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2.
Am Surg ; 85(6): 595-600, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-31267899

RESUMEN

Interhospital transfer of emergency general surgery (EGS) patients is a common occurrence. Modern individual hospital practices for interhospital transfers have unknown variability. A retrospective review of the Maryland Health Services Cost Review Commission database was undertaken from 2013 to 2015. EGS encounters were divided into three groups: encounters not transferred, encounters transferred from a hospital, and encounters transferred to a hospital. In total, 380,405 EGS encounters were identified, including 12,153 (3.2%) encounters transferred to a hospital, 10,163 (2.7%) encounters transferred from a hospital, and 358,089 (94.1%) encounters not transferred. For individual hospitals, percentage of encounters transferred to a hospital ranged from 0 to 30.05 per cent, encounters transferred from a hospital from 0.02 to 14.62 per cent, and encounters not transferred from 69.25 to 99.95 per cent of total encounters at individual hospitals. Percentage of encounters transferred from individual hospitals was inversely correlated with annual EGS hospital volume (P < 0.001, r = -0.59), whereas percentage of encounters transferred to individual hospitals was directly correlated with annual EGS hospital volume (P < 0.001, r = 0.51). Individual hospital practices for interhospital transfer of EGS patients have substantial variability. This is the first study to describe individual hospital interhospital transfer practices for EGS.


Asunto(s)
Tratamiento de Urgencia/métodos , Cirugía General/organización & administración , Transferencia de Pacientes/organización & administración , Calidad de la Atención de Salud , Estudios de Cohortes , Bases de Datos Factuales , Urgencias Médicas , Femenino , Hospitales de Alto Volumen , Humanos , Relaciones Interinstitucionales , Tiempo de Internación , Masculino , Maryland , Estudios Retrospectivos , Contrato de Transferencia
3.
Med. infant ; 26(2): 130-139, Junio 2019. tab, ilus
Artículo en Español | LILACS | ID: biblio-1015635

RESUMEN

Introducción: Los grandes avances en el diagnóstico y tratamiento de los pacientes con cardiopatías congénitas en las últimas décadas han permitido que mas del 90% lleguen a la adolescencia y edad adulta. Sin embargo, muchos de ellos requirieran seguimiento e intervenciones de por vida, por lo que necesitaran ser transferidos desde el hospital pediátrico al de adultos. Material y Métodos: Se incluyeron los pacientes mayores de 15 años que consultaron en el área ambulatoria del servicio de cardiología del Hospital Garrahan durante el periodo agosto 2017 - agosto 2018. Las variables analizadas fueron: procedencia, cardiopatía de base y variedad pronostica ,procedimientos intervencionistas factores asociados como síndrome genéticos y otras comorbilidades, cobertura social, nivel educativo, terapéutica medicamentosa, clase funcional, embarazos, prevalencia de cardiopatías en la descendencia y transición-transferencia al hospital de adultos. Resultados: Registramos 704 consultas de 309 pacientes con una edad media de 19,17 años (DS +- 4,62; (rango 15- 49,4 años). Fueron 112 mujeres y 197 varones. El 51,1 % provenían de Buenos Aires,40 % de las provincias del interior y 8,1% CABA. El 92% de los pacientes tenía cardiopatías de moderada y severa complejidad, y el 93,5% eran operadas. El 13,2 % eran síndromes genéticos. El 48.5% tenían comorbilidades, siendo los trastornos electrofisiológicos los más frecuentes en el 72,66% de los casos. El 63% tenía cobertura social pero solo el 2,6% prepagos con cobertura en centros alta complejidad. El 23.6% recibía terapia combinada con 2 o más drogas. El 48,78% ya presentaban antecedente de algún tipo de reintervención, 98,5% de estas se vincularon a las cardiopatías moderadas a complejas. Registramos 15 embarazos con 14 recién nacidos vivos, 1 con cardiopatía congénita. El proceso de transición ­ transferencia en el 55% (170 p) se había iniciado, siendo efectiva (8p), frustra (9p), compartida (49 p), y en proceso (103 p). Hubo un solo fallecimiento durante el periodo de estudio, vinculado a cardiopatía compleja, múltiples reintervenciones y endocarditis. Conclusiones: El 92% de los pacientes en nuestro estudio, tienen cardiopatías operadas de moderada y severa complejidad. Los trastornos electrofisiológicos y la necesidad de reintervenciones durante el seguimiento alejado han sido las complicaciones más frecuentes de esta población. El proceso de transición y transferencia desde el hospital pediátrico al de adultos es deficitario, principalmente por falta de cobertura y experiencia sobre todo para la atención continua de las cardiopatías moderadas y complejas (AU)


