Effects of Acuity-Adaptable Rooms on Flow of Patients and Delivery of Care

2004 ◽  
Vol 13 (1) ◽  
pp. 35-45 ◽  
Author(s):  
Ann L. Hendrich ◽  
Joy Fay ◽  
Amy K. Sorrells
Keyword(s):  
Business Case ◽  
Direct Care ◽  
First Year ◽  
Base Number ◽  
Nursing Time ◽  
Financial Measures ◽  
Delivery Of Care ◽  
Hospital Capacity ◽  
Patients Satisfaction ◽  
Sentinel Events

• Background Delayed transfers of patients between nursing units and lack of available beds are significant problems that increase costs and decrease quality of care and satisfaction among patients and staff.• Objective To test whether use of acuity-adaptable rooms helps solve problems with transfers of patients, satisfaction levels, and medical errors.• Methods A pre-post method was used to compare the effects of environmental design on various clinical and financial measures. Twelve outcome-based questions were formulated as the basis for inquiry. Two years of baseline data were collected before the unit moved and were compared with 3 years of data collected after the move.• Results Significant improvements in quality and operational cost occurred after the move, including a large reduction in clinician handoffs and transfers; reductions in medication error and patient fall indexes; improvements in predictive indicators of patients’ satisfaction; decrease in budgeted nursing hours per patient day and increased available nursing time for direct care without added cost; increase in patient days per bed, with a smaller bed base (number of beds per patient days). Some staff turnover occurred during the first year; turnover stabilized thereafter.• Conclusions Data in 5 key areas (flow of patients and hospital capacity, patients’ dissatisfaction, sentinel events, mean length of stay, and allocation of nursing productivity) appear to be sufficient to test the business case for future investment in partial or complete replication of this model with appropriate populations of patients.

scholarly journals Evaluation of Patient-Initiated Direct Care Mobile Phone–Based Teledermatology During The COVID-19 Pandemic (Preprint)

2021 ◽  
Author(s):  
Jasleen Kaur ◽  
Priyanka Sharma ◽  
G P Thami ◽  
Maninder Sethi ◽  
Shruti Kakar
Keyword(s):  
Patient Satisfaction ◽  
Mobile Phone ◽  
Care Center ◽  
Tertiary Care ◽  
Confidence Score ◽  
Accurate Diagnosis ◽  
Direct Care ◽  
Tertiary Care Center ◽  
Patients Satisfaction ◽  
Assess Patient Satisfaction

BACKGROUND With advances in telecommunication, especially smartphones, teledermatology services offered by specialists are now being directly requested by the patients themselves. This model is known as patient-initiated, direct care teledermatology. It has been pushed to the forefront due to the COVID-19 pandemic. OBJECTIVE The objectives of this study were to determine patients’ satisfaction and dermatologists’ confidence when a diagnosis was made via direct care mobile phone–based teledermatology. METHODS Patients availing direct care teledermatology services during the COVID-19 pandemic at a tertiary care center were subjected to a questionnaire within 5 days of the teleconsultation to assess patient satisfaction and opinions regarding using this model during and beyond the current COVID-19 pandemic. The dermatologists rated their confidence in making the clinical diagnosis on a scale from 1-10 for every case. RESULTS Of 437 participants, 419 (95.9%) were satisfied with this mode of teledermatology. An overwhelming majority (n=428, 97.9%) felt safe consulting the dermatologist via teleconsultation and not having to visit the hospital during the COVID-19 pandemic. In addition, 269 (61.6%) patients agreed that they would be happy to use a teledermatology service beyond the COVID-19 pandemic. The dermatologists’ confidence score in making an accurate diagnosis ranged from 3 to 10, with a mean of 9.20 (SD 1.12). CONCLUSIONS The high levels of patient satisfaction and dermatologists’ confidence scores indicate that direct care mobile phone–based teledermatology may be a useful tool in providing dermatological services in appropriate settings and its use should continue to be explored beyond the COVID-19 pandemic.

