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Acute Hospitals (acute + hospital)
Terms modified by Acute Hospitals Selected AbstractsImmediate follow-up after ICU discharge: establishment of a service and initial experiencesNURSING IN CRITICAL CARE, Issue 2 2003Eunice Strahan Summary ,Follow-up of patients discharged from the intensive care unit (ICU) is recommended as a means of service evaluation (Department of Health (2000). Comprehensive Critical Care: a Review of Adult Critical Care Services), in order to monitor the quality of the services provided ,Without patient follow-up, ICU staff have only ,death' or ,discharge alive from hospital' as clinical outcomes from which to judge practice performance, and limited evidence exists on which to base decisions about improvements to critical care practice (Audit Commission (1999). Critical to Success , the Place of Efficient and Effective Critical Care Services Within the Acute Hospital ) ,To address these issues the Regional Intensive Care Unit (RICU) obtained information from patient assessment/interview on problems experienced by patients within 8,9 days (mean), following discharge from RICU ,A nurse-administered questionnaire was used to identify functional outcomes, nutrition and psychological issues such as anxiety and sleep disturbances ,Benefits of patient follow-up introduced and planned include: ,patient diaries for long-term patients ,input from clinical psychologist ,review of sedation used in RICU [source] Early Markers of Prolonged Hospital Stays in Older People: A Prospective, Multicenter Study of 908 Inpatients in French Acute HospitalsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2006Pierre-Olivier Lang MD OBJECTIVES: To identify early markers of prolonged hospital stays in older people in acute hospitals. DESIGN: A prospective, multicenter study. SETTING: Nine hospitals in France. PARTICIPANTS: One thousand three hundred six patients aged 75 and older were hospitalized through an emergency department (Sujet Âgé Fragile: Évaluation et suivi (SAFEs) ,Frail Elderly Subjects: Evaluation and follow-up). MEASUREMENTS: Data used in a logistic regression were obtained through a gerontological evaluation of inpatients, conducted in the first week of hospitalization. The center effect was considered in two models as a random and fixed effect. Two limits were used to define a prolonged hospital stay. The first was fixed at 30 days. The second was adjusted for Diagnosis Related Groups according to the French classification (f-DRG). RESULTS: Nine hundred eight of the 1,306 hospital stays that made up the cohort were analyzed. Two centers (n=298) were excluded because of a large volume of missing f-DRGs. Two-thirds of subjects in the cohort analyzed were women (64%), with a mean age of 84. One hundred thirty-eight stays (15%) lasted more than 30 days; 46 (5%) were prolonged beyond the f-DRG-adjusted limit. No sociodemographic variables seemed to influence the length of stay, regardless of the limit used. For the 30-day limit, only cognitive impairment (odds ratio (OR)=2.2, 95% confidence interval (CI)=1.2,4.0) was identified as a marker for prolongation. f-DRG adjustment revealed other clinical markers. Walking difficulties (OR=2.6, 95% CI=1.2,16.7), fall risk (OR=2.5, 95% CI=1.7,5.3), cognitive impairment (OR=7.1, 95% CI=2.3,49.9), and malnutrition risk (OR=2.5, 95% CI=1.7,19.6) were found to be early markers for prolonged stays, although dependence level and its evolution, estimated using the Katz activity of daily living (ADL) index, were not identified as risk factors. CONCLUSION: When the generally recognized parameters of frailty are taken into account, a set of simple items (walking difficulties, risk of fall, risk of malnutrition, and cognitive impairment) enables a predictive approach to the length of stay of elderly patients hospitalized under emergency circumstances. Katz ADLs were not among the early markers identified. [source] Are Aggressive Treatment Strategies Less Cost-Effective for Older Patients?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2001Aggressive Care for Patients with Acute Respiratory Failure, The Case of Ventilator Support OBJECTIVES: A common assumption is that life-sustaining treatments are much less cost-effective for older patients than for younger patients. We estimated the incremental cost-effectiveness of providing mechanical ventilation and intensive care for patients of various ages who had acute respiratory failure. DESIGN: Retrospective analysis of data on acute respiratory failure from Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). SETTING: Acute hospital. PARTICIPANTS: 1,005 with acute respiratory failure; 963 received ventilator support and 42 had ventilator support withheld. MEASUREMENTS: We studied 1,005 patients enrolled in a five-center study of seriously ill patients (SUPPORT) with acute respiratory failure (pneumonia or acute respiratory distress syndrome and an Acute Physiology Score ,10) requiring ventilator support. For cost-effectiveness analyses, we estimated life expectancy based on long-term follow-up of SUPPORT patients and estimated utilities (quality-of-life weights) using time-tradeoff questions. We used hospital fiscal data and Medicare data to estimate healthcare costs. We divided patients into three age groups (<65, 65,74, and ,75 years); for each age group, we performed separate analyses for patients with