From theory to practice of electronic handover

2011 ◽  
Vol 35 (3) ◽  
pp. 384 ◽  
Author(s):  
Sara L. Barnes ◽  
Donald A. Campbell ◽  
Keith A. Stockman ◽  
Dirk Wunderlink
Keyword(s):  
Patient Outcomes ◽  
Allied Health ◽  
Clinical Care ◽  
Hospital Setting ◽  
Work Practice ◽  
Tertiary Hospital ◽  
Multidisciplinary Teams ◽  
Post Intervention ◽  
Serious Adverse Events ◽  
Handover Process

Clinical handover is an essential process occurring at many levels of inpatient care. Multiple studies within a hospital setting have identified that a breakdown in the handover process can lead to poor patient outcomes and serious adverse events. The use of electronic handover tools is an intervention identified to decrease errors in clinical care arising from poor handover practice. An electronic handover tool was implemented in a general medical unit in a metropolitan tertiary hospital setting. The program was written by a Medical Professional who also used the tool. The program was evaluated with a pre- and post-intervention survey within the medical, allied health and nursing staff members of the multidisciplinary teams. The use of the Electronic Handover program resulted in improved satisfaction of the handover process within the medical, nursing and allied health professions. This trial demonstrates that an electronic handover program can be successfully integrated into normal medical work practice, resulting in positive outcomes for a multidisciplinary staff team. Further work is required to determine whether patient outcomes are improved as a result.

Managing a Stroke Unit: An Example from Australia with an Emphasis on Nursing Roles

2007 ◽  
Vol 2 (3) ◽  
pp. 201-207 ◽  
Author(s):  
Louise Weir ◽  
Dominique A. Cadilhac
Keyword(s):  
Patient Outcomes ◽  
Clinical Care ◽  
Stroke Care ◽  
Multidisciplinary Teams ◽  
Special Report ◽  
Royal Melbourne Hospital ◽  
Team Members ◽  
Stroke Team ◽  
Nursing Roles ◽  
Participation In Research

Stroke care units (SCUs), which are co-ordinated by dedicated multidisciplinary teams and geographically located in one area, are currently the most generaliseable form of effective treatment for stroke. Although the evidence for SCUs is compelling, to date there has been limited evidence regarding the contribution of the different clinical team members who assist in producing the better patient outcomes observed in SCUs. In particular, there has been limited exploration of the different nursing roles. The purpose of this special report is to describe how an SCU operates and highlight the contribution of the various nursing roles as part of the multidisciplinary stroke team. The article is based on one of the longest established stroke services in Melbourne, Australia. The characteristics and composition of the Royal Melbourne Hospital stroke service in providing clinical care and management will be highlighted as an example. Further, the nursing roles related to avoiding complications, education for patients and families and other staff in the unit, as well as participation in research and future career development opportunities are discussed.

Abstract TMP87: Improving t-PA Assessment Compliance Using a Hand-Off Communication Tool

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jeanette D Stebelton ◽  
Kelly Kozlowski ◽  
Laurie Neldberg-Weesen ◽  
Roman Politi
Keyword(s):  
Patient Outcomes ◽  
Clinical Guidelines ◽  
Clinical Care ◽  
Time Frame ◽  
Communication Tool ◽  
Post Intervention ◽  
Hand Off ◽  
Primary Stroke Center ◽  
Evidenced Based ◽  
Assessment Activities

Background: Programs seeking Primary Stroke Center Certification (PSCC) must use a standardized method of delivering clinical care, based on the American Heart/American Stroke Association or equivalent evidenced-based guidelines. After reviewing the assessment activities following the administration of IV tissue plasminogen activator (t-PA), opportunities for improvement were noted. Marquette General Hospital is a 315 bed hospital in Michigan’s Northern Peninsula, and is the only PSC within a 180 mile radius. Objective: To improve our program’s processes and assessment activities to attain 100% compliance with t-PA administration clinical guidelines and documentation surrounding the same. Methods: A review of records was conducted from December 2011 to July 2012 on all ischemic stroke patients receiving t-PA either at our institution or though the drip and ship transfer method during this time frame. A total of 6 pre-intervention and 3 post-intervention records represented the total t-PA patient volume for this time period (n=9). Specific interventions were developed to improve compliance with t-PA clinical guidelines including: the identification of barriers preventing compliance with assessment activities, obstacles preventing import of vitals to Electronic Medical Record (EMR), development of a standardized process for hand-off communication regarding frequency of vitals and neurological assessments, and a review process to assess correlation of missed assessment activities with patient outcomes. Results: Within 3 months after implementation of the process changes, adherence for vitals went from 85% to 95%. Adherence for neurological assessment went from 72% to 90%. Conclusion: These interventions were associated with an increase in the program’s assessment activities that are consistent with clinical practice guidelines, suggesting that the development of a standardized process for hand-off communication regarding frequency of vitals and neurological assessments was of benefit to compliance. Further research is needed to evaluate patient outcomes associated with inter-hospital post t-PA transfer and patient assessment nursing protocols.

