scholarly journals Pathways Project: Development of a Multimodal Innovation to Improve Kidney Supportive Care in Dialysis Centers

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0005892020
Author(s):  
Dale E. Lupu ◽  
Annette Aldous ◽  
Glenda Harbert ◽  
Manjula Kurella Tamura ◽  
Laura Holdsworth ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Supportive Care ◽  
Kidney Failure ◽  
Best Practice ◽  
Technical Assistance ◽  
Data Feedback ◽  
Care Models ◽  
Seriously Ill Patients ◽  
Seriously Ill

Current care models for older patients with kidney failure in the U.S. do not incorporate supportive care approaches. The absence of supportive care contributes to poor symptom management and unwanted forms of care at the end-of-life. Using an Institute for Healthcare Improvement Collaborative Model for Achieving Breakthrough Improvement, we conducted a focused literature review, interviewed implementation experts, and convened a technical expert panel to distill existing evidence into an evidence-based supportive care change package. The change package consists of 14 best practice recommendations for the care of seriously ill patients with kidney failure, emphasizing three key practices: systematic identification of seriously ill patients, goals of care conversations with identified patients, and care options to respond to patient wishes. Implementation will be supported through a collaborative consisting of three intensive learning sessions, monthly learning and collaboration calls, site data feedback, and quality improvement technical assistance. To evaluate the change package's implementation and effectiveness, we designed a mixed methods hybrid study. 1) Effectiveness evaluation (including patient outcomes and staff perception of the effectiveness of the implementation of the change package), 2) Quality improvement monitoring via monthly tracking of a suite of quality improvement indicators tied to the change package; and 3) Implementation evaluation conducted by the external evaluator using mixed methods to assess implementation of the Collaborative processes. Ten dialysis centers across the country treating approximately 1,550 patients will participate. This article describes the process informing the intervention design, components of the intervention, evaluation design and measurements, and preliminary feasibility assessments.

Giving Voice: Nurse-Patient Communication in the Intensive Care Unit

2021 ◽  
Vol 30 (4) ◽  
pp. 256-265
Author(s):  
Mary Beth Happ
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Best Practice ◽  
Patient Communication ◽  
Evidence Based ◽  
Patient Relationship ◽  
Communication Partner ◽  
Seriously Ill Patients ◽  
Tools And Techniques ◽  
Seriously Ill

Communication is the essence of the nurse-patient relationship. The critical care nurse’s role in facilitating patient communication and enabling communication between patients and their families has never been more important or poignant than during the COVID-19 pandemic. We have witnessed tremendous examples of resourceful, caring nurses serving as the primary communication partner and support for isolated seriously ill patients during this pandemic. However, evidence-based tools and techniques for assisting awake, communication-impaired, seriously ill patients to communicate are not yet systematically applied across all settings. Missed communication or misinterpretation of patients’ messages induces panic and fear in patients receiving mechanical ventilation and can have serious deleterious consequences. This lecture presents a 23-year program of research in developing and testing combination interventions (eg, training, tailored assessment, and tools) for best practice in facilitating patient communication during critical illness. Evidence from related nursing and inter pro fessional research is also included. Guidance for unit-based assessment, tailoring, and implementation of evidence-based patient communication protocols also is provided.

scholarly journals P021: Interventions to reduce emergency department door-to-ECG times: a systematic review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S70
Author(s):  
S. Chhabra ◽  
D. Eagles ◽  
E. Kwok ◽  
J. Perry
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Emergency Departments ◽  
Best Practice ◽  
Quality Criteria ◽  
Local Context ◽  
Post Intervention ◽  
Eligibility Criteria ◽  
Coronary Syndrome ◽  
Data Feedback

Introduction: We wished to identify emergency department interventions that lead to improvement in door-to-ECG times for adults presenting with symptoms suggestive of acute coronary syndrome (ACS). Methods: Two reviewers searched Medline, Embase, CINAHL and Cochrane CENTRAL from inception to April 2018 for studies in adult emergency departments with an identifiable intervention to reduce median door-to-ECG times when compared to the institution's baseline. Quality was assessed using the ‘Quality Improvement Minimum Quality Criteria Set’ (QI-MQCS) critical appraisal tool. The primary outcome was the absolute median reduction in door-to-ECG times as calculated by the difference between the post-intervention time and pre-intervention time. Results: Two reviewers identified 809 unique articles, yielding 11 before-after quality improvement studies that met eligibility criteria (N = 15,622 patients). The majority of studies (10/11) reported bundled interventions and most (10/11) showed statistical improvement in door-to-ECG times. The most common interventions were: having a dedicated ECG machine and technician in triage (5/11); improved triage education (4/11); improved triage disposition (2/11); and data feedback mechanisms (1/11). Conclusion: There are multiple interventions that show promise for reducing emergency department door-to-ECG times. Effective bundled interventions include having a dedicated ECG technician, triage education and better triage disposition. These changes, bundled together, can help intuitions attain best practice guidelines. Emergency departments must first understand their local context before adopting any single or group of interventions.