Introduction: In recent decades, important advances in the diagnosis and treatment of patients with congenital heart defects have allowed more than 90% of them to reach adolescence and adulthood. However, many patients required lifelong follow-up and interventions, and therefore the need to be transitioned from pediatric to adult care. Material and Methods: Patients older than 15 years who consulted at the outpatient clinic of the department of cardiology at Garrahan Hospital from August 2017 to August 2018 were included. The variables analyzed were place of origin, underlying heart disease, and diagnosis, interventions, associated factors, such as genetic syndromes and other comorbidities, insurance coverage, educational level, pharmacological treatment, functional class, pregnancies, prevalence of heart disease in offspring, and transition-transfer to adult hospital. Results: We recorded 704 consultations from 309 patients with an average age of 19.17 years (SD +- 4.62; range 15-49.4 years); 112 patients were female and 197 male. Overall, 51.1% came from the province of Buenos Aires, 40% from the other provinces, and 8.1% from the city of Buenos Aires. Of the patients, 92% had moderate and severe heart disease, and 93.5% had undergone surgery. Genetic syndromes were identified in 13.2%. Overall, 48.5% had comorbidities, of which electrophysiological disorders were the most common in 72.66% of cases. 63% had social insurance coverage but only 2.6% had a prepaid insurance with coverage in tertiary-level centers. Overall, 23.6% received combination therapy with 2 or more drugs. 48.78% had undergone some type of previous reintervention, 98.5% of whom had moderate-to-severe heart disease. We recorded 15 pregnancies with 14 live neonates, one of whom had congenital heart defects. The transition - transfer had been initiated in 55% (170 p) and was effective (8p), frustrated (9p), shared (49 p), or in progress (103 p). There was only one death during the study period, related to severe heart disease, multiple reinterventions, and endocarditis. Conclusions: 92% of patients in our study have moderate or severe operated heart disease. Electrophysiological disorders and the need for reintervention during the long-term follow-up were the most common complications of this population. The process of transition and transfer from pediatric to adult care is deficient, mainly due to lack of insurance coverage and experience especially for the ongoing care of moderate-to-severe heart disease


Asunto(s)
Humanos , Adolescente , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Planificación de Atención al Paciente , Transferencia de Pacientes/organización & administración , Continuidad de la Atención al Paciente/organización & administración , Transición a la Atención de Adultos/organización & administración , Cardiopatías Congénitas/terapia , Estudios Retrospectivos , Estudio Observacional
4.
Crit Care Nurs Clin North Am ; 31(2): 249-256, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31047097

RESUMEN

This article reports findings of a qualitative study describing how the US Department of Veterans Affairs cared for vulnerable veterans after Hurricane Sandy while medical center was closed for an extended period. This experience highlights how vulnerable patients continued to need care. Hospital preparedness planning efforts focus primarily on sheltering in place and evacuation. Research is needed to identify how hospitals provided temporary emergency services in alternative settings to inform practical guidance. Hospital planners should anticipate that their most vulnerable patients will continue to need emergency care. Viable solutions should be considered to meet immediate and long-term patient needs.


Asunto(s)
Tormentas Ciclónicas , Planificación en Desastres/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Refugio de Emergencia/organización & administración , Hospitales , Humanos , Transferencia de Pacientes/organización & administración , Veteranos/psicología , Poblaciones Vulnerables/psicología
5.
J Stroke Cerebrovasc Dis ; 28(7): 1926-1929, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31010762

RESUMEN

BACKGROUND: A major barrier to acute stroke trial enrollment is timely access to participating centers. Establishing referral relationships via telemedicine may broaden trial access. We sought to understand the utilization of telemedicine in trial enrollment at a large academic center. METHODS: This is a single center, retrospective review of subjects consecutively enrolled into cerebrovascular trials requiring urgent consent between January 2005 and December 2016. Subjects were classified to either direct presentation to hub hospital, or transfer from spoke hospitals. We used Pearson linear correlation and a simple linear regression model to describe the relationship between annual trial enrollment rate and the number of spoke sites capable of audio-video evaluation (AVR) as a proxy for the size of the telemedicine network. We correlated the annual increase in enrollment with that of each group using parametric and nonparametric analysis. RESULTS: Sixteen trials met our criteria, enrolling 299 subjects: 117 in the hub group and 182 in the spoke group. There was a direct relationship between the number of AVR-capable sites and annual trial enrollment rate (P = <.05). Annual increase in spoke enrollment was higher compared to hub enrollment (15.55 ± 11.30 versus 0.68 ± 1.03, P <.0005) and better correlated with total increase in enrollments (0.98 versus 0.94, P <.0001). CONCLUSIONS: Telemedicine networks are a major resource for trial enrollment. Expanding the use of remote enrollment could expedite the completion of acute cerebrovascular trials.


