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1.
J Nurs Adm ; 50(5): 281-286, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32317569

RESUMEN

OBJECTIVE: The aim of this study was to determine the effect of an evidence-based practice (EBP) education and mentoring program on the knowledge, practice, and attitudes toward EBP among staff nurses and clinicians in a rural critical access hospital. BACKGROUND: While rural nurses value EBP, they often have more limited resources to engage in EBP activities compared with urban-based nurses. METHODS: Direct care nurses and clinicians participated in a 5-month EBP education and mentoring program following the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care. The Evidence-Based Practice Questionnaire was used to assess pretest-posttest knowledge, practice, and attitudes toward EBP. RESULTS: Knowledge and practice of EBP increased significantly (P = .008 and P = .015, respectively) after the EBP education and mentoring intervention. Attitudes toward EBP also increased, although the increase was not statistically significant (P = .106). CONCLUSIONS: Education and mentoring of healthcare clinicians in rural settings are crucial to the translation of evidence-based research into practice to improve patient outcomes.


Asunto(s)
Cuidados Críticos , Enfermería Basada en la Evidencia , Conocimientos, Actitudes y Práctica en Salud , Hospitales Rurales/organización & administración , Tutoría , Adulto , Competencia Clínica , Humanos , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto Joven
2.
N Z Med J ; 133(1512): 67-75, 2020 04 03.
Artículo en Inglés | MEDLINE | ID: mdl-32242180

RESUMEN

Rural hospitals in New Zealand face difficult workforce challenges to maintain services and quality outcomes. Ashburton Hospital has undergone a 10-year transition from a secondary specialist to a rural generalist medical model of care. Current senior medical staff (rural hospital medicine fellows) here explore their experience of the process and outcomes of this transition. Key drivers for change included commitment and support from management, senior medical staff and the local community, the new rural hospital medicine qualification and a core group of doctors willing to train in it. Challenges included the need to adapt rapidly to even a single doctor's departure, initial lack of credibility of the new qualification, and choice between a single or two-tier system of medical rostering. While acute and elective surgical services were lost, acute medical and rehabilitation services were maintained or increased. Presentations to the acute assessment unit, including high acuity cases, have more than doubled over the period described. Workforce stability has been enhanced and commitment to training contributes to future workforce sustainability. Long-term shared strategic commitment to transition was a key factor in successfully traversing challenges faced. Rural and provincial communities should consider rural generalism as a medical model to sustain and further develop their local hospital services.


Asunto(s)
Hospitales Rurales/organización & administración , Cuerpo Médico de Hospitales/psicología , Modelos Organizacionales , Evaluación de Procesos y Resultados en Atención de Salud , Adulto , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Nueva Zelanda , Calidad de la Atención de Salud , Recursos Humanos
3.
Am J Surg ; 219(2): 355-358, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31898943

RESUMEN

BACKGROUND: A shortage of general surgeons is predicted in the future, with particular impact on rural surgery. This is an exploratory analysis on a rural-focused longitudinal integrated clerkship to determine if such clerkships can be used to increase interest and recruitment in rural general surgery. METHODS: An institutional database was reviewed to identify students who became general surgeons after completing a rural-focused longitudinal integrated clerkship. Telephone interviews were conducted on a portion of these surgeons. RESULTS: Fifty-seven students (3.6%) completing the rural-focused longitudinal integrated clerkship became general surgeons. Of those participating in phone interviews, most (90%) decided to become surgeons during their experience while all stated that preclinical years did not influence their specialty decision. CONCLUSIONS: A substantial portion of these surgeons went on to practice in rural communities. Pre-existing rural and primary care-focused education could help to address the future projected shortage of rural general surgeons.


