scholarly journals Partnering with Hospital Providers to Facilitate Handoff for Persons with Dementia in the Acute Care Setting

2021 ◽  
Author(s):  
◽  
Vanessa Jeune
Keyword(s):  
Care Transitions ◽  
Transitions Of Care ◽  
Cognitively Impaired ◽  
Communication Tool ◽  
Care Needs ◽  
Support Person ◽  
Practice Problem ◽  
Clinically Significant ◽  
Person With Dementia ◽  
Standardized Care

Practice Problem: Individuals with Alzheimer's disease and related dementias cannot verbalize their care needs during transitions of care (TOC) and rely on their home caregivers (HCs) for advocacy. The lack of communication between clinicians in one setting and HCs can lead to detrimental health outcomes for the length of stay. PICOT: The PICOT question that guided this project was: With the assistance of family nurse consultants (P), how does the implementation of standardized care needs communication tool for support persons of persons with dementia (I) vs. no standardized process (C) enhance the ability for the support person to communicate care needs during TOC (O) within 5 weeks (T)? Evidence: The review of high-quality studies reveals evidence that supports clinician-home caregiver communication as an approach to bridge gaps for the person with dementia (PWD) across health care settings. Intervention: The clinician-home caregiver communication checklist was used as an evidence-based tool to enhance the HC’s ability to communicate care needs for the PWD during care transitions. Outcome: There was a clinically significant improvement with the family nurse consultants’ utilization of the tool, and HCs who were offered the tool benefited from that time of preparation for their loved ones. There was a statistically significant improvement in family nurse consultants’ perception of the value and usefulness of the tool after they were introduced to it. Conclusion: The project findings revealed that using the standardized care needs communication tool, HCs can be crucial members to strengthen TOC for the cognitively impaired individual.

scholarly journals Partners at Care Transitions: exploring healthcare professionals’ perspectives of excellence at care transitions for older people

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022468 ◽  
Author(s):  
Ruth Baxter ◽  
Jane O’Hara ◽  
Jenni Murray ◽  
Laura Sheard ◽  
Alison Cracknell ◽  
...  
Keyword(s):  
Older People ◽  
Hospital Admissions ◽  
Transitional Care ◽  
Transition Period ◽  
Care Transitions ◽  
Transitions Of Care ◽  
Care Needs ◽  
High Performing ◽  
Health And Social Care ◽  
Hospital To Home

IntroductionHospital admissions are shorter than they were 10 years ago. Notwithstanding the benefits of this, patients often leave hospital requiring ongoing care. The transition period can therefore be risky, particularly for older people with complex health and social care needs. Previous research has predominantly focused on the errors and harms that occur during transitions of care. In contrast, this study adopts an asset-based approach to learn from factors that facilitate safe outcomes. It seeks to explore how staff within high-performing (‘positively deviant’) teams successfully support transitions from hospital to home for older people.Methods and analysisSix high-performing general practices and six hospital specialties that demonstrate exceptionally low or reducing 30-day emergency hospital readmission rates will be invited to participate in the study. Healthcare staff from these clinical teams will be recruited to take part in focus groups, individual interviews and/or observations of staff meetings. Data collection will explore the ways in which teams successfully deliver exceptionally safe transitional care and how they overcome the challenges faced in their everyday clinical work. Data will be thematically analysed using a pen portrait approach to identify the manifest (explicit) and latent (abstract) factors that facilitate success.Ethics and disseminationEthical approval was obtained from the University of Leeds. The study will help develop our understanding of how multidisciplinary staff within different healthcare settings successfully support care transitions for older people. Findings will be disseminated to academic and clinical audiences through peer-reviewed articles, conferences and workshops. Findings will also inform the development of an intervention to improve the safety and experience of older people during transitions from hospital to home.

scholarly journals Unmet Caregiving Needs Are Associated With Cognitive Functioning Among Older Sepsis Survivors

