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1.
Plast Reconstr Surg ; 146(2): 332-338, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740583

RESUMO

BACKGROUND: Local health care facilities are often unequipped to treat complex upper extremity injuries, and patients are therefore transferred to designated trauma centers. This study describes the characteristics of patients transferred to a Level I trauma center for hand and upper extremity injuries and to investigate the accuracy of the provided diagnosis at the time of referral. METHODS: Adult patients transferred from outside facilities to the authors' Level I trauma center by means of direct contract with the on-call fellow for the care of hand and upper extremity injuries were identified. Patient- and injury-related information was prospectively collected at the time of referral before patient transfer, and again following diagnostic evaluation by a hand surgeon at the authors' institution. RESULTS: Sixty-three patients were transferred to the authors' hand surgery service from outside facilities after direct contact with the on-call fellow. Most patients were referred by emergency medicine physicians [n = 47 (76 percent)], followed by midlevel emergency department providers (physician assistant or nurse practitioner) [n = 12 (19 percent)] or hand surgeons [n = 3 (5 percent)]. Six patients were transferred directly from a Level I trauma center. Twenty-one transferred patients (33 percent) had an inaccurate diagnosis at the time of referral. Factors associated with an inaccurate diagnosis included trauma level of the referring hospital and diagnoses of infection or dysvascularity. CONCLUSIONS: The diagnostic accuracy for hand injuries transferred from outside facilities by means of provider-to-provider communication is imperfect, and some injuries are misdiagnosed. Hand surgeons should continue to improve the triage and transfer process for patients with acute hand surgery injuries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Traumatismos do Braço/diagnóstico , Traumatismos da Mão/diagnóstico , Sobremedicalização/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Triagem/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
2.
J Nurs Adm ; 50(9): 438-441, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32804703

RESUMO

This column discusses the establishment of a multidisciplinary model for care transition of COVID-19-positive patients from hospital to community. The pandemic has presented challenging issues for discharge transition. A tiered patient identification and clinical messaging referral system was developed. The use of the COVID-19 transition model provided support to patients and physicians during the 30-day discharge period and can serve as a model for emerging public health issues in the future.


Assuntos
Infecções por Coronavirus/enfermagem , Modelos de Enfermagem , Pandemias , Transferência de Pacientes/organização & administração , Pneumonia Viral/enfermagem , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
4.
Am J Disaster Med ; 15(1): 7-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804382

RESUMO

Hospitals, which care for some of the most vulnerable individuals, have been impacted by disasters in the past and are likely to be affected by future disasters. Yet data on hospital evacuations are infrequent and outdated, at best. This goal of this study was to determine the characteristics and frequency of disasters in the United States that have resulted in hospital evacuations by an appraisal of the literature from 2000 to 2017. There were 158 hospital evacuations in the United States over 18 years. The states with the highest number of evacuations were Florida (N = 39), California (N = 30), and. Texas (N = 15). The reason for the evacuation was "natura" in 114 (72.2 percent), made-man "intentional" 14 (8.9 percent), and man-made "unintentional" or technological related to internal hospital infrastructure 30 (19 percent).The most common natural threats were hurricanes (N = 65) (57 percent), wildfires (N = 21) (18.4 percent), floods (N = 10) (8.8 percent), and storms (N = 8) (7 percent). Bombs/bomb threats were the most common reason (N = 8) (57.1 percent) for a hospital evacuation result-ing from a man-made intentional disaster, followed by armed gunman (N = 4) (28.6 percent). The most frequent infrastruc-ture problems included hospital fires/smoke (N = 9) (30 percent), and chemical fumes (N = 7) (23.3 percent). Of those that reported the duration and number of evacuees, 30 percent of evacuations lasted over 24 h and the number of evacuees was >100 in over half (55.2 percent) the evacuations. This information regarding hospital evacuations should allow hospital administrators, disaster planners, and others to better prepare for disasters that result in the need for hospital evacuation.


