scholarly journals Home Care Nursing After Elective Vascular Surgery: An Opportunity to Reduce Emergency Department Visits and Hospital Readmission

2019 ◽  
Vol 70 (4) ◽  
pp. e109
Author(s):  
Charles de Mestral ◽  
Ahmed Kayssi ◽  
Mohammed Al-Omran ◽  
Konrad Salata ◽  
Mohamad A. Hussain ◽  
...  
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Vascular Surgery ◽  
Hospital Readmission ◽  
Emergency Department Visits ◽  
Home Care Nursing ◽  
Care Nursing

Home care nursing after elective vascular surgery: an opportunity to reduce emergency department visits and hospital readmission

2019 ◽  
Vol 28 (11) ◽  
pp. 901-907 ◽  
Author(s):  
Charles de Mestral ◽  
Ahmed Kayssi ◽  
Mohammed Al-Omran ◽  
Konrad Salata ◽  
Mohamad Anas Hussain ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Home Care ◽  
Vascular Surgery ◽  
Hospital Readmission ◽  
Arterial Disease ◽  
Home Care Nursing ◽  
Peripheral Arterial ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
Care Nursing

BackgroundEvents occurring outside the hospital setting are underevaluated in surgical quality improvement initiatives and research.ObjectiveTo quantify regional variation in home care nursing following vascular surgery and explore its impact on emergency department (ED) visits and hospital readmission.MethodsPatients who underwent elective vascular surgery and were discharged directly home were identified from population-based administrative databases for the province of Ontario, Canada, 2006–2015. The index surgeries included carotid endarterectomy, open and endovascular aortic aneurysm repair and bypass for lower extremity peripheral arterial disease. Home care nursing within 30 days of discharge was captured and compared across regions. Using multilevel logistic regression, we characterised the association between home care nursing and the risk of an ED visit or hospital readmission within 30 days of discharge.ResultsThe cohort included 23 617 patients, of whom 9002 (38%) received home care nursing within 30 days of discharge home. Receipt of nursing care after discharge home varied widely across Ontario’s 14 administrative health regions (range 16%–84%), even after accounting for differences in patient case mix. A lower likelihood of an ED visit or hospital readmission within 30 days of discharge was observed among patients who received home care nursing following three of four index surgeries: carotid endarterectomy OR 0.74, 95% CI 0.61 to 0.91; endovascular aortic aneurysm repair OR 0.85, 95% CI 0.72 to 0.99; open aortic aneurysm repair OR 1.06, 95% CI 0.91 to 1.23; bypass for lower extremity peripheral arterial disease OR 0.81, 95% CI 0.72 to 0.92.ConclusionHome care nursing may contribute to reducing ED visits and hospital readmission and is variably prescribed after vascular surgery.

scholarly journals A survey of Canadian surgeons on the indications for home care nursing following vascular surgery

2021 ◽  
Vol 64 (2) ◽  
Author(s):  
Jean Jacob-Brassard ◽  
Mohammed Al-Omran ◽  
Konrad Salata ◽  
Mohamad A. Hussain ◽  
Ahmed Kayssi ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Home Care ◽  
Vascular Surgery ◽  
Hospital Readmissions ◽  
Emergency Department Visits ◽  
Patient Specific ◽  
Wound Complications ◽  
Home Care Nursing ◽  
Hybrid Revascularization ◽  
Care Nursing

