Ready to Go Home? Assessment of Shared Mental Models of the Patient and Discharging Team Regarding Readiness for Hospital Discharge

2020 ◽  
Author(s):  
Kirstin A Manges ◽  
Andrea S Wallace ◽  
Patricia S Groves ◽  
Marilyn M Schapira ◽  
Robert E Burke
Keyword(s):  
Mental Models ◽  
Hospital Discharge ◽  
Short Form ◽  
Hospital Medicine ◽  
Patient Discharge ◽  
Absolute Difference ◽  
Average Score ◽  
Self Assessment ◽  
Interprofessional Team ◽  
Discharge Readiness

BACKGROUND: A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient’s self-assessment. OBJECTIVE: Determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments. DESIGN: We surveyed interprofessional discharging teams and each team’s patient at time of hospital discharge using validated tools to capture their SMMs. PARTICIPANTS: Discharge events (n = 64) from a single hospital consisting of the patient and their team (nurse, coordinator, physician). MEASURES: Clinician and patient versions of the validated Readiness for Hospital Discharge Scales/Short Form (RHDS/SF). We measured team convergence by comparing the individual clinicians’ scores on the RHDS/SF, and we measured team-patient convergence as the absolute difference between the Patient-RHDS/SF score and the team average score on the Clinician-RHDS/SF. RESULTS: Discharging teams assessed patients as having high readiness for hospital discharge (mean score, 8.5 out of 10; SD, 0.91). The majority of teams had convergent SMMs with high to very high interrater agreement on discharge readiness (mean r*wg(J), 0.90; SD, 0.10). Yet team-patient SMM convergence was low: Teams overestimated the patient’s self-assessment of readiness for discharge in 48.4% of events. We found that teams reporting higher-quality teamwork (P = .004) and bachelor’s level–trained nurses (P < .001) had more convergent SMMs with the patient. CONCLUSION: Measuring discharge teams’ SMM of patient discharge readiness may represent an innovative assessment tool and potential lever to improve the quality of care transitions. Journal of Hospital Medicine 2020;15:XXX-XXX.

Barriers of physical activity (kinesiophobia) in patients subjected to cardiac rehabilitation

2014 ◽  
Vol 6 (4) ◽  
Author(s):  
Janusz Kocjan ◽  
Andrzej Knapik
Keyword(s):  
Physical Activity ◽  
Cardiac Rehabilitation ◽  
Short Form ◽  
Social Activity ◽  
Self Assessment ◽  
Rehabilitation Process ◽  
Sf 36 ◽  
Polish Version ◽  
High Level ◽  
The Relationship

AbstractBackground: Comprehensive cardiac rehabilitation (CR) is a process designed to restore full physical, psychological and social activity and to reduce cardiovascular risk factors. Fear of movement may contribute to the occurrence and intensification of hypokinesia, and consequently affect the effectiveness of therapy. The aim of the study was to determine the level of barriers of physical activity in patients undergoing cardiac rehabilitation. The relationship between selected determinants (age and health selfassessment) and the kinesiophobia level were also examined.Material/Methods: 115 people aged 40-84 years were examined: 50 females (x = 63.46; SD = 11.19) and 65 males (x = 64.65; SD = 10.59) - patients undergoing cardiac rehabilitation at the Upper-Silesian Medical Centre in Katowice. In the present study, the Polish version of questionnaires: Kinesiophobia Causes Scale (KCS) and Short Form Health Survey (SF-36) were used. Questionnaires were supplemented by authors’ short survey.Results: The patients presented an elevated level of kinesiophobia, both in general as well as in individual components. In women, the kinesiophobia level was higher than in men. The psychological domain was a greater barrier of physical activity than the biological one. Strong, negative correlations of psychological and biological domains of kinesiophobia to physical functioning (SF-36) were noted in women. In the case of men, correlations were weaker, but also statistically significant.Conclusions: 1. Sex differentiates patients in their kinesiophobia level 2. Poor self-assessment of health is associated with a greater intensification of kinesiophobia 3. A high level of kinesiophobia may negatively affect cardiac rehabilitation process

scholarly journals Pharmacists’ clinical knowledge and practice in the safe use of contraceptives: real knowledge vs. self-perception and the implications