Assuntos
Planejamento em Desastres/organização & administração , Desastres/estatística & dados numéricos , Hospitais , Transferência de Pacientes/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos , Tempestades Ciclônicas , Fogo , Inundações , Administração Hospitalar , Humanos , Estados Unidos
5.
BMJ Open ; 10(8): e039177, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819955

RESUMO

OBJECTIVE: COVID-19 started spreading widely in China in January 2020. Outpatient fever clinics (FCs), instituted during the SARS epidemic in 2003, were upgraded to serve for COVID-19 screening and prevention of disease transmission in large tertiary hospitals in China. FCs were hoped to relieve some of the healthcare burden from emergency departments (EDs). We aimed to evaluate the effect of upgrading the FC system on rates of nosocomial COVID-19 infection and ED patient attendance at Peking Union Medical College Hospital (PUMCH). DESIGN: A retrospective cohort study. PARTICIPANTS: A total of 6365 patients were screened in the FC. METHODS: The FC of PUMCH was upgraded on 20 January 2020. We performed a retrospective study of patients presenting to the FC between 12 December 2019 and 29 February 2020. The date when COVID-19 was declared an outbreak in Beijing was 20 January 2020. Two groups of data were collected and subsequently compared with each other: the first group of data was collected within 40 days before 20 January 2020; the second group of data was collected within 40 days after 20 January 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions and the transfer records between the FC and ED, were collected and analysed. RESULTS: 6365 patients were screened in the FC, among whom 2912 patients were screened before 21 January 2020, while 3453 were screened afterward. Screening results showed that upper respiratory infection was the major disease associated with fever. After the outbreak of COVID-19, the number of patients who were transferred from the FC to the ED decreased significantly (39.21% vs 15.75%, p<0.001), and patients generally spent more time in the FC (55 vs 203 min, p<0.001), compared with before the outbreak. For critically ill patients waiting for their screening results, the total length of stay in the FC was 22 min before the outbreak, compared with 442 min after the outbreak (p<0.001). The number of in-hospital deaths of critically ill patients in the FC was 9 out of 29 patients before the outbreak and 21 out of 38 after the outbreak (p<0.05). Nineteen cases of COVID-19 were confirmed in the FC during the period of this study. However, no other patients nor any healthcare providers were cross-infected. CONCLUSION: The workload of the FC increased significantly after the COVID-19 outbreak. New protocols regarding the use of FC likely helped prevent the spread of COVID-19 within the hospital. The upgraded FC also reduced the burden on the ED.


Assuntos
Infecções por Coronavirus/diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Febre/virologia , Ambulatório Hospitalar/organização & administração , Pneumonia Viral/diagnóstico , Centros de Atenção Terciária/organização & administração , Carga de Trabalho , Adulto , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias , Transferência de Pacientes/estatística & dados numéricos , Pneumonia Viral/transmissão , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
6.
Pediatrics ; 146(Suppl 1): S54-S59, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737233

RESUMO

In 2017, the court case over medical treatment of UK infant, Charlie Gard, reached global attention. In this article, I will analyze one of the more distinctive elements of the case. The UK courts concluded that treatment of Charlie Gard was not in his best interests and that it would be permissible to withdraw life-sustaining treatment. However, in addition, the court ruled that Charlie should not be transferred overseas for the treatment that his parents sought, even though specialists in Italy and the US were willing to provide that treatment. Is it ethical to prevent parents from pursuing life-prolonging treatment overseas for their children? If so, when is it ethical to do this? I will outline arguments in defense of obstructing transfer in some situations. I will argue, however, that this is only justified if there is good reason to think that the proposed treatment would cause harm.