Asunto(s)
Selección de Profesión , Prácticas Clínicas/organización & administración , Educación de Pregrado en Medicina/organización & administración , Cirugía General/educación , Evaluación de Resultado en la Atención de Salud , Bases de Datos Factuales , Femenino , Hospitales Rurales/organización & administración , Humanos , Entrevistas como Asunto , Masculino , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos , Servicios de Salud Rural/organización & administración , Estudiantes de Medicina/estadística & datos numéricos , Cirujanos/provisión & distribución , Estados Unidos , Adulto Joven
4.
Artículo en Inglés | MEDLINE | ID: mdl-31847490

RESUMEN

This narrative review explores relevant literature that is related to the challenges in implementing evidence-based management for clinicians in rural and remote areas, while primarily focussing on management of acute coronary syndrome (ACS) and follow up care. A targeted literature search around rural/urban differences in the management of ACS, cardiovascular disease, and cardiac rehabilitation identified multiple issues that are related to access, including the ability to pay, transport and geographic distances, delays in patients seeking care, access to diagnostic testing, and timely treatment in an appropriate facility. Workforce shortages or lack of ready access to relevant expertise, cultural differences, and complexity that arises from comorbidities and from geographical isolation amplified diagnostic challenges. Given the urgency in management of ACS, rural clinicians must act quickly to achieve optimal patient outcomes. New technologies and quality improvement approaches enable better access to rapid diagnosis, as well as specialist input and care. Achieving an uptake of cardiac rehabilitation in rural and remote settings poses challenges that may reduce with the use of alternative models to centre-based rehabilitation and use of modern technologies. Expediting improvement in cardiovascular outcomes and reducing rural disparities requires system changes and that clinicians embrace attention to prevention, emergency management, and follow up care in rural contexts.


Asunto(s)
Cuidados Posteriores , Enfermedades Cardiovasculares/terapia , Hospitales Rurales/organización & administración , Servicios de Salud Rural/organización & administración , Enfermedad Aguda , Humanos , Calidad de la Atención de Salud , Población Rural
5.
Hosp Pract (1995) ; 47(4): 177-180, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31594430

RESUMEN

Objective: We sought to determine a benchmark for our blood glucose monitoring and compare our data to published data.Methods: Natividad Medical Center is a 172-bed rural hospital located in Salinas, California.Point of care blood glucose (POC-BG) data was extracted from our EMR for all ICU patients greater than 18 years of age between January 2014 and May 2018. Patient day-weighted mean POC-BGs were calculated for each patient by calculating the average POC-BG per day for each patient. Proportion measurements for each of our measurements groups were recorded (>180 mg/dL, <70 mg/dL, >250 mg/dL and <50 mg/dL). Monthly averages were plotted for visual comparison. Benchmarks were calculated by using 2x Standard Deviation for each measurement group.Results: A total of 3164 patients were found with 21,006 POC-BG measurements. The average POC-BG was 136 mg/dL and median 119 mg/dL. Proportion measurements of monthly day-weighted mean POC-BGs ranged from 0-1.2%, 5.3-44.8%, 0-0.3% and 0.6-16.5%, respectively for less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. A 2x Standard Deviation was used to calculate our benchmark cut offs which provides a 95% confidence interval and includes 97.5% when neglecting the lower range. Our calculated benchmark values are 1.2, 38.2, 0.19, and 13.1% respectively for measurement groups less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL.Conclusion: Here we present data from a small rural hospital in the Western United States. We calculated benchmarks that could be used to track our ongoing hyper/hypoglycemia improvement projects. We found that when compared to published data, our hyper/hypoglycemia data was comparable to national data.


Asunto(s)
Glucemia , Hospitales Rurales/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Monitoreo Fisiológico/normas , Sistemas de Atención de Punto/normas , Hospitales Rurales/normas , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Unidades de Cuidados Intensivos/normas , Estándares de Referencia , Índice de Severidad de la Enfermedad
6.
Am J Health Syst Pharm ; 76(1): 17-25, 2019 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31381097

