scholarly journals Tele-Follow-Up of Older Adult Patients from the Geriatric Emergency Department Innovation (GEDI) Program

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 18 ◽  
Author(s):  
Lucy Morse ◽  
Linda Xiong ◽  
Vanessa Ramirez-Zohfeld ◽  
Scott Dresden ◽  
Lee Lindquist
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Social Services ◽  
Care Coordination ◽  
Symptom Management ◽  
Comparative Method ◽  
Patient Needs ◽  
Time Points ◽  
Phone Calls

The objective of this study was to characterize the content and interventions performed during follow-up phone calls made to patients discharged from the Geriatrics Emergency Department Innovation (GEDI) Program and to demonstrate the benefit of these calls in the care of older adults discharged from the emergency department (ED). This study utilizes retrospective chart review with qualitative analysis. It was set in a large, urban, academic hospital emergency department utilizing the Geriatric Emergency Department Innovations (GEDI) Program. The subjects were adults aged 65 and over who visited the emergency department for acute care. Follow-up telephone calls were made by geriatric nurse liaisons (GNLs) at 24–72 h and 10–14 days post-discharge from the ED. The GNLs documented the content of the phone calls, and these notes were analyzed through a constant comparative method to identify emergent themes. The results showed that the most commonly arising themes in the patients’ questions and nurses’ responses across time-points included symptom management, medications, and care coordination (physician appointments, social services, therapy, and medical equipment). Early follow-up presented the opportunity for nurses to address needs in symptom management and care coordination that directly related to the ED admission; later follow-up presented a unique opportunity to resolve sub-acute issues that were not addressed by the initial discharge plan and to manage newly arising symptoms and patient needs. Thus, telephone follow-up after emergency department discharge presents an opportunity to better connect older adults with appropriate outpatient care and to address needs arising shortly after discharge that may not have otherwise been detected. By following up at two discrete time-points, this intervention identifies and addresses distinct patient needs.

scholarly journals Decisions to Enter and Leave Skilled Nursing Facilities for Post-Acute Rehabilitation: A Qualitative Study

2020 ◽  
Vol 3 ◽  
Author(s):  
Daniel Chimitt ◽  
Jennifer Carnahan
Keyword(s):  
Older Adults ◽  
Qualitative Study ◽  
Comparative Method ◽  
Skilled Nursing Facilities ◽  
Phone Call ◽  
Healthcare Team ◽  
Discharge Process ◽  
Nursing Facilities ◽  
Skilled Nursing

Background and Hypothesis:   Approximately 40% of patients aged 80+ enter a Skilled Nursing Facility (SNF) following a hospitalization. SNFs can be used as “safety nets” to expedite the discharge process of older adults and it can be difficult to pinpoint how and who made the decision for a hospitalized older adult to discharge to a SNF.   This project examines the factors that drive older adults to enter and leave a SNF for their rehabilitation care.    Project Methods:   Interview transcripts from a qualitative study with patients and their caregivers were used to examine factors influencing admission to and discharge from SNFs. Baseline interviews were conducted within two to seven days after returning home from a SNF stay followed by a follow up phone call one to two weeks after the initial interview. Transcripts and audio files were coded (using NVivo version 12+) for major themes. Interviews were analyzed using a constant comparative method to elicit themes of interest to interviewees.    Results:   There were 24 baseline interviews and X follow up interviews performed with a total of 24 patients and 15 caregivers. The primary theme identified was that patients perceived a loss of autonomy when considering the decision-making process. 75% (18/24) patients or their caregivers felt the healthcare team told them they must go to a SNF for their rehabilitation. 38% (9/24) patients or caregivers felt they had no choice but to leave due to insurance coverage and 50% (12/24) stated that they needed more time.    Potential Impact:   To achieve better patient outcomes, one must understand both the purpose of skilled nursing facilities and also how patients and their families are feeling as they transition through this uncertain period of their lives. Restoring a patient’s sense of autonomy will foster better patient-healthcare relationships and improve trust in the system. 