Assuntos
Temas Bioéticos , Futilidade Médica/ética , Transferência de Pacientes/ética , Suspensão de Tratamento/ética , Dissidências e Disputas , História do Século XXI , Humanos , Internacionalidade , Malformações Arteriovenosas Intracranianas/terapia , Itália , Masculino , Futilidade Médica/legislação & jurisprudência , Turismo Médico/ética , Turismo Médico/legislação & jurisprudência , Pais , Transferência de Pacientes/legislação & jurisprudência , Recusa do Médico a Tratar/ética , Recusa do Médico a Tratar/legislação & jurisprudência , Texas , Traqueostomia/ética , Traqueostomia/legislação & jurisprudência , Reino Unido , Estados Unidos , Suspensão de Tratamento/legislação & jurisprudência
7.
Pediatrics ; 146(Suppl 1): S60-S65, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737234

RESUMO

Charlie Gard (August 4, 2016, to July 28, 2017) was an infant in the United Kingdom who was diagnosed with an encephalopathic form of mitochondrial DNA depletion syndrome caused by a mutation in the RRM2B gene. Charlie's parents raised £1.3 million (∼$1.6 million US) on a crowdfunding platform to travel to New York to pursue experimental nucleoside bypass treatment, which was being used to treat a myopathic form of mitochondrial DNA depletion syndrome caused by mutations in a different gene (TK2). The case made international headlines about what was in Charlie's best interest. In the medical ethics community, it raised the question of whether best interest serves as a guidance principle (a principle that provides substantive directions as to how decisions are to be made), an intervention principle (a principle specifying the conditions under which third parties are to intervene), both guidance and intervention, or neither. I show that the United Kingdom uses best interest as both guidance and intervention, and the United States uses best interest for neither. This explains why the decision to withdraw the ventilator without attempting nucleoside bypass treatment was the correct decision in the United Kingdom and why the opposite conclusion would have been reached in the United States.


Assuntos
Proteínas de Ciclo Celular/genética , Encefalomiopatias Mitocondriais/terapia , Defesa do Paciente/ética , Respiração Artificial/ética , Ribonucleotídeo Redutases/genética , Suspensão de Tratamento/ética , Tomada de Decisão Clínica/ética , Crowdsourcing/economia , História do Século XXI , Humanos , Lactente , Masculino , Futilidade Médica/ética , Encefalomiopatias Mitocondriais/genética , Cidade de Nova Iorque , Poder Familiar , Defesa do Paciente/legislação & jurisprudência , Transferência de Pacientes/ética , Transferência de Pacientes/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Timidina Quinase/genética , Reino Unido , Estados Unidos , Suspensão de Tratamento/legislação & jurisprudência
8.
Korean J Intern Med ; 35(4): 749-757, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32668513

RESUMO

Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus 2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities; the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Isquemia Miocárdica/terapia , Pandemias/prevenção & controle , Intervenção Coronária Percutânea , Pneumonia Viral/prevenção & controle , Ar Condicionado , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Desinfecção , Humanos , Transferência de Pacientes , Equipamento de Proteção Individual , Triagem
9.
Am Surg ; 86(5): 400-406, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684018

RESUMO

INTRODUCTION: This study sought to compare the outcomes of trauma patients taken directly from the field to a level I trauma center (direct) versus patients that were first brought to a level III trauma center prior to being transferred to a level I (transfer) within our inclusive Delaware trauma system. METHODS: A retrospective review of the level I center's trauma registry was performed using data from 2013 to 2017 for patients brought to a single level I trauma center from two surrounding counties. The direct cohort consisted of 362 patients, while the transfer cohort contained 204 patients. Linear regression analysis was performed to investigate hospital length of stay (LOS), while logistic regression was used for mortality, complications, and craniotomy. Covariates included age, gender, county, and injury severity score (ISS). Propensity score weighting was also performed between the direct and transfer cohorts. RESULTS: When adjusting for age, gender, ISS, and county, transferred patients demonstrated worse outcomes compared to direct patients in both the regression and propensity score analyses. Transferred patients were at increased risk of mortality (OR 2.17, CI 1.10-4.37, P = .027) and craniotomy (OR 3.92, CI 1.87-8.72, P < .001). Age was predictive of mortality (P < .001). ISS was predictive of increased risk of mortality (P < .001), increased LOS (P < .001), and craniotomy (P < .001). Older age, Sussex County, and higher ISS were predictive of patients being transferred (P < .001). DISCUSSION: Delays in presentation to our level I trauma center resulted in worse outcomes. Patients that meet criteria should be considered for transport directly to the highest level trauma center in the system to avoid delays in care.