Asunto(s)
Centros Médicos Académicos/organización & administración , Ensayos Clínicos como Asunto/métodos , Consentimiento Informado , Selección de Paciente , Accidente Cerebrovascular/terapia , Telemedicina/organización & administración , Conducta Cooperativa , Humanos , Transferencia de Pacientes/organización & administración , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Factores de Tiempo , Tiempo de Tratamiento , Flujo de Trabajo
6.
J Stroke Cerebrovasc Dis ; 28(6): 1759-1766, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30879712

RESUMEN

GOAL: Interhospital transfer (IHT) facilitates access to specialized neurocritical care but may also introduce unique risk. Our goal was to describe providers' perceptions of safety threats during IHT for patients with nontraumatic intracranial hemorrhage. MATERIALS AND METHODS: We employed qualitative, semi-structured interviews at an academic medical center receiving critically-ill neurologic transfers, and 5 referring hospitals. Interviewees included physicians, nurses, and allied health professionals with experience caring for patients transferred between hospitals for nontraumatic intracranial hemorrhage. Interviews continued until data saturation was reached. Coding occurred concurrently with interviews. Analysis was inductive, using the constant comparative method. FINDINGS: The predominant impediments to safe, high-quality neurocritical care transitions between hospitals are insufficient communication, gaps in clinical practice, and lack of IHT structure. Insufficient communication highlights the unique communication challenges specific to IHT, which overlay and compound known intrahospital communication barriers. Gaps in clinical practice revolve primarily around the provision of neurocritical care for this patient population, often subject to resource availability, by receiving hospital emergency medicine providers. Lack of structure outlines providers' questions that emerge when institutions fail to identify process channels, expectations, and accountability during complex neurocritical care transitions. CONCLUSIONS: The predominant impediments to safe, high-quality neurocritical care transitions between hospitals are insufficient communication, gaps in clinical practice, and lack of IHT structure. These themes serve as fundamental targets for quality improvement initiatives. To our knowledge, this is the first description of challenges to quality and safety in high-risk neurocritical care transitions through clinicians' voices.


Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Hemorragias Intracraneales/terapia , Seguridad del Paciente , Transferencia de Pacientes/organización & administración , Actitud del Personal de Salud , Conducta Cooperativa , Conocimientos, Actitudes y Práctica en Salud , Humanos , Comunicación Interdisciplinaria , Entrevistas como Asunto , Hemorragias Intracraneales/diagnóstico , Grupo de Atención al Paciente/organización & administración , Brechas de la Práctica Profesional , Pronóstico , Investigación Cualitativa , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
7.
J Stroke Cerebrovasc Dis ; 28(5): 1219-1228, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30745000

RESUMEN

BACKGROUND AND OBJECTIVES: Acute Ischemic stroke (AIS) is a time-sensitive emergency and patients frequently present to, and are transferred from emergency departments (EDs). We sought to evaluate potential factors, particularly organizational, that may influence the timeliness of interfacility transfer for ED patients with AIS. METHODS: We conducted semistructured interviews at 3 EDs that routinely transfer AIS patients. A structured interview guide was developed and piloted prior to use. Staff were asked about perceived facilitators and barriers to timely and high quality emergency care for patients with AIS who require transfer. Each interview was audio recorded, transcribed, coded, and analyzed using an iterative inductive-deductive approach to build a list of themes and subthemes, and identify supporting quotes. RESULTS: We interviewed 45 ED staff (administrative staff, nurses, and physicians) involved in acute stroke care. We identified 4 major themes influencing the execution of interfacility transfers of AIS patients: (1) processes, (2) historical experiences; (3) communication; and (4) resources. Pre-existing protocols that standardized processes (eg, autoacceptance protocols) and reduced unnecessary communication, combined with direct communication with the neurology team at the comprehensive stroke center, and the flexibility and availability of human and physical resources (eg, staff and equipment) were commonly cited as facilitators. Lack of communication of clinical and operational outcomes back to transferring ED staff was viewed as a lost opportunity for process improvement, interorganization relationship building, and professional satisfaction. CONCLUSIONS: ED staff view the interfacility transfer of AIS patients as highly complex with multiple opportunities for delay. Coordination through the use of protocols and communication pre- and post-transfer represented opportunities to facilitate transfers. Staff and clinicians at transferring facilities identified multiple opportunities to enhance existing processes and ongoing communication quality among facilities involved in the acute management of patients with AIS.


