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1.
Can J Cardiol ; 34(7): 850-862, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29960614

RESUMO

Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented.


Assuntos
Monitorização Fisiológica/métodos , Cuidados Pós-Operatórios/métodos , Procedimentos Cirúrgicos Operatórios , Telemedicina/métodos , Sinais Vitais/fisiologia , Humanos
2.
Stud Health Technol Inform ; 209: 102-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25980711

RESUMO

The Ontario Telemedicine Network's Telehomecare initiative brings together specially trained clinicians and technology to coach patients with COPD and/or heart failure to monitor vital signs and manage their health at home. The objective of the study was to evaluate pre- and post-enrollment and post discharge data captured by Telehomecare host William Osler Health System (WOHS). Results demonstrate a 46% reduction in emergency department use and a 53% reduction in hospitalizations post-enrollment compared to pre-enrollment. Average length of stay (LOS) dropped by 25% of a day compared to pre-enrollment. In addition, six months after Telehomecare discharge, inpatient admissions and emergency department visits continued to decline, by 65% and 57% respectively, compared to pre-enrollment. While average LOS increased between pre-enrollment and post-discharge, the reduction in acute inpatient episodes created a net reduction in accumulated inpatient days of 563.16 days (63% reduction). The WOHS Telehomecare results strongly support the positive influence of the program on health system utilization and the development of effective long-term self-management skills. Next steps could include reviewing, more closely, the reasons for hospital utilization and undertaking a cost-benefit analysis to support further expansion of the program to address other chronic illness and care needs.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Telemedicina/estatística & dados numéricos , Idoso , Comorbidade , Feminino , Insuficiência Cardíaca/diagnóstico , Serviços de Assistência Domiciliar/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Ontário/epidemiologia , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Fatores de Risco , Autocuidado/estatística & dados numéricos , Resultado do Tratamento , Revisão da Utilização de Recursos de Saúde
3.
J Allied Health ; 41(4): e83-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23224289

RESUMO

Researchers, hospital administrators and governments are striving to define competencies in interprofessional care and education, as well as to identify effective models in chronic disease management. For more than 25 years The Arthritis Program (TAP) at Southlake Regional Health Centre in Newmarket, Ontario, has actively practiced within these two interrelated priorities, which are now at the top of the healthcare agenda in Ontario and Canada. The approximately 135 different rheumatic conditions are the primary cause of long-term disability in Canada, affecting those from youth to the senior years, with an economic burden estimated at $4.4 billion (CAD$) annually, and growing. For the benefit of healthcare managers and their clients with chronic conditions, this article discusses TAP's history and demonstrable success, predicated on an educational model of patient self-management and self-efficacy. Also outlined are TAP's contributions in supporting evidence-based best practices in interprofessional collaboration and chronic disease management; approaches that are arguably understudied and under-practiced. Next steps for TAP include a larger role in empirical research in chronic-disease management and integration of a formal training program to benefit health professionals launching or expanding their interprofessional programs using TAP as the dynamic clinical example.


Assuntos
Artrite/terapia , Prática Clínica Baseada em Evidências , Desenvolvimento de Programas , Artrite/economia , Doença Crônica , Acesso aos Serviços de Saúde , Humanos , Comunicação Interdisciplinar , Ontário , Avaliação de Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto , Autocuidado
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