in Portugal

2020 ◽  
Author(s):  
João Sarmento ◽  
João Vitor Muniz Rocha ◽  
Rui Santana
Keyword(s):  
Colorectal Cancer ◽  
Ambulatory Care ◽  
Adult Population ◽  
Healthcare Management ◽  
Chronic Obstructive ◽  
Venous Disease ◽  
Delphi Panel ◽  
Ambulatory Care Setting ◽  
Tract Infections ◽  
Sensitive Conditions

Abstract BackgroundAmbulatory Care Sensitive Conditions (ACSCs) are health conditions for which adequate management, treatment and interventions delivered in the ambulatory care setting could potentially prevent hospitalization. Which conditions are sensitive to ambulatory care varies according to the scope of health care services and the context in which the indicator is used. The need for a country-specific validated list for Portugal has already been identified, but currently no national list has been developed yet. MethodsA modified web-based Delphi panel approach was designed, in order to determine which conditions can be considered ACSCs in the Portuguese adult population. The selected experts were general practitioners and internal medicine physicians identified by the most relevant Portuguese scientific societies. Experts were presented with previously identified ACSC and asked to select which could be accepted in the Portuguese context. They were also asked to identify other conditions they considered relevant. We estimated the number of ACSC hospitalizations in 2017 in Portugal according to the identified conditions. ResultsAfter three rounds the experts agreed on 34 of the 45 initially proposed items. Fourteen new conditions were proposed and four achieved consensus, namely uterine cervical cancer, colorectal cancer, thromboembolic venous disease and voluntary termination of pregnancy. In 2017 136626 hospitalizations were for ACSC (16.1% of all hospitalizations). This represents a rate of 1,540 per 100,000 adults. The most frequent diagnosis were pneumonia, chronic obstructive pulmonary disease/chronic bronchitis, heart failure, hypertensive disease, colorectal cancer, atrial fibrillation, urinary tract infections and complications of diabetes mellitus. ConclusionsNew ACSC where identified. It is expected that this list could be used henceforward by epidemiologic studies, health services research and for healthcare management purposes.

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