scholarly journals 109 Improving Escalation and Treatment Plans in the Borders General Hospital (BGH) During COVID-19

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
K Ralston ◽  
A Campbell ◽  
G Alcorn
Keyword(s):  
Improve Patient Care ◽  
Patient Centered ◽  
Qualitative Feedback ◽  
Centered Care ◽  
Medical Inpatients ◽  
Treatment Plans ◽  
Specific Care ◽  
Data Collections ◽  
Treatment Escalation ◽  
Capacity Decision

Abstract Topic Clear escalation and treatment plans created in discussion with patients are crucial to managing patients safely and appropriately. Our goal was to introduce a standardised, easily identifiable document for this purpose, with an aim of 90% of medical inpatients having a clear escalation plan discussed and documented. Intervention We developed a Treatment Escalation Plan (TEP), raised awareness via different platforms and delivered teaching for staff. For baseline and subsequent data collections following interventions, we reviewed the notes of twenty random medical inpatients for decisions regarding escalation, patient involvement in decision making including capacity and specific interventions considered. We also included time taken to find information; documented patient/family discussions and whether a TEP was present. We collected qualitative feedback from staff. Improvement After introduction, TEP was present in 35/60 patients (58%). Improvement was demonstrated across all measured domains when a TEP form was present: escalation decision (no TEP 80%, TEP 100%), discussion with patient/relative (no TEP 4%, TEP 85%), capacity decision regarding escalation (no TEP 52%, TEP 91%), decision on specific interventions (no TEP 12%, TEP 94%), mean time taken to find information (no TEP 84 seconds, TEP 34 seconds). Qualitative feedback from staff was positive, particularly the inclusion of specific care decisions beyond “DNACPR”. Discussion We felt it was critical to develop a TEP to ensure appropriate decisions are made and clearly documented for medical inpatients, especially in light of COVID-19. In patients with a TEP completed, we observed improvements in all domains, particularly in the involvement of patients/relatives in escalation decisions, which is key to delivering patient-centered care. Implementing a new system in a pandemic had challenges, such as continuity of staffing, however feedback was uniformly positive. This is an ongoing project that will continue to promote TEPs to improve patient care.

scholarly journals Care and cost trajectories of asylum seekers in a nurse-led, patient centered, care network in Switzerland

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jacques Spycher ◽  
Patrick Bodenmann ◽  
Raphaël Bize ◽  
Joachim Marti
Keyword(s):  
Health System ◽  
Asylum Seekers ◽  
Contact Point ◽  
Patient Centered Care ◽  
First Year ◽  
Patient Centered ◽  
Care Network ◽  
Complex Needs ◽  
Centered Care ◽  
Specific Care

Abstract Background Switzerland, with its decentralized health system, has seen the emergence of a variety of care models to meet the complex needs of asylum seekers. A network of public and private providers was designed in the canton Vaud, in which a nurse-led team acts as a first contact point to the health system and provides health checks, preventive care, and health education to this population. In addition, the service plays a case management role for more complex and vulnerable patients. While the network has been examined from a clinical angle, we provide the first descriptive evidence on the care and cost trajectories of asylum seekers in the canton. Methods We used routinely collected administrative, patient-level data in a Swiss region responsible for 10% of the asylum seekers in the country. We extracted data on all asylum seekers aged 18 or older who entered the network between 2012 and 2015. The data covered all healthcare costs during the period until they left the network, either because they were granted residence, they left the country, or until 31 December 2018. We estimated random effects regression models for costs and consultations within and outside the network for each month of stay in the network. We investigated language barriers in access to care by stratifying the analysis between patients who spoke one of the official Swiss languages or English and patients who did not speak any of these languages. Principal findings We found that both overall health care costs and contacts with the nurse-led team were relatively high during the first year of stay. Asylum seekers then progressively integrated into the regular health system. Individuals who did not speak the language generally had more contacts with the network and fewer contacts outside. Conclusions In this exploratory study, we observe a transition from nurse-led specific care with frequent contacts to care in the regular health system. This leads us to generate the hypothesis that a nurse-led, patient-centered care network for asylum seekers can play an important role in providing primary care during the first year after their arrival and can subsequently help them navigate autonomously within the conventional healthcare system.

Rehabilitation, not injury or treatment details, dominate proximal humeral fracture patient concerns: a thematic analysis

2017 ◽  
Vol 5 (3) ◽  
pp. 351 ◽  
Author(s):  
Nathan N O'Hara ◽  
Alisha Garibaldi ◽  
Sheila Sprague ◽  
Joshua Jackson ◽  
Alyson K Kwok ◽  
...  
Keyword(s):  
Proximal Humeral Fracture ◽  
Improve Patient Care ◽  
Humeral Fracture ◽  
Patient Centered Care ◽  
Care Patient ◽  
Structured Interviews ◽  
Post Injury ◽  
Patient Centered ◽  
Information Recovery ◽  
Centered Care

Background, objectives, and aims: To provide treatment using a patient-centered care model, the provider must understand the needs and wants of the patient and ensure the patient has access to appropriate and necessary health information. The objective of this study was to determine what information is most desired by proximal humeral fracture patients following their injury.Methods: This qualitative study enrolled patients aged 60 years or older presenting with a proximal humeral fracture. Semi-structured interviews were conducted within one-month of injury and at 6-months post-injury. The interviews were transcribed, coded and analyzed using thematic analysis.Results: Four themes (biomedical information, recovery, engagement opportunities and support available) emerged from the coded data. Within one-month post-injury, the most commonly identified themes were rehabilitation and support available. Six-months after the injury, the most commonly identified theme remained rehabilitation, while the second most frequently identified theme shifted to engagement opportunities. The biomedical information theme emerged infrequently at both interviews. Conclusions: Patient-centered care models for proximal humeral fracture patients could be improved by adapting to dynamic information concerns. While the effect of the injury on the patient’s rehabilitation remained the leading concern for the duration of the study period, secondary concerns did change over time. Providing germane information to patients at timely intervals supports patient-centered care, patient engagement and ultimately may improve patient care.

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behavior Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Treatment Information ◽  
Centered Care ◽  
Potential Risks ◽  
Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

Principles of Solution Focused Therapy and Their Application to Audiology

2014 ◽  
Vol 15 (1) ◽  
pp. 27-33
Author(s):  
James C. Blair
Keyword(s):  
Basic Assumption ◽  
Current Practice ◽  
Helping Professions ◽  
Patient Centered ◽  
Therapy Approach ◽  
Agents Of Change ◽  
Centered Care ◽  
Client Centered Therapy ◽  
Solution Focused ◽  
Solution Focused Therapy

The concept of client-centered therapy (Rogers, 1951) has influenced many professions to refocus their treatment of clients from assessment outcomes to the person who uses the information from this assessment. The term adopted for use in the professions of Communication Sciences and Disorders and encouraged by The American Speech-Language-Hearing Association (ASHA) is patient-centered care, with the goal of helping professions, like audiology, focus more centrally on the patient. The purpose of this paper is to examine some of the principles used in a patient-centered therapy approach first described by de Shazer (1985) named Solution-Focused Therapy and how these principles might apply to the practice of audiology. The basic assumption behind this model is that people are the agents of change and the professional is there to help guide and enable clients to make the change the client wants to make. This model then is focused on solutions, not on the problems. It is postulated that by using the assumptions in this model audiologists will be more effective in a shorter time than current practice may allow.

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