DELIVERY OF CARE TO HEMOPHILIC CHILDREN: HOME CARE VERSUS HOSPITALIZATION

PEDIATRICS ◽  
1973 ◽  
Vol 51 (6) ◽  
pp. 986-991
Author(s):  
Hanna Strawczynski ◽  
Andrew Stachewitsch ◽  
Gert Morgenstern ◽  
Marjorie E. Shaw
Keyword(s):  
Home Care ◽  
School Attendance ◽  
Great Majority ◽  
Social Aspects ◽  
First Year ◽  
Delivery Of Care ◽  
Children And Parents ◽  
Second Year ◽  
Hospital Days ◽  
At Home

Medical, economic, and social aspects of home care versus hospitalization in treatment of hemophiliacs were assessed in a two-year study. Thirty-six children were divided into two groups. During the first year of study half the patients were hospitalized when bleeding was reported, the other half were treated at home by Home Care, a team of physicians and paramedical personnel. During the second year groups changed assignments, thus each served as its own control. Home Care provided a 24-hour telephone service; treatment was carried out by a nurse at home or school. Results showed that great majority of bleedings did not require hospitalization. No complications were noted. While on Home Care more bleedings were reported and they were reported faster; school attendance was better. Home Care, preferred by children and parents, provided an excellent model for teaching and a new role for a nursepractitioner. Hospital days were reduced by 85%.

Impacting Neonatal Patient Care: Reducing Needle Sticks, with an Extended Dwell Catheter

2021 ◽  
Author(s):  
Tara M. Daly ◽  
Constance Girgenti
Keyword(s):  
Seldinger Technique ◽  
Nursing Time ◽  
Improvement Project ◽  
Delivery Of Care ◽  
Efficient Delivery ◽  
Days Of Therapy ◽  
Ultimate Result ◽  
Neonatal Patient ◽  
Needle Sticks ◽  
Preterm Newborns

Highlights Abstract Background: The use and efficacy of extended dwell peripheral intravenous catheters (EPIVs) has been extensively described at scientific conferences and in recent literature. The ramifications of repeated needle sticks include damage to vessels and ultimately the need for more invasive and costly access devices, which clearly support the need for reliable forms of vascular access. Methods: This quality improvement project spanned 4 years, 2017 through 2020, and included 128 patients who required a peripherally inserted catheter as their primary or secondary access site for a prescribed therapy. The EPIV utilized was a 4-cm, 22-gauge catheter made of thermosensitive polyurethane inserted using the Seldinger technique. Results: Over the course of 4 years, 128 patients received an EPIV for 2 or more days, totaling 849 days of therapy. Total insertion attempts were 174 or an average of 1.4 per patient. An estimated number of short PIVs needed for 849 days would have been 404 with 1011 attempts. Resultant savings with EPIV are estimated to be $30,686. Conclusions: Reducing the number of patient peripheral intravenous attempts while extending the dwell time results in less patient trauma, reliable longer-term access, reduced infection risk, reduced supply usage, and savings in terms of nursing time. The ultimate result for preterm newborns is more efficient delivery of care with less cost.

Direct and Indirect Care: Defining Domains of Nursing Practice

1997 ◽  
Vol 1 (3) ◽  
pp. 43-52 ◽  
Author(s):  
Zane Robinson Wolf
Keyword(s):  
Patient Care ◽  
Registered Nurses ◽  
Communication Skills ◽  
Delphi Study ◽  
Nursing Practice ◽  
Physical Contact ◽  
Direct Care ◽  
Delivery Of Care ◽  
Indirect Care

Experienced registered nurses completed a three-round Delphi study that induced definitions of direct and indirect care functions and ranked those functions. The highest ranked direct care functions involved actions in which physical contact was employed and when communication skills were used to teach patients and attend to their emotional concerns. Highest ranked indirect care functions included: facilitating the delivery of care, improving outcomes, collaborating with other caregivers, communicating about patient progress, and planning patient care.

scholarly journals Improving the Use of Healthcare Resources in Canadian Hospitals: The Impact of a Reintegration Unit in Expanding Acute Care Capacity and Resource Use in Sunnybrook Health Sciences Centre

2020 ◽  
Author(s):  
Ivy Cheng ◽  
G. Ross Baker ◽  
Debra Carew ◽  
Stacy Landau ◽  
Debra Walko ◽  
...  
Keyword(s):  
Service Providers ◽  
Patient Flow ◽  
Business Case ◽  
Level Of Care ◽  
Term Care ◽  
Healthcare Budget ◽  
Hospital Capacity ◽  
Alternate Level Of Care ◽  
Care Capacity ◽  
The Impact