Multidisciplinary care needs in an Australian tertiary teaching hospital

2010 ◽  
Vol 34 (2) ◽  
pp. 234 ◽  
Author(s):  
Timothy H. M. To ◽  
Owen J. Davies ◽  
Jackie Sincock ◽  
Craig Whitehead
Keyword(s):  
Health Care ◽  
Allied Health ◽  
Hospital Setting ◽  
Multidisciplinary Care ◽  
Tertiary Hospital ◽  
Aged Care ◽  
Care Staff ◽  
Health Staff ◽  
Care Needs ◽  
Surgical Units

Background.The ageing of the Australian population is placing increasing demand on the nation’s healthcare system. This study set out to describe the level of need for multidisciplinary care in an Australian tertiary hospital setting. Methods.A cross-sectional audit by case note review of all patients on acute medical and surgical wards in an Australian tertiary hospital. The primary outcome was an identified need for multidisciplinary assessment and intervention. Results.A total of 60% of the 295 inpatients audited required multidisciplinary care. Of those who were admitted to geriatric and rehabilitation units, 84% required multidisciplinary care. Patients in acute medical and surgical units also had substantial multidisciplinary care needs. Age was a significant influence with 79% of those aged 86 and above having multidisciplinary care needs, whilst only 38% of those aged 55 or less required multidisciplinary care. Difficulties with mobility, need for assistance with self-care, and continence problems were associated with higher requirement for multidisciplinary care. Conclusions.In the hospital population, significant multidisciplinary care needs exist. These needs are not limited to inpatients that are elderly or admitted to geriatric or rehabilitation units. This has implications for planning, funding, provision of health care resources, and training of medical and allied health staff. What is known about the topic?Multidisciplinary care is the collaboration of health care staff from a variety of disciplines. This approach has been attributed to reductions in mortality and the duration of length of stay in hospital. Multidisciplinary care is widely applied to older patients and those requiring rehabilitation. However, multidisciplinary care is less frequently adopted in other areas, suggesting that some patients requiring this approach may not receive it. What does this paper add?The findings of this study demonstrate that the need for multidisciplinary care extends beyond aged care and rehabilitation patients. Although the majority of aged care and rehabilitation patients required multidisciplinary care, a significant number of patients in medical and surgical units also needed this approach. What are the implications for practitioners?A need exists for a multidisciplinary approach to be utilised more widely in the hospital setting. Collaboration between allied health and medical staff may require consideration in the allocation of resources for patient care. This also has implications for the training of medical and allied health staff both now and in the future.

scholarly journals Protocol for Exploring Effective Clinical Governance Strategies in South Africa’s Eastern Cape and Mpumalanga Provinces

2021 ◽  
Author(s):  
Wezile W. Chitha ◽  
Onke R. Mnyaka ◽  
Danleen J. Hongoro ◽  
Lizo Godlimpi ◽  
Buyiswa Swartbooi ◽  
...  
Keyword(s):  
Health Workers ◽  
Clinical Care ◽  
National Health System ◽  
Tertiary Hospital ◽  
Clinical Governance ◽  
Public Hospitals ◽  
Eastern Cape ◽  
Post Intervention ◽  
Randomised Study ◽  
Regional Hospitals