Assuntos
Seleção de Pacientes , Transferência de Pacientes/normas , Centros de Traumatologia , Triagem/normas , Ferimentos e Lesões/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tempo para o Tratamento , Centros de Traumatologia/classificação , Resultado do Tratamento
10.
Am Surg ; 86(5): 467-475, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684019

RESUMO

Trauma centers monitor under- and overtriage rates to comply with American College of Surgeons Committee on Trauma verification requirements. Efforts to maintain acceptable rates are often undertaken as part of quality assurance. The purpose of this project was to improve the institutional undertriage rate by focusing on appropriately triaging patients transferred from outside hospitals (OSHs). Trauma physicians received education and pocket cards outlining injury severity score (ISS) calculation to aid in prospectively estimating ISS for patients transferred from OSHs, and activate the trauma response expected for that score. Under- and overtriage rates before and after the intervention were compared. The postintervention period saw a significant decrease in overall overtriage rate, with simultaneous trend toward lower overall undertriage rate, attributable to the significant reduction in undertriage rate of patients transferred from OSHs. Prospectively estimating ISS to assist in determining trauma activation level shows promise in managing appropriate patient triage. However, questions arose regarding the necessity for full trauma activation for transferred patients, regardless of ISS. It may be necessary to reconsider how patients transferred from OSHs are evaluated. Full trauma activation can be a financial and resource burden, and should not be taken lightly.


Assuntos
Transferência de Pacientes/normas , Centros de Traumatologia , Triagem/normas , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Centros de Traumatologia/classificação
11.
J Stroke Cerebrovasc Dis ; 29(8): 104953, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689621

RESUMO

INTRODUCTION: Although there is evidence to suggest a high rate of cerebrovascular complications in patients with SARS-CoV-2 infection, anecdotal reports indicate a falling rate of new ischemic stroke diagnoses. We conducted an exploratory single-center analysis to estimate the change in number of new stroke diagnoses in our region, and evaluate the proximate reasons for this change during the COVID-19 pandemic at a tertiary care center in New Jersey. PATIENTS AND METHODS: A Comprehensive Stroke Center prospective cohort was retrospectively analyzed for the number of stroke admissions, demographic features, and short-term outcomes 5 months prior to 3/1/2020 (pre-COVID-19), and in the 6 weeks that followed (COVID-19 period). The primary outcome was the number of new acute stroke diagnoses before and during the COVID-19 period, as well as the potential reasons for a decline in the number of new diagnoses. RESULTS: Of the 328 included patients, 53 (16%) presented in the COVID-19 period. There was a mean fall of 38% in new stroke diagnoses (mean 1.13/day [SD 1.07] from 1.82/day [SD 1.38], p<0.01), which was related to a 59% decline in the number of daily transfers from referral centers (p<0.01), 25% fewer telestroke consultations (p=0.08), and 55% fewer patients presenting directly to our institution by private vehicle (p<0.01) and 29% fewer patients through emergency services (p=0.09). There was no significant change in the monthly number of strokes due to large vessel occlusion (LVO), however the proportion of new LVOs nearly doubled in the COVID-19 period (38% vs. 21%, p=0.01). CONCLUSIONS: The observations at our tertiary care center corroborate anecdotal reports that the number of new stroke diagnoses is falling, which seems related to a smaller proportion of patients seeking healthcare services for milder symptoms. These preliminary data warrant validation in larger, multi-center studies.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Centros de Atenção Terciária , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Serviços Médicos de Emergência , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , New Jersey/epidemiologia , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Transferência de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Consulta Remota , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/virologia , Fatores de Tempo
12.
Medicine (Baltimore) ; 99(29): e21245, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702904

