Enhancing dermatology nursing education in Scotland and Ireland: a multifaceted approach.

The purpose of the National Dermatology Improvement Project was to identify the educational requirements of dermatology nurses and understand factors impacting the uptake of education for nurses. An educational needs analysis was performed to evaluate the strengths and weaknesses of current and future educational provision for all levels of nursing staff. Data were collected from department managers using questionnaires and interviews, and focus groups were held with nursing staff in bands 2-7. The majority of participants felt there was an overall lack of dermatology education, and that most of what was available was peer led and experiential. A number of barriers to the uptake of education were also identified, such as a lack of time, opportunity and motivation. These findings support the need for a nationally coordinated programme of dermatology education with formal and informal education provided for all levels of dermatology nursing staff.

Integration of Data to Establish a Standard Operating Procedure for the Diabetic Patient Undergoing Hyperbaric Oxygen Therapy.

PURPOSE: The purpose of this study was to describe occurrences of hypoglycemia in the diabetic population undergoing hyperbaric oxygen therapy (HBOT). We also examined 2 secondary aims: link industry standards for management of hypoglycemia in the general diabetic population to the HBOT environment; and integrate HBOT data into an electronic health record system, as patients transition across inpatient and outpatient services and settings. DESIGN: A retrospective, descriptive study. SUBJECTS AND SETTING: The study took place within a hyperbaric medicine department located in a 1393-bed acute care medical center, part of a large, multihospital system. The study sample comprised 100 diabetic patients who underwent HBOT between January 1 and May 31, 2015. Sixty-seven percent were male; the mean age of participants was 62 years (range 32-92 years). Admission status was nearly equal with 53% hospital inpatients and 47% ambulatory outpatients. Hospital protocol required all patients to have a minimal prehyperbaric blood glucose level (BGL) of 100 mg/dL. RESULTS: The incidence of hypoglycemia (defined as a BGL <100 mg/dL, 5.5 mmol/L) was 122 of 1175 treatments (10.4%). Additional analysis was based on records for 66 of the 122 incidences with evaluable data from electronic medical records. The mean BGL pre-HBOT was 177.86 mg/dL, 6.54 mmol/L (range 53-439 mg/dL, 2.94-24.36 mmol/L); the mean BGL after HBOT was 165.09 mg/dL, 9.16 mmol/L (range 56-414 mg/dL, 3.11-22.98 mmol/L). Analysis of these 66 occurrences revealed that 52 of 66 (79%) were managed with high-carbohydrate juices and snacks; 8 of 66 (12%) received oral glucagon; and 6 of 66 (9%) received glucagon and high-carbohydrate snack. We found that standard treatment protocols for hypoglycemia ranged from 70 to 100 mg/dL, 3.89 to 5.55 mmol/L, for the general population and 80 to 120 mg/dL, 4.44 to 6.66 mmol/L, for the general diabetic population. We also found that HBOT diabetic data were not fully integrated into the electronic health records across all settings. CONCLUSIONS: Hypoglycemia is prevalent during HBOT. We recommend a minimum pre-treatment serum glucose of 120 mg/dL, 6.7 mmol/L.

Health care transitions and the aging population: a framework for measuring the value of rapid rehabilitation.

A study was undertaken to establish a framework to measure the value of rapid rehabilitation and identify indicators to quantify effective outcomes and efficient processes as health care services are delivered to the aging population across providers, services, and settings. The rapid rehabilitation protocol serving as intervention in this research provides patients (≥65 years old) the option to transition from the acute-care hospital, early in the continuum of care, to an outpatient, skilled nursing facility operated by a division of the hospital organization. A quasi-experimental, cross-sectional, retrospective study is designed to identify and quantify the relationships present in processes and outcomes inherent in health care transitions. Statistical analysis yields unexpected relationships with limited explanatory power for the selected indicators: length of stay, cost of care, discharge delays, 30-day readmissions, falls, and patient satisfaction. However, this research finds 4 imperatives for hospital and clinical leadership: (1) increase collaboration across providers, settings, and stakeholders; (2) educate workforce to optimize risk assessment of aging population; (3) standardize critical to quality measures as scientific foundation for management of services; (4) invest in technologies to ensure the integrity, validity, and reliability of information used to draw inferences about services, risk, and performance.

Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre-Post Study.

BACKGROUND: Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. OBJECTIVE: Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. METHODS: Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient's condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. RESULTS: Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79% reduction of emergency department revisits post monitoring, an 87% reduction in hospital readmissions, and a 60% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71%, and emergency department visit costs decreased by 58% (n=30). Overall health system costs for our participants showed a 56% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19% (n=35) on the mental component score (P<.001) and 19% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. CONCLUSIONS: Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. TRIAL REGISTRATION: ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384.

Uncompensated care and emergency department utilization: a local study having national implications.

This article provides a comprehensive picture of the manner in which uncompensated care patients utilize the emergency departments (EDs) of two Central Florida hospitals. Specifically, this study assesses the impact of treating uncompensated and primary care patients in ED settings on scarce hospital and community resources. Recommendations are being offered to manage a troubling situation that is occurring with alarming frequency in today's health care system throughout the United States. Special emphasis is placed on recommendations addressing alternative triage and financing models that are considered to be both socially responsible and economically viable. The results of this study suggest strongly that health care organizations must find an alternative to the current trend in ED utilization, in order to meet the primary care needs of patients and not compromise the care provided to those with emergent conditions. The recommendations emanating from this study outline a mechanism that can improve the timeliness of emergency care to those in need, while at the same time, making available primary care resources to those seeking services through an emergency department.