Integrated Clinical Pathways: Communication and Participation in a Multidisciplinary Team

BACKGROUND: An integrated clinical pathway (ICP) is a key method for structuring or planning processes of care, enabling the modernization of health-care delivery and coordination of multiple roles, forming a complete, patient-centered multidisciplinary health-care team and establishing the sequence of activities, promoting individual and team communication, collaboration, networking, and transparency, and reducing the cost of care. AIM: As there is a research gap in the area of communication among members of a multidisciplinary team for the treatment of patients through an ICP, the aim of this study was to determine the impact of communication of a member of a multidisciplinary team on the active participation of an individual in this multidisciplinary team. METHODS: A cross-sectional study of three ICPs, forchronic kidney disease, stroke, and total hip arthroplasty was conducted in a typical Slovenian general hospital. RESULTS: The results show that in the analyzed hospital, two of the three clinical pathways are not yet fully integrated. CONCLUSION: There is a weak influence of staff communication within a multidisciplinary team on an individual’s participation in this multidisciplinary team, indicating the need for various activities to actually implement clinical pathway “integration,” and promote better communication within teams to strengthen participation in multidisciplinary patient care pathways.

Download Full-text

Teachers’ view about feminization of Medical Education in Bangladesh

Bangladesh Journal of Medical Education ◽

10.3329/bjme.v12i2.54447 ◽

2021 ◽

Vol 12 (2) ◽

pp. 4-9

Author(s):

Muqbula Tasrin Aktar ◽

Fuad Reajwan Kabir ◽

M Kumrul Hasan ◽

Md Rafiqul Islam

Keyword(s):

Health Care ◽

Medical Education ◽

Care Delivery ◽

Health Care Delivery System ◽

Cross Sectional Study ◽

Female Students ◽

Working Environment ◽

Medical Emergency ◽

Cross Sectional ◽

The Impact

This descriptive type of cross-sectional study was driven to explore the teachers’ view about feminization of medical education in Bangladesh. This study was carried out in 4 government and 4 non-government medical colleges of Bangladesh during the period of July 2019 to June 2020. From all four phases, total 104 teachers were respondents of this study to seek information regarding the factors affecting and effects of feminization of medical education in Bangladesh with a pretested self-administered questionnaire. The study revealed that high social respect, high marriage value, parental pressure, financial security are the factors for feminization of medical education in Bangladesh. Other factor that may influence female students to get admitted in the MBBS course is female students are more studious. There are limited better alternate profession for female students. This study also revealed that empathetic to patients are more satisfied with female doctors, they like some specific subspecialty as their career choice and feminization do not hamper quality of health care. 46 (44.2%) teachers were disagreed that female doctors like to work in rural area. and 49 (47.1%) teachers were disagreed that female doctors are efficient in medical emergency management during disaster. Study recommended establishment of female friendly working environment at all levels of the hospital. Study also recommended further long term and wider scale study with more participants to observe the impact of feminization of medical education on health care delivery system in Bangladesh Bangladesh Journal of Medical Education Vol.12(2) July 2021: 4-9

Download Full-text

Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes

VASA ◽

10.1024/0301-1526/a000771 ◽

2019 ◽

Vol 48 (3) ◽

pp. 262-269 ◽

Cited By ~ 3

Author(s):

Christian-Alexander Behrendt ◽

Tilo Kölbel ◽

Thea Schwaneberg ◽

Holger Diener ◽

Ralf Hohnhold ◽

...

Keyword(s):

Multidisciplinary Team ◽

Positive Impact ◽

Cross Sectional Study ◽

Invasive Treatment ◽

Cross Sectional ◽

Hospital Outcomes ◽

Vascular Intervention ◽

Medical Specialties ◽

Team Decision ◽

The Impact

Abstract. Background: Worldwide prevalence of peripheral artery disease (PAD) is increasing and peripheral vascular intervention (PVI) has become the primary invasive treatment. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to depict practice patterns and time changes regarding MTD of different medical specialties. Methods: This is a retrospective cross-sectional study design. 20,748 invasive, percutaneous PVI of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2014. Results: MTD prior to PVI was associated with lower odds of early unsuccessful termination of the procedures (Odds Ratio 0.662, p < 0.001). The proportion of MTD decreased over the study period (30.9 % until 2009 vs. 16.6 % from 2010, p < 0.001) while rates of critical limb-threatening ischemia (34.5 % vs. 42.1 %), patients´ age (70 vs. 72 years), PVI below-the-knee (BTK) (13.2 % vs. 22.4 %), and rates of severe TASC C/D lesions BTK (43.2 % vs. 54.2 %) increased (all p < 0.001). Utilization of MTD was different between medical specialties with lowest frequency in procedures performed by internists when compared to other medical specialties (7.1 % vs. 25.7 %, p < 0.001). Conclusions: MTD prior to PVI is associated with technical success of the procedure. Nonetheless, rates of MTD prior to PVI are decreasing during the study period. Future studies should address the impact of multidisciplinary vascular teams on long-term outcomes.

