What Makes the "Perfect" Inpatient Consultation? A Qualitative Analysis of Resident and Fellow Perspectives.

PURPOSE: To characterize the methods of inpatient consult communication, given new communication modalities; to explore residents' and fellows' perspectives on the ideal consult and how this consult could affect their teaching, learning, and patient safety; and to identify barriers to and strategies for optimizing consultations. METHOD: Using qualitative grounded theory, the authors conducted semistructured focus groups with pediatric residents and fellows at Lucile Packard Children's Hospital at Stanford University from October 2016 to September 2017, using questions developed by expert consensus to address study objectives. Sessions were audiorecorded and transcribed verbatim. Two authors independently coded the transcripts and reconciled codes to develop categories and themes using constant comparison. The third author validated the codes, categories, and themes. To ensure trustworthiness, participants edited the themes for accuracy. RESULTS: Twenty-seven residents and 16 fellows participated in 7 focus groups (3 with residents, 4 with fellows). Four themes emerged: (1) Many forms of communication are successfully used for initial inpatient consult recommendations (in person, phone, text messages, notes in electronic medical records); (2) residents and fellows prefer in-person communication for consults, believing it leads to improved teaching, learning, and patient safety; (3) multiple strategies can optimize consults regardless of communication modality; and (4) how residents frame the initial consult affects the interaction and can increase fellow engagement, which leads to more fellow teaching, residents' improved understanding, and better patient care. CONCLUSIONS: Residents and fellows believe that structured initial consults conducted in person improve teaching, learning, and patient care. Several strategies exist to optimize this process.

Perspectives of nurse managers on information communication technology and e-Leadership.

AIM: We sought nurse managers' perspectives on challenges and opportunities with technology and how it may influence communication and leadership. BACKGROUND: e-Leadership is a conceptual framework used to understand and teach organisational leaders about the application of technology to leadership. Technology is integral to leadership, yet little is understood about how nurse managers may use this technology and how they negotiate the complexity of the multiple communication systems currently in use. METHODS: Sixteen nurse managers from individual hospitals within a large US healthcare system participated in qualitative open-ended interviews and focus groups. RESULTS: Four themes emerged from the qualitative data regarding the nurse managers' perspectives of e-Leadership and their use of information and communication technologies: (a) Can't live without it, (b) Too much, too many, (c) Poor onboarding education and (d) Difficulty maintaining virtual relationships. IMPLICATIONS FOR NURSING MANAGEMENT: Effective and safe patient care is dependent on multiple technology applications that require significant knowledge and practice. Nursing leadership may consider the need for more supported mentorship, and engaging programs to educate nurse managers about the dozens of applications required to effectively manage and lead. For technology to be used to its full potential it should be designed with nursing involvement.

Communication problems between nurses and patient's family

Communication between the nurse and the patient's family is a significant aspect of nursing practice. This paper presents the results of a research aimed to characte-rize problematic situations that occur in the relations involving nurses and patients' relatives: I) the type and frequency with which nurses deal with problematic situa-tions involving the patient's relatives in the context of their professional activity; II) the level of difficulty in dealing with these situations; and III) the psychological exhaustion they cause. The research focused on nurses of two clinical services of a public hospital: an In-tensive Care Unit and an Emergency Department. The methodological approach to this study is quantitative and has a descriptive and correlational nature. A question-naire was elaborated for the collection of data, contemplating questions related to the objective of the research. From a total of 99 nurses of the two clinical services, 50 were interviewed. The results show that there are statistically significant differences between the two services regarding the frequency with which nurses are threatened and intimi-dated, being more frequent in the emergency department. The insistent demand for information on the part of the family members constitutes the situation with greater occurrence and, simultaneously, the situation that causes greater impact on nurses. The lack of preparation stands out for the way it correlates with the wea-riness of nurses caused by requests of confidential information by the family on the patient's health status (rs = -0,473; p < 0.05) and the insistent search for information on the part of the relatives (rs = -0.416; p < 0.05)

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Entropy Measures of Human Communication Dynamics.

Human communication is commonly represented as a temporal social network, and evaluated in terms of its uniqueness. We propose a set of new entropy-based measures for human communication dynamics represented within the temporal social network as event sequences. Using real world datasets and random interaction series of different types we find that real human contact events always significantly differ from random ones. This human distinctiveness increases over time and by means of the proposed entropy measures, we can observe sociological processes that take place within dynamic communities.