a ,50% probability of surviving at least 2 months (high-risk group) and those with a> 50% probability of surviving at least 2 months (low-risk group). RESULTS: Of the 963 patients who received ventilator support, 44% were female; 48% survived 6 months; and the median (25th, 75th percentile) age was 63 (46, 75) years. For the 42 patients for whom ventilator support was withheld, the median survival was 3 days. For low-risk patients (>50% estimated 2-month survival), the incremental cost (1998 dollars) per quality-adjusted life-year (QALY) saved by providing ventilator support and aggressive care increased across the three age groups ($32,000 for patients age <65, $44,000 for those age 65,74, and $46,000 for those age ,75). For high-risk patients, the incremental cost-effectiveness was much less favorable and was least favorable for younger patients ($130,000 for patients age <65, $100,000 for those age 65,74, and $96,000 for those age ,75). When we varied our assumptions from 50% to 200% of our baseline estimates in sensitivity analyses, results were most sensitive to the costs of the index hospitalization. CONCLUSIONS: For patients with relatively good short-term prognoses, we found that ventilator support and aggressive care were economically worthwhile, even for patients 75 years and older. For patients with poor short-term prognoses, ventilator support and aggressive care were much less cost-effective for adults of all ages. [source] How many cases of Type 2 diabetes mellitus are due to being overweight in middle age?DIABETIC MEDICINE, Issue 1 2007Evidence from the Midspan prospective cohort studies using mention of diabetes mellitus on hospital discharge or death records Abstract Aims To relate body mass index (BMI) in middle age to development of diabetes mellitus. Methods Participants were 6927 men and 8227 women from the Renfrew/Paisley general population study and 3993 men from the Collaborative occupational study. They were aged 45,64 years and did not have reported diabetes mellitus. Cases who developed diabetes mellitus, identified from acute hospital discharge data and from death certificates in the period from screening in 1970,1976 to 31 March 2004, were related to BMI at screening. Results Of Renfrew/Paisley study men 5.4%, 4.8% of women and 5% of Collaborative study men developed diabetes mellitus. Odds ratios for diabetes mellitus were higher in the overweight group (BMI 25 to < 30 kg/m2) than in the normal weight group (BMI 18.5 to < 25 kg/m2) and highest in the obese group (BMI , 30 kg/m2). Compared with the normal weight group, age-adjusted odds ratios for overweight and obese Renfrew/Paisley men were 2.73 [95% confidence interval (CI) 2.05, 3.64] and 7.26 (95% CI 5.26, 10.04), respectively. Further subdividing the normal, overweight and obese groups showed increasing odds ratios with increasing BMI, even at the higher normal level. Assuming a causal relation, around 60% of cases of diabetes could have been prevented if everyone had been of normal weight. Conclusions Overweight and obesity account for a major proportion of diabetes mellitus, as identified from hospital discharge and death records. With recent increases in the prevalence of overweight, the burden of disease related to diabetes mellitus is likely to increase markedly. Primordial prevention of obesity would be a major strategy for reducing the incidence of diabetes mellitus in populations. [source] Effectiveness of a community-based 3-year advisory program after acquired brain injuryEUROPEAN JOURNAL OF NEUROLOGY, Issue 11 2007E. Grill Objective of this study was to examine the effectiveness of a coordinated, community based 3-year advisory program in 1534 patients with acquired brain injury. Patients and caregivers were offered a coordinated advisory program after discharge from rehabilitation. Patients in the historical control group received standard aftercare. The main outcomes were functional status [Functional Independence Measure (FIM)], and days spent in the acute hospital. The secondary outcome was survival. Patients were comparable for sex (intervention: 41.3% female, control: 38.0%), and younger in the control group (mean age intervention: 55.3, control: 49.6). Functional status at discharge was lower in the intervention group (mean FIM intervention: 66.2, control: 80.3). Patients in the intervention group experienced a moderate gain in FIM. Rate of days in hospital was 15.4 per 1000 person days (intervention) and 15.5 per 1000 person days (control). Patients of the intervention group had an increased rate of days in hospital. A total of 16.0% of patients in the intervention group and 19.3% in the control group died during follow-up. Patients in the intervention had a significant lower mortality risk depending on follow-up period and discharge FIM. The advisory program may be effective for all patients with acquired brain injury. [source] How Much Is Postacute Care Use Affected by Its Availability?HEALTH SERVICES RESEARCH, Issue 2 2005Melinda Beeuwkes Buntin Objective. To assess the relative impact of clinical factors versus nonclinical factors,such as postacute care (PAC) supply,in determining whether patients receive care from skilled nursing facilities (SNFs) or inpatient rehabilitation facilities (IRFs) after discharge from acute care. Data Sources and Study Setting. Medicare acute hospital, IRF, and SNF claims provided data on PAC choices; predictors