Asunto(s)
Isquemia Encefálica/terapia , Prestación Integrada de Atención de Salud/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Transferencia de Pacientes/organización & administración , Accidente Cerebrovascular/terapia , Tiempo de Tratamiento/organización & administración , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatología , Conducta Cooperativa , Vías Clínicas/organización & administración , Humanos , Comunicación Interdisciplinaria , Entrevistas como Asunto , Grupo de Atención al Paciente/organización & administración , Investigación Cualitativa , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Tennessee , Factores de Tiempo , Resultado del Tratamiento , Flujo de Trabajo
10.
J Cardiovasc Med (Hagerstown) ; 20(4): 253-260, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30676496

RESUMEN

AIMS: The aim of this study was to assess the impact of a transition clinic model on adolescent congenital heart disease (CHD) patients' health perception outcomes. The transition clinic model consists of multidisciplinary standardized interventions to educate and support CHD patients and represents a key element in the adequate delivery of care to these individuals during their transition from childhood to adulthood. Currently, empirical data regarding the impact of transition clinic models on the improvement of health perceptions in CHD adolescent patients are lacking. METHODS: A quasi-experimental design was employed. Quality of life, satisfaction, health perceptions and knowledge were assessed at the time of enrolment (T0) and a year after enrolment (T1), respectively. During the follow-up period, the patients enrolled (aged 11-18 years) were involved in the CHD-specific transition clinic model (CHD-TC). RESULTS: A sample of 224 CHD adolescents was enrolled (60.7% boys; mean age: 14.84 ±â€Š1.78 years). According to Warnes' classification, 22% of patients had simple heart defect, 56% showed moderate complexity and 22% demonstrated severe complexity. The overall results suggested a good impact of the CHD-TC on adolescents' outcomes, detailing in T1 the occurrence of a reduction of pain (P < 0.001) and anxiety (P < 0.001) and an improvement of knowledge (P < 0.001), life satisfaction (P < 0.001), perception of health status (P < 0.001) and quality of life (P < 0.001). CONCLUSION: The CHD-TC seems to provide high-quality care to the patient by way of a multidisciplinary team. The results of the present study are encouraging and confirm the need to create multidisciplinary standardized interventions in order to educate and support the delivery of care for CHD adolescents and their families.


Asunto(s)
Conducta del Adolescente , Servicios de Salud del Adolescente/organización & administración , Conducta Infantil , Servicios de Salud del Niño/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Cardiopatías Congénitas/terapia , Transferencia de Pacientes/organización & administración , Adaptación Psicológica , Adolescente , Factores de Edad , Niño , Femenino , Estado de Salud , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/fisiopatología , Cardiopatías Congénitas/psicología , Humanos , Masculino , Grupo de Atención al Paciente/organización & administración , Educación del Paciente como Asunto/organización & administración , Participación del Paciente , Satisfacción del Paciente , Percepción , Calidad de Vida
11.
Home Healthc Now ; 37(1): 44-49, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30608467

RESUMEN

The ability to maintain functional status is an essential aspect of self-care for older adults. Instrumental activities of daily living (IADLs) decline within hours of hospitalization and are often overlooked, underassessed, and underreported. The aim of this integrative review was to examine and compare methods used to assess IADLs to determine the best measure for use across the care continuum, especially during transitions of care. A literature search without date restrictions was conducted using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Embase databases. Twelve studies of moderate quality were included in this review. More than half (58%) of the studies utilized the Lawton and Brody Scale to measure IADL among home-based and hospitalized patients. Implementation of this scale as standard practice and sharing the results with healthcare providers would encourage continuity of care with the goal of supporting older adults aging in place and preventing rehospitalization. In turn, this communication process may improve the transition from the inpatient to home setting, where, since 1999, the Outcome and Assessment Information Set has been mandated.