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ana Golić Jelić ◽  
Ljiljana Tasić ◽  
Ranko Škrbić ◽  
Valentina Marinković ◽  
Svjetlana Stoisavljević Šatara ◽  
...  
Keyword(s):  
Bosnia And Herzegovina ◽  
Medical Information ◽  
Community Pharmacists ◽  
Subject Area ◽  
Rank Test ◽  
Average Score ◽  
Clinical Knowledge ◽  
Self Assessment ◽  
Significant Difference ◽  
Knowledge And Practice

Abstract Background Pharmacists are often the first healthcare professionals that patients contact with their illnesses and requests for medical information, which is enhanced following the recent COVID-19 pandemic. Community pharmacists are expected and required to possess a broad spectrum of knowledge and skills. Self-assessment of these competencies is needed for their self-improvement. Purpose of the study To assess pharmacists’ clinical knowledge and practice in the safe use of contraceptives, and to compare the scores obtained by external observation with pharmacists’ self-assessment of their knowledge as well as investigate the significance of preceptorship experiences. Contraceptives was chosen as the subject area in view of high rates of abortions as a means of contraception in Bosnia and Herzegovina. Methods A questionnaire approach was used. The questionnaire included the following: the first domain contained two case scenarios (safe use of contraceptives), which evaluated clinical knowledge, a second domain in which pharmacists self-assessed their knowledge to resolve cases from the first domain and a third domain that measured the demographics of pharmacists (including experience in preceptorship). Dispensing practice was evaluated in the second domain. The questionnaires were distributed to a convenient sample of 100 pharmacists at the Annual Meeting of Bosnia and Herzegovina Pharmacists. The results were presented as counts (%). The groups (preceptors and non-preceptors) were compared using Mann-Whitney U test, paired assessments were analyzed by Wilcoxon signed-rank test and Spearman’s correlation was used to assess the correlation between variables. Results Of the 100 pharmacists invited to participate, 84 completed the questionnaire (84 % response rate). There was no agreement between pharmacists’ real knowledge (average score - case 1: 2.71, case 2: 3.3) and their self-assessment (average score - case 1: 3.77, case 2: 3.91). There was no statistically significant difference in the actual knowledge of pharmacists (experienced/non-experienced in precepting), while the difference in the self-assessment was significant between these two groups. Conclusion Pharmacists appear to overrate themselves, which leads to self-enhancement bias, in which the experience in precepting has some influence. Pharmacists’ capability in performing an objective self-assessment of their clinical knowledge needs to be carefully studied in the future to fully benefit patients.

scholarly journals Nutritional differences in malnourished patients according to their liquid-intake habits after hospital discharge

2016 ◽  
Vol 33 (3) ◽  
Author(s):  
Cristina Casals ◽  
María Ángeles Vázquez Sánchez ◽  
José Luis Casals Sánchez ◽  
Ernesto Suárez-Cadenas
Keyword(s):  
Quality Of Life ◽  
Body Mass Index ◽  
Nutritional Status ◽  
Hospital Discharge ◽  
Body Mass ◽  
Short Form ◽  
Functional Dependency ◽  
The Body ◽  
Liquid Intake

Introduction: Malnutrition is a serious and relatively common problem among hospitalized patients; moreover, it is known that a good hydration state contributes to health and wellbeing. Objective: The aim of this study was to determine the relationship between nutritional status, functional dependency, quality of life and liquid-intake habits in malnourished patients after hospital discharge. Methods: Cross-sectional descriptive study in 91 patients (45 males) who presented malnutrition at hospital discharge. The patients were grouped according to their liquid intake estimated through the Mini Nutritional Assessment questionnaire: 3-5 glasses (n = 42), and > 5 glasses (n = 46); removing from analysis < 3 glasses of liquid intake (n = 3). The body mass index, weight, Malnutrition Universal Screening Tool (MUST), functional dependency (Barthel questionnaire), and quality of life (Short Form 12 Health Survey [SF-12]) were assessed 2-months after discharge. Results: The > 5 glasses liquid intake group showed better nutritional status than the 3-5 glasses intake group, for weight (p < 0.001), body mass index (p = 0.001), and MUST scale (p = 0.020). Additionally, the > 5 glasses liquid intake group signifi cantly scored higher values in the total SF-12 questionnaire (p = 0.013), presenting better self-reported quality of life, and higher functional independency in the Barthel index (p = 0.037) than the 3-5 glasses liquid intake group (p = 0.013). Conclusions: Although further research is needed to elucidate the characteristics of this relationship, descriptive comparisons between groups showed favorable nutritional status, functional independency and quality of life for the > 5 glasses of liquid intake compared with the 3-5 glasses of liquid intake group during a 2-months follow-up.

