scholarly journals Effect of an Intervention to Improve Team Coordination on Patients Who are Likely to be Discharged by General Internal Medicine

1970 ◽  
Vol 10 (1) ◽  
Author(s):  
Lina Pham BA ◽  
Teri Arany ◽  
William Coke MD ◽  
Vivian Lo ◽  
Robert C. Wu MD
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
Length Of Stay ◽  
General Internal Medicine ◽  
Discharge Planning ◽  
Teaching Hospitals ◽  
Post Discharge ◽  
General Internal ◽  
Effective Discharge ◽  
The Impact

Effective discharge planning is important to ensuring a high quality of patient care and operational efficiency. The general internal medicine (GIM) environment is very complex and fluid, with multiple health professions providing care for patients. This makes coordination of discharges difficult, even with structured daily interprofessional rounds.The purpose of this case-control study was to evaluate a discharge notification form that predicts next-day discharges. The main measures of the study, which took place in GIM wards at two academic teaching hospitals, were the completion and accuracy of the discharge forms, length of stay, discharge times, post-discharge admissions, and emergency department visits.Seventy-six of 200 patients studied had information completed on the discharge notification form. The overall effect appeared to move discharges earlier in the day, while having no effect on length of stay.Patients whose information was completed on the discharge notification form were less likely to have an emergency department visit within 30 days post-discharge.The use of a discharge notification form appears to move discharges earlier in the day, without increasing length of stay. Further refinement and evaluation is necessary to increase usage and assess the impact onoutcomes of care.

scholarly journals Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program

2018 ◽  
Vol 42 (5) ◽  
pp. 542 ◽  
Author(s):  
Sharon Lawn ◽  
Sara Zabeen ◽  
David Smith ◽  
Ellen Wilson ◽  
Cathie Miller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Heart Disease ◽  
Length Of Stay ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Hospital Admissions ◽  
Self Management ◽  
Psychosocial Needs ◽  
Post Discharge ◽  
The Impact

Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.

scholarly journals Type of facility influences lengths of stay of children presenting to high volume emergency departments

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rhonda J. Rosychuk ◽  
Brian H. Rowe
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
High Volume ◽  
Population Based ◽  
Initial Assessment ◽  
Teaching Hospitals ◽  
Emergency Department Crowding ◽  
Academic Teaching ◽  
The Impact

Abstract Background Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada. Methods This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained. Results About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals. Conclusions Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

Drug-related problems identification in general internal medicine: The impact and role of the clinical pharmacist and pharmacologist

2015 ◽  
Vol 26 (6) ◽  
pp. 399-406 ◽  
Author(s):  
Bertrand Guignard ◽  
Pascal Bonnabry ◽  
Arnaud Perrier ◽  
Pierre Dayer ◽  
Jules Desmeules ◽  
...  
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Clinical Pharmacist ◽  
Drug Related Problems ◽  
General Internal ◽  
The Impact

scholarly journals Disability Impacts Length of Stay in General Internal Medicine Patients

2014 ◽  
Author(s):  
Chunzhen Tan ◽  
Yee Sien Ng ◽  
Gerald C. H. Koh ◽  
Deidre A. De Silva ◽  
Arul Earnest ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Length Of Stay ◽  
General Internal Medicine ◽  
General Internal

scholarly journals Infectious Diseases on a General Internal Medicine Clinical Teaching Unit

1999 ◽  
Vol 10 (1) ◽  
pp. 33-38
Author(s):  
LE Nicolle ◽  
J Uhanova ◽  
P Orr ◽  
A Kraut ◽  
K Van Ameyde ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Length Of Stay ◽  
Infectious Diseases ◽  
General Internal Medicine ◽  
Clinical Teaching ◽  
Cost Of Care ◽  
Therapeutic Interventions ◽  
General Internal ◽  
Teaching Unit ◽  
Time Of Admission

OBJECTIVE: To describe the spectrum of infectious diseases and characteristics of patients admitted with infections on a general internal medicine clinical teaching unit.DESIGN: Retrospective review of patients admitted to one general internal medicine unit at a tertiary care teaching hospital during two three-month periods.METHODS: Data collection through chart review.OUTCOME MEASURES: Descriptive analysis of types of infections: therapeutic interventions; consultations and outcomes, including death; hospital-acquired infection; and length of stay.RESULTS: During the two three-month periods, 76 of 233 (33%) and 52 of 209 (25%) admissions were associated with a primary diagnosis of infection. An additional 23 (10%) and 24 (12%) patients had infection at the time of admission, but this was not the primary admitting diagnosis. Pneumonia, urinary infection, and skin and soft tissue infection were the most frequent diagnosis at the time of admission, but these accounted for only about 50% of admissions with infection. Patients admitted with infection were characterized by a younger age, greater number of therapeutic interventions in the first 24 h, and increased medication costs, entirely attributable to antimicrobial therapy, but patients admitted with infection did not differ in comorbidity, death, nosocomial infection or length of stay compared with patients without infection.CONCLUSIONS: A wide variety of infections contribute to admissions to general internal medical clinical teaching units. Patients with infection have more interventions and an increased cost of care, but do not differ in outcome.