scholarly journals The impact of data feedback on continuous quality improvement projects in Rwanda: A mixed methods analysis

2020 ◽  
Vol 10 ◽  
pp. S78-S84
Author(s):  
Helen E. Noble ◽  
John W. Scott ◽  
Jeanne D. Nyinawankusi ◽  
Jean M. Uwitonze ◽  
Ignace Kabagema ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Continuous Quality Improvement ◽  
Continuous Quality ◽  
Data Feedback ◽  
The Impact

scholarly journals Partnering with frail or seriously ill patients in research: a systematic review

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Claire Ludwig ◽  
Ian D. Graham ◽  
Wendy Gifford ◽  
Josee Lavoie ◽  
Dawn Stacey
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Lived Experience ◽  
Narrative Analysis ◽  
Mixed Methods Research ◽  
Well Being ◽  
Research Partnerships ◽  
Research Teams ◽  
Seriously Ill Patients ◽  
Seriously Ill

Abstract Background The expectation to include patients as partners in research has steadily gained momentum. The vulnerability of frail and/or seriously ill patients provides additional complexity and may deter researchers from welcoming individuals from this patient population onto their teams. The aim was to synthesize the evidence on the engagement of frail and/or seriously ill patients as research partners across the research cycle. Methods A systematic review was conducted using PRISMA guidelines. A search strategy included MEDLINE®, EMBASE®, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO from database inception to April, 2019. Eligible studies were peer-reviewed qualitative, quantitative, and mixed methods research reporting on the engagement of frail and/or seriously ill patients as partners on research teams. The Mixed Methods Appraisal Tool was used to appraise study quality. Narrative analysis was conducted. Results Of 8763 citations, 30 were included. Most studies included individuals with cancer on the research team (60%). Barriers included: lack of time and resources (50%), discontinuity in contribution (37%), and concerns for well-being (33%). Facilitators included: trust and mutual respect (60%), structural accessibility (57%), flexibility in timing and methods of engagement (43%), and attention to care and comfort, (33%). Perceived impacts for patients included: renewed personal sense of agency (37%) and emotional/peer support (37%). Impacts for researchers included sensitization to the lived experience of disease (57%) and an increased appreciation of the benefits of patient engagement (23%). Research design, execution, and outcomes, developed with patients, were deemed more suitable, relevant and reflective of patients’ priorities. Conclusions There is emerging evidence to suggest that research partnerships with frail and/or seriously ill patients can be achieved successfully. Patients mostly report benefit from partnering with research teams. Frailty and/or serious illness do present legitimate concerns for their well-being but appear to be successfully mitigated when researchers ensure that the purpose of engagement is well-defined, the timing and methods of engagement are flexible, and the practical and emotional needs of patient partners are addressed throughout the process. Systematic review registration The systematic review protocol was registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019127994).

scholarly journals Interventions to reduce emergency department door-to- electrocardiogram times: A systematic review

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 607-617 ◽  
Author(s):  
Shawn Chhabra ◽  
Debra Eagles ◽  
Edmund S.H. Kwok ◽  
Jeffrey J Perry
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Emergency Departments ◽  
Best Practice ◽  
Quality Criteria ◽  
Local Context ◽  
Post Intervention ◽  
Eligibility Criteria ◽  
Coronary Syndrome ◽  
Data Feedback

ABSTRACTObjectivesWe sought to identify emergency department interventions that lead to improvement in door-to-electrocardiogram (ECG) times for adults presenting with symptoms suggestive of acute coronary syndrome.MethodsTwo reviewers searched Medline, Embase, CINAHL, and Cochrane CENTRAL from inception to April 2018 for studies in adult emergency departments with an identifiable intervention to reduce median door-to-ECG times when compared with the institution's baseline. Quality was assessed using the Quality Improvement Minimum Quality Criteria Set critical appraisal tool. The primary outcome was the absolute median reduction in door-to-ECG times as calculated by the difference between the post-intervention time and pre-intervention time.ResultsTwo reviewers identified 809 unique articles, yielding 11 before-after quality improvement studies that met eligibility criteria (N = 15,622 patients). The majority of studies (10/11) reported bundled interventions, and most (10/11) showed statistical improvement in door-to-ECG times. The most common interventions were having a dedicated ECG machine and technician in triage (5/11); improved triage education (4/11); improved triage disposition (2/11); and data feedback mechanisms (2/11).ConclusionsThere are multiple interventions that show potential for reducing emergency department door-to-ECG times. Effective bundled interventions include having a dedicated ECG technician, triage education, and better triage disposition. These changes can help institutions attain best practice guidelines. Emergency departments must first understand their local context before adopting any single or group of interventions.