scholarly journals Quality of life of blind people’s carers

2020 ◽  
Vol 66 (3) ◽  
Author(s):  
Łukasz Lewandowski ◽  
Iwona Smotryś ◽  
Angelika Puls ◽  
Anita Radziejewska ◽  
Magda Płocharczyk ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Married Couples ◽  
Educational Background ◽  
Mental Condition ◽  
Professional Activity ◽  
Self Assessment ◽  
The Disabled ◽  
Sight Loss

Introduction: Quality of life is a multidimensional concept and a subjective value that depends on many factors. Disability caused by sight loss induces changes for both patients and their carers. The function of a blind person’s carer is usually performed by family members, whose limited knowledge limits their ability to help effectively and satisfactorily. This, in turn, may lead to their reduced sense of the quality of life.The aim of this study was to assess the quality of life of blind people’s carers.Materials and methods: The study was conducted September–October 2016 and involved 130 blind peoples’ carers using a diagnostic poll. Short Form Survey SF-36 and a specially designed questionnaire were used. The majority of participants were women (69.23%), married couples (63.1%), with high school education (40.77%).Results: Wellbeing self-assessment indicated that 36.15% of carers considered their mental condition to have worsened, while 43.08% remained at the same level when compared to 1 year earlier. Analysis of quality of life showed that carers very highly rated their physical functioning 59.46 ±26.35; social functioning 57.4 ±26.12; vitality 55.48 ±23.27; and emotional functioning 54.81 ±29.24.Conclusions: Quality of life tends to gradually deteriorate as the carers grow older. The carer’s educational background and the professional activity of the disabled person influence the assessment of the carer’s quality of life.

Model Estimates of Hospitalization Discharge Rates for Norovirus Gastroenteritis in Europe, 2004-2015

2020 ◽  
Author(s):  
Elsa Negro Calduch ◽  
Tom Cattaert ◽  
Thomas Verstraeten
Keyword(s):  
Hospital Discharge ◽  
Acute Gastroenteritis ◽  
Patient Discharge ◽  
Trade Association ◽  
Hospital Discharges ◽  
European Free Trade Association ◽  
Hospitalization Rates ◽  
Discharge Rates ◽  
Norovirus Gastroenteritis ◽  
Modelling Methods

Abstract Background: Norovirus is an important cause of acute gastroenteritis globally. However, norovirus is rarely laboratory confirmed or recorded explicitly as a cause of hospitalization. In recent years, there has been an interest in using medical databases and indirect modelling methods to estimate the incidence of norovirus gastroenteritis. The objective of this study was to estimate the incidence of hospitalizations for norovirus gastroenteritis in Europe (2004- 2015) using nationwide in-patient discharge records from different European countries.Methods: National hospital discharge registers in all 28 European Union countries (at that time) and all 4 European Free Trade Association countries were contacted and invited to participate in the study. Discharges with ICD9/ICD10 codes for acute gastroenteritis (AGE) as first-listed (principal) diagnosis were extracted to assess hospitalization rates for AGE and norovirus gastroenteritis (NGE), overall, by age group, country, month, and seasonal year. To estimate NGE hospital discharge rates, a statistical model, based on the temporal patterns of occurrence of AGE, was used. Results: Data were available from 15 countries, representing 68% of the total population in Europe. Only 24.4% of all AGE discharges were coded as cause-specified. We estimated that between 2004 and 2015, the overall rate of NGE hospital discharges in Europe was 3.9 per 10,000 person-years, ranging from 1.2 (Portugal) to 10.7 (Lithuania). Norovirus was predicted to be responsible for 17% of all AGE hospital discharges in Europe in this period. Norovirus affects individuals of all ages, but NGE discharge rates were highest in children <5 years (24.8 per 10,000 person-years), and adults aged ≥80 years (10.7 per 10,000 person-years). Conclusion: We estimated that 1 in 400 hospitalizations in Europe can be attributed to Norovirus. In the absence of routine norovirus testing and recording in hospital settings, modelling methods are useful resources to estimate the incidence of norovirus gastroenteritis.