Abstract Background: Hospitals are an integral part of the national health system. They provide a hub for health services that cannot be provided in the primary care setting, provide facilities for advanced investigation, diagnosis, and treatment, and constitute the platform for training and development of health professionals. However, when inspections were done at public sector facilities in preparation for the implementation of the NHI, the lowest average performance score was in leadership and corporate governance. This study aims to assess the effectiveness of clinical governance interventions in selected public hospitals in South Africa’s Eastern Cape and Mpumalanga provinces. Methods: This will be a cluster randomised study where there will be two intervention sites (a tertiary hospital and a regional hospital) and control sites (non-intervention central and regional hospitals). The intervention will comprise a focused implementation of clinical governance protocols (through training and coaching of hospital management and frontline health workers). There will be a pre-intervention baseline assessment; an assessment immediately at the end of the 12 months long intervention and an assessment at 36 months post-intervention. This builds on existing policy initiatives, quality improvement initiatives and tools. Information will be sourced through six sub-studies – three qualitative and three quantitative. Ethical clearance with reference number: 040/21 has been granted by the Research Ethics Committee of the Faculty of Health Sciences at Walter Sisulu University. Approvals to access the research sites with refence numbers: EC_202106_019 and MP_202106_009 have been granted by the Eastern Cape and Mpumalanga Provincial Health Research Committees respectively.Discussion: There is a need for a deeper understanding of how tertiary and regional hospitals operate, how these hospitals ensure provision of safe high-quality patient-centred clinical care and factors enabling them or hindering them from achieving higher performance. In addition, it is necessary to explore if the performance of the hospitals improves where there is a focused implementation of clinical governance protocols.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

The changing role of GP clinicians working in community hospitals.

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696713
Author(s):  
David Seamark ◽  
Deborah Davidson ◽  
Helen Tucker ◽  
Angela Ellis-Paine ◽  
Jon Glasby
Keyword(s):  
Medical Care ◽  
Local Community ◽  
Community Hospital ◽  
Clinical Care ◽  
Hospital Setting ◽  
Community Hospitals ◽  
Recruitment Challenges ◽  
Acute Hospitals ◽  
Changing Role

BackgroundIn 2000 20% of UK GPs had admitting rights to community hospitals. In subsequent years the number of GPs engaged in community hospital clinical care has decreased.AimWhat models of medical care exist in English community hospitals today and what factors are driving changes?MethodInterviews with community hospital clinical staff conducted as part of a multimethod study of the community value of community hospitals.ResultsSeventeen interviews were conducted and two different models of medical care observed: GP led and Trust employed doctors. Factors driving changes were GP workload and recruitment challenges; increased medical acuity of patients admitted; fewer local patients being admitted; frustration over the move from ‘step-up’ care from the local community to ‘step-down’ care from acute hospitals; increased burden of GP medical support; inadequate remuneration; and GP admission rights removed due to bed closures or GP practices withdrawing from community hospital work.ConclusionMultiple factors have driven changes in the role of GP community hospital clinicians with a consequent loss of GP generalist skills in the community hospital setting. The NHS needs to develop a focused strategy if GPs are to remain engaged with community hospital care.

scholarly journals Death, dying and bereavement care during COVID-19: Creativity in hospital social work practice

2021 ◽  
Vol 20 (1-2) ◽  
pp. 131-137
Author(s):  
Mim Fox ◽  
Joanna McIlveen ◽  
Elisabeth Murphy
Keyword(s):  
Social Work ◽  
Social Workers ◽  
Hospital Setting ◽  
Work Practice ◽  
Social Work Practice ◽  
Bereavement Support ◽  
Hospital System ◽  
Hospital Social Work ◽  
Complicating Factors ◽  
Bereavement Care

Bereavement support and conducting viewings for grieving family members are commonplace activities for social workers in the acute hospital setting, however the risks that COVID-19 has brought to the social work role in bereavement care has necessitated the exploration of creative alternatives. Social workers are acutely aware of the complicating factors when bereavement support is inadequately provided, let alone absent, and with the aid of technology and both individual advocacy, social workers have been able to continue to focus on the needs of the most vulnerable in the hospital system. By drawing on reflective journaling and verbal reflective discussions amongst the authors, this article discusses bereavement support and the facilitation of viewings as clinical areas in which hospital social work has been observed adapting practice creatively throughout the pandemic.

scholarly journals Promoting HIV indicator condition-guided testing in hospital settings (PROTEST 2.0): study protocol for a multicentre interventional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saskia J. Bogers ◽  
Maarten F. Schim van der Loeff ◽  
Udi Davidovich ◽  
Anders Boyd ◽  
Marc van der Valk ◽  
...  
Keyword(s):  
The Netherlands ◽  
Hiv Testing ◽  
Quantitative Methods ◽  
Hospital Setting ◽  
Audit And Feedback ◽  
Interventional Study ◽  
Hiv Diagnosis ◽  
Post Intervention ◽  
Hiv Test ◽  
Undiagnosed Hiv

