scholarly journals Defining Delayed Discharges of Inpatients and Their Impact in Acute Hospital Care: A Scoping Review

2020 ◽  
Author(s):  
Alexander Micallef ◽  
Sandra C. Buttigieg ◽  
Gianpaolo Tomaselli ◽  
Lalit Garg
Keyword(s):  
Scoping Review ◽  
Care Staff ◽  
Extensive Literature ◽  
Discharge Process ◽  
Exclusion Criteria ◽  
Vast Number ◽  
Healthcare Settings ◽  
Delayed Discharges ◽  
Acute Healthcare ◽  
The Impact

Background: With the ever-increasing demand on acute healthcare, the hospital discharge process and delayed discharges are considered relevant in achieving optimal performance in clinical settings. The purpose of this paper is to review the literature to identify conceptual and operational definitions of delayed discharges, identify causes and effects of delayed discharges, and also to explore the literature for interventions aimed at decreasing the impact (in terms of reducing the number/rate of delays) of delayed discharges in acute healthcare settings. Methods: An extensive literature search yielded a total of 26 248 records. Sixty-four research articles were included in the scoping review after considering inclusion/exclusion criteria and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) search strategy. The following databases were utilized: Cochrane, EBSCO, PubMed, PubMed Central, Medline, and Web of Science. The search was carried out between January 2017 and March 2020 and covered literature ranging from 1990 to 2019. Results were reviewed by authors for duplicates and filtered using the inclusion/ exclusion criteria. Tables were created to classify the chosen articles (n = 64), allowing us to organise findings and results. Results: Conceptual and operational definitions were analysed. In turn, causes and effects of delayed discharges were extracted and represented in diagrammatic format, together with specific interventions used in acute healthcare settings to lessen the effect of delayed discharges. Operational definitions of delayed discharges were found to be more difficult to establish, particularly in the light of the vast number of different scenarios and workplace interventions uncovered in the literature. The main causes of delayed discharges were faulty organisational management, inadequate discharge planning, transfer of care problems, and age. The main effects were bed-blocking, A&E (Accident & Emergency) overcrowding, and financial implications. The main interventions included ‘discharge before noon’ initiative, ‘discharge facilitation tools,’ ‘discharge delay tracking’ mechanisms, and the role of general practitioners and social care staff. Conclusion: This paper fills a gap in the fragmented literature on delayed inpatient discharges by providing a researchbased perspective on conceptual and operational definitions, causes and effects, as well as interventions to minimize their impact. The findings and definitions are intended as points of reference for future research.

scholarly journals Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
L. Lennox ◽  
A. Linwood-Amor ◽  
L. Maher ◽  
J. Reed
Keyword(s):  
Scoping Review ◽  
Evidence Base ◽  
Vast Number ◽  
Community Healthcare ◽  
Healthcare Settings ◽  
Future Assessment ◽  
Scoping Reviews ◽  
Or Practice ◽  
The Impact ◽  
Appraisal Tool

Abstract Background Numerous models, tools and frameworks have been produced to improve the sustainability of evidence-based interventions. Due to the vast number available, choosing the most appropriate one is increasingly difficult for researchers and practitioners. To understand the value of such approaches, evidence warranting their use is needed. However, there is limited understanding of how sustainability approaches have been used and how they have impacted research or practice. This review aims to consolidate evidence on the application and impact of sustainability approaches in healthcare settings. Methods A systematic scoping review was designed to search for peer-reviewed publications detailing the use of sustainability approaches in practice. A 5-stage framework for scoping reviews directed the search strategy, and quality assessment was performed using the Mixed Method Appraisal Tool. Searches were performed through electronic citation tracking and snowballing of references. Articles were obtained through Web of Science, PubMed and Google Scholar. Six outcome variables for sustainability were explored to ascertain impact of approaches. Results This review includes 68 articles demonstrating the application of sustainability approaches in practice. Results show an increase in the use of sustainability approaches in peer-reviewed studies. Approaches have been applied across a range of healthcare settings, including primary, secondary, tertiary and community healthcare. Approaches are used for five main purposes, namely analysis, evaluation, guidance, assessment and planning. Results outline benefits (e.g. improved conceptualisation of sustainability constructs and improved ability to interpret sustainability data) and challenges (e.g. issues with approach constructs and difficulty in application) associated with using a sustainability approach in practice. Few articles (14/68) reported the sustainability outcome variables explored; therefore, the impact of approaches on sustainability remains unclear. Additional sustainability outcome variables reported in retrieved articles are discussed. Conclusions This review provides practitioners and researchers with a consolidated evidence base on sustainability approaches. Findings highlight the remaining gaps in the literature and emphasise the need for improved rigour and reporting of sustainability approaches in research studies. To guide future assessment and study of sustainability in healthcare settings an updated list of sustainability outcome variables is proposed. Trial Registration This review was registered on the PROSPERO database CRD 42016040081 in June 2016.