Download Full-text

Assessing the Preparedness of Healthcare Facilities for Disasters and Emergencies in Damghan, Iran

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.104 ◽

2021 ◽

pp. 1-7

Author(s):

Behrad Pourmohammadi ◽

Ahad Heydari ◽

Farin Fatemi ◽

Ali Modarresi

Keyword(s):

Health Care ◽

Cross Sectional Study ◽

Health Care Facilities ◽

Mitigation Measures ◽

Health Staff ◽

Cross Sectional ◽

Healthcare Facilities ◽

Wide Range ◽

Care Facilities ◽

The Impact

Abstract Objectives: Iran is exposed to a wide range of natural and man-made hazards. Health-care facilities can play a significant role in providing life-saving measures in the minutes and hours immediately following the impact or exposure. The aim of this study was to determine the preparedness of health-care facilities in disasters and emergencies. Methods: This cross-sectional study was conducted in Damghan, Semnan Province, in 2019. The samples consisted of all the 11 health-care facilities located in Damghan County. A developed checklist was used to collect the data, including 272 questions in 4 sections: understanding threatening hazards, functional, structural, and nonstructural vulnerability of health-care facilities. The data were analyzed using SPSS 21. Results: The results revealed that the health-care facilities were exposed to 22 different natural and man-made hazards throughout the county. The total level of preparedness of the health-care centers under assessment was 45.8%. The average functional, structural, and nonstructural vulnerability was assessed at 49.3%, 31.6%, and 56.4%, respectively. Conclusions: Conducting mitigation measures is necessary for promoting the functional and structural preparedness. Disaster educational programs and exercises are recommended among the health staff in health-care facilities.

Download Full-text

Impact of COVID-19 and mitigation plans on essential health services: institutional experience of a hospital in Ethiopia

BMC Health Services Research ◽

10.1186/s12913-021-07106-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Firaol Dandena ◽

Berhanetsehay Teklewold ◽

Dagmawi Anteneh

Keyword(s):

Health Care ◽

Health Services ◽

Health Care Services ◽

Cross Sectional Study ◽

Vital Role ◽

Treatment Center ◽

Cross Sectional ◽

Poor Countries ◽

Care Services ◽

The Impact

Abstract Background Health systems around the world are being challenged by an on-going COVID-19 pandemic. The COVID-19 pandemic and associated response can have a significant downstream effect on access to routine health care services, and indirectly cause morbidity and mortality from causes other than the disease itself, especially in resource-poor countries such as Ethiopia. This study aimed to explore the impact of the pandemic on these services and measures taken to combat the effect. Methods The study was conducted at St. Paul’s hospital millennium medical college (SPHMMC) from December 15, 2020 to January 15, 2021 using a comparative cross-sectional study design. We collected data on the number of clients getting different essential health care services from May to October 2019 (Pre COVID) and the same period in 2020 (during a COVID-19 pandemic) from the patient registry book. The analysis was done with SPSS version 24 software. Result Overall, the essential services of SPHMMC were affected by the COVID-19 pandemic. The most affected service is inpatient admission, which showed a 73.3% (2044 to 682) reduction from the pre-COVID period and the least affected is maternal service, which only decreased by 13% (3671 to 3177). During the 6 months after the COVID-19 pandemic, there was a progressive increment in the number of clients getting essential health services. Conclusion and recommendation The establishment of a triple setup for fighting against COVID-19, which encompasses non-COVID services, an isolation center and a COVID-19 treatment center, played a vital role in preserving essential health services.

Download Full-text

Delays and Disruptions in Cancer Health Care Due to COVID-19 Pandemic: Systematic Review

JCO Global Oncology ◽

10.1200/go.20.00639 ◽

2021 ◽

pp. 311-323

Author(s):

Rachel Riera ◽

Ângela Maria Bagattini ◽

Rafael Leite Pacheco ◽

Daniela Vianna Pachito ◽

Felipe Roitberg ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Health Services ◽