Outcomes

2013 ◽  
pp. 221-226
Author(s):  
David L. Scott
Keyword(s):  
Quality Of Life ◽  
Disease Activity ◽  
Short Form ◽  
Organ Damage ◽  
Confounding Factors ◽  
Short Term ◽  
Self Assessment ◽  
The Matrix ◽  
The Impact

Outcomes evaluate the impact of disease. In rheumatology they span measures of disease activity, end-organ damage, and quality of life. Some outcomes are categorical, such as the presence or absence of remission. Other outcomes involve extended numeric scales such as joint counts, radiographic scores, and quality of life measures. Outcomes can be measured in the short term—weeks and months—or over years and decades. Short-term outcomes, though readily related to treatment, may have less relevance for patients. Clinical trials focus on short-term outcomes whereas observational studies explore longer-term outcomes. The matrix of rheumatic disease outcomes is exemplified by rheumatoid arthritis. Its outcomes span disease activity assessments like joint counts, damage assessed by erosive scores, quality of life evaluated by disease-specific measures like the Health Assessment Questionnaire (HAQ) or generic measures like the Short Form 36 (SF-36), overall assessments like remission, and end result such as joint replacement or death. Outcome measures capture the impact of treating rheumatic diseases. They are influenced by disease severity and effective treatment. They also reflect many confounding factors. These include demographic factors like age, gender, and ethnicity and also deprivation, as poverty worsens outcomes. Comorbidities affect outcomes and patients with multiple comorbid conditions have worse quality of life with poorer outcomes. Patient self-assessment has grown in importance; it is simple and understandable. However, self-assessment can vary over time and does not always reflect assessors’ perspectives. Caution is needed comparing outcomes across units; the various confounding factors and measurement complexities make such comparative analyses challenging.

Physical Function in the Hospital Is Associated With Patient-Centered Outcomes in an Inpatient Rehabilitation Facility

2020 ◽  
Vol 100 (8) ◽  
pp. 1237-1248 ◽  
Author(s):  
Joshua K Johnson ◽  
Julie M Fritz ◽  
Benjamin S Brooke ◽  
Paul C LaStayo ◽  
Anne Thackeray ◽  
...  
Keyword(s):  
Physical Function ◽  
Hospital Discharge ◽  
Short Form ◽  
Academic Medical Center ◽  
Inpatient Rehabilitation ◽  
Acute Hospital ◽  
Adjusted Relative Risk ◽  
Day Hospital ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility

Abstract Objective Poor knowledge of the relationships between physical function (PF) in the hospital and patient outcomes in an inpatient rehabilitation facility (IRF) limits the identification of patients most appropriate for discharge to an IRF. This study aimed to test for independent associations between PF measured via the AM-PAC “6-clicks” basic mobility short form in the hospital and outcomes in an IRF. Methods This was a retrospective cohort study. Primary data were collected from an acute hospital and IRF at 1 academic medical center. Associations were tested between PF at hospital admission or discharge and PF improvement in the IRF, discharge from the IRF to the community, and 30-day hospital events by estimating adjusted relative risk (aRR) using modified Poisson regression and the relative difference in IRF length of stay (LOS) using Gamma regression. Results A total of 1323 patients were included. Patients with moderately low, (aRR = 1.50; 95% CI = 1.15–1.93), moderately high (aRR = 1.52; 95% CI = 1.16–2.01), or high (aRR = 1.37; 95% CI = 1.02–1.85) PF at hospital discharge were more likely than those with very low PF to improve their PF while in the IRF. These same patients were more likely to discharge from IRF to the community and had significantly shorter IRF LOS. Hospital-measured PF did not differentiate risk for 30-day hospital events. Conclusion Patients with moderate—but not very low or very high—PF measured near the time of acute hospital discharge were likely to achieve meaningful PF improvement in an IRF. They also had a shorter IRF LOS so may be ideal candidates for discharge to IRF. Prospective studies with larger samples are necessary to test this assertion. Impact Providers in the hospital should identify patients with moderate PF near the time of hospital discharge as those who may benefit most from post-acute rehabilitation in an IRF.