The Grief and Bereavement Experiences of Informal Caregivers: A Scoping Review of the North American Literature

2021 ◽  
pp. 082585972110522
Author(s):  
Neerjah Skantharajah ◽  
Carol Barrie ◽  
Sharon Baxter ◽  
M. Carolina Borja ◽  
Anica Butters ◽  
...  
Keyword(s):  
American Literature ◽  
Scoping Review ◽  
Informal Caregivers ◽  
Exclusion Criteria ◽  
The North ◽  
Current State ◽  
Grief And Bereavement ◽  
Hospice And Palliative Care ◽  
The Impact

Background Informal caregivers are a significant part of the hospice and palliative care landscape as members of the interdisciplinary care team. Despite this, little is known about the impact this responsibility has on informal caregivers’ experiences of grief and bereavement. To address this, a scoping review of the literature was conducted to explore the current state of knowledge toward grief and bereavement of informal caregivers of adult/geriatric patients in the hospice and palliative/end-of-life care realm within North America. Methods Using Arksey and O’Malley's 5-step framework, key electronic health care and social sciences databases (eg, CINAHL, MEDLINE, ProQuest Sociological Abstracts, PsycINFO) alongside gray literature sources were searched and screened against inclusion and exclusion criteria. A thematic content analysis was used to identify key themes. Results 29 articles met the final inclusion criteria with 3 central themes emerging: (1) mediators of grief, (2) grief experiences, and (3) types of grief. Discussion Informal caregivers encounter unique grief and bereavement experiences: The range of psychosocial outcomes, both negative and positive, can be affected by various mediators such as caregiver burden, demographics, disease type of the patient being cared for, etc. Bereavement interventions must be designed with the mediators of grief in mind. Conclusions Understanding the nuances of informal caregivers’ experiences with grief and bereavement will inform and advance practice, policy, and research. Practitioners/clinicians should be further educated on how to properly acknowledge the complexity of grief and bereavement for informal caregivers, specifically paying attention to mediators. Further research needs to consider the role of culture.

scholarly journals Nurses’ workarounds in acute healthcare settings: a scoping review

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Deborah S Debono ◽  
David Greenfield ◽  
Joanne F Travaglia ◽  
Janet C Long ◽  
Deborah Black ◽  
...  
Keyword(s):  
Scoping Review ◽  
Healthcare Settings ◽  
Acute Healthcare

scholarly journals Patient discharge from intensive care: an updated scoping review to identify tools and practices to inform high-quality care

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Kara M. Plotnikoff ◽  
Karla D. Krewulak ◽  
Laura Hernández ◽  
Krista Spence ◽  
Nadine Foster ◽  
...  
Keyword(s):  
Intensive Care ◽  
Scoping Review ◽  
Organizational Level ◽  
Discharge Process ◽  
Provider Communication ◽  
Family Needs ◽  
High Quality ◽  
Icu Discharge ◽  
Facilitators And Barriers ◽  
The Impact

Abstract Background Critically ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. The aim of this study was to answer the question: what elements facilitate a successful, high-quality discharge from the ICU? Methods This scoping review is an update to a review published in 2015. We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases from 2013-December 3, 2020 including adult, pediatric, and neonatal populations without language restrictions. Data were abstracted using different phases of care framework models, themes, facilitators, and barriers to the ICU discharge process. Results We included 314 articles from 11,461 unique citations. Two-hundred and fifty-eight (82.2%) articles were primary research articles, mostly cohort (118/314, 37.6%) or qualitative (51/314, 16.2%) studies. Common discharge themes across all articles included adverse events, readmission, and mortality after discharge (116/314, 36.9%) and patient and family needs and experiences during discharge (112/314, 35.7%). Common discharge facilitators were discharge education for patients and families (82, 26.1%), successful provider-provider communication (77/314, 24.5%), and organizational tools to facilitate discharge (50/314, 15.9%). Barriers to a successful discharge included patient demographic and clinical characteristics (89/314, 22.3%), healthcare provider workload (21/314, 6.7%), and the impact of current discharge practices on flow and performance (49/314, 15.6%). We identified 47 discharge tools that could be used or adapted to facilitate an ICU discharge. Conclusions Several factors contribute to a successful ICU discharge, with facilitators and barriers present at the patient and family, health care provider, and organizational level. Successful provider-patient and provider-provider communication, and educating and engaging patients and families about the discharge process were important factors in a successful ICU discharge.