RESUMEN

PURPOSE: To evaluate the impact of a pharmacy-directed pain management service (PPMS) designed to optimize analgesic pharmacotherapy, minimize adverse events, and improve patients' experience of pain management. METHODS: A retrospective analysis was conducted to evaluate the PPMS consisting of 3 dedicated pain management clinical pharmacists who perform both consult-based and stewardship functions. Multiple measures of opioid use and associated patient satisfaction outcomes during 3-year periods before and after implementation of the PPMS were compared. RESULTS: Significant decreases in use of institutionally defined high-risk opioid medications (e.g., parenteral hydromorphone, fentanyl, transdermal fentanyl patches), a decrease in total institutional opioid use, increased coanalgesic and adjunctive medication use, and a decrease in rapid response team (RRT) and code blue events associated with opioid-induced oversedation were seen after service implementation. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey domains. CONCLUSION: Our data highlights the impact of a pharmacy directed pain management service on institutional opioid use with available data suggesting improved patient satisfaction scores and indirect cost savings. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated HCAHPS survey pain management domains.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Administración del Tratamiento Farmacológico/organización & administración , Manejo del Dolor/métodos , Dolor/tratamiento farmacológico , Farmacéuticos , Adulto , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Implementación de Plan de Salud , Hospitales Rurales/organización & administración , Hospitales Rurales/estadística & datos numéricos , Humanos , Masculino , Administración del Tratamiento Farmacológico/estadística & datos numéricos , Trastornos Relacionados con Opioides/etiología , Trastornos Relacionados con Opioides/prevención & control , Dolor/diagnóstico , Dimensión del Dolor , Seguridad del Paciente , Satisfacción del Paciente , Rol Profesional , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos
7.
Am J Health Syst Pharm ; 76(2): 108-113, 2019 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-31408091

RESUMEN

PURPOSE: The stages of development of a health system-wide antimicrobial stewardship program (ASP) using existing personnel and technology are described. SUMMARY: Small hospitals with limited resources may struggle to meet ASP requirements, particularly facilities without onsite infectious disease physicians and/or experienced infectious disease pharmacists. Strategies for ASP development employed by Avera Health, a 33-hospital health system in the Midwest, included identifying relevant drug utilization and resistance patterns, education and pathway development, and implementation of Web-based conferencing to provide pharmacists throughout the system with access to infectious disease expertise on a daily basis. These efforts resulted in an evolving single-system ASP that has leveraged existing resources to overcome some system barriers. Program outcomes to date include a reduction in the use of a targeted agent, improved pathogen susceptibility trends, and rates of hospital-associated Clostridium difficile infection below national benchmarks. CONCLUSION: The Avera Health ASP grew from a collaborative project targeting levofloxacin overuse and resistance among key bacteria to a formal, health system-wide ASP in a rural setting. This program used existing personnel to provide standardized processes, educational campaigns, and antimicrobial expertise through the use of technology. This ASP program may provide helpful examples of ASP strategies for other rural health systems with similar resources.


Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Infecciones por Clostridium/tratamiento farmacológico , Hospitales Rurales/organización & administración , Desarrollo de Programa , Antibacterianos/farmacología , Programas de Optimización del Uso de los Antimicrobianos/economía , Infecciones por Clostridium/microbiología , Clostridium difficile/efectos de los fármacos , Clostridium difficile/aislamiento & purificación , Clostridium difficile/fisiología , Farmacorresistencia Bacteriana/efectos de los fármacos , Utilización de Medicamentos , Hospitales Rurales/economía , Humanos , Levofloxacino/farmacología , Levofloxacino/uso terapéutico , Pruebas de Sensibilidad Microbiana , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/economía , Servicio de Farmacia en Hospital/organización & administración , Rol Profesional , Evaluación de Programas y Proyectos de Salud , Servicios de Salud Rural/economía , Servicios de Salud Rural/organización & administración
8.
Am Surg ; 85(6): 587-594, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-31267898

RESUMEN

Rural surgeons are performing operations typically performed by "specialists." This study describes specialty procedures performed by general surgeons operating in a rural state and how prepared the surgeons felt starting their rural practice after residency A survey was sent to all exclusively rural surgeons actively practicing in the state, inquiring about their perception of preparedness for rural practice and specialty procedures performed. The survey had a 65.2 per cent response rate. Responders felt well prepared for rural practice after residency (mean response 4.6 ± 0.8 on a Likert scale from 1 to 5; 5 = "well prepared"). Noteworthy, specialty procedures performed by rural surgeons included hysterectomies (51.2%), thyroidectomies (81.4%), parathyroidectomies (60.5%), carotid endarterectomies (11.6%), video-assisted thoracoscopic surgery (37.2%), and lobectomies (23.3%). Prominent write-ins included nephrectomies (n = 1), ileal conduits (n = 1), open and endovascular abdominal aortic aneurysm repair (n = 1), Whipples (n = 3), and liver resections (n = 2). Rural general surgeons perform many major operations usually performed by specialists. These surgeons felt well prepared for these operations out of residency.