Abstract 220: Impact of a Cardiology-managed, Non-emergency Department, Outpatient Observation Unit

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Karen Cajiao ◽  
Joseph Wallins ◽  
Peter Zimetbaum ◽  
Michael Gavin
Keyword(s):  
Emergency Department ◽  
Discharge Rate ◽  
Medical Center ◽  
Tertiary Care ◽  
Direct Access ◽  
Observation Units ◽  
Phone Calls ◽  
Final Disposition ◽  
Made In

Background: With the progress emergency department (ED) observation units have made in reducing admissions for cardiac conditions, we previously reported a discharge rate of only 23.7% (n=1,549/6,546) from our ED, without an observation stay, for these patients. We opened a Cardiac Direct Access (CDAc) unit at a tertiary care urban medical center hypothesizing that cardiologists can reduce testing and observation stays for appropriate cardiac patients. Methods: Patients are referred to the CDAc for evaluation on an emergent (same day) or urgent (within 7 day) basis. We performed a retrospective review of 629 consecutive patients referred to the CDAc between November 2016 and June 2017. Final disposition was determined using charge data. The 30-day return rate to an ED, hospital, or the CDAc was determined by follow-up phone calls and chart review. Results: Patients were referred by non-cardiologists (n=403/629, 64%) and cardiologists (n=226/629, 36%). The most common indications for evaluation were chest pain, arrhythmia, and suspected heart failure. Disposition of patients evaluated in the CDAc are reported in the figure. The mean length of stay in CDAc observation was 22+/-13 hours. Among the 574 patients discharged from the CDAc, 62 (11%) were seen in an ED and/or hospitalized, while 31 (5.4%) were seen in the CDAc within 30 days. Conclusion: A CDAc unit may serve as a high value alternative to the ED. Further research can help assess comparative cost-effectiveness and refine patient selection.

scholarly journals An inventory of collaborative medication reviews for older adults - evolution of practices

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
A. Kiiski ◽  
M. Airaksinen ◽  
A. Mäntylä ◽  
S. Desselle ◽  
A. Kumpusalo-Vauhkonen ◽  
...  
Keyword(s):  
Older Adults ◽  
Medication Review ◽  
Care Plan ◽  
Patient Needs ◽  
Common Criteria ◽  
Medication Reviews ◽  
Patient Groups ◽  
Source Of Information ◽  
Medication Changes

Abstract Background Collaborative medication review (CMR) practices for older adults are evolving in many countries. Development has been under way in Finland for over a decade, but no inventory of evolved practices has been conducted. The aim of this study was to identify and describe CMR practices in Finland after 10 years of developement. Methods An inventory of CMR practices was conducted using a snowballing approach and an open call in the Finnish Medicines Agency’s website in 2015. Data were quantitatively analysed using descriptive statistics and qualitatively by inductive thematic content analysis. Clyne et al’s medication review typology was applied for evaluating comprehensiveness of the practices. Results In total, 43 practices were identified, of which 22 (51%) were designed for older adults in primary care. The majority (n = 30, 70%) of the practices were clinical CMRs, with 18 (42%) of them being in routine use. A checklist with criteria was used in 19 (44%) of the practices to identify patients with polypharmacy (n = 6), falls (n = 5), and renal dysfunction (n = 5) as the most common criteria for CMR. Patients were involved in 32 (74%) of the practices, mostly as a source of information via interview (n = 27, 63%). A medication care plan was discussed with the patient in 17 practices (40%), and it was established systematically as usual care to all or selected patient groups in 11 (26%) of the practices. All or selected patients’ medication lists were reconciled in 15 practices (35%). Nearly half of the practices (n = 19, 44%) lacked explicit methods for following up effects of medication changes. When reported, the effects were followed up as a routine control (n = 9, 21%) or in a follow-up appointment (n = 6, 14%). Conclusions Different MRs in varying settings were available and in routine use, the majority being comprehensive CMRs designed for primary outpatient care and for older adults. Even though practices might benefit from national standardization, flexibility in their customization according to context, medical and patient needs, and available resources is important.

scholarly journals Teach-back of discharge instructions in the emergency department: a pre–post pilot evaluation

2021 ◽  
pp. emermed-2020-210168
Author(s):  
Gijs Hesselink ◽  
Özcan Sir ◽  
Nadia Koster ◽  
Carolien Tolsma ◽  
Maartje Munsterman ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Transitional Care ◽  
Knowledge Retention ◽  
Self Management ◽  
Academic Hospital ◽  
Discharge Instructions ◽  
Discharge Care ◽  
Full Knowledge