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 255-255
Author(s):  
Jo-Ana Chase ◽  
Lizyeka Jordan ◽  
Christina Whitehouse ◽  
Kathryn Bowles
Keyword(s):  
Cognitive Functioning ◽  
Unmet Need ◽  
Caregiver Training ◽  
Cognitively Impaired ◽  
Medicare Beneficiaries ◽  
Care Needs ◽  
Information Set ◽  
Sepsis Survivors ◽  
The Relationship ◽  
Care Outcome

Abstract Sepsis survivorship is associated with cognitive decline and complex post-acute care needs. Family caregivers may be unprepared to manage these needs, resulting in decline or no improvement in patient outcomes. Using a national dataset of Medicare beneficiaries who were discharged from the hospital for sepsis and received post-acute HHC between 2013 and 2014 (n=165,228), we examined the relationship between unmet caregiving needs and improvement or decline in cognitive functioning. Multivariate logistic regression was used to determine associations between unmet caregiving needs at the start of HHC and changes in cognitive functioning. Unmet caregiving needs included seven items from the start of care Outcome and Assessment Information Set (OASIS). Changes in cognitive functioning were measured using the start of care and discharge OASIS assessments. Twenty-four percent of patients either declined or did not improve in cognitive functioning from HHC admission to discharge, with variation seen by unmet need type. Sepsis survivors with unmet caregiving needs for activities of daily living assistance (OR 1.05, 95% CI 1.01, 1.09), medication assistance (OR 1.06, 95% CI 1.02,1.10), and supervision and safety assistance (OR 1.110, 95% CI 1.06,1.16) were more likely to decline or not improve in cognitive functioning, even after accounting for clinical and demographic characteristics. Older sepsis survivors with both cognitive impairment and unmet caregiving needs in the post-acute HHC setting are at high-risk for worsening cognition. Alerting the care team of cognitively impaired sepsis survivors with unmet caregiving needs may trigger evidence-based strategies to enhance caregiver training and reduce unmet caregiving needs.

scholarly journals Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study (Preprint)

2020 ◽  
Author(s):  
Carolyn Steele Gray ◽  
Terence Tang ◽  
Alana Armas ◽  
Mira Backo-Shannon ◽  
Sarah Harvey ◽  
...  
Keyword(s):  
Older Adults ◽  
Phase 1 ◽  
Care Transitions ◽  
Self Management ◽  
Complex Care ◽  
Phase 2 ◽  
Care Needs ◽  
Centered Care ◽  
Hospital To Home ◽  
Complex Care Needs

BACKGROUND Older adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and organizations involved in the transition from hospital to home can impede access to needed support and resources. Establishing digitally supported communication that enables person-centered care and supported self-management may offer significant advantages as we support older adults with CCN transitioning from hospital to home. OBJECTIVE This protocol outlines the plan for the development, implementation, and evaluation of a Digital Bridge co-designed to support person-centered health care transitions for older adults with CCN. The Digital Bridge builds on the foundation of two validated technologies: Care Connector, designed to improve interprofessional communication in hospital, and the electronic Patient-Reported Outcomes (ePRO) tool, designed to support goal-oriented care planning and self-management in primary care settings. This project poses three overarching research questions that focus on adapting the technology to local contexts, evaluating the impact of the Digital Bridge in relation to the quadruple aim, and exploring the potential to scale and spread the technology. METHODS The study includes two phases: workflow co-design (phase 1), followed by implementation and evaluation (phase 2). Phase 1 will include iterative co-design working groups with patients, caregivers, hospital providers, and primary care providers to develop a transition workflow that will leverage the use of Care Connector and ePRO to support communication through the transition process. Phase 2 will include implementation and evaluation of the Digital Bridge within two hospital systems in Ontario in acute and rehab settings (600 patients: 300 baseline and 300 implementation). The primary outcome measure for this study is the Care Transitions Measure–3 to assess transition quality. An embedded ethnography will be included to capture context and process data to inform the implementation assessment and development of a scale and spread strategy. An Integrated Knowledge Translation approach is taken to inform the study. An advisory group will be established to provide insight and feedback regarding the project design and implementation, leading the development of the project knowledge translation strategy and associated outputs. RESULTS This project is underway and expected to be complete by Spring 2024. CONCLUSIONS Given the real-world implementation of Digital Bridge, practice changes in the research sites and variable adherence to the implementation protocols are likely. Capturing and understanding these considerations through a mixed-methods approach will help identify the range of factors that may influence study results. Should a favorable evaluation suggest wide adoption of the proposed intervention, this project could lead to positive impact at patient, clinician, organizational, and health system levels. CLINICALTRIAL ClinicalTrials.gov NCT04287192; https://clinicaltrials.gov/ct2/show/NCT04287192 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/20220