Asunto(s)
Competencia Clínica , Servicios de Salud Rural/organización & administración , Especialidades Quirúrgicas/educación , Cirujanos/educación , Encuestas y Cuestionarios , Femenino , Encuestas de Atención de la Salud , Hospitales Rurales/organización & administración , Humanos , Kansas , Masculino , Medición de Riesgo , Especialidades Quirúrgicas/métodos , Análisis y Desempeño de Tareas , Estados Unidos
10.
Rural Remote Health ; 19(2): 4918, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31100202

RESUMEN

INTRODUCTION: Tuberculosis (TB) remains a significant public health challenge in Solomon Islands. Limited healthcare resources, geography, and sociocultural beliefs, coupled with lack of laboratory diagnostic tools, leads to diagnostic and treatment outcome uncertainty. METHODS: Kirakira Hospital (KKH) is the main provincial hospital of Makira-Ulawa Province in Solomon Islands. A retrospective clinical audit of hospitalised TB patients in KKH over a 2-year period between July 2015 and July 2017 was conducted. The cost of TB treatment was estimated by calculating the total number of inpatient bed days of treatment. RESULTS: Data were available for 42 of 78 listed TB patients including 23 males and 19 females, and 9 children aged less than 16 years. The average age was 35 years (range 9 months - 74 years). Thirty-five of these received a chest X-ray. All patients had at least one of the following: fever, night sweats, chronic cough and haemoptysis as part of their clinical TB presentation. Thirty-six completed the full 8-week duration of intensive HRZE treatment as inpatients of KKH. The audit shows the treatment of TB consumes 15% of the current healthcare budget of Makira-Ulawa Province. CONCLUSION: TB remains a common clinical diagnosis in KKH. TB consumes 15% of the current healthcare budget of Makira-Ulawa Province. The limited capacity and data about the management of TB in Makira province mean that it is not currently possible to measure if there has been any progress towards eradicating TB in Solomon Islands. Laboratory investigations for TB available in Makira including sputum analysis and the GeneXpert are required to improve the accuracy of diagnosis and identify multidrug resistant strains of TB. This needs to be coupled with robust monitoring and data collection of both inpatients and outpatients to ensure the current treatment protocols for TB are being followed in Makira-Ulawa Province. These steps are essential if TB is to be eradicated from the provinces of Solomon Islands by 2030.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Tuberculosis/diagnóstico , Tuberculosis/terapia , Adolescente , Adulto , Anciano , Niño , Femenino , Hospitales Rurales/organización & administración , Humanos , Lactante , Masculino , Melanesia , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos
11.
N Z Med J ; 132(1493): 25-37, 2019 04 12.
Artículo en Inglés | MEDLINE | ID: mdl-30973857

RESUMEN

AIMS: Accelerated diagnostic chest pain pathways (ADP) have become standard of care in urban emergency departments. It is, however, unknown how widely they are used in New Zealand's rural hospitals because ADP require immediate access to contemporary or high-sensitivity troponin (hs-Tn). We aimed to determine for rural hospitals the troponin assay being used, if they were using an ADP and if they had access to on-site exercise tolerance testing (ETT). METHODS: An online survey was sent to 27 rural hospitals providing acute care in New Zealand. RESULTS: Most rural hospitals (23/27, 85%) responded to the survey. Most (17/23, 74%) used point-of-care cardiac troponin (POC-cTn) and the majority of these hospitals (15/17, 88%) were reliant on this assay 24-hours per day. All hospitals that had timely access to hs-Tn (8/23, 35%) used an ADP but only a minority (4/17, 24%) of hospitals using POC-cTn used an ADP. Only a minority of the larger rural hospitals (7/23, 30%) had access to on-site ETT. CONCLUSIONS: Most New Zealand rural hospitals rely on POC-cTn to assess chest pain and are not using an ADP. There are limited data available to support this approach in rural settings especially with patients who are not low-risk.