Principles of care for seriously ill patients in palliative office

2020 ◽  
pp. 15-18
Author(s):  
Nina Tishchenko
Keyword(s):  
Palliative Care ◽  
The State ◽  
State Budget ◽  
Oncological Patients ◽  
Seriously Ill Patients ◽  
Seriously Ill

The article reflects the importance and importance of the work of nurses of the Department of Palliative Care for Oncological Patients of the State Budget Health Establishment «Samara Regional Clinical Oncological Clinic». Important stages and features of care when dealing with seriously ill patients.

Home Health Agencies: Empirical Evidence on the Patient-Driven Groupings Model’s Expected Effects on Agency Reimbursements

2021 ◽  
pp. 108482232199038
Author(s):  
Elizabeth Plummer ◽  
William F. Wempe
Keyword(s):  
Ordinary Least Squares ◽  
Process Quality ◽  
Home Health ◽  
Least Squares Regression ◽  
Residual Variation ◽  
Health Agencies ◽  
Dual Eligible ◽  
Home Health Agencies ◽  
Seriously Ill Patients ◽  
Seriously Ill

Beginning January 1, 2020, Medicare’s Patient-Driven Groupings Model (PDGM) eliminated therapy as a direct determinant of Home Health Agencies’ (HHAs’) reimbursements. Instead, PDGM advances Medicare’s shift toward value-based payment models by directly linking HHAs’ reimbursements to patients’ medical conditions. We use 3 publicly-available datasets and ordered logistic regression to examine the associations between HHAs’ pre-PDGM provision of therapy and their other agency, patient, and quality characteristics. Our study therefore provides evidence on PDGM’s likely effects on HHA reimbursements assuming current patient populations and service levels do not change. We find that PDGM will likely increase payments to rural and facility-based HHAs, as well as HHAs serving greater proportions of non-white, dual-eligible, and seriously ill patients. Payments will also increase for HHAs scoring higher on quality surveys, but decrease for HHAs with higher outcome and process quality scores. We also use ordinary least squares regression to examine residual variation in HHAs’ expected reimbursement changes under PDGM, after accounting for any expected changes related to their pre-PDGM levels of therapy provision. We find that larger and rural HHAs will likely experience residual payment increases under PDGM, as will HHAs with greater numbers of seriously ill, younger, and non-white patients. HHAs with higher process quality, but lower outcome quality, will similarly benefit from PDGM. Understanding how PDGM affects HHAs is crucial as policymakers seek ways to increase equitable access to safe and affordable non-facility-provided healthcare that provides appropriate levels of therapy, nursing, and other care.

The Surprise Question and Serious Illness Conversations: A pilot study

2021 ◽  
pp. 096973302098339
Author(s):  
Kathy Le ◽  
Jenny Lee ◽  
Sameer Desai ◽  
Anita Ho ◽  
Holly van Heukelom
Keyword(s):  
Pilot Study ◽  
Healthcare Professionals ◽  
Post Intervention ◽  
Acute Medicine ◽  
Serious Illness ◽  
Patient Goals ◽  
Ethical Approval ◽  
Seriously Ill Patients ◽  
Surprise Question ◽  
Seriously Ill

Background: Serious Illness Conversations aim to discuss patient goals. However, on acute medicine units, seriously ill patients may undergo distressing interventions until death. Objectives: To investigate the feasibility of using the Surprise Question, “Would you be surprised if this patient died within the next year?” to identify patients who would benefit from early Serious Illness Conversations and study any changes in the interdisciplinary team’s beliefs, confidence, and engagement as a result of asking the Surprise Question. Design: A prospective cohort pilot study with two Plan-Do-Study-Act cycles. Participants/context: Fifty-eight healthcare professionals working on Acute Medicine Units participated in pre- and post-intervention questionnaires. The intervention involved asking participants the Surprise Question for each patient. Patient charts were reviewed for Serious Illness Conversation documentation. Ethical considerations: Ethical approval was granted by the institutions involved. Findings: Equivocal overall changes in the beliefs, confidence, and engagement of healthcare professionals were observed. Six out of 23 patients were indicated as needing a Serious Illness Conversation; chart review provided some evidence that these patients had more Serious Illness Conversation documentation compared with the 17 patients not flagged for a Serious Illness Conversation. Issues were identified in equating the Surprise Question to a Serious Illness Conversation. Discussion: Appropriate support for seriously ill patients is both a nursing professional and ethical duty. Flagging patients for conversations may act as a filtering process, allowing healthcare professionals to focus on conversations with patients who need them most. There are ethical and practical issues as to what constitutes a “serious illness” and if answering “no” to the Surprise Question always equates to a conversation. Conclusion: The barriers of time constraints and lack of training call for institutional change in order to prioritise the moral obligation of Serious Illness Conversations.

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