of site of PAC chosen were generated from Medicare claims, provider of services, enrollment file, and Area Resource File data. Study Design. We used multinomial logit models to predict PAC use by elderly patients after hospitalizations for stroke, hip fractures, or lower extremity joint replacements. Data Collection/Extraction Methods. A file was constructed linking acute and postacute utilization data for all medicare patients hospitalized in 1999. Principal Findings. PAC availability is a more powerful predictor of PAC use than the clinical characteristics in many of our models. The effects of distance to providers and supply of providers are particularly clear in the choice between IRF and SNF care. The farther away the nearest IRF is, and the closer the nearest SNF is, the less likely a patient is to go to an IRF. Similarly, the fewer IRFs, and the more SNFs, there are in the patient's area the less likely the patient is to go to an IRF. In addition, if the hospital from which the patient is discharged has a related IRF or a related SNF the patient is more likely to go there. Conclusions. We find that the availability of PAC is a major determinant of whether patients use such care and which type of PAC facility they use. Further research is needed in order to evaluate whether these findings indicate that a greater supply of PAC leads to both higher use of institutional care and better outcomes,or whether it leads to unwarranted expenditures of resources and delays in returning patients to their homes. [source] The care of older people with dementia in acute hospitalsINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2010BA(Hons), DProf, Fiona Cowdell RN cowdell f. (2010) The care of older people with dementia in acute hospitals. International Journal of Older People Nursing 5, 83,92. Aim., To explore the experiences of patients and nursing staff of the care received by older people with dementia in acute hospitals. Background., The prevalence of dementia is steadily increasing as is the number of people with the condition requiring acute hospital care. Significant concerns about the quality of this care have been raised. There is a paucity of knowledge about the views of such care from the perspectives of people with dementia and nurses. Method., An ethnographic approach was used and data were collected thorough observation and interviews in one acute hospital in the United Kingdom. Findings., Findings suggest that care for older people with dementia in acute hospitals is not always optimum although there are clear exceptions. Generally, people with dementia found the delivery of care and the experience of being in hospital distressing as they did not know what was happening and they were often ignored. Nurses strive to give good care but do not always achieve this. Conclusion., Bourdieu's Model of Practice assists in explaining why care is as it is. There is a clear need to improve current practice. Relevance to clinical practice., It is imperative that innovative methods of developing practice are implemented and evaluated. Education alone will not lead to sustained changes in practice. Further research into this subject needs to be undertaken. [source] Pressure Ulcers in Elderly Patients with Hip Fracture Across the Continuum of CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2009Mona Baumgarten PhD OBJECTIVES: To identify care settings associated with greater pressure ulcer risk in elderly patients with hip fracture in the postfracture period. DESIGN: Prospective cohort study. SETTING: Nine hospitals that participate in the Baltimore Hip Studies network and 105 postacute facilities to which patients from these hospitals were discharged. PARTICIPANTS: Hip fracture patients aged 65 and older who underwent surgery for hip fracture. MEASUREMENTS: A full-body skin examination was conducted at baseline (as soon as possible after hospital admission) and repeated on alternating days for 21 days. Patients were deemed to have an acquired pressure ulcer (APU) if they developed one or more new stage 2 or higher pressure ulcers after hospital admission. RESULTS: In 658 study participants, the APU cumulative incidence at 32 days after initial hospital admission was 36.1% (standard error 2.5%). The adjusted APU incidence rate was highest during the initial acute hospital stay (relative risk (RR)=2.2, 95% confidence interval (CI)=1.3,3.7) and during re-admission to the acute hospital (RR=2.2, 95% CI=1.1,4.2). The relative risks in rehabilitation and nursing home settings were 1.4 (95% CI=0.8,2.3) and 1.3 (95% CI=0.8,2.1), respectively. CONCLUSION: Approximately one-third of hip fracture patients developed an APU during the study period. The rate was highest in the acute setting, a finding that is significant in light of Medicare's policy of not reimbursing hospitals for the treatment of hospital-APUs. Hip fracture patients constitute an important group to target for pressure ulcer prevention in hospitals. [source] Differences in End-of-Life Preferences Between Congestive Heart Failure and Dementia in a Medical House Calls ProgramJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2004Ziad R. Haydar MD Objectives: To compare end-of-life preferences in elderly individuals with dementia and congestive heart failure (CHF). Design: Retrospective case-control study. Setting: Geriatrician-led interdisciplinary house-call program using an electronic