Abstract TP308: Transitional Care in Stroke Certified and Non-certified Hospitals: The Comprehensive Post-Acute Stroke Services (COMPASS) Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Janet Prvu Bettger ◽  
Sara Jones ◽  
Anna Kucharska-Newton ◽  
Janet Freburger ◽  
Walter Ambrosius ◽  
...  
Keyword(s):  
Transitional Care ◽  
Discharge Planning ◽  
Care Transitions ◽  
Cluster Randomized Trial ◽  
Stroke Patients ◽  
Care Needs ◽  
Post Discharge ◽  
Exact Test ◽  
Chi Squared

Background: Greater than 50% of stroke patients are discharged home from the hospital, most with continuing care needs. In the absence of evidence-based transitional care interventions for stroke patients, procedures likely vary by hospital even among stroke-certified hospitals with requirements for transitional care protocols. We examined the standard of transitional care among NC hospitals enrolled in the COMPASS study comparing stroke-certified and non-certified hospitals. Methods: Hospitals completed an online, self-administered, web-based questionnaire to assess usual care related to hospitals’ transitional care strategy, stroke program structural components, discharge planning processes, and post-discharge patient management and follow-up. Response frequencies were compared between stroke certified versus non-certified hospitals using chi-squared statistics and Fisher’s exact test. Results: As of July 2016, the first 27 hospitals enrolled (of 40 expected) completed the survey (67% certified as a primary or comprehensive stroke center). On average, 54% of stroke patients were discharged home. Processes supporting hospital-to-home care transitions, such as timely follow-up calls and follow-up with neurology, were infrequent and overall less common for non-certified hospitals (Table). Assessment of post-discharge outcomes was particularly infrequent among non-certified sites (11%) compared with certified sites (56%). Uptake of transitional care management billing codes and quality metrics was low for both certified and non-certified hospitals. Conclusion: Significant variation exists in the infrastructure and processes supporting care transitions for stroke patients among COMPASS hospitals in NC. COMPASS as a pragmatic cluster-randomized trial will compare outcomes among hospitals that implement a CMS-directed model of transitional care with those hospitals that provide highly variable transitional care services.

Abstract T P277: Time Out: Safe Patient Transition Pre-Hospital to Hospital

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tony Nunn ◽  
Bradley Barth ◽  
David Bram ◽  
Janice Sandt ◽  
Seamus Murphy ◽  
...  
Keyword(s):  
Medical History ◽  
Best Practice ◽  
Care Delivery ◽  
Care Transitions ◽  
Final Analysis ◽  
Hospital Staff ◽  
Communication Tool ◽  
Frontline Staff ◽  
Hand Off ◽  
Standardized Method

Background and Purpose: Historically, Emergency Medical Services (EMS) and Emergency Department (ED) nursing staff have had no standardized method of hand-off reporting, and documentation of the communication has been difficult to locate in the medical record. Comprehensive Stroke Centers (CSC) are called to collaborate and communicate with all care delivery partners, including providers from transferring facilities. A standardized method of communication and documentation sets the stage for safe patient care transitions. Methods: Regional community discussion began in 2011. Proposals were made and no early adopters came forward. Internal discussion was readdressed. A team was assembled consisting of researchers and frontline staff from ED, EMS and the CSC. A hand-off communication tool was developed using Situation, Background, Assessment, and Treatments format. The tool includes stroke specific data points important to care and pilot data will be collected during fourth quarter of 2013. Metrics include compliance of tool use and an accurate medical history with home medications. Three EMS providers representing urban, suburban and rural services have been recruited. Each Paramedic-RN team involved in a hand-off will receive an electronic survey measuring engagement and satisfaction. Results: A standardized method for communicating important hand-off information was developed and will be demonstrated. Final analysis of the data at the end of the quarter will provide direction to further improve the tool with the goal of permanent implementation within the region. Ongoing data analysis will be communicated to all providers monthly via electronic communication. Sharing the story with the region on a regular basis presents a road-map for successful safe patient transitions. Conclusions: The development of consistent standardized hand-off communication between pre-hospital and hospital staff is essential to patient safety. Collaboration empowers best practice solutions. Accurate medical history assists in rapid emergent evaluation. Engaged pre-hospital and hospital personnel using standardized tools are likely to provide consistent safe patient transitions. Safe hand-off communication is paramount for all CSC partners.