Methodological Quality ◽

Data Extraction ◽

Cross Sectional Study ◽

Routine Activity ◽

Cross Sectional ◽

Cancer Services ◽

The Impact

PURPOSE There has been noteworthy concern about the impact of COVID-19 pandemic on health services including the management of cancer. In addition to being considered at higher risk for worse outcomes from COVID-19, people with cancer may also experience disruptions or delays in health services. This systematic review aimed to identify the delays and disruptions to cancer services globally. METHODS This is a systematic review with a comprehensive search including specific and general databases. We considered any observational longitudinal and cross-sectional study design. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the studies was assessed by specific tools. The delays and disruptions identified were categorized, and their frequency was presented. RESULTS Among the 62 studies identified, none exhibited high methodological quality. The most frequent determinants for disruptions were provider- or system-related, mainly because of the reduction in service availability. The studies identified 38 different categories of delays and disruptions with impact on treatment, diagnosis, or general health service. Delays or disruptions most investigated included reduction in routine activity of cancer services and number of cancer surgeries; delay in radiotherapy; and delay, reschedule, or cancellation of outpatient visits. Interruptions and disruptions largely affected facilities (up to 77.5%), supply chain (up to 79%), and personnel availability (up to 60%). CONCLUSION The remarkable frequency of delays and disruptions in health care mostly related to the reduction of the COVID-19 burden unintentionally posed a major risk on cancer care worldwide. Strategies can be proposed not only to mitigate the main delays and disruptions but also to standardize their measurement and reporting. As a high number of publications continuously are being published, it is critical to harmonize the upcoming reports and constantly update this review.

Download Full-text

Psychological Impact of COVID-19 Pandemic on Health Care Workers: A Cross Sectional Study

BioMedica ◽

10.51441/biomedica//biomedica/5-410 ◽

2020 ◽

Vol 36 (2S) ◽

pp. 223-227

Author(s):

Zaina Jabeen ◽

Aysha Rani ◽

Sohaib Ahmed ◽

Sadaf Ghaffar ◽

Tazaeen Hina Kazmi ◽

...

Keyword(s):

Health Care ◽

Health Care Workers ◽

Psychological Health ◽

Psychological Impact ◽

Cross Sectional Study ◽

Ethical Review ◽

Sectional Study ◽

Cross Sectional ◽

Care Workers ◽

The Impact

Background and Objective: The Coronavirus disease 2019 (COVID-19) pandemic has affected more than four million people in 213 countries. Health care workers (HCWs) who deal with COVID-19 patients have a high chance of getting infected. They have got valid concerns regarding their own health as well as the impact it can have on the wellbeing of their family and acquaintances. The current study aims to assess the prevalence of psychological problems among HCWs during the COVID-19 pandemic. Methods: A cross-sectional study was conducted among HCWs of Wah Medical College and Pakistan Ordnance Factories (POF) Hospital Wah Cantt from 1st May 2020 to 7th May 2020 after an ethical approval by ethical review board. A total of 340 HCWs participated by filling an online questionairre; questions on demographic profile and validated Depression, Anxiety and Stress Scale–21 (DASS-21) score were included. Frequency of depression, anxiety and stress and mean DASS-21 scores between house officers and all other healthcare workers and between Medicine and allied department and other departments was assessed. Data was analysed using Statistical Package for the Social Sciences (SPSS)-23. P-value ≤ 0.05 was considered statistically significant. Results: Among 340 HCWs majority i.e. 66.8% were less than 35 years of age and the mean age of participants was 40.65 ± 11.64 years. There was a female proponderance with a F:M ratio of 1.7:1. Most (55.3%) of the participants were single and there was a high percentage of house officers with 45% among all. The overall prevalence of depressiom, anxiety and stress among all HCWs was 32.9%, 25% and 23.5% respectively. The depression, anxiety and stress among house officers than other HCWs and higher prevalence in Medicine and Allied Departments than other departments. Conclusion: As the global threat of COVID-19 continues to emerge, it is important not to underestimate the psychological impact of this pandemic on HCWs. Interventions and support to especially vulnerable groups of HCWs will help improve psychological health, which in turn will help improve the quality of patient care.

Download Full-text

PATIENTS SATISFACTION ABOUT HEALTH CARE DELIVERY IN OUT-PATIENTS DEPARTMENT OF COMBINED MILITARY HOSPITAL RAWALPINDI

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70i6.5850 ◽

2020 ◽

Vol 70 (6) ◽

pp. 1929-34

Author(s):

Tahir Sardar ◽

Iqbal Ahmad Khan ◽

Muhammed Alamgir Khan

Keyword(s):