Asunto(s)
Síndrome Coronario Agudo/sangre , Infarto del Miocardio/sangre , Sistemas de Atención de Punto/organización & administración , Troponina/sangre , Síndrome Coronario Agudo/diagnóstico , Dolor en el Pecho/etiología , Femenino , Hospitales Rurales/organización & administración , Humanos , Masculino , Infarto del Miocardio/diagnóstico , Nueva Zelanda , Salud Rural/normas
12.
Artículo en Inglés | MEDLINE | ID: mdl-30970548

RESUMEN

Workforce shortages in the field of public health and healthcare are significant. Due to the limitations of career opportunities and compensation, rural hospitals and healthcare centres usually have on-going career openings for all departments. As a result, university departments of public health and healthcare management, and rural hospitals and health centres may need to establish internship and training programmes for undergraduate senior-year students in order to provide opportunities and human resource opportunities for both students and public health professions. The research examined the performance, feedback, and opinions of a university-based one-year-long on-site internship training programme between a university public health and healthcare undergraduate department and a regional hospital and healthcare centre in a rural region in the United States. Individual interview data were collected from management trainees and focus group activities data were collected from hospital departmental supervisors who have completed this one-year-long on-site internship training programme. The results offered an assessment of performance and evaluation of how a one-year-long internship programme could be beneficial to hospitals and health centres in the areas of human resources, manpower management, and skill training to prospective professionals in rural and regional communities. Also, the study provided a blueprint and alternative for universities and partnered sites to redesign and improve their current internship programmes which may better fit their needs for their actual situations.


Asunto(s)
Educación de Pregrado en Medicina/organización & administración , Personal de Salud/educación , Hospitales Rurales/organización & administración , Internado y Residencia/organización & administración , Salud Pública/educación , Salud Rural/educación , Desarrollo de Personal/organización & administración , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Servicios de Salud Rural , Población Rural , Estados Unidos
13.
BMC Health Serv Res ; 19(1): 245, 2019 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-31018844

RESUMEN

BACKGROUND: Costs for the provision of regional hospital care depend, among other things, on the population density and the maximum reasonable distance to the nearest hospital. In regions with a low population density, it is a challenge to plan the number and location of hospitals with respect both to economic efficiency and to the availability of hospital care close to residential areas. We examined whether the hospital landscape in rural regions can be planned on the basis of a regional economic model using the example which number of paediatric and obstetric wards in a region in the Northeast of Germany is economically efficient and what would be the consequences for the accessibility when one or more of the three current locations would be closed. METHODS: A model of linear programming was developed to estimate the costs and revenues under different scenarios with up to three hospitals with both a paediatric and an obstetric ward in the investigation region. To calculate accessibility of the wards, geographic analyses were conducted. RESULTS: With three hospitals in the study region, there is a financial gap of €3.6 million. To get a positive contribution margin for all three hospitals, more cases have to be treated than the region can deliver. Closing hospitals in the parts of the region with the smallest population density would lead to reduced accessibility for about 8% of the population under risk. CONCLUSIONS: Quantitative modelling of the costs of regional hospital care provides a basis for planning. A qualitative discussion to the locations of the remaining departments and the implementation of alternative healthcare concepts should follow.


Asunto(s)
Hospitales Rurales/economía , Modelos Econométricos , Servicio de Ginecología y Obstetricia en Hospital/organización & administración , Pediatría/organización & administración , Eficiencia Organizacional , Alemania , Accesibilidad a los Servicios de Salud , Hospitales Rurales/organización & administración , Modelos Lineales , Programas Informáticos
14.
Matern Child Health J ; 23(3): 307-315, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30756280