medical record. Participants: Homebound individuals who died while under the care of the house-call program from October 1996 to April 2001. Measurements: Medical records review for demographics, functional status, advance medical planning, hospice use, and place of death. Results: Of 172 patients who died in the program, 29 had CHF, 79 had dementia, 34 had both, and 30 had neither. Patients with CHF were younger (82.6 vs 87.0, P=.011) and less functionally dependent (activities of daily living score 9.1 vs 11.5, P=.001). Time from enrollment to death was not significantly different (mean±standard deviation=444±375 days for CHF vs 325±330 days for dementia, P=.113). A do-not-resuscitate (DNR) directive was given in 62% of patients with CHF and 91% with dementia (P<.001). Advance medical planning discussions were not significantly different (2.10 in CHF vs 1.65 in dementia, P=.100). More patients with CHF participated in their advance medical planning than those with dementia (86% vs 17%, P<.001). Hospice was used in 24% of CHF and 61% of dementia cases (P<.001). Finally, 45% of patients with CHF and 18% of patients with dementia died in the acute hospital (P=.006). Multivariate analysis showed that the fact that more patients with CHF were involved in their medical planning was not significant in predicting end-of-life preferences. Alternatively, Caucasian ethnicity was an independent predictor of having a documented DNR and death outside of the acute hospital. Conclusion: In the months before death, patients with CHF were more likely to have care plans directed at disease modification and treatment, whereas dementia patients were more likely to have care plans that focused on symptom relief and anticipation of dying. Several factors may contribute to this difference. [source] Optimizing Coding and Reimbursement to Improve Management of Alzheimer's Disease and Related DementiasJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2002Howard Fillit MD The objectives of this study were to review the diagnostic, International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM), diagnosis related groups (DRGs), and common procedural terminology (CPT) coding and reimbursement issues (including Medicare Part B reimbursement for physicians) encountered in caring for patients with Alzheimer's disease and related dementias (ADRD); to review the implications of these policies for the long-term clinical management of the patient with ADRD; and to provide recommendations for promoting appropriate recognition and reimbursement for clinical services provided to ADRD patients. Relevant English-language articles identified from MEDLINE about ADRD prevalence estimates; disease morbidity and mortality; diagnostic coding practices for ADRD; and Medicare, Medicaid, and managed care organization data on diagnostic coding and reimbursement were reviewed. Alzheimer's disease (AD) is grossly undercoded. Few AD cases are recognized at an early stage. Only 13% of a group of patients receiving the AD therapy donepezil had AD as the primary diagnosis, and AD is rarely included as a primary or secondary DRG diagnosis when the condition precipitating admission to the hospital is caused by AD. In addition, AD is often not mentioned on death certificates, although it may be the proximate cause of death. There is only one ICD-9-CM code for AD,331.0,and no clinical modification codes, despite numerous complications that can be directly attributed to AD. Medicare carriers consider ICD-9 codes for senile dementia (290 series) to be mental health codes and pay them at a lower rate than medical codes. DRG coding is biased against recognition of ADRD as an acute, admitting diagnosis. The CPT code system is an impediment to quality of care for ADRD patients because the complex, time-intensive services ADRD patients require are not adequately, if at all, reimbursed. Also, physicians treating significant numbers of AD patients are at greater risk of audit if they submit a high frequency of complex codes. AD is grossly undercoded in acute hospital and outpatient care settings because of failure to diagnose, limitations of the coding system, and reimbursement issues. Such undercoding leads to a lack of recognition of the effect of AD and its complications on clinical care and impedes the development of better care management. We recommend continuing physician education on the importance of early diagnosis and care management of AD and its documentation through appropriate coding, expansion of the current ICD-9-CM codes for AD, more appropriate use of DRG coding for ADRD, recognition of the need for time-intensive services by ADRD patients that result in a higher frequency of use of complex CPT codes, and reimbursement for CPT codes that cover ADRD care management services. [source] Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patientsJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2006P. J. Barry MB Summary Background:, In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) , 2003 version]. The Beers' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers' criteria CD contains 19 different categories containing possible drug,disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug,disease interactions. Objectives:, The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. Methods:, A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80·3 ± 6·1 years) and all patients