Background: Recent evidence suggests that home care nursing is variably prescribed after vascular surgery, and may reduce emergency department visits and hospital readmissions. We therefore sought to characterize the indications for home care nursing following vascular surgery from the surgeon’s perspective. Methods: An online survey was distributed to the 141 members of the Canadian Society for Vascular Surgery with questions related to home care nursing after carotid endarterectomy (CEA), endovascular aortic aneurysm repair (EVAR), open abdominal aortic aneurysm (AAA) repair and open or hybrid revascularization for peripheral arterial disease (PAD). We included all questionnaires in our analysis; the frequency denominator changes according to the number of respondents who completed each survey item. Results: There were 46 survey respondents (33% of 141) from across the country. A total of 28 (62% of 45) worked in a teaching hospital. Home care nursing was routinely prescribed by 5%, 10%, 31% and 41% of respondents following CEA, EVAR, open AAA repair and open or hybrid revascularization for PAD, respectively. Across all procedure types, the same procedure-related criteria were most often deemed to warrant a prescription for home care nursing: surgical site infection, wound complications (e.g., open wound, lymphatic leak) and use of negative-pressure wound therapy. Across all procedure types, lack of social support, physical frailty and cognitive impairment were most frequently identified as patient-specific considerations for prescribing home care nursing. Few respondents reported restrictions or standards that informed their prescribing practice. Conclusion: Most surgeon respondents agreed on the indications for home care nursing after vascular surgery. However, evidence-based standards to guide patient selection for home care nursing after vascular surgery are needed.

scholarly journals Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

2020 ◽  
pp. 084456212094942
Author(s):  
Connie Schumacher ◽  
Aaron Jones ◽  
Andrew P. Costa
Keyword(s):  
Emergency Department ◽  
Home Care ◽  
Service Use ◽  
Urinary Catheter ◽  
Community Dwelling ◽  
Care Needs ◽  
Home Care Nursing ◽  
Nursing Visit ◽  
Ed Visits ◽  
Care Nursing

Background Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. Purpose The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. Methods A case-crossover design within a retrospective cohort of adult home care patients in Ontario. Results A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED afterhours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15–1.60) vs. 1.21 (95% CI 1.15–1.28)). No other clinical indicator modified the association. Conclusions The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended.

scholarly journals Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study

2018 ◽  
Vol 61 (4) ◽  
pp. 257-263 ◽  
Author(s):  
Muzammil H. Syed ◽  
Mohamad A. Hussain ◽  
Zeyad Khoshhal ◽  
Konrad Salata ◽  
Beidaa Altuwaijri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Vascular Surgery ◽  
Prospective Cohort Study ◽  
Hospital Readmission ◽  
Prospective Cohort ◽  
Emergency Department Visits ◽  
Day Hospital

scholarly journals Hospital Readmission and Emergency Department Visits After Vascular Surgery: A Prospective Cohort Study

2017 ◽  
Vol 66 (3) ◽  
pp. e80
Author(s):  
Mohamad A. Hussain ◽  
Zeyad Khoshhal ◽  
Konrad Salata ◽  
Baidaa Altuwaijri ◽  
Norah Alsaif ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Vascular Surgery ◽  
Prospective Cohort Study ◽  
Hospital Readmission ◽  
Prospective Cohort ◽  
Emergency Department Visits

scholarly journals Adverse Events in Home-Care Nursing Agencies and Related Factors: A Nationwide Survey in Japan

2021 ◽  
Vol 18 (5) ◽  
pp. 2546
Author(s):  
Noriko Morioka ◽  
Masayo Kashiwagi
Keyword(s):  
Adverse Event ◽  
Patient Safety ◽  
Adverse Events ◽  
Home Care ◽  
Process Of Care ◽  
Related Factors ◽  
Cross Sectional ◽  
Home Care Nursing ◽  
Number Of Patients ◽  
Care Nursing

Despite the importance of patient safety in home-care nursing provided by licensed nurses in patients’ homes, little is known about the nationwide incidence of adverse events in Japan. This article describes the incidence of adverse events among home-care nursing agencies in Japan and investigates the characteristics of agencies that were associated with adverse events. A cross-sectional nationwide self-administrative questionnaire survey was conducted in March 2020. The questionnaire included the number of adverse event occurrences in three months, the process of care for patient safety, and other agency characteristics. Of 9979 agencies, 580 questionnaires were returned and 400 were included in the analysis. The number of adverse events in each agency ranged from 0 to 47, and 26.5% of the agencies did not report any adverse event cases. The median occurrence of adverse events was three. In total, 1937 adverse events occurred over three months, of which pressure ulcers were the most frequent (80.5%). Adjusting for the number of patients in a month, the percentage of patients with care-need level 3 or higher was statistically significant. Adverse events occurring in home-care nursing agencies were rare and varied widely across agencies. The patients’ higher care-need levels affected the higher number of adverse events in home-care nursing agencies.