ObjectivesWith the 'teach-back' method, patients or carers repeat back what they understand, so that professionals can confirm comprehension and correct misunderstandings. The effectiveness of teach-back has been underexamined, particularly for older patients discharged from the emergency department (ED). We aimed to determine whether teach-back would reduce ED revisits and whether it would increase patients’ retention of discharge instructions, improve self-management at home and increase satisfaction with the provision of instructions.MethodsA nonrandomised pre–post pilot evaluation in the ED of one Dutch academic hospital including patients discharged from the ED receiving standard discharge care (pre) and teach-back (post). Primary outcomes were ED-revisits within 7 days and within 8–30 days postdischarge. Secondary outcomes for a subsample of older adults were retention of instructions, self-management 72 hours after discharge and satisfaction with the provision of discharge instructions.ResultsA total of 648 patients were included, 154 were older adults. ED revisits within 7 days and within 8–30 days were lower in the teach-back group compared with those receiving standard discharge care: adjusted odds ratios (AORs) of 0.23 (95% CI 0.05 to 1.07) and 0.42 (95% CI 0.14 to 1.33), respectively. Participants in the teach-back group had an increased likelihood of full knowledge retention on information related to their ED diagnosis and treatment (AOR 2.19; 95% CI 1.01 to 4.75; p=0.048), medication (AOR 14.89; 95% CI 4.12 to 53.85; p>0.001) and follow-up appointments (AOR 3.86; 95% CI 1.33 to 10.19; p=0.012). Use of teach-back was not significantly associated with improved self-management and higher satisfaction with discharge instructions. Discharge conversations were generally shorter for participants receiving teach-back.ConclusionsDischarging patients from the ED with a relatively simple and feasible teach-back method can contribute to safer and better transitional care from the ED to home.

scholarly journals NUTRITIONAL RISK PREDICTS HEALTH SERVICES UTILIZATION AND DEATH OVER 1 YEAR: RESULTS FROM THE UAB STUDY OF AGING II

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S347-S347
Author(s):  
David R Buys ◽  
Richard E Kennedy ◽  
Yue Zhang ◽  
Julie Locher ◽  
Cynthia J Brown
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Nursing Home ◽  
Health Services ◽  
Community Dwelling ◽  
Emergency Department Visits ◽  
Nutritional Risk ◽  
Nursing Home Admission ◽  
Services Utilization

Abstract Nutritional risk has been demonstrated to be associated with poor health outcomes, increased risk of health services utilization (HSU), and mortality among older adults. The aim of this study was to assess the prospective relationship between nutritional risk; HSU focusing separately on emergency department visits, hospitalization, and nursing home admission; and mortality. Using the University of Alabama-Birmingham Study of Aging II, we examined this relationship among 419 community-dwelling older Alabamians (75+years). We used the Mini-Nutrition Assessment (MNA), a well-validated nutritional risk assessment, which classifies individuals as either well-nourished, at-risk or malnourished, collected at baseline. We assessed HSU by asking about healthcare encounters since the last monthly follow-up call for 12 months and verified death with family reports and official documents. We completed univariate, bivariate, and Cox proportional hazards regression analyses with one-year of follow-up data, adjusting for social support, social isolation, comorbidities, and demographic variables. Accounting for covariates, being either at-risk or malnourished, relative to well-nourished, was associated with emergency department visits (HR: 1.30, 95% CI:1.14,1.48), hospitalization (HR: 1.58, 95% CI:1.37,1.82), nursing home admission (HR: 8.94, 95% CI:3.99,20.02), and mortality (HR: 1.90, 95% CI:1.25,2.88). These findings underscore the growing awareness that nutritional risk, particularly for older adults, is a significant factor affecting their well-being and particularly their ability to continue living in the community. Nutrition assessment, interventions, and services for community-dwelling older adults may lead to a reduction in health care utilization, particularly nursing home placement, and ultimately to reduced healthcare costs to families and taxpayers.

scholarly journals Association between social isolation and outpatient follow-up in older adults following emergency department discharge

2021 ◽  
Vol 93 ◽  
pp. 104298
Author(s):  
Nia A. Cayenne ◽  
Gwen Costa Jacobsohn ◽  
Courtney M.C. Jones ◽  
Eva H. DuGoff ◽  
Amy L. Cochran ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Social Isolation ◽  
Emergency Department Discharge

scholarly journals Lessons Learned by Medical Students about Systems-Based Practice as Patients Transition their Care