had both Beers' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. Results:, The results of the study identified a high rate of inappropriate prescribing among this population of community-dwelling subjects. The total number of inappropriate prescriptions identified using the Beers' criteria (ID) was 148 affecting 121 patients. The Beers' criteria (CD) identified 69 inappropriate prescriptions in 60 patients and the IPET identified 112 inappropriate prescriptions in 78 patients. The Beers criteria (ID and CD combined) identified at least one inappropriate prescription in 34% of subjects and the IPET identified one in at least 22% of subjects. Conclusions:, This study identifies high rates of use of inappropriate medications in community-dwelling elderly presenting with acute illness to hospital. These are comparable with inappropriate prescribing rates identified in previous studies. The revised Beers' criteria (2003) identified more inappropriate prescriptions than the IPET in this population of elders. [source] Leadership behaviours: effects on job satisfaction, productivity and organizational commitmentJOURNAL OF NURSING MANAGEMENT, Issue 4 2001J. CHIOK FOONG LOKE RN MBA BN CCNC Background, Research in the west has shown that job satisfaction, productivity and organizational commitment are affected by leadership behaviours. The purpose of this study is to determine the effect of leadership behaviours on employee outcomes in Singapore. Very little research related to this subject has been done in health care settings in this country. The comparison of the results of the different types of settings and samples will allow a better understanding of the relationshiop between leadership behaviours and employee outcomes and thus help to determine if leadership is worth the extra effort. Method, The study explored the relationships between five leadership behaviours identified by Kouzes and Posner and the employee outcomes of registered nurses practising in the general wards, intensive care units and the coronary care unit in an acute hospital. Survey questionnaires were used to elicit responses from 100 registered nurses and 20 managers belonging to the organization. Data collected included demographic characteristics and the degree to which the five types of leadership behaviours were used as perceived by the nurse managers and the registered nurses. In addition, the level of nurse job satisfaction, the degree of productivity and the extent of organizational commitment are described. Findings, The findings show a similar trend to the original studies in the United States of America. Use of leadership behaviours and employee outcomes were significantly correlated. The regression results indicate that 29% of job satisfaction, 22% of organizational commitment and 9% of productivity were explained by the use of leadership behaviours. Recommendations are made in the light of these findings. [source] An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unitNURSING IN CRITICAL CARE, Issue 6 2007Brian McFetridge Abstract The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi-method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi-method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others' roles and expectations. [source] The Attitudes of British National Health Service Managers and Clinicians Towards the Introduction of BenchmarkingFINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 2 2002C. S. Jones This paper describes an empirical study, conducted in three acute hospitals, of the attitudes of central managers, medical managers and clinicians towards the adoption of benchmarking. Benchmarking was portrayed in The New NHS White Paper (1997) as an important means of improving efficiency over the next decade. The present paper examines the context of change and nature of benchmarking. Findings are presented in seven sections including: the understanding which respondents had of benchmarking; their willingness to be involved in benchmarking; the existence of strategies and policies for implementing benchmarking; the relevance of existing costing information; and the role of networks in facilitating benchmarking. The study concludes that the process of change adopted contradicted most of the factors associated with creating receptivity to change. Also, that the publication of the National Reference Costs seemed to have more relevance to resource planning at central National Health Service Management Executive level, than to effecting improvements at operational level in acute hospitals. [source] Appraising and Evaluating PFI for NHS HospitalsFINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 3 2001Julie Froud This paper explores the use of appraisal in the development of proposals to use private finance to provide acute hospitals under the Private Finance Initiative (PFI). It addresses the extent to which value for money (VFM) and affordability (which must be satisfied to enable a scheme to be approved) are demonstrated in the documents prepared by hospital Trusts. It identifies a number of issues (such as the transfer of risk and the development of public sector comparators) that pose new problems for investment appraisal, which are specific to its application to PFI. [source] Interventions to reduce the incidence of falls in older adult patients in acute-care hospitals: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2009Cindy