Abstract Background: Alternate level of care (ALC) patients are those who reside in acute hospital beds but can be managed in non-hospital settings. They contribute to high occupancy levels in Canadian hospitals. Between 2017-18, Ontario spent 1.1 billion dollars on hospitalized patients waiting for alternate level of care (ALC) beds. To improve value for care, Ontario Ministry of Health (MOHLTC) invested into reintegration units which are designed to transfer ALC patients out of hospital and transition them back into the community or long-term care (LTC). Given today’s healthcare budget pressures, it is unclear if reactivation units are feasible. In 2018, the MOHLTC funded a reintegration unit, Pine Villa with an operational partner, Sunnybrook Hospital and community service providers (SPRINT Senior Care, LOFT) in Toronto, Ontario. The objective was to determine averted costs for ALC-patients and impact on Sunnybrook patient flow-through if ALC-patient Pine Villa transfers occurred on the day of ALC readiness. Methods: Retrospective, observational analysis of Sunnybrook ALC-patients discharged to Pine Villa between January 9, 2018 to February 4, 2019. From the healthcare payer’s perspective (MOHTLC), cost analysis was modelled for ALC patients designated for 1) LTC and 2) home with supports. Avoided costs at time of ALC readiness were determined by case-costing. Averted hospital ALC days were established. Results: If ALC patients were transferred to Pine Villa at time of ALC readiness for LTC, the healthcare system could have averted 5.4 million dollars from Sunnybrook. If the patients were transferred for home, 2.3 million dollars could have been averted. Both models increased acute Sunnybrook Hospital capacity by 34 beds. Conclusion: There is a business case supporting reintegration units if ALC-patients are discharged from the hospital on the day of ALC-readiness.

Characterization of relapse in patients with clinical stage I (CSI) nonseminoma (NS-TC) managed with active surveillance (AS): A large multicenter study.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4503-4503 ◽  
Author(s):  
Christian K. Kollmannsberger ◽  
Torgrim Tandstad ◽  
Philippe L. Bedard ◽  
Michael A. S. Jewett ◽  
Gabriella Cohn-Cedermark ◽  
...  
Keyword(s):  
Lymphovascular Invasion ◽  
Clinical Stage ◽  
First Year ◽  
Delivery Of Care ◽  
Centralized Management ◽  
Large Databases ◽  
Alive With Disease ◽  
Almost All

4503 Background: Large single institution trials have demonstrated that AS for patients with CSI NS-TC is safe and effective. Information on timing and extent of relapse following AS has the potential to guide intensity and duration of imaging on AS. Methods: Retrospective clinical data on CSI patients were obtained from existing large databases, including institutions/regions which have a standardized policy of centralized management of testicular cancer including AS for patients with CSI NS-TC. In all, 1,034 patients with CSI NS-TC managed with AS were reviewed of whom 886 had no lymphovascular invasion (LVI-), 220 had lymphovascular invasion (LVI+) and 28 had unknown lymphovascular status (LVI unknown). Results: A total of 221 relapses occurred with 150/886 (17%) of LVI– pts , 60/120 (50%) LVI+ pts and 11/28 (39%) of LVI unknown pts (Table). Median follow-up was 63 months (1-163 months). At last follow up 1,013/1,034 (98%) were alive without disease, 16/1,034 (1.5%) were dead of other causes and 7/1,035 (0.05%) were alive with disease or dead of disease. Relapse was identified by marker elevation and/or abdominal imaging in almost all patients. Few patients relapsed with IGCCCC intermediate (18/221, 8%) or poor risk disease (3/221, 1.4%). Conclusions: AS for CSI NS-TC is safe and effective, using a policy of centralized management with loco-regional delivery of care. Our multinational outcomes compare well to single institutional reports. Relapse other than with IGCCC good risk disease was uncommon and death from disease was rare. Compared to patients with LVI-, relapses in LVI + CSI patients occur earlier and few relapses are detected past the first year of follow-up. This data may help in the design of follow up schedules tailored towards the relapse risk in CSI NS-TC AS. [Table: see text]

scholarly journals Evaluation of Patient-Initiated Direct Care Mobile Phone–Based Teledermatology During The COVID-19 Pandemic