2021 ◽  
Author(s):  
Eduard Pey ◽  
Diego Sierra ◽  
Sydney Katz ◽  
Laura Greisman ◽  
Deanna Jannat-Khah ◽  
...  
Keyword(s):  
Medical Students ◽  
Care Coordination ◽  
Care Transitions ◽  
Transitions Of Care ◽  
Phone Call ◽  
Post Discharge ◽  
Medicine Clerkship ◽  
Practice Improvement ◽  
Phone Calls

Abstract Background: One in five patients suffer an adverse event within two weeks of discharge as they transition from one healthcare setting to another. Systems-based practice is a core competency of physicians and seeks to minimize these events; however, education of trainees is inconsistent. We asked whether structured post-discharge phone calls and reflections on barriers to discharge and practice improvement can enhance students’ understanding of systems-based practice. Method: Medical students in the Internal Medicine Clerkship were assigned to perform a structured post-discharge phone call on hospitalized patients as part of a “Transitions of Care” assignment. Students reflected on issues occurring at the transition from hospitalization to discharge. We performed qualitative analysis of 90 medical student responses and identified themes and sub-themes addressing issues with care transitions. Results: Students consistently identified barriers to safe discharge including issues scheduling follow-up care, poor care coordination, and inadequate social support. The post-discharge phone calls revealed problems with patients’ understanding of their discharge diagnosis, medication-related issues and patients’ failure to attend scheduled follow-up. Common student-proposed practice improvement interventions included: enhanced provider-patient communication and education, improved interdisciplinary collaboration and care coordination, and greater attention to patient’s psychosocial and financial status. Conclusions: Medical students learned about systems-based practice from a transitions of care assignment involving a post-discharge phone call, identifying critical events in over half of patients identified. Self-reflective practice within the context of direct patient care offers insights into practice improvement in care transitions.

scholarly journals Facilitators and barriers to post-discharge pain assessment and triage: a qualitative study of nurses’ and patients’ perspectives

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinying Chen ◽  
Jessica G. Wijesundara ◽  
Angela Patterson ◽  
Sarah L. Cutrona ◽  
Sandra Aiello ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Coordination ◽  
Pain Assessment ◽  
Transitional Care ◽  
Symptom Assessment ◽  
Medical Attention ◽  
Post Discharge ◽  
Phone Calls ◽  
Facilitators And Barriers

Abstract Background After hospital discharge, patients can experience symptoms prompting them to seek acute medical attention. Early evaluation of patients’ post-discharge symptoms by healthcare providers may improve appropriate healthcare utilization and patient safety. Post-discharge follow-up phone calls, which are used for routine transitional care in U.S. hospitals, serve as an important channel for provider-patient communication about symptoms. This study aimed to assess the facilitators and barriers to evaluating and triaging pain symptoms in cardiovascular patients through follow-up phone calls after their discharge from a large healthcare system in Central Massachusetts. We also discuss strategies that may help address the identified barriers. Methods Guided by the Practical, Robust, Implementation and Sustainability Model (PRISM), we completed semi-structured interviews with 7 nurses and 16 patients in 2020. Selected nurses conducted (or supervised) post-discharge follow-up calls on behalf of 5 clinical teams (2 primary care; 3 cardiology). We used thematic analysis to identify themes from interviews and mapped them to the domains of the PRISM model. Results Participants described common facilitators and barriers related to the four domains of PRISM: Intervention (I), Recipients (R), Implementation and Sustainability Infrastructure (ISI), and External Environment (EE). Facilitators include: (1) patients being willing to receive provider follow-up (R); (2) nurses experienced in symptom assessment (R); (3) good care coordination within individual clinical teams (R); (4) electronic health record system and call templates to support follow-up calls (ISI); and (5) national and institutional policies to support post-discharge follow-up (EE). Barriers include: (1) limitations of conducting symptom assessment by provider-initiated follow-up calls (I); (2) difficulty connecting patients and providers in a timely manner (R); (3) suboptimal coordination for transitional care among primary care and cardiology providers (R); and (4) lack of emphasis on post-discharge follow-up call reimbursement among cardiology clinics (EE). Specific barriers for pain assessment include: (1) concerns with pain medication misuse (R); and (2) no standardized pain assessment and triage protocol (ISI). Conclusions Strategies to empower patients, facilitate timely patient-provider communication, and support care coordination regarding pain evaluation and treatment may reduce the barriers and improve processes and outcomes of pain assessment and triage.

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