Asunto(s)
Actividades Cotidianas , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados de Enfermería en el Hogar/organización & administración , Aceptación de la Atención de Salud/estadística & datos numéricos , Transferencia de Pacientes/organización & administración , Anciano , Servicios de Salud para Ancianos/organización & administración , Servicios de Atención a Domicilio Provisto por Hospital/organización & administración , Humanos , Masculino
12.
J Stroke Cerebrovasc Dis ; 28(2): 259-266, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30442556

RESUMEN

BACKGROUND: Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship). METHODS: We retrospectively analyzed 179 consecutive patients (93 in the mothership group and 86 in the drip-and-ship group), with AIS secondary to LVO in the anterior cerebral circulation and a clinical-radiological mismatch (NIHSS ≥ 8 and DWI-ASPECT score ≥5), up to 6 hours after symptoms onset. We evaluated 3-month functional modified Rankin scale (mRS), periprocedural time management, mortality, and symptomatic intracranial haemorrhage (sICH). RESULTS: Despite significant longer process time in the drip-and-ship group, mRS ≤ 2 at 3 months (39.8% versus 44.1%, P = .562), Thrombolysis in cerebral infarction 2b-3 (85% versus 78%, P = .256), and sICH (7.0% versus 9.7%, P = .515) were similar in both group regardless of baseline clinical or radiological characteristics. After multivariate logistic regression, the predictive factors for favorable outcome were age (odds ratio [OR] -5years= 1.32, P < .001), initial NIHSS (OR -5points = 1.59, P = .010), absence of diabetes (OR = 3.35, P = .075), and the delay magnetic resonance imagining-puncture (OR -30min = 1.16, P = .048). CONCLUSIONS: Our study showed encouraging results from a regional protocol of MT comparing patients transferred from PSC or brought directly in CSC.


Asunto(s)
Infarto Encefálico/cirugía , Prestación Integrada de Atención de Salud/organización & administración , Fibrinolíticos/administración & dosificación , Trombolisis Mecánica , Transferencia de Pacientes/organización & administración , Regionalización/organización & administración , Trombectomía , Tiempo de Tratamiento/organización & administración , Anciano , Infarto Encefálico/diagnóstico , Infarto Encefálico/mortalidad , Infarto Encefálico/fisiopatología , Evaluación de la Discapacidad , Estudios de Factibilidad , Femenino , Fibrinolíticos/efectos adversos , Humanos , Infusiones Intravenosas , Masculino , Trombolisis Mecánica/efectos adversos , Trombolisis Mecánica/mortalidad , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Trombectomía/efectos adversos , Trombectomía/mortalidad , Factores de Tiempo , Resultado del Tratamiento
13.
Prof Case Manag ; 24(1): 39-45, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30489473

RESUMEN

PURPOSE/OBJECTIVE: The Community-based Care Transitions Program (CCTP) defined a broad spectrum of interventions and services for elderly patients at high risk of hospital readmission. The purposes for a CCTP as developed by the Centers for Medicare & Medicaid Services are to improve transitions of beneficiaries from the inpatient hospital setting to other care settings, to improve quality of care, to reduce readmissions for high-risk beneficiaries, and to document measurable savings. The goals for this CCTP initiative were as follows: achievement of a 20% reduction in the 30-day all-cause readmission rate across all partner hospitals compared with baseline; reduction in the 30-day all-cause readmission rate among the high-risk cohort served; and achievement of the target volumes for full enrollment. PRIMARY PRACTICE SETTINGS: The partnership included acute care institutions and community-based care organizations that have been involved with care transition programs for years and have a long history of working collaboratively to provide services to a largely low-income, underserved, and ethnically and racially diverse target population. FINDINGS/CONCLUSIONS: The program successfully transitioned to full operation within the first year of inception. To date, the partnership of the acute hospital setting and the community-based organizations has reached and provided services to nearly 8,000 total individuals, surpassing our target enrollment goal. To date, the readmission rate has decreased to 12.5%, which is an 11% decline since inception of the program. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The collaboration of health care providers, social workers, nurse practitioners, physicians, community pharmacists, and the visiting nurses is integral to a successful transition from hospital to home. Home visits by the transition facilitators allowed for the coordination of a multitude of services in the community, including those previously available to patients in the past that have rarely been accessed. Including a pharmacist on the team provided teaching regarding medication adherence, medication management, and pharmacy services, which added to interventions to decrease future hospitalizations.