Health Care ◽

Health Care Delivery ◽

Care Delivery ◽

Cost Effective ◽

Armed Forces ◽

Cross Sectional Study ◽

Military Hospital ◽

Nursing Assistant ◽

Cross Sectional ◽

Level Of Satisfaction

Objective: To determine patient’s level of satisfaction and factors leading to dissatisfaction in selected patientsgroup with health care delivery in outpatients department of CMH Rawalpindi. Study Design: Cross sectional study. Place and Duration of Study: Out Patients Department of Combined Military Hospital Rawalpindi, from Sep2013 to Aug 2015. Methodology: Before data collection, written informed consent was taken from all the participants. The studypopulation comprised of armed forces personnel and their families. Patients, including both, males and females, coming to the outpatient department of Combined Military Hospital Rawalpindi were included in the study through consecutive sampling. Results: Results revealed that only 30% were satisfied. 67% patients were satisfied with the facilities in reception and 70% were satisfied with cleanliness in waiting area. A relatively low level of satisfaction with dealing of nursing assistant was recorded while very high percentage of satisfaction with performance of doctor i.e. 91%, examination done by doctor 91% and information provided by doctor 93% was recorded.90% patients reported high level of satisfaction with medicines provided.95.33% patients were satisfied with lab tests being done in hospital. Conclusion: Assessing satisfaction of patients is a simple and cost effective way for assessment of hospitalservices. Most of the patients were contented with services delivered in OPD and showed their trust in doctors,medicines provided and lab facilities offered. Majority were willing to revisit the hospital if required.

Download Full-text

Evaluation of prescription containing medication via enteral feeding tubes in an adult emergency unit

Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde ◽

10.30968/rbfhss.2020.114.0497 ◽

2020 ◽

Vol 11 (4) ◽

pp. 497

Author(s):

Inaê A. SPEZIA ◽

Filipe C. MATHEUS

Keyword(s):

Health Care ◽

Enteral Feeding ◽

Feeding Tube ◽

Medication Administration ◽

Health Care Team ◽

Cross Sectional Study ◽

Care Team ◽

Emergency Unit ◽

Cross Sectional ◽

Pharmaceutical Form

Objective: This study aims to evaluate medication prescriptions to be used by a feeding tube in an emergency unit, identify and classify the problems with the prescriptions and suggest interventions, done by a pharmacist, when necessary. Also aims to develop a guide with information about administering medication through the feeding tube in order to help the health care team. Methods: the study is characterized as a quantitative cross-sectional study, with data collected during March to September of 2019 at an adult emergency unit, a total of 47 prescriptions were analyzed by a pharmacist and 138 drugs were prescripted to be administered through a feeding tube. Results: A total of 18.8% of those medications presented some restriction to be administered by the feeding tube. The most common problems observed were the loss or reduction of therapeutic effect present in 61,6% of the cases, followed by drug-food interactions with 30.8%. About the pharmaceutical intervention more performed was requesting to change the pharmaceutical form (36%), followed by orientation about stop the enteral feeding (30.2%). To the elaboration of the guide for the health care team, 181 medications standardized at the hospital were analyzed, of that 33.1% presented some restriction to administer by feeding tube and only 35% presented another pharmaceutical form for substitution. Conclusion: it was possible to note the importance of pharmaceutical evaluation of prescriptions to identify errors and prevent future problems assuring the patient’s safety. The guide elaboration sought to assist and optimize the process of medication administration by feeding tube guaranteeing the safety and effectiveness of pharmacotherapy.

Download Full-text

Residency training amid the COVID-19 pandemic: exploring the impact on mental health and training, a lesson from Iran

BMC Medical Education ◽

10.1186/s12909-021-03029-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ashraf Moini ◽

Khadije Maajani ◽

Ramesh Omranipour ◽

Mohamad-Reza Zafarghandi ◽

Ashraf Aleyasin ◽

...

Keyword(s):

Mental Health ◽

Residency Training ◽

General Surgery ◽

Negative Impact ◽

Care Delivery ◽

Cross Sectional Study ◽

Multiple Choice Questions ◽

Cross Sectional ◽

Questions And Answers ◽

The Impact

Abstract Background COVID-19 has affected the training programs and the clinical schedules of surgical wards in many countries, including Iran. Also, the continuous involvement with COVID-19 patients has caused stress in health care workers; among them, residents are on the frontlines of care delivery. Therefore, we designed a study to assess the mental effects of these circumstances, and the effects on General Surgery and Obstetrics & Gynecology residency training in the busiest surgical departments of our university. Methods Participants of this cross-sectional study were residents of General Surgery and Obstetrics & Gynecology of Tehran University of Medical Sciences, and the conventional sampling method was used. We used a questionnaire consisting of 47 questions (mostly using multiple choice questions and answers on the Likert scale) about personal, familial, and demographic characteristics; training activities, and mental effects of COVID-19. Results The response rate was 63.5%. (127 filled questionnaires). Around 96% of the residents had emotional problems, 85.9% were highly stressed about contracting COVID-19, 81.3% were worried about transferring it to their families; and 78% believed that their residency training had been impaired. Conclusion Overall, our study shows the negative impact of COVID-19 on mental health and the training of residents. We propose that appropriate emotional support and suitable planning for compensation of training deficits is provided for residents.

Download Full-text