RESUMEN

Objectives Get Healthy in Pregnancy (GHiP) is a telephone based lifestyle coaching service for pregnant women, in New South Wales, Australia. GHiP had two service options; a telephone-based health coaching program consisting of up to 10 calls and information only (including one call). This study sought to compare the outcomes of the two GHiP options, to determine the characteristics of women likely to use the service and to explore the feedback from women and health professionals. Methods A pragmatic stratified clustered randomised controlled trial was conducted. Two metro and three rural hospitals were randomised into health coaching or information only arms. Self-reported measures of height and weight and health behaviours (dietary and physical activity) were collected at baseline and 36 weeks gestation. Process evaluation included descriptive analysis of routine program data, and semi-structured interviews with participants and health professionals. Results Of 3736 women screened, 1589 (42.5%) were eligible to participate, and of those eligible, 923 (58.1%) were recruited. More women in the health coaching arm gained weight within the target range for their BMI at 36 weeks gestation (42.9%) compared with information only (31.9%). Women found GHiP to be useful and supportive and midwives and doctors said that it facilitated conversations about weight with pregnant women. Conclusions for Practice Telephone-based lifestyle programs integrated with routine clinical care show promise in helping pregnant women achieve healthy gestational weight gain, but in this case was not significantly different from one information telephone call. Strong positive feedback suggests that scaled-up service delivery would be well received. TRIAL REGISTRATION: ACTRN12615000397516 (retrospectively registered).


Asunto(s)
Tutoría/métodos , Mujeres Embarazadas/psicología , Adulto , Femenino , Hospitales Rurales/organización & administración , Humanos , Entrevistas como Asunto/métodos , Modelos Logísticos , Tutoría/normas , Nueva Gales del Sur , Proyectos Piloto , Ensayos Clínicos Pragmáticos como Asunto , Embarazo , Conducta de Reducción del Riesgo , Teléfono
15.
Simul Healthc ; 14(2): 129-136, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30730469

RESUMEN

INTRODUCTION: With the growth of telehealth, simulation personnel will be called upon to support training that integrates these new technologies and processes. We sought to integrate remote telehealth electronic intensive care unit (eICU) personnel into in situ simulations with rural emergency department (ED) care teams. We describe how we overcame technical challenges of creating shared awareness of the patient's condition and the care team's progress among those executing the simulation, the care team, and the eICU. METHODS: The objective of the simulations was to introduce telehealth technology and new processes of engaging the eICU via telehealth during sepsis care in 2 rural EDs. Scenario development included experts in sepsis, telehealth, and emergency medicine. We describe the operational systems challenges, alternatives considered, and solutions used. Participants completed surveys on self-confidence presimulation/postsimulation in using telehealth and in managing patients with sepsis (1-10 Likert scale, with 10 "completely confident"). Pre-post responses were compared by two-tailed paired t test. RESULTS: We successfully engaged the staff of two EDs: 42 nurses, 9 physicians or advanced practice providers, and 9 technicians (N = 60). We used a shared in situ simulation clinical actions observational checklist, created within an off-the-shelf survey software program, completed during the simulations by an on-site observer, and shared with the eICU team via teleconferencing software, to message and cue eICU nurse engagement. The eICU nurse also participated in debriefing via the telehealth video system with successful simulation engagement. These solutions avoided interfering with real ED or eICU operations. The postsimulation mean ± SD ratings of confidence using telehealth increased from 5.3 ± 2.9 to 8.9 ± 1.1 (Δ3.5, P < 0.05) and in managing patients with sepsis increased from 7.1 ± 2.5 to 8.9 ± 1.1 (Δ1.8, P < 0.05). CONCLUSIONS: We created shared awareness between remote eICU personnel and in situ simulations in rural EDs via a low-cost method using survey software combined with teleconferencing methods.


Asunto(s)
Medicina de Emergencia/educación , Servicio de Urgencia en Hospital/organización & administración , Hospitales Rurales/organización & administración , Grupo de Atención al Paciente/organización & administración , Entrenamiento Simulado/organización & administración , Telemedicina/organización & administración , Competencia Clínica , Personal de Salud/educación , Humanos , Sepsis/terapia , Entrenamiento Simulado/economía
16.
Aust J Rural Health ; 27(4): 344-350, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30693988

RESUMEN

PROBLEM: The increasing specialisation of medical care in larger centres is contributing to the declining use of rural hospitals that are close to larger centres, risking bed closures or even facility closure. DESIGN: An allied health-led model of care supported by telehealth geriatrician services was developed and implemented in eight beds in a rural hospital to manage older patients needing geriatric evaluation and management. SETTING: The project was set in Kilcoy Hospital, a small facility north of Caboolture in Queensland, Australia. The feeder hospital was Caboolture Hospital, the regional centre. KEY MEASURES FOR IMPROVEMENT: Occupancy rates at the rural hospital along with length of stay, discharge destination and functional independence measure. STRATEGIES FOR CHANGE: A project officer was employed 1 day a week to facilitate the implementation of the new model of care. Training and education were provided to medical and nursing staff to understand and implement the geriatric evaluation and management model of care. EFFECTS OF CHANGE: Over the project time frame, 93 patients were successfully managed in the rural hospital with improved occupancy rates. Outcomes were as effective and safe as compared to the group managed at the regional centre. The model of care is now routine practice. LESSONS LEARNT: Using excess capacity in rural hospitals by employing a geriatric evaluation and management approach is a viable strategy to address declining rural hospital usage.