Iproceedings ◽  
10.2196/35400 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35400
Author(s):  
Jasleen Kaur ◽  
Priyanka Sharma ◽  
G P Thami ◽  
Maninder Sethi ◽  
Shruti Kakar
Keyword(s):  
Patient Satisfaction ◽  
Mobile Phone ◽  
Conflicts Of Interest ◽  
Care Center ◽  
Tertiary Care ◽  
Confidence Score ◽  
Accurate Diagnosis ◽  
Direct Care ◽  
Patients Satisfaction ◽  
Assess Patient Satisfaction

Background With advances in telecommunication, especially smartphones, teledermatology services offered by specialists are now being directly requested by the patients themselves. This model is known as patient-initiated, direct care teledermatology. It has been pushed to the forefront due to the COVID-19 pandemic. Objective The objectives of this study were to determine patients’ satisfaction and dermatologists’ confidence when a diagnosis was made via direct care mobile phone–based teledermatology. Methods Patients availing direct care teledermatology services during the COVID-19 pandemic at a tertiary care center were subjected to a questionnaire within 5 days of the teleconsultation to assess patient satisfaction and opinions regarding using this model during and beyond the current COVID-19 pandemic. The dermatologists rated their confidence in making the clinical diagnosis on a scale from 1-10 for every case. Results Of 437 participants, 419 (95.9%) were satisfied with this mode of teledermatology. An overwhelming majority (n=428, 97.9%) felt safe consulting the dermatologist via teleconsultation and not having to visit the hospital during the COVID-19 pandemic. In addition, 269 (61.6%) patients agreed that they would be happy to use a teledermatology service beyond the COVID-19 pandemic. The dermatologists’ confidence score in making an accurate diagnosis ranged from 3 to 10, with a mean of 9.20 (SD 1.12). Conclusions The high levels of patient satisfaction and dermatologists’ confidence scores indicate that direct care mobile phone–based teledermatology may be a useful tool in providing dermatological services in appropriate settings and its use should continue to be explored beyond the COVID-19 pandemic. Conflicts of Interest None declared.

scholarly journals Interventions as an alternative to penalties in preventable readmissions

2015 ◽  
Vol 4 (3) ◽  
pp. 70
Author(s):  
Andres Garcia-Arce ◽  
Jose L. Zayas-Castro
Keyword(s):  
Affordable Care Act ◽  
Hospital Readmissions ◽  
Prospective Payment System ◽  
The United States ◽  
Fiscal Year ◽  
First Year ◽  
Readmission Rates ◽  
Delivery Of Care ◽  
Patient Protection ◽  
The Government

While expenditures in healthcare in the United States are the highest in the world, it is widely known that those resources are not being used efficiently. The government addressed this situation in the Patient Protection and Affordable Care Act, in an attempt to improve quality and affordability of healthcare. In the fiscal year 2013, the Centers for Medicare and Medicaid Services began imposing financial penalties through the Inpatient Prospective Payment System to hospitals that have higher than expected readmission rates for specific diseases. The nature and effects of this new policy have raised several concerns. This article discusses Medicare’s hospital readmissions reduction program and presents an alternate policy based on diseasespecific interventions to reduce preventable readmissions. Our results show that a policy based on implementing disease-specific interventions, instead of penalties, may save 33.43% of hospitals from being under the penalization level in the first year, while at the same time improving the delivery of care.

scholarly journals The Evolution of Physician Practice Styles: Evidence from Cardiologist Migration

2018 ◽  
Vol 10 (1) ◽  
pp. 326-356 ◽  
Author(s):  
David Molitor
Keyword(s):  
Physician Behavior ◽  
First Year ◽  
Point Change ◽  
Hospital Capacity ◽  
Learned Behavior ◽  
Percentage Points ◽  
Change In Practice ◽  
Specific Factors ◽  
Changes Over Time

Physician treatment choices for observably similar patients vary dramatically across regions. This paper exploits cardiologist migration to disentangle the role of physician-specific factors such as preferences and learned behavior versus environment-level factors such as hospital capacity and productivity spillovers on physician behavior. Physicians starting in the same region and subsequently moving to dissimilar regions practice similarly before the move. After the move, physician behavior in the first year changes by 0.6–0.8 percentage points for each percentage point change in practice environment, with no further changes over time. This suggests environment factors explain between 60–80 percent of regional disparities in physician behavior. (JEL H75, I11, I12, I18)

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