Stern BHS(Hons) Abstract Aim, Falls can cause serious physical and emotional injuries to patients leading to poor quality of life and increased length of hospital stay. The aim of this study was to present the best available evidence regarding the effectiveness of risk assessment or other interventions that aimed to minimise the number of falls. Methods, A systematic review of randomised controlled trials was undertaken to determine the effectiveness of interventions that were designed to reduce the incidence of falls in older acute-care patients. Only trials published between 1998 and 2008 were considered. Results, Only seven studies were included in the review, indicating the evidence on this topic is sparse. There is some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult inpatients: ,,A multidisciplinary multifactorial intervention program consisting of falls risk alert card, an exercise program, an education program and the use of hip protectors after approximately 45 days ,,A one-on-one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ,,A targeted fall risk factor reduction intervention that includes a fall risk factor screen, recommended interventions encompassing local advice and a summary of the evidence There is also some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications, can reduce the amount of falls in patients following surgery for femoral neck fracture. Conclusion, There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit. Further high-quality research is needed in order to ascertain effective fall-prevention strategies in acute-care facilities. [source] The care of older people with dementia in acute hospitalsINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2010BA(Hons), DProf, Fiona Cowdell RN cowdell f. (2010) The care of older people with dementia in acute hospitals. International Journal of Older People Nursing 5, 83,92. Aim., To explore the experiences of patients and nursing staff of the care received by older people with dementia in acute hospitals. Background., The prevalence of dementia is steadily increasing as is the number of people with the condition requiring acute hospital care. Significant concerns about the quality of this care have been raised. There is a paucity of knowledge about the views of such care from the perspectives of people with dementia and nurses. Method., An ethnographic approach was used and data were collected thorough observation and interviews in one acute hospital in the United Kingdom. Findings., Findings suggest that care for older people with dementia in acute hospitals is not always optimum although there are clear exceptions. Generally, people with dementia found the delivery of care and the experience of being in hospital distressing as they did not know what was happening and they were often ignored. Nurses strive to give good care but do not always achieve this. Conclusion., Bourdieu's Model of Practice assists in explaining why care is as it is. There is a clear need to improve current practice. Relevance to clinical practice., It is imperative that innovative methods of developing practice are implemented and evaluated. Education alone will not lead to sustained changes in practice. Further research into this subject needs to be undertaken. [source] Early Markers of Prolonged Hospital Stays in Older People: A Prospective, Multicenter Study of 908 Inpatients in French Acute HospitalsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2006Pierre-Olivier Lang MD OBJECTIVES: To identify early markers of prolonged hospital stays in older people in acute hospitals. DESIGN: A prospective, multicenter study. SETTING: Nine hospitals in France. PARTICIPANTS: One thousand three hundred six patients aged 75 and older were hospitalized through an emergency department (Sujet Âgé Fragile: Évaluation et suivi (SAFEs) ,Frail Elderly Subjects: Evaluation and follow-up). MEASUREMENTS: Data used in a logistic regression were obtained through a gerontological evaluation of inpatients, conducted in the first week of hospitalization. The center effect was considered in two models as a random and fixed effect. Two limits were used to define a prolonged hospital stay. The first was fixed at 30 days. The second was adjusted for Diagnosis Related Groups according to the French classification (f-DRG). RESULTS: Nine hundred eight of the 1,306 hospital stays that made up the cohort were analyzed. Two centers (n=298) were excluded because of a large volume of missing f-DRGs. Two-thirds of subjects in the cohort analyzed were women (64%), with a mean age of 84. One hundred thirty-eight stays (15%) lasted more than 30 days; 46 (5%) were prolonged beyond the f-DRG-adjusted limit. No sociodemographic variables seemed to influence the length of stay, regardless of the limit used. For the 30-day limit, only cognitive impairment (odds ratio (OR)=2.2, 95% confidence interval (CI)=1.2,4.0) was identified as a marker for prolongation. f-DRG adjustment revealed other clinical markers. Walking difficulties (OR=2.6, 95% CI=1.2,16.7), fall risk (OR=2.5, 95% CI=1.7,5.3), cognitive impairment (OR=7.1, 95% CI=2.3,49.9), and malnutrition risk (OR=2.5, 95% CI=1.7,19.6) were found to be early markers for prolonged stays, although dependence level and its evolution, estimated using the Katz activity of daily living (ADL) index, were not identified as risk factors. CONCLUSION: When the generally recognized