Asunto(s)
Geriatría/organización & administración , Hospitales Rurales/organización & administración , Telemedicina/organización & administración , Anciano , Femenino , Evaluación Geriátrica , Humanos , Masculino , Modelos Organizacionales , Queensland
17.
World J Surg ; 43(1): 75-86, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30178129

RESUMEN

BACKGROUND: African surgical workforce needs are significant, with largest disparities existing in rural settings. Pan-African Academy of Christian Surgeons (PAACS), a primarily rural-based general surgery training program, has published successes in producing rural African surgeons; however, long-term follow-up data are unreported. The goal of our study was to define characteristics of PAACS alumni surgeons working in rural hospitals, documenting successes and illuminating strategies for trainee recruitment and retention. METHOD: PAACS' twenty-year surgery residency database was reviewed for 12 programs throughout Africa regarding trainee demographics and graduate outcomes. Characteristics of PAACS' graduate surgeons were further analyzed with a 42-question survey. RESULTS: Among active PAACS graduates, 100% practice in Africa and 79% within their home country. PAACS graduates had 51% short-term and 35% long-term (beyond 5 years) rural retention rate (less than 50,000 population). CONCLUSION: Our study shows that PAACS general surgery training program has a high retention rate of African surgeons in rural settings compared to all programs reported to date, highlighting a multifaceted, rural-focused approach that could be emulated by surgical training programs worldwide.


Asunto(s)
Cirugía General/educación , Fuerza Laboral en Salud , Hospitales Rurales/organización & administración , Personal de Hospital/provisión & distribución , Servicios de Salud Rural/organización & administración , Cirujanos/provisión & distribución , Adulto , África , Femenino , Estudios de Seguimiento , Humanos , Internado y Residencia , Masculino , Persona de Mediana Edad , Selección de Personal , Encuestas y Cuestionarios
18.
Artif Organs ; 43(1): 76-80, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30203850

RESUMEN

We aim to evaluate clinical outcomes of emergent extracorporeal membrane oxygenation (ECMO) implantation in newborns with life-threatening meconium aspiration syndrome (MAS) in peripheral hospitals with Hub and Spoke (HandS) setting. We retrospectively reviewed all neonates presenting with MAS, with no other comorbidities, treated with HandS ECMO, in peripheral hospitals. Team activation time (TAT) was described as the time from first alerting call to ECMO support initiation. From May 2014 to December 2016, 4 patients met our inclusion criteria. In addition, 2 cases occurred on the same day, requiring a second simultaneous HandS ECMO team activation. All patients were younger than 8 days of life (1, 1, 4, and 7), with a mean BSA 0.21 ± 0.03m2 , and TAT of 203, 265, 320, and 340 min. One patient presented ventricular fibrillation after priming administration. Veno-arterial ECMO was established in all patients after uneventful surgical neck vessels cannulation (right carotid artery and jugular vein). Mean time from skin incision to ECMO initiation was 19 ± 1.4 min. Mean length of ECMO support was 2.75 ± 1.3 days. All patients were weaned off support without complications. At a mean follow up of 20.5 ± 7.8 months, all patients are alive, with no medications, normal somatic growth, and neuropsychological development. MAS is a life-threatening condition that can be successfully managed with ECMO support. A highly trained multidisciplinary HandS ECMO team is crucial for the successful management of these severely ill newborns in peripheral hospitals.


Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Hospitales Rurales/estadística & datos numéricos , Síndrome de Aspiración de Meconio/cirugía , Grupo de Atención al Paciente/organización & administración , Oxigenación por Membrana Extracorpórea/instrumentación , Oxigenación por Membrana Extracorpórea/estadística & datos numéricos , Estudios de Seguimiento , Hospitales Rurales/organización & administración , Humanos , Recién Nacido , Síndrome de Aspiración de Meconio/mortalidad , Tempo Operativo , Estudios Retrospectivos , Tiempo de Tratamiento , Resultado del Tratamiento
19.
Int Nurs Rev ; 66(1): 70-77, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29672843

RESUMEN

AIM: The aim of this study was to understand nurse ward managers perceived challenges in the rural healthcare setting in Uganda. BACKGROUND: The health workforce, essential medicines and equipment and political unrest are the main factors affecting the international community in addressing the hefty disease burden in World Health Organization African regions. Nurse ward managers have an important role to play to mitigate these factors in health facilities in these regions through leadership, supervision and support for staff. METHODS: This study utilized interpretive phenomenology based on Gadamer's hermeneutical principles. Eleven nurse managers from two rural public hospitals in Uganda were interviewed. Those with more than a 2-year experience in their management role were invited to participate in the study. RESULTS: Nurse managers pointed out four major challenges with staffing, while they worked in the rural healthcare settings. These are summarized into themes: 'Numbers do matter'; 'I cannot access them when I need them at work'; 'Challenges in dealing with negative attitudes'; and 'Questioning own ability to manage health services'. DISCUSSION: Health facilities in rural areas face extremely low staff-to-patient ratio, a high level of workload, lack of essential medicines and equipment, low salaries and delayed payment for staff. CONCLUSION: Nurse managers demonstrated situation-based performance to minimize the impact of these challenges on the quality and safety of patient care, but they had less influence on policy and resource development. IMPLICATIONS FOR NURSING POLICY: It is imperative to mobilize education for nurse ward managers to enable them to improve leadership, management skills and to have a greater impact on policy and resource development.


Asunto(s)
Actitud del Personal de Salud , Hospitales Rurales/organización & administración , Satisfacción en el Trabajo , Enfermeras Administradoras/psicología , Rol Profesional , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Uganda
20.
Telemed J E Health ; 25(2): 93-100, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-29958087

RESUMEN

BACKGROUND: Meeting time goals for patients with time-sensitive conditions can be challenging in rural emergency departments (EDs), and adopting policies is critical. ED-based telemedicine has been proposed to improve quality and timeliness of care in rural EDs. INTRODUCTION: The objective of this study was to test the hypothesis that diagnostic testing in telemedicine-supplemented ED care for patients with myocardial infarction (MI) and stroke would be faster than nontelemedicine care in rural EDs. MATERIALS AND METHODS: This observational cohort study included all ED patients with MI or stroke in 19 rural critical access hospitals served by a single real-time contract-based telemedicine provider in the upper Midwest (2007-2015). The primary outcome for the MI cohort was time-to-electrocardiogram (EKG) and for the stroke cohort was time-to-head computed tomography (CT) interpretation. To measure the relationship between telemedicine and timeliness parameters, generalized estimating equations models were used, clustering on presenting hospital. RESULTS: Of participating ED visits, 756 were included in the MI cohort (29% used telemedicine) and 140 were included in the stroke cohort (30% used telemedicine). Time-to-EKG did not differ when telemedicine was used (1% faster, 95% confidence interval [CI] -4% to 7%), or after telemedicine was implemented (4% faster, 95% CI -3% to 10%). Head CT interpretation was faster for telemedicine cases (15% faster, 95% CI 4-26%). No differences were observed in time to reperfusion therapy. CONCLUSIONS: Telemedicine implementation was associated with more timely head CT interpretation for rural patients with stroke, but no difference in early MI care. Future work will focus on the specific manner in which telemedicine changes ED care processes and ongoing professional education.


Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Hospitales Rurales/organización & administración , Infarto del Miocardio/diagnóstico , Accidente Cerebrovascular/diagnóstico , Telemedicina/organización & administración , Electrocardiografía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hospitales Rurales/estadística & datos numéricos , Humanos , Masculino , Accidente Cerebrovascular/diagnóstico por imagen , Telemedicina/estadística & datos numéricos , Factores de Tiempo , Tomografía Computarizada por Rayos X
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