Abstract Background Late presentation remains a key barrier towards controlling the HIV epidemic. Indicator conditions (ICs) are those that are AIDS-defining, associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be impeded if an HIV infection were undiagnosed. IC-guided HIV testing is an effective strategy in identifying undiagnosed HIV, but opportunities for earlier HIV diagnosis through IC-guided testing are being missed. We present a protocol for an interventional study to improve awareness of IC-guided testing and increase HIV testing in patients presenting with ICs in a hospital setting. Methods We designed a multicentre interventional study to be implemented at five hospitals in the region of Amsterdam, the Netherlands. Seven ICs were selected for which HIV test ratios (proportion of patients with an IC tested for HIV) will be measured: tuberculosis, cervical/vulvar cancer or high-grade cervical/vulvar dysplasia, malignant lymphoma, hepatitis B and C, and peripheral neuropathy. Prior to the intervention, a baseline assessment of HIV test ratios across ICs will be performed in eligible patients (IC diagnosed January 2015 through May 2020, ≥18 years, not known HIV positive) and an assessment of barriers and facilitators for HIV testing amongst relevant specialties will be conducted using qualitative (interviews) and quantitative methods (questionnaires). The intervention phase will consist of an educational intervention, including presentation of baseline results as competitive graphical audit and feedback combined with discussion on implementation and opportunities for improvement. The effect of the intervention will be assessed by comparing HIV test ratios of the pre-intervention and post-intervention periods. The primary endpoint is the HIV test ratio within ±3 months of IC diagnosis. Secondary endpoints are the HIV test ratio within ±6 months of diagnosis, ratio ever tested for HIV, HIV positivity percentage, proportion of late presenters and proportion with known HIV status prior to initiating treatment for their IC. Discussion This protocol presents a strategy aimed at increasing awareness of the benefits of IC-guided testing and increasing HIV testing in patients presenting with ICs in hospital settings to identify undiagnosed HIV in Amsterdam, the Netherlands. Trial registration Dutch trial registry: NL7521. Registered 14 February 2019.

scholarly journals Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Paibul Suriyawongpaisal ◽  
Samrit Srithamrongsawad ◽  
Pongsakorn Atiksawedparit ◽  
Khanisthar Phooseemungkun ◽  
Krongkan Bunchaiyai ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Care ◽  
Patient Outcomes ◽  
Prehospital Care ◽  
Clinical Care ◽  
Mixed Methods Approach ◽  
Time Flow ◽  
Care Systems ◽  
Pay System ◽  
Made In

Introduction. Financing health systems constitutes a key element of well-functioning healthcare system. Prior to 2015, two new financial arrangements (direct-pay and E-claim systems) were introduced on a voluntary basis which aimed to pool more financial resources and improve cash flow of prehospital care systems. The aims of this study were to (1) assess the effects of direct-pay system in terms of (a) timeliness of reimbursement to EMS agencies, (b) changes in clinical care processes, and (c) the outcomes of patient care as compared to previous system; (2) identify the reasons for or against EMS agencies to participate in direct-pay system mechanisms; (3) identify the emerging issues with potential to significantly further the advancement of EMS systems. Using a mixed-methods approach, retrospective datasets of 3,769,399 individual records of call responses from 2015 to 2017 were analyzed which compared EMS units with the direct-pay system against those without in terms of time flow of claim data and patient outcomes. For qualitative data, in-depth interviews were conducted. Results. EMS units participating in both systems had the highest percentages of financial claim being made in time as compared to those not participating in any (p=0.012). However, there were not any practically meaningful differences between EMS units participating and not participating in either of the payment systems in terms of patient care such as appropriateness of response time, airway management, and outcome of treatment. Analysis of data from focus-group and individual interviews ended up with a causal loop diagram demonstrating potential explanatory mechanisms for those findings. Conclusion. It is evident that progress has been made in terms of mobilising more financial inputs and improving financial information flow. However, there is no evidence of any changes in patient outcomes and quality of care. Furthermore, whether the progress is meaningful in filling the gaps of financial demands of the prehospital care systems is still questionable. Room for future improvement of prehospital care systems was discussed with implications for other countries.

scholarly journals Embedding surveillance into clinical care to detect serious adverse events in pregnancy

Vaccine ◽  
2015 ◽  
Vol 33 (47) ◽  
pp. 6466-6468 ◽  
Author(s):  
Anna C. Seale ◽  
Hellen C. Barsosio ◽  
Angela C. Koech ◽  
James A. Berkley
Keyword(s):  
Adverse Events ◽  
Clinical Care ◽  
Serious Adverse Events ◽  
In Pregnancy
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