parameters of frailty are taken into account, a set of simple items (walking difficulties, risk of fall, risk of malnutrition, and cognitive impairment) enables a predictive approach to the length of stay of elderly patients hospitalized under emergency circumstances. Katz ADLs were not among the early markers identified. [source] A Randomized, Controlled Trial of an Intensive Community Nurse,Supported Discharge Program in Preventing Hospital Readmissions of Older Patients with Chronic Lung DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2004Timothy Kwok FRCP Objectives: To evaluate the effectiveness of an intensive community nurse (CN)-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease (CLD). Design: Randomized, controlled trial. Setting: Two acute hospitals in the same health region in Hong Kong. Participants: One hundred fifty-seven hospitalized patients aged 60 and older with a primary diagnosis of CLD and at least one hospital admission in the previous 6 months. Intervention: CNs made home visits within 7 days of discharge, then weekly for 4 weeks and monthly until 6 months. CNs coordinated closely with a geriatric or respiratory specialist in hospital. Subjects had telephone access to CNs during normal working hours from Monday to Saturday. Measurements: The primary outcome was the rate of unplanned readmission within 6 months. The secondary outcomes were the rate of unplanned readmission within 28 days, number of unplanned readmissions, hospital bed days, accident and emergency room attendance, functional and psychosocial status, and caregiver burden. Results: One hundred forty hospitalized patients completed the trial. Intervention group subjects had a higher rate of unplanned readmission within 6 months than control group subjects (76% vs 62%, P=.080, ,2 test). There was no significant group difference in any of the secondary outcomes except that intervention group subjects did better on social handicap scores. Conclusion: There was no evidence that an intensive CN-supported discharge program can prevent hospital readmissions in older patients with CLD. [source] A literature review: factors that impact on nurses' effective use of the Medical Emergency Team (MET)JOURNAL OF CLINICAL NURSING, Issue 24 2009Lisa Jones Aims and objectives., The aim of this literature review is to identify factors, both positive and negative, that impact on nurses' effective use of the Medical Emergency Team (MET) in acute care settings. Background., Outcomes for patients are often dependent on nurses' ability to identify and respond to signs of increasing illness and initiate medical intervention. In an attempt to improve patient outcomes, many acute hospitals have implemented a rapid response system known as the Medical Emergency Team (MET) which has improved management of critically ill ward patients. Subsequent research has indicated that the MET system continues to be underused by nurses. Design., A comprehensive thematic literature review. Methods., The review was undertaken using key words and the electronic databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID/MEDLINE, Blackwell Synergy, Science Direct and Informit. Fifteen primary research reports were relevant and included in the review. Results., Five major themes emerged from the analysis of the literature as the major factors effecting nurses' use of the MET system. They were: education on the MET, expertise, support by medical and nursing staff, nurses' familiarity with and advocacy for the patient and nurses' workload. Conclusions., Ongoing education on all aspects of the MET system is recommended for nursing, medical and MET staff. Bringing MET education into undergraduate programs to prepare new graduates entering the workforce to care for acutely ill patients is also strongly recommended. Further research is also needed to determine other influences on MET activation. Relevance to clinical practice., Strategies that will assist nurses to use the MET system more effectively include recruitment and retention of adequate numbers of permanent skilled staff thereby increasing familiarity with and advocacy for the patient. Junior doctors and nurses should be encouraged to attend ward MET calls to gain skills in management of acutely ill patients. [source] Acute Pain Teams in England: current provision and their role in postoperative pain managementJOURNAL OF CLINICAL NURSING, Issue 3 2003Ann Mcdonnell BSc Summary ,,This survey describes the current provision of multidisciplinary Acute Pain Teams (APTs) in acute English hospitals performing adult in-patient surgery (excluding maternity). Associations between the presence of an APT and a number of organizational and clinical initiatives for the management of postoperative pain are also explored. ,,Postal questionnaires were sent to the Clinical Director of Anaesthetics or head of the APT at every acute English hospital providing separate anaesthetic services. ,,After written and telephone reminders, the response rate was 86% (n = 226). ,,Eighty-four per cent (n = 190) of respondents had an APT in their hospital. The presence of an APT was associated (P,0.05) with higher estimates of patient controlled analgesia and epidural use, regular in-service training for nurses and junior doctors, written guidelines/protocols for management of postoperative pain, routine use of postoperative pain measurement systems and audit/research in relation to postoperative pain issues. ,,Acute Pain Teams, in which nurses play a major role, have a pivotal influence not only in relation to postoperative analgesia but also in wider service development. Since 1995, the number of hospitals offering in-patient surgery that are covered by an APT has risen. However, despite repeated endorsements from professional bodies, some acute hospitals still have no APT and recent evidence indicates that some APTs face financial problems and provide a ,token' service only. Recent policy recommendations may have little impact on the current situation. [source] Public health in the undergraduate medical curriculum , can we achieve integration?