Transitions of Care—Disposition Planning

2019 ◽  
pp. 293-312
Author(s):  
Kimberly Kopecky ◽  
Pringl Miller
Keyword(s):  
Adverse Events ◽  
Care Transitions ◽  
Safety Data ◽  
Transitions Of Care ◽  
Transition Of Care ◽  
Quality And Safety ◽  
Care Continuum ◽  
Hospital Readmission Rates ◽  
National Patient ◽  
Policy Priority

Care transitions are a hot topic in healthcare delivery, research, and policy today because national patient quality and safety data have identified transition of care as a critical time during a patient’s care continuum when both quality and safety are potentially compromised. Poorly executed transitions of care are associated with preventable adverse events and hospital readmissions that are burdensome to patients and their caregivers, correlating to suboptimal outcomes and exorbitant costs. Therefore, reducing both adverse events during a care transition and hospital readmission rates is a matter of clinical and policy priority. High-risk surgical patients are particularly vulnerable to preventable adverse events and readmissions during care transitions because of the complexity of their care needs. To address this problem, governmental and other healthcare organizations are allocating resources and investing in research initiatives to improve, refine, and standardize the transition-of-care process in order to optimize quality of care throughout a patient’s care continuum.

scholarly journals Transitions to palliative care for older people in acute hospitals: a mixed-methods study

2013 ◽  
Vol 1 (11) ◽  
pp. 1-138 ◽  
Author(s):  
M Gott ◽  
C Ingleton ◽  
C Gardiner ◽  
N Richards ◽  
M Cobb ◽  
...  
Keyword(s):  
Palliative Care ◽  
Focus Groups ◽  
Care Transitions ◽  
Case Note ◽  
Hospital Inpatient ◽  
Care Needs ◽  
Retrospective Case ◽  
Acute Hospitals ◽  
Palliative Care Needs ◽  
Case Note Review

BackgroundImproving the provision of palliative and end-of-life care is a priority for the NHS. Ensuring an appropriately managed ‘transition’ to a palliative approach for care when patients are likely to be entering the last year of life is central to current policy. Acute hospitals represent a significant site of palliative care delivery and specific guidance has been published regarding the management of palliative care transitions within this setting.Aims(1) to explore how transitions to a palliative care approach are managed and experienced in acute hospitals and to identify best practice from the perspective of clinicians and service users; (2) to examine the extent of potentially avoidable hospital admissions amongst hospital inpatients with palliative care needs.DesignA mixed-methods design was adopted in two hospitals in England, serving diverse patient populations. Methods included (1) two systematic reviews; (2) focus groups and interviews with 58 health-care professionals to explore barriers to, and facilitators of, palliative care transitions in hospital; (3) a hospital inpatient survey examining palliative care needs and aspects of management including a self-/proxy-completed questionnaire, a survey of medical and nursing staff and a case note review; (4) in-depth interviews with 15 patients with palliative care needs; (5) a retrospective case note review of all inpatients present in the hospital at the time of the survey who had died within the subsequent 12 months; and (6) focus groups with 83 key decision-makers to explore the implications of the findings for service delivery and policy.ResultsOf the 514 patients in the inpatient survey sample, just over one-third (n = 185, 36.0%) met one or more of the Gold Standards Framework (GSF) prognostic indicator criteria for palliative care needs. The most common GSF prognostic indicator was frailty, with almost one-third of patients (27%) meeting this criteria. Agreement between medical and nursing staff and the GSF with respect to identifying patients with palliative care needs was poor. In focus groups, health professionals reported difficulties in recognising that a patient had entered the last 12 months of life. In-depth interviews with patients found that many of those interviewed were unaware of their prognosis and showed little insight into what they could expect from the trajectory of their disease. The retrospective case note review found that 35 (7.2%) admissions were potentially avoidable. The potential annual cost saving across both hospitals of preventing these admissions was approximately £5.3M. However, a 2- or 3-day reduction in length of stay for these admissions would result in an annual cost saving of £21.6M or £32.4M respectively.ConclusionsPatients with palliative care needs represent a significant proportion of the hospital inpatient population. There is a significant gap between NHS policy regarding palliative and end-of-life care management in acute hospitals in England and current practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Improving Mammography Rates Among the Hispanic Population: An Evidence-Based Project Utilizing a Promotora Intervention