scholarly journals UK-wide study of the opinions of gastroenterology trainees: COVID-19, Shape of Training and the future workforce

2021 ◽  
pp. flgastro-2021-101965
Author(s):  
Suneil A Raju ◽  
Rebecca Harris ◽  
Charlotte Cook ◽  
Philip Harvey ◽  
Elizabeth Ratcliffe
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Training Programme ◽  
British Society ◽  
Specialty Training ◽  
Endoscopy Training ◽  
Electronic Survey ◽  
General Internal ◽  
The Impact ◽  
Training Opportunities

IntroductionThe COVID-19 pandemic has disrupted training. Gastroenterology higher specialty training is soon to be reduced from 5 years to 4. The British Society of Gastroenterology Trainees Section biennial survey aims to delineate the impact of COVID-19 on training and the opinions on changes to training.MethodsAn electronic survey allowing for anonymised responses at the point of completion was distributed to all gastroenterology trainees from September to November 2020.ResultsDuring the first wave of the COVID-19 pandemic, 71.0% of the respondents stated that more than 50% of their clinical time was mostly within general internal medicine. Trainees reported a significant impact on all aspects of their gastroenterology training due to lost training opportunities and increasing service commitments. During the first wave, 88.5% of the respondents reported no access to endoscopy training lists. Since this time, 66.2% of the respondents stated that their endoscopy training lists had restarted. This has resulted in fewer respondents achieving endoscopy accreditation. The COVID-19 pandemic has caused 42.2% of the respondents to consider extending their training to obtain the skills required to complete training. Furthermore, 10.0% of the respondents reported concerns of a delay to completion of training. The majority of respondents (84.2%) reported that they would not feel ready to be a consultant after 4 years of training.ConclusionsReductions in all aspects of gastroenterology training were reported. This is mirrored in anticipated concerns about completion of training in a shorter training programme as proposed in the new curriculum. Work is now required to ensure training is restored following the pandemic.

The Impact of Suspension of Dermatology On-Call Services

2020 ◽  
Vol 24 (4) ◽  
pp. 380-385
Author(s):  
Annie Langley ◽  
Mark G. Kirchhof
Keyword(s):  
Internal Medicine ◽  
Emergency Department ◽  
Clinical Work ◽  
Descriptive Statistics ◽  
Ottawa Hospital ◽  
General Internal ◽  
Life Threatening ◽  
Survey Results ◽  
Survey Responses ◽  
The Impact

Background Dermatological conditions are commonly seen in the emergency department and inpatient wards. The ability to access dermatology on-call services improves the accuracy of diagnosis and management of common and sometimes life-threatening conditions. Limitations of dermatologist availability led to the suspension of the dermatology on-call service for 3 months in Ottawa, Canada. Objectives Our objective was to assess the impact of this call suspension on patient care and the need for a dermatology on-call service at our hospital, as perceived by nondermatologist physicians at our center. Methods A survey was sent to all departments at The Ottawa Hospital, addressed to staff physicians and residents. Participation was entirely voluntary. Descriptive statistics were used to analyze survey responses. Results A total of 105 physicians completed the survey including staff physicians (85%) and resident trainees (15%). The most represented specialties were emergency medicine ( N = 21), general internal medicine ( N = 19), nephrology ( N = 17), neurology ( N = 13), and plastic surgery ( N = 13). Over half of the respondents felt that the lack of dermatology on-call service impacted the care of their patients by a moderate or great extent. Over half reported performing dermatology-related clinical work during the call suspension and two-thirds of these individuals reported feeling uncomfortable or very uncomfortable doing so. Most (94%) participants felt that an on-call dermatology service was useful and 57% deemed it essential. Conclusion Our survey results demonstrate a significant impact of the suspension of a dermatology on-call service, as perceived by nondermatologist physicians. Hospitals need to recognize the importance of on-call dermatology consultations and provide support for divisions to enable this service to continue.

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