Asunto(s)
Redes Comunitarias/organización & administración , Colaboración Intersectorial , Transferencia de Pacientes/organización & administración , Salud Poblacional , Calidad de la Atención de Salud/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Estados Unidos
14.
Support Care Cancer ; 27(1): 199-208, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29931489

RESUMEN

PURPOSE: Regular exercise is recommended to mitigate the adverse effects of androgen deprivation therapy in men with prostate cancer. The purpose of this study was to explore the experience of transition to unsupervised, community-based exercise among men who had participated in a hospital-based supervised exercise programme in order to propose components that supported transition to unsupervised exercise. METHODS: Participants were selected by means of purposive, criteria-based sampling. Men undergoing androgen deprivation therapy who had completed a 12-week hospital-based, supervised, group exercise intervention were invited to participate. The programme involved aerobic and resistance training using machines and included a structured transition to a community-based fitness centre. Data were collected by means of semi-structured focus group interviews and analysed using thematic analysis. RESULTS: Five focus group interviews were conducted with a total of 29 men, of whom 25 reported to have continued to exercise at community-based facilities. Three thematic categories emerged: Development and practice of new skills; Establishing social relationships; and Familiarising with bodily well-being. These were combined into an overarching theme: From learning to doing. Components suggested to support transition were as follows: a structured transition involving supervised exercise sessions at a community-based facility; strategies to facilitate peer support; transferable tools including an individual exercise chart; and access to 'check-ups' by qualified exercise specialists. CONCLUSIONS: Hospital-based, supervised exercise provides a safe learning environment. Transferring to community-based exercise can be experienced as a confrontation with the real world and can be eased through securing a structured transition, having transferable tools, sustained peer support and monitoring.


Asunto(s)
Terapia por Ejercicio/organización & administración , Relaciones Paciente-Hospital , Cooperación del Paciente/estadística & datos numéricos , Transferencia de Pacientes , Neoplasias de la Próstata/terapia , Autocuidado , Anciano , Antagonistas de Andrógenos/uso terapéutico , Actitud Frente a la Salud , Terapia Combinada , Dinamarca/epidemiología , Terapia por Ejercicio/métodos , Terapia por Ejercicio/psicología , Grupos Focales , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Cooperación del Paciente/psicología , Transferencia de Pacientes/métodos , Transferencia de Pacientes/organización & administración , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/psicología , Calidad de Vida , Entrenamiento de Resistencia , Autocuidado/métodos , Autocuidado/psicología
15.
Am J Emerg Med ; 37(3): 395-400, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-29861365

RESUMEN

BACKGROUND: Patients who cannot be stabilized at a lower-level emergency department (ED) should be transferred to an upper-level ED by emergency medical services. However, some patients are subsequently discharged after transfer without any intervention or admission, and this secondary overtriage (SO) wastes the limited resources of upper-level EDs. This study aimed to investigate whether an emergency transfer coordination center (ETCC) could reduce the risk of SO among patients who were transferred to a tertiary ED by emergency medical services. METHODS: This retrospective observational study evaluated data from a prospective registry at an urban tertiary ED in Korea (January 2017 to May 2017). The exposure of interest was defined as ETCC approval prior to transfer and the primary outcome was SO. Univariate analyses were used to identify statistically significant variables, which were used for a multivariate logistic regression analysis to estimate the effects of ETCC approval on SO. RESULTS: During the study period, 1270 patients were considered eligible for this study. A total of 291 transfers were approved by the center's ETCC, and the remaining patients were transferred without approval. Compared to cases without ETCC approval, cases with transfer after ETCC approval had a significantly lower risk of SO (odds ratio: 0.624, 95% confidence interval: 0.413-0.944). CONCLUSION: Transfers that were evaluated by an ETCC had a lower risk of SO, which may improve the appropriateness of transfer. Thus, tertiary EDs that have high proportions of transferred patients should have a transfer coordination system that is similar to an ETCC.


Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Transferencia de Pacientes/organización & administración , Derivación y Consulta/organización & administración , Servicios de Salud Rural/organización & administración , Triaje/organización & administración , Anciano , Anciano de 80 o más Años , Femenino , Hospitalización , Humanos , Puntaje de Gravedad del Traumatismo , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Sistema de Registros , República de Corea , Estudios Retrospectivos
16.
J Pharm Pract ; 32(1): 28-35, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29061080