scholarly journals Functional outcome and muscle wasting in adults with tetanus

2019 ◽  
Vol 113 (11) ◽  
pp. 706-713
Author(s):  
Truong N Trung ◽  
Nguyen V T Duoc ◽  
Le T H Nhat ◽  
Lam M Yen ◽  
Nguyen V Hao ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Hospital Discharge ◽  
Barthel Index ◽  
Muscle Wasting ◽  
Short Form ◽  
Severe Disease ◽  
Rectus Femoris ◽  
Long Term Outcome ◽  
Sf 36

Abstract Background In many countries, in-hospital survival from tetanus is increasing, but long-term outcome is unknown. In high-income settings, critical illness is associated with muscle wasting and poor functional outcome, but there are few data from resource-limited settings. In this study we aimed to assess muscle wasting and long-term functional outcome in adults with tetanus. Methods In a prospective observational study involving 80 adults with tetanus, sequential rectus femoris ultrasound measurements were made at admission, 7 days, 14 days and hospital discharge. Functional outcome was assessed at hospital discharge using the Timed Up and Go test, Clinical Frailty Score, Barthel Index and RAND 36-item Short Form Health Survey (SF-36) and 3 and 6 months after discharge using the SF-36 and Barthel Index. Results Significant muscle wasting occurred between hospital admission and discharge (p&lt;0.01), particularly in severe disease, where a median 23.49% (interquartile range 10.01–26.07) reduction in rectus femoris cross-sectional area occurred in those with severe (Ablett grades 3 and 4) disease. Muscle mass at discharge was related to objective and subjective measures of physical and emotional function at discharge and 3 and 6 months after discharge. In patients &gt;70 y of age, functional recovery at 6 months was reduced compared with younger patients. Hospital-acquired infection and age were risk factors for muscle wasting. Conclusions Significant muscle wasting during hospitalization occurred in patients with tetanus, the extent of which correlates with functional outcome.

Use of the Activity Measure for Post-Acute Care “6 Clicks” Basic Mobility Inpatient Short Form and National Institutes of Health Stroke Scale to Predict Hospital Discharge Disposition After Stroke

2020 ◽  
Vol 100 (9) ◽  
pp. 1423-1433
Author(s):  
Stephanie Covert ◽  
Joshua K Johnson ◽  
Mary Stilphen ◽  
Sandra Passek ◽  
Nicolas R Thompson ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Acute Care ◽  
Short Form ◽  
Predictive Ability ◽  
National Institutes Of Health ◽  
Nihss Score ◽  
Discharge Disposition ◽  
Activity Measure ◽  
Mobility Score ◽  
Post Acute Care

Abstract Objective Therapists in the hospital are charged with making timely discharge recommendations to improve access to rehabilitation after stroke. The objective of this study was to identify the predictive ability of the Activity Measure for Post-Acute Care “6 Clicks” Basic Mobility Inpatient Short Form (6 Clicks mobility) score and the National Institutes of Health Stroke Scale (NIHSS) score for actual hospital discharge disposition after stroke. Methods In this retrospective cohort study, data were collected from an academic hospital in the United States for 1543 patients with acute stroke and a 6 Clicks mobility score. Discharge to home, a skilled nursing facility (SNF), or an inpatient rehabilitation facility (IRF) was the primary outcome. Associations among these outcomes and 6 Clicks mobility and NIHSS scores, alone or together, were tested using multinomial logistic regression, and the predictive ability of these scores was calculated using concordance statistics. Results A higher 6 Clicks mobility score alone was associated with a decreased odds of actual discharge to an IRF or an SNF. The 6 Clicks mobility score alone was a strong predictor of discharge to home versus an IRF or an SNF. However, predicting discharge to an IRF versus an SNF was stronger when the 6 Clicks mobility score was considered in combination with the NIHSS score, age, sex, and race. Conclusion The 6 Clicks mobility score alone can guide discharge decision making after stroke, particularly for discharge to home versus an SNF or an IRF. Determining discharge to an SNF versus an IRF could be improved by also considering the NIHSS score, age, sex, and race. Future studies should seek to identify which additional characteristics improve predictability for these separate discharge destinations. Impact The use of outcome measures can improve therapist confidence in making discharge recommendations for people with stroke, can enhance hospital throughput, and can expedite access to rehabilitation, ultimately affecting functional outcomes.

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