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2000David H. Stone MD, FFPHM, FRCP (Glasg) Abstract Public health is widely regarded by medical students as peripheral or even irrelevant to the acquisition of clinical knowledge and skills. This paper attempts to set out some of the reasons for this, to encourage innovative approaches to integrating public health with clinical teaching and to offer a theoretical framework of integrated public health education for curriculum development and evaluation. The points of convergence between public health and clinical practice should not be regarded as self-evident. A practical demonstration of the application of public health principles to clinical problem solving may be the most effective means of overcoming resistance. Almost anywhere that clinical services are provided is suitable for this purpose. Community clinics, health centres or general practices have obvious appeal but acute hospitals have important advantages arising from students' preoccupation with clinical medicine. The main aim of integrated public health teaching is to facilitate the students' acquisition of knowledge, skills and attitudes that promote the effective application of public health approaches to clinical practice. The interrelationships between clinical practice and public health may be represented in the form of a grid. The vertical headings are the clinical skills that relate to the different stages of the natural history of disease , from the pre-disease state through diagnosis, treatment and follow up. The horizontal headings describe four key public health dimensions: epidemiology, behaviour/lifestyle, environment and health policy. The text in the boxes suggests appropriate topics for discussion. The grid is also potentially useful for course documentation and content evaluation. [source] An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unitNURSING IN CRITICAL CARE, Issue 6 2007Brian McFetridge Abstract The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi-method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi-method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others' roles and expectations. [source] The Scottish Audit of Surgical Mortality: a review of areas of concern related to anaesthesia over 10 yearsANAESTHESIA, Issue 12 2009H. J. McFarlane Summary The Scottish Audit of Surgical Mortality is a voluntary, peer reviewed, critical event analysis of patients who die under the care of consultant surgeons in acute hospitals in Scotland. The anaesthetic contribution to surgical mortality over a 10-year period from 1996 was reviewed. The total number of deaths was 44 230 or 1.5% of all admissions. Forty thousand, eight hundred and ninety-six deaths (92%) were audited. Deaths after elective surgery declined over 10 years. Over 80% of deaths followed emergency admission. The number of deaths where an anaesthetist was present was 16 981 or 0.6% of all admissions. Anaesthetic areas of concern were identified in 8% of deaths. Of these, 43% were related to pre-operative assessment. Anaesthesia also played a part in a further 18% of deaths where decision making was shared with the surgical team. Of these, 41% were related to access to critical care. A further 24% related to communication failures, principally when the operation should not have been done or was unnecessary. [source] Feasibility study of multicentre comparison of NHS hospital pharmacy computer dataBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 1 2000Pauline Debra Walker Aims This study aims to determine the feasibility of collecting, collating and analysing drug expenditure data from a sample of acute hospitals in England. Methods The hospital pharmacy computer system was used to report on drug expenditure from 16 hospitals throughout England for a 2 year period. These data were analysed as a whole and hospital episode statistics were correlated to hospital drug costs. Results Hospital outpatient costs were found to be approximately one third of hospital inpatient costs. Cardiovascular drugs accounted for the greatest increase in expenditure for both inpatients and outpatients (25%). The most expensive therapeutic area of drug use across all sites was anti-infectives. The average daily number of occupied beds explained 55% of the variation in inpatient expenditure and the number of outpatient (including Accident and Emergency) attendances explained 60% of the outpatient drug expenditure. Conclusions This project has confirmed the feasibility of collecting, collating and analysing hospital drug expenditure and identified some interesting patterns and trends in hospital drug use. Hospital activity is reflected in hospital drug costs. [source] | ||||||||||||||||||||||