La revelación del diagnóstico en oncología: una investigación transcultural Brasil-España / Cancer disclosure: a cross-cultural research Brazil-Spain

Objetivo: examinar aspectos transculturales de la revelación del diagnóstico de cáncer en pacientes brasileños y españoles. Método: Se realizó una investigación cualitativa en la que fueron entrevistados 28 pacientes en quimioterapia (14 brasileños y 14 españoles). El análisis de contenido identificó tres ejes temáticos: 1) Cómo fue revelado el diagnóstico; 2) Contexto en que el diagnóstico fue revelado y 3) Quién reveló el diagnóstico. Resultados: existen particularidades en la manera de revelar el diagnostico entre los dos países. En Brasil aún ocurre que el enfermo puede ser derivado a un oncólogo sin una explicación satisfactoria previa sobre su estado de salud. Aunque en los dos países existan relatos de comunicación de diagnóstico en el contexto apropiado (consulta), también ha aparecido revelación de manera informal (por teléfono) sin un ambiente adecuado para que el paciente sea acogido y tenga posibilidad de expresar sus miedos y sus dudas. Conclusión: es necesario invertir en la formación profesional para mejorar la habilidad de comunicación y educación en salud para tratar pacientes con cáncer (AU)

Objective: The aim of this study was to examine cross-cultural aspects of the disclosure of cancer diagnosis in Brazilian and Spanish patients. Method: A qualitative research was carried out in which 28 chemotherapy patients (14 Brazilian and 14 Spanish) were interviewed. Content analysis identified three thematic categories: 1) How the diagnosis was disclosured; 2) Context in which the diagnosis was disclosured; 3) Who disclosured the diagnosis. Results: Particularities in the diagnosis disclosure between the two countries was found. In Brazil, it still happens that patient can be referred to an oncologist without a satisfactory explanation about his health status. Although there are reports of diagnosis disclosure in the appropriate context (consultation), also there are reports informal disclosure (by telephone), without an adequate environment for the patient to be welcomed and able to express their fears and doubts. Conclusion: It is necessary to improve the professional training to improve communication skills and health education to treat cancer patients (AU)

Experiencia del paciente: una nueva forma de entender la atención al paciente oncológico / Patient experience: A new way to understand care for the oncological patient

En el presente trabajo se analiza el concepto de Experiencia del Paciente (PX) así como las variables que contribuyen a la mejora del mismo. El objetivo es explicar su utilidad clínica en el ámbito de la salud, en concreto sobre la población oncológica, además de demostrar el papel activo que la Psicooncología puede tener en la implementación de esta estrategia, en relación directa con la humanización de la asistencia sanitaria. Para ello, se ha revisado la literatura con evidencia empírica existente hasta el momento y que sitúa la experiencia del paciente como un pilar indispensable a la hora de mejorar la calidad de la atención clínica, junto con la efectividad del tratamiento y la seguridad del paciente. Estos elementos presentan una interacción positiva entre ellos y están moderados por la comunicación médico-paciente, lo que evidencia la necesidad de desarrollar habilidades de comunicación por los profesionales en la práctica clínica, la coordinación de la atención sanitaria, el acceso a los servicios y la percepción del paciente respecto a la atención recibida. La experiencia del paciente resulta clínicamente relevante e influyente en la recuperación del estado de salud del paciente, así como constituye un cambio en la cultura sanitaria, cuyo protagonista es el paciente y en torno a él debe girar dicho cambio de manera multidisciplinar e integral por parte de los profesionales sanitarios implicados en su cuidado. Se concluye con una nueva línea de actuación del psicooncólogo en la experiencia del paciente para promover un servicio oncológico de calidad (AU)

In the present paper, the concept of Patient Experience (PX) is analyzed, as well as the variables that contribute to its improvement. The aim is to explain its clinical utility in the field of health, specifically on the oncology population, in addition to demonstrating the active role that Psychooncology can have in the implementation of this strategy, in direct relation with the humanization of health care. For this, the literature has been reviewed with empirical evidence that has existed up to now and which places the patient's experience as an essential pillar when improving the quality of clinical care, together with the effectiveness of treatment and patient safety. These elements present a positive interaction between them and are moderated by the doctor-patient communication, which evidences the need to develop communication skills by professionals in clinical practice, the coordination of healthcare, access to services and perception of the patient regarding the care received. The patient's experience is clinically relevant and influential in the recovery of the health status of the patient, as well as constitutes a change in the health culture, whose protagonist is the patient and around him must turn this change in a multidisciplinary and integral way of the health professionals involved in their care. It is concluded with a new line of action of the psycho-oncologist in the patient’s experience to promote a quality oncological service (AU)

The Fate of Radical Cystectomy Patients after Hospital Discharge: Understanding the Black Box of the Pre-readmission Interval.