scholarly journals Health, Quality of Life, and Economic Impacts of Home Care Vouchers for Middle-Income Adults With Disabilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 78-78
Author(s):  
Joanne Spetz ◽  
Jacqueline Miller ◽  
Connie Kwong ◽  
Laura Wagner
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Economic Analysis ◽  
Home Care ◽  
San Francisco ◽  
Comparison Group ◽  
Financial Stress ◽  
Emergency Department Visits ◽  
Middle Income

Abstract The Support at Home pilot program provided financial support for the purchase of home care services by middle-income adults with disabilities in San Francisco to support aging in place. Enrollees had income below the area median and made copayments based on household income. The mixed-methods evaluation of the program incorporated administrative records, surveys of clients and comparison group members, surveys of unpaid caregivers, surveys of paid care providers, and focus groups with clients and unpaid caregivers. Outcome measures included the Older People’s Quality of Life Questionnaire, Patient Health Questionnaire-2, an adapted Burden Scale for Family Caregivers, and self-reported falls, emergency department visits, and hospitalizations. Analyses included pre-post chi-squared and t-test comparisons between client and comparison groups and multivariate regressions. An economic analysis was conducted to learn whether changes in costs associated with reduced health care utilization were greater than the costs of the program. Results indicated statistically significant positive changes in client ratings of personal and financial stress, but not in the composite quality of life score. There were statistically significant reductions in attendance at medical appointments, falls, emergency department visits, and hospitalizations. Similar changes were not found in the comparison group. The focus group data supported the findings regarding personal and financial stress and indicated that clients and their caregivers perceived quality of life benefits. The economic analysis indicated substantial cost savings from the program due to reduced use of medical services. Due to its positive impacts, San Francisco has made Support at Home a permanent program.

scholarly journals Transitional care models for chronic patients: preliminary results from an umbrella review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M T Riccardi ◽  
M Cicconi ◽  
W Ricciardi ◽  
M M Gianino ◽  
G Damiani
Keyword(s):  
Emergency Department ◽  
Usual Care ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Care Setting ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Current Evidence ◽  
Chronic Patients ◽  
Care Models

Abstract Worldwide, chronic diseases are burdening and the health systems need to be rethought to better manage this epidemiologic shift. One of the critical points in the care pathway of chronic patients is the transition from one care setting to another. Aim of this study is to provide an overview of the current evidence on the impact of transitional care programs on health and economic outcomes for chronic patients Medline, Web of Science and EMBASE were queried for relevant reviews using the Population-Intervention-Context-Outcome (PICO) model. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Data were analyzed using descriptive statistic, and comparison among studies carried out in European Union (EU) versus non-EU was performed (Chi-square test was used and a p < 0.05 was deemed as statistically significant) 124 reviews were assessed for eligibility and 14 were eventually included (for a total of 167 primary articles). Quality appraisal was critically low in 60% of the reviews. Both hospital readmission rate and Emergency Department (ED) visit rate were lower than those in usual care group, but this difference was significant in 40% of articles. In EU studies readmission rate was lower in 65% of cases while in non-EU ones the percentage was 51.0%, but the difference was not significant (p = 0.23). Six reviews (43%) investigated the economic impact of the transitional care: most reported an initial increase in cost due to investment in staff training and creation of organizational networks, followed by a sharp decrease in costs due to a better utilization of health services, thus leading to a reduction in overall costs. Compared with usual care, transitional care shows an overall cost reduction, even if with limited effects on re-hospitalization or ED visit rates. These findings should encourage decision makers to invest in the development of this kind of programs in order to identify models that best perform. Key messages The patient transfer supervision from one care setting to another is necessary for continuity of care, but there is no robust evidence about the better performance of transitional care models. Systematically reviewed transitional care models has been shown be more cost saving, with a moderate impact on hospital readmission or emergency department visits rates.

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