RESUMO

Little is known about how emergency transfers take place and what outcomes they lead to in the patients who receive home care in Japan. We aimed to assess outcomes of emergency transfers and factors associated with such outcomes in the Japanese home care setting.A retrospective analysis of patient data from a home care clinic in Fukui, Japan, included all patients who experienced emergency transfers which were reported to the clinic during 2018 and 2019. We collected data on patients' sociodemographic and clinical characteristics, as well as the transfer process and its outcome, using patient charts and other administrative records. We first analyzed the overall outcome and then evaluated whether transfer outcomes would differ according to by whom and from where the emergency medical service (EMS) was called, by univariate and multivariate analyses.We considered 63 patients who experienced emergency transfers during the study period. Of the total, 10 (15.9%) returned to their residences without being admitted or being dead on arrival. Although only 2.6% (1/39) of patients whose transfers were determined by health care professionals (HCPs) returned home without being admitted, a direct return was observed for 37.5% (9/24) of patients whose transfer was determined by those other than HCPs (odds ratio of direct return to residences 22.80, 95% confidence interval 2.65-195.87). There was no other variable which was significantly associated with the outcomes after the emergency transfers, although all the patients who have no available caregivers resulted in hospitalization.In this preliminary analysis in the Japanese home care setting, only a small proportion of patients returned to their residences without being admitted following emergency transfers. Patients whose EMS transfer was requested by an HCP usually resulted in an admission to the clinic, whereas transfers requested by non-HCPs frequently did not.


Assuntos
Serviço Hospitalar de Emergência , Serviços de Assistência Domiciliar , Transferência de Pacientes/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Demografia , Feminino , Humanos , Lactente , Recém-Nascido , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
14.
S Afr Med J ; 110(4): 327-331, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657746

RESUMO

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is one of the main contributors to morbidity and mortality in South Africa (SA). Timeous intervention by means of percutaneous coronary intervention (PCI) or fibrinolysis can significantly improve the outcome of STEMI. OBJECTIVES: To determine the median time interval between diagnosis and fibrinolysis in patients presenting to centres within the drainage area of Tygerberg Hospital, Cape Town, SA, and compare it with the European Society of Cardiology (ESC) recommendation of 10 minutes. METHODS: A retrospective medical record review of patients presenting to the abovementioned centres between 1 March 2017 and 28 February 2018 was performed. The primary presenting centre, time between diagnosis and fibrinolysis and discharge medication were recorded, in addition to other relevant demographic information. RESULTS: A total of 492 patients were identified, of whom 447 were included in the study. Three hundred and eighteen patients received fibrinolysis, of whom 18 (5.7%) were treated within 10 minutes of diagnosis. The median time interval between diagnosis and fibrinolysis was 67 (interquartile range (IQR) 32.5 -122.5) minutes. CONCLUSIONS: Most patients received fibrinolysis >10 minutes after diagnosis, which indicates suboptimal therapy when compared with the ESC guidelines. Future studies should investigate the factors prolonging this therapeutic delay.


Assuntos
Instituições de Assistência Ambulatorial , Hospitais de Distrito , Hospitais Privados , Transferência de Pacientes , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Centros de Atenção Terciária , Terapia Trombolítica/métodos , Tempo para o Tratamento/estatística & dados numéricos , Centros Médicos Acadêmicos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , África do Sul
15.
Rev Lat Am Enfermagem ; 28: e3325, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32696919

RESUMO

OBJECTIVE: to map the available evidence on the components of the transition of care, practices, strategies, and tools used in the discharge from the Intensive Care Unit (ICU) to the Inpatient Unit (IU) and its impact on the outcomes of adult patients. METHOD: a scoping review using search strategies in six relevant health databases. RESULTS: 37 articles were included, in which 30 practices, strategies or tools were identified for organizing and executing the transfer process, with positive or negative impacts, related to factors intrinsic to the Intensive Care Unit and the Inpatient Unit and cross-sectional factors regarding the staff. The analysis of hospital readmission and mortality outcomes was prevalent in the included studies, in which trends and potential protective actions for a successful care transition are found; however, they still lack more robust evidence and consensus in the literature. CONCLUSION: transition of care components and practices were identified, in addition to factors intrinsic to the patient, associated with worse outcomes after discharge from the Intensive Care Unit. Discharges at night or on weekends were associated with increased rates of readmission and mortality; however, the association of other practices with the patient's outcome is still inconclusive.