scholarly journals The Significance of Taking Antiretroviral Medications for African-Born People Living with HIV and Residing in Minnesota

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 108
Author(s):  
Alina Cernasev ◽  
William L. Larson ◽  
Cynthia Peden-McAlpine ◽  
Todd Rockwood ◽  
Paul L. Ranelli ◽  
...  
Keyword(s):  
People Living With Hiv ◽  
Extensive Literature ◽  
Exclusion Criteria ◽  
Persons Living With Hiv ◽  
Antiretroviral Medications ◽  
Interview Guide ◽  
Data Saturation ◽  
Social And Cultural Factors ◽  
Living With Hiv ◽  
The Impact

Thanks to the development of antiretroviral (ART) medications, HIV is now a chronic and manageable disease. This study aimed to (1) capture the experiences of African-born persons living with HIV and taking antiretroviral treatment, and (2) explore the impact of social and cultural factors on their decisions to follow the prescribed treatment. For this study, a qualitative approach was used. The participants were recruited via fliers, then screened for inclusion and exclusion criteria. Recruitment of the participants continued until data saturation occurred. The interview guide was developed based on the extensive literature and recommendations from the clinical team. In-person narrative interviews were conducted with 14 participants—African-born persons living with HIV and residing in Minnesota. Thematic Analysis revealed three emergent themes: “To exist I have to take the medicine”; barriers and facilitators in taking ART medications; and the power of spirituality and prayers. The findings of this study paint a picture of African-born persons living with HIV, and their experiences with ART medications. This study not only presents the participants’ medication experiences and their significance, but also tells their stories of how God and prayers play a significant role in helping them to get through the difficult moments of their lives.

scholarly journals Parent-led strategies supporting personal well-being when caring for a child with a life-limiting condition: A scoping review

2021 ◽  
pp. 136749352110261
Author(s):  
Sarah Oakley ◽  
Helena Dunbar ◽  
Kay de Vries
Keyword(s):  
Scoping Review ◽  
Daily Life ◽  
Empirical Evaluation ◽  
Well Being ◽  
Exclusion Criteria ◽  
Factors Associated ◽  
Pertinent Data ◽  
Management Techniques ◽  
Limiting Condition ◽  
The Impact

The objectives of this review were to identify strategies initiated by parents of children with life-limiting conditions to support their own well-being at home and to describe the impact of these strategies on parental well-being. A systematic scoping review was performed using PRISMA-ScR guidelines, identifying 15 relevant studies that fit the inclusion and exclusion criteria. There were no studies that specifically assessed how parents support their own well-being; however, the 15 identified studies did provide pertinent data secondary to the primary aims of each study. This resulted in the identification of 14 parent-initiated strategies which were grouped thematically into 4 categories: (i) social experience and peer support, (ii) information and management techniques, (iii) reframed perspectives and (iv) prioritising own needs. Overall, there was some evidence of parents initiating specific, individualised and useful strategies to supporting their well-being. Notably lacking was any empirical evaluation as to the effectiveness of these strategies and the wider factors associated with them. Further research is required to assess how parents support their personal well-being in daily life and how these strategies can be implemented alongside service-initiated support to ensure full parental well-being.

No Ticket To Ride: A Systematic Definition of Transit Insecurity

2021 ◽  
Vol 65 (1) ◽  
pp. 1307-1311
Author(s):  
Andy Chen ◽  
Ilayda Karagoel ◽  
Noah Friedman-Biglin ◽  
Dan Nathan-Roberts
Keyword(s):  
Scoping Review ◽  
Public Discourse ◽  
City Planning ◽  
Policy Research ◽  
Final Analysis ◽  
Travel Distance ◽  
Exclusion Criteria ◽  
Definition Of ◽  
The Impact ◽  
Shed Light