BACKGROUND: Radical cystectomy has one of the highest 30-d hospital readmission rates but circumstances leading to readmission remain poorly understood. OBJECTIVE: To examine the postdischarge period and better understand hospital readmission after radical cystectomy. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective cohort study of patients treated with radical cystectomy for bladder cancer from 2005 to 2012 using our institutional database. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We assessed patient communication with any healthcare system after hospital discharge based on timing, methods, and concern types. Logistic regression and Cox proportional-hazards analyses were used to compare postdischarge concerns among readmitted and nonreadmitted patients. We internally validated the logistic model using a bootstrap resampling technique. RESULTS AND LIMITATIONS: One-hundred patients (23%) were readmitted within 30 d of index discharge. Readmitted patients were more likely to use the emergency department with initial concerns compared with nonreadmitted patients (27% vs 1.0%, p<0.001). Patients who took longer to first communicate their concerns and who were able to tolerate their symptoms longer had lower odds of readmission. Patients who reported infection (adjusted hazard ratio: 2.8, 95% confidence interval: 1.4-5.8) and failure to thrive concerns (adjusted hazard ratio: 4.4, 95% confidence interval: 2.0-9.3) were more likely to be readmitted compared with those who communicated noninfectious wounds and/or urinary concerns. CONCLUSIONS: Radical cystectomy patients who contact the health system soon after discharge or communicated infectious or failure to thrive symptoms (fever, poor oral intake, or vomiting) are more likely to experience readmission as opposed to those that endorse pain, constipation, or ostomy issues. Better understanding of this pre-readmission interval can optimize postdischarge practices. PATIENT SUMMARY: We looked at bladder cancer patients who had surgery and the reasons why they were readmitted to hospital. We found patients who had a fever or difficulty with eating and maintaining their weight had the highest chance of being readmitted.

Análisis del proceso de derivación del paciente hipertenso en España: Estudio DERIVA / Evaluation of referral process of the hypertensive patient in Spain: DERIVA study

INTRODUCCIÓN: La buena comunicación entre niveles asistenciales es clave para el control de la hipertensión arterial. OBJETIVOS: Valorar la adecuación de la derivación del hipertenso desde atención primaria a atención especializada.como objetivos secundarios, valoramos el contenido del informe de derivación y la concordancia entre el motivo de derivación y el diagnóstico final. DISEÑO: Estudio observacional descriptivo. Emplazamiento: Estudio realizado a nivel nacional. PARTICIPANTES: Médicos de atención especializada que reciben pacientes hipertensos derivados de atención primaria. MEDICIONES PRINCIPALES: En una visita basal, el médico de atención especializada evaluó la calidad del informe de derivación y al paciente, y en visita final se establecen diagnóstico y tratamiento definitivos. RESULTADOS: Se incluyeron 1.769 sujetos, edad media de 62,4 (13,6) años, 45% mujeres. El tiempo medio de diagnóstico de hipertensión fue de 8,0 (7,7) años. Algo más de la mitad de los informes de derivación contienen información muy buena (5,4%; IC 4,3-6,5) o suficiente (50,7%; IC 48,4-53,0). Un 7,1% (IC 5,9-8,3) no indican causa de derivación. Fueron correctas el 74,7% de las derivaciones, y el 30% de estas fueron tardías. La concordancia entre las causas de derivación y los diagnósticos finales fueron bajas (índice Kappa 0,208). CONCLUSIONES: Una cuarta parte de los pacientes se derivan innecesariamente, y del 75% de los bien derivados, un 30% lo fueron tardíamente. Se debería mejorar la coordinación operativa entre los 2 niveles de atención en el área de hipertensión y del riesgo cardiovascular