Assuntos
Unidades de Terapia Intensiva , Alta do Paciente , Transferência de Pacientes , Adulto , Estudos Transversais , Mortalidade Hospitalar , Humanos , Readmissão do Paciente , Estudos Prospectivos , Estudos Retrospectivos
18.
J Aging Soc Policy ; 32(4-5): 334-342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32496899

RESUMO

This perspective addresses the challenges that assisted living (AL) providers face concerning federal guidelines to prevent increased spread of COVID-19. These challenges include restriction of family visitation, use of third-party providers as essential workers, staffing guidelines, transfer policies, and rural AL hospitalizations. To meet these challenges we recommend that AL providers incorporate digital technology to maintain family-resident communication. We also recommend that states adopt protocols that limit the number of AL communities visited by home health care workers in a 14-day period, appeal to the federal government for hazard pay for direct care workers, and to extend the personal care attendant program to AL. It is further recommended that states work with AL communities to implement COVID-19 comprehensive emergency management plans that are well-coordinated with local emergency operation centers to assist with transfers to COVID-19 specific locations and to assist in rural areas with hospital transfers. Together, these recommendations to AL providers and state and federal agencies address the unique structure and needs of AL and would enable AL communities to be better prepared to care for and reduce those infected with COVID-19.


Assuntos
Moradias Assistidas/organização & administração , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Moradias Assistidas/normas , Betacoronavirus , Comunicação , Planejamento em Desastres/organização & administração , Família , Fidelidade a Diretrizes , Humanos , Pandemias , Transferência de Pacientes/normas , População Rural , Estados Unidos/epidemiologia
20.
South Med J ; 113(6): 320-324, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32483643

RESUMO

OBJECTIVE: To evaluate pharmacist involvement in the inpatient transition of care (TOC) process for patients hospitalized with type 1 diabetes mellitus, type 2 diabetes mellitus, or chronic obstructive pulmonary disease. METHODS: A pharmacist screened patients admitted with one or more of the qualifying conditions within 48 hours of admission to perform medication reconciliation. During medication reconciliation, the pharmacist removed any duplicate or nonindicated medications and added any omitted medications. The pharmacist also reviewed the discharge summary to ensure medication optimization upon discharge. RESULTS: Pharmacist involvement in the admission and discharge reconciliation processes of the 50 identified patients was 100% and 44%, respectively. A medication-related problem was identified in 96% (n = 48) of patients, representing 338 pharmacist-mediated interventions with an average of 6.8 ± 4.0 (range 0-16) interventions per patient. Of those 338 interventions, 298 drug discrepancies were identified and corrected, with an average of 6.0 ± 3.7 (range 0-15) discrepancies per patient. Average time spent was 66 ± 22 (range 30-130) minutes with each patient. Of the 50 patients enrolled, 12 were readmitted within 30 days. CONCLUSIONS: This pilot study demonstrated an improved medication reconciliation process with pharmacist involvement, expanding the body of evidence that pharmacists can enhance TOC management in an inpatient setting. These results highlight the utility of a pharmacist in the implementation and refinement of TOC services and provides impetus for a team-based approach when patients experience a TOC.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hospitalização , Reconciliação de Medicamentos , Transferência de Pacientes , Serviço de Farmácia Hospitalar , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Registros Eletrônicos de Saúde , Feminino , Humanos , Ciência da Implementação , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Readmissão do Paciente , Farmacêuticos , Projetos Piloto , Papel Profissional , Adulto Jovem
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