While the concept of ‘transit insecurity’ may seem self-explanatory, the phrase is not widely used in the current lexicon of city planning, public discourse, or in policy research. The term also lacks a widely accepted definition, scale, or metric of assessment. This scoping review will provide a definition, and explore metrics that demonstrate the extent to which a person or community is transit insecure. To arrive at this definition and set of metrics, a systematic search was conducted in three electronic databases for studies pertaining to transit insecurity. Articles were screened and assessed based on inclusion/exclusion criteria. Over 200 articles were initially identified and after review, a total of 15 articles were included in the final analysis, ranging in publication from 2005 to 2020. There were four factors found to affect transit insecurities: income level; travel distance; duration; and accessibility. By examining the impact of transit insecurity we hope to shed light on these problems and assist in proposing and studying solutions to transit insecurity.

Exploring the Heath Equity Impact of Current Digital Health Design Practices: A Protocol for a Scoping Review (Preprint)

2021 ◽  
Author(s):  
Laura Evans ◽  
Jay Evans ◽  
Claudia Pagliari ◽  
Karin Källander
Keyword(s):  
Health Equity ◽  
Scoping Review ◽  
Web Of Science ◽  
Digital Health ◽  
Evidence Base ◽  
Narrative Synthesis ◽  
Exclusion Criteria ◽  
Design Practices ◽  
Scoping Reviews ◽  
The Impact

BACKGROUND The field of digital health has grown rapidly in part due to the potential to reduce heath inequities. However, such potential has not always been realized. The design approaches used in digital health are one of the known aspects to have an impact on health equity. OBJECTIVE The aim of this scoping review will be to understand how design approaches in digital health have an impact on health equity. METHODS A scoping review of studies that describe how design practices for digital health have an impact on health equity will be carried out. The scoping review will follow the methodology laid out by Arksey and O’Malley, the Joanna Briggs Institute, and the PRISMA extension for scoping reviews checklist. The PubMed, EMBASE, Web of Science, and AMC Library will be searched for peer-reviewed papers. ProQuest Dissertations and Theses and Global Index Medicus databases will be searched for gray literature. The results will be screened against the inclusion and exclusion criteria. Subsequently, the data extracted from the included studies will be analyzed. RESULTS A twofold approach will be used to present the results. First, we will present a numerical overview of the amount, kind, and key themes of the studies. Second, we will write a narrative synthesis from the evidence extracted. CONCLUSIONS While there has been much discussion of the importance of design for lowering barriers to digital health participation, the evidence base demonstrating its impacts on health equity is less obvious. We hope our findings will contribute to better understanding the impact that design in digital health has on health equity and that these findings will translate into action that leads to stronger, more equitable healthcare systems.

scholarly journals Impact of SARS-CoV-2 on orthodontic education and global practice guidance: A scoping review

2020 ◽  
Vol 10 ◽  
pp. 78-88
Author(s):  
Ronnel Azizollahi ◽  
Niloufar Mohajerani ◽  
Chung H. Kau ◽  
Min-Lin Fang ◽  
Snehlata Oberoi
Keyword(s):  
Patient Safety ◽  
Scoping Review ◽  
Personal Protective Equipment ◽  
Clinical Skills ◽  
Respiratory Illness ◽  
Protective Equipment ◽  
Exclusion Criteria ◽  
Practice Recommendations ◽  
Dental Schools ◽  
The Impact

The acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, has had unprecedented impact on orthodontic care and education. Dental schools and clinics have stopped their normal educational and clinical activities worldwide, while only accepting emergency cases. It is still unknown when students will return to clinics to resume patient care and receive training. This scoping review aims to examine, summarize, and reference current resources to analyze the impact of SARSCoV-2 on orthodontic practice recommendations and orthodontic education. This review summarizes recommended global guidelines to provide a better understanding of the current consensus for protocols of safe orthodontic care; this scoping review serves to help create concrete guidelines for orthodontists to deal with the current SARS-CoV-2 pandemic, and for future infectious diseases, and assessing the impact on orthodontic education. Using inclusion/exclusion criteria, 456 articles were screened by two independent screeners and data were extracted and charted from 50 relevant sources. These 50 sources conveyed similar guidelines for provider and patient safety in orthodontic practices, with some stressing certain protocols such as personal protective equipment over others. Impacts on orthodontic education conveyed changes in protocols for learning, competency, and clinical skills. As this respiratory illness progresses, the field of orthodontics needs cohesive universal clinical guidelines and further assessment of the impacts of SARS-CoV-2 on orthodontic education.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

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