RESUMEN

BACKGROUND:: Barriers exist for patients transitioning from one health-care setting to another, or to home, and health-care systems are falling short of meeting patient needs during this time. Community pharmacist incorporation poses a solution to the current communication breakdown and high rates of medication errors during transitions of care (TOC). The purpose of this study was to determine community pharmacists' involvement in and perceptions of TOC services. METHODS:: Cross-sectional study using electronic surveys nationwide to pharmacists employed by a community pharmacy chain. RESULTS:: Of 7236 pharmacists surveyed, 546 (7.5%) responded. Only 33 (6%) pharmacists reported their pharmacy participates in TOC services. Most pharmacists (81.5%) reported receiving discharge medication lists. The most common reported barrier to TOC participation is lack of electronic integration with surrounding hospitals (51.1%). Most pharmacists agreed that (1) it is valuable to receive discharge medication lists (83.3%), (2) receiving discharge medication lists is beneficial for patients' health (89.1%), (3) discharge medication list receipt improves medication safety (88.8%). CONCLUSIONS:: Most pharmacists reported receiving discharge medication lists and reported discharge medication lists are beneficial, but less than half purposefully used medication lists. To close TOC gaps, health-care providers must collaborate to overcome barriers for successful TOC services.


Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Alta del Paciente , Transferencia de Pacientes/organización & administración , Farmacéuticos/organización & administración , Actitud del Personal de Salud , Comunicación , Estudios Transversales , Encuestas de Atención de la Salud , Humanos , Errores de Medicación/prevención & control , Percepción , Farmacéuticos/psicología , Rol Profesional
17.
Health Care Manag Sci ; 22(2): 287-303, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29455441

RESUMEN

Hospital emergency departments are often overcrowded, resulting in long wait times and a public perception of poor attention. Delays in transferring patients needing further treatment increases emergency department congestion, has negative impacts on their health and may increase their mortality rates. A model built around a Markov decision process is proposed to improve the efficiency of patient flows between the emergency department and other hospital units. With each day divided into time periods, the formulation estimates bed demand for the next period as the basis for determining a proactive rather than reactive transfer decision policy. Due to the high dimensionality of the optimization problem involved, an approximate dynamic programming approach is used to derive an approximation of the optimal decision policy, which indicates that a certain number of beds should be kept free in the different units as a function of the next period demand estimate. Testing the model on two instances of different sizes demonstrates that the optimal number of patient transfers between units changes when the emergency patient arrival rate for transfer to other units changes at a single unit, but remains stable if the change is proportionally the same for all units. In a simulation using real data for a hospital in Chile, significant improvements are achieved by the model in key emergency department performance indicators such as patient wait times (reduction higher than 50%), patient capacity (21% increase) and queue abandonment (from 7% down to less than 1%).


Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Política Organizacional , Transferencia de Pacientes/organización & administración , Ocupación de Camas , Chile , Simulación por Computador , Cuidados Críticos/organización & administración , Toma de Decisiones , Eficiencia Organizacional , Hospitales , Humanos , Unidades de Cuidados Intensivos/organización & administración , Tiempo de Internación , Cadenas de Markov , Modelos Organizacionales
18.
J Pharm Pract ; 32(1): 68-76, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29183253

RESUMEN

BACKGROUND:: Pharmacists may assist with reducing 30-day readmission rates for patients with heart failure (HF) exacerbation or acute myocardial infarction (AMI) by promoting medication adherence. OBJECTIVE:: To determine the change in 30-day readmission rates for patients with HF exacerbation or AMI after implementation of a "high-touch" standard of care. METHODS:: Patients admitted with HF exacerbation, non-ST-segment elevation AMI, or ST-segment elevation AMI from August 1, 2013, to June 30, 2015, were included in this prospective study. Patients were educated while in the inpatient setting and followed up in the outpatient setting through telephone contact and scheduling a medication therapy management (MTM) appointment with a pharmacist. Data were collected by pharmacy personnel involved in the implementation of the intervention. RESULTS:: Within the HF and AMI arms, 100 and 93 patients, respectively, were included in the study. The 30-day readmission rates were 24% and 17.2% for HF and AMI, respectively, which were not statistically significant when compared to historical institutional readmission rates prior to study initiation (18.2% for HF, P = .238; 11.4% for AMI, P = .252). CONCLUSION:: A "high-touch" pharmacist-driven transitions of care program may affect 30-day readmission rates for patients with HF exacerbation or AMI; potential processes for initiating transitions of care programs are provided.


Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Infarto del Miocardio sin Elevación del ST/tratamiento farmacológico , Farmacéuticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Infarto del Miocardio con Elevación del ST/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/organización & administración , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Administración del Tratamiento Farmacológico/organización & administración , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Readmisión del Paciente/estadística & datos numéricos , Transferencia de Pacientes/organización & administración , Proyectos Piloto , Rol Profesional , Estudios Prospectivos
19.
Am J Hosp Palliat Care ; 36(1): 38-44, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30041532

RESUMEN

INTRODUCTION:: Transition to comfort measures only (CMO) is common in the neurocritical care unit, and close communication between interdisciplinary health-care teams is vital to a smooth transition. We developed and implemented a CMO huddle in an effort to reduce inconsistencies during the process of CMO transition. METHODS:: The CMO huddle was a multiphase quality improvement project in a neurocritical care unit of a level-1 trauma and comprehensive stroke center. Interdisciplinary critical care clinicians engaged in a huddle during CMO processes and participated in a pre- and postimplementation survey to examine the impact of CMO huddle on communication, missed opportunities, and improvement in knowledge. RESULTS:: Since the CMO implementation, a total of 131 patients underwent CMO transitions. After implementation of an interdisciplinary CMO huddle, 64.3% of neurocritical care nurses reported that they felt included and involved in CMO process compared to 28% before implementation ( P = .003); 87.9% of all neurocritical care clinicians reported that they felt comfortable participating in CMO discussions compared to 69.8% before ( P < .001); 57.4% of all neurocritical care clinicians reported that the CMO huddle improved communication among neurocritical care clinicians, 51.9% reported reduction in missed opportunities during CMO process, and 21.7% reported witnessing less-than-ideal CMO process compared to 80% before ( P < .001). CONCLUSIONS:: Implementation of a multidisciplinary huddle in the neuro-intensive care unit before transition to CMO may improve clinician's experience of the end-of-life process through enhanced nursing inclusion and involvement and organized communication with the neurocritical care team.


Asunto(s)
Unidades de Cuidados Intensivos/organización & administración , Grupo de Atención al Paciente/organización & administración , Comodidad del Paciente/organización & administración , Transferencia de Pacientes/organización & administración , Mejoramiento de la Calidad/organización & administración , Cuidado Terminal/organización & administración , Comunicación , Enfermedad Crítica/epidemiología , Humanos , Enfermedades del Sistema Nervioso/epidemiología
20.
BMJ Open ; 8(12): e022425, 2018 12 22.
Artículo en Inglés | MEDLINE | ID: mdl-30580262

RESUMEN

OBJECTIVES: Conversion is a term for treatments that seek to suppress or change a person's sexual orientation or gender. Our review focuses on transgender and gender-diverse (TGD) people. Our aims were to (1) describe the frequency, nature and structure of conversion practices; (2) document difficulties in accessing transition-related healthcare and (3) evaluate the mental health consequences of such practices and access barriers. METHOD: Systematic review and narrative synthesis using the Critical Appraisals Skills Programme and Joanne Briggs Institute critical appraisal tools. Data sources include Embase, MEDLINE, PsychINFO, PsychARTICLES and Web of Science between 1990 and June 2017. PARTICIPANTS: Studies were included that (1) document use of conversion therapies or access barriers to transition-related healthcare; and/or (2) describe how such therapeutic practices and access barriers have been applied and/or (3) evaluate the mental health impacts of such therapies and difficulties accessing transition-related healthcare. Two reviewers screened papers for eligibility. Data were then grouped according to the objectives. Narratives and themes were presented per study. RESULTS: Seven studies met inclusion criteria. Four reports were on 'realignment', involving case studies or case series. Two involved psychoanalysis, one self-exposure therapy and one open-ended play psychotherapy. All four studies concerning 'realignment' were of poor methodological quality. The other three studies explored access barriers from the view point of TGD youth, their parents and healthcare providers. All papers reported access barriers, such as inability to access puberty-delaying medications. The papers concerning barriers to access were of good methodological quality. CONCLUSION: We found limited published evidence on use, nature, structure and/or health consequences of conversion therapies and access barriers to transition in TGD people. However, reports of restriction to access may indicate a more widespread problem. Research is needed into TGD people's experiences of conversion therapy and access barriers to transition-related healthcare TRIAL REGISTRATION NUMBER: CRD42017062149.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Narración , Procedimientos de Reasignación de Sexo/métodos , Conducta Sexual/psicología , Personas Transgénero/psicología , Adaptación Fisiológica , Adaptación Psicológica , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Transferencia de Pacientes/organización & administración , Medición de Riesgo , Educación Sexual/métodos , Adulto Joven
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