2021 ◽  
Author(s):  
◽  
Dawn Mirowski
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Hispanic Women ◽  
Effective Means ◽  
Breast Cancer Mortality ◽  
Hispanic Population ◽  
Practice Problem ◽  
Clinically Significant ◽  
The Cost ◽  
Improve Health

Practice Problem: Breast cancer is the leading cause of death in Hispanic women in the U.S., with mammography being the most effective means of reducing breast cancer mortality. Promotoras have been shown to improve health promotion, including mammography, among the Hispanic population. PICOT: The PICOT question that guided this project was: In Hispanic women 40 years or older (P), how does the use of a promotora intervention (I), compared to no promotora intervention (C), affect mammography rates (O) within an 8-week period (T)? Evidence: Twenty-one studies that met the inclusion criteria supported the use of promotoras to improve mammography rates. Interventions included education and counseling, navigation assistance, providing a link to resources, and facilitating interaction with providers. Intervention: A promotora was assigned to contact patients with a mammogram order to provide education, counseling, and other assistance needed. Outcome: The intervention improved compliance with mammography rates by 37% over baseline. The results are clinically significant as the cost of the promotora intervention is minimal compared to the benefits of an early-stage diagnosis. Conclusion: The implementation of this project was consistent with the research evidence supporting a promotora intervention to improve mammography rates in the Hispanic population.

scholarly journals Protecting Sleep to Reduce Delirium in an Adult Intensive Care Unit

2021 ◽  
Author(s):  
◽  
Heather Thomas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Standard Of Care ◽  
Practice Change ◽  
Adult Intensive Care Unit ◽  
Project Outcome ◽  
The Hours ◽  
Practice Problem ◽  
Clinically Significant ◽  
Icu Delirium

Practice Problem: Delirium is a common, yet often preventable complication in hospitalized patients. It is often caused by fragmented sleep, medications, environmental stimuli, and treatment therapies. PICOT: The PICOT question that guided this evidence-based practice change project was: For patients in an adult Intensive Care Unit (ICU), does using a nurse-initiated, non-pharmacological sleep-enhancement protocol, versus no sleep-enhancement protocol, reduce the incidence of ICU-delirium over a period of 2 months? Evidence: The reviewed literature supported the evidence for effective use of a nurse-initiated protocol in reducing delirium in the ICU. Sixteen articles met the inclusion criteria for the review of literature that supported the DNP project. Intervention: A nurse-initiated sleep-enhancement protocol was implemented, which reduced interruptions during the hours between midnight and 0400. Outcome: While there was a 50% reduction in delirious patients after the protocol was initiated, the data pool was small and was not proven to be statistically significant. Due to the Covid-19 outbreak, there were far fewer eligible patients than originally anticipated. Conclusion: Although a clinically significant project outcome was not realized, staff felt that the protocol improved patient care and advocated for its use on all patients as a standard of care. Unit-based shared governance councils on other acute care floors have also adopted the sleep enhancement protocol

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