INTRODUCTION: An adequate communication between levels of medical attention is the key point for optimal treatment and outcomes of the hypertensive population. AIMS: The aim of this study was to evaluate the adequacy of the hypertensive patients' derivation from Primary Care to Specialized Care. As secondary objectives, the information registered on the derivation report was assessed and concordance between derivation reason and final diagnosis was analysed. DESIGN: This is an observational, descriptive, multicentre study. Site: Study conducted at the national level. PARTICIPANTS: Specialty Care Physicians receiving hypertensive patients referred from primary care. Principal measurements: On the baseline visit, the specialist physicians assessed the quality of the derivation records and attended the patient. After the study, final diagnosis and treatment is suggested on the final visit. RESULTS: 1769 subjects were included, mean aged 62,4 (13,6) years, 45% female. Time of diagnosis of hypertension was 8,0 (7,7) years. More than the half of the derivation records contained very good information (5,4%; CI 4,3-6,5) or sufficient (50,7%; CI 48,4-53,0). In 7,1% (IC 5,9-8,3) derivation cause was not specified.74,7% of the derivations were considered as appropriate, though 30% were late. Concordance between derivation reasons and final diagnosis was low (kappa index 0,208). CONCLUSIONS: A quarter of the hypertensive population is unnecessary derived to Secondary Care and 30% of the appropriately derived was late. We should improve the interrelation of attention in the hypertension and cardiovascular area between the both attention levels

Difusión de los resultados en salud de los hospitales / Diffusion of hospital health outcomes

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Application of a smartphone nurse call system for nursing care.

BACKGROUND: Traditionally, a patient presses the nurse call button and alerts the central nursing station. This system cannot reach the primary care nurse directly. The aim of this study was to apply a new smartphone system through the cloud system and information technology that linked a smartphone and a mobile nursing station for nursing care service. MATERIALS AND METHODS: A smartphone and mobile nursing station were integrated into a smartphone nurse call system through the cloud and information technology for better nursing care. RESULTS: Waiting time for a patient to contact the most responsible nurse was reduced from 3.8 min to 6 s. The average time for pharmacists to locate the nurse for medication problem was reduced from 4.2 min to 1.8 min by the new system. CONCLUSIONS: After implementation of the smartphone nurse call system, patients received a more rapid response. This improved patients' satisfaction and reduced the number of complaints about longer waiting time due to the shortage of nurses.

Las tecnologías de la información y la comunicación en los sistemas sanitarios. Un nuevo reto para la enfermera / Information and communication technologies in health systems. A new challenge for the nurse

En la actualidad, diversos países están incorporando las Tecnologías dela Información y la Comunicación (TIC) en sus procesos asistenciales, abriendo una nueva perspectiva en la gestión de la información sanitaria. La importancia que adquieren las TIC viene determinada por la posibilidad de poder mejorar la eficiencia de los recursos dedicados al cuidado de la salud de la población. En este proceso de cambio hay que tener en cuenta el factor humano como elemento crucial del sector salud, ya que a pesar de la presión asistencial y el nivel de exigencia de la población, debe garantizar un nivel de excelencia profesional que permita avanzaren la implantación de las TIC. Por todo ello, en este nuevo contexto asistencial, los profesionales enfermeros tienen un papel clave, lo que plantea la necesidad de disponer de una formación específica que les permita dar respuesta a esta nueva situación. La incorporación de las TIC en el ámbito sanitario implica un proceso de adaptación, así como un cambio estructural y social tanto de los profesionales como de los usuarios. El presente artículo tiene como objetivo analizar el proceso de incorporación de las TIC en los sistemas sanitarios y algunas de las implicaciones más destacadas que ello supone para las enfermeras (AU)

At present, many countries are incorporating Information and Communication Technology (ICT) in their care processes, opening a new perspective in the management of health information. The importance gained by ICT is determined by the possibility to improve the efficiency of resources devoted to the health care of the population. In this process of change the human factor must be taken into account and regarded as a crucial element of the health sector, since despite the health workload and the level of demand by the people, a level of professional excellence must be ensured in order to advance in the implementation of ICT. Therefore, in this new context of care, nursing professionals have a key role, raising the need for specific training to enable them to respond to this new situation. The incorporation of information and communication technologies in health care involves a process of adjustment as well asa social structural change, both on the part of professionals and on the part of the users. This article aims to analyze the process of incorporating ICT in health systems and some of the most important implications this has for the nurses (AU)

Numerous ways to answer the call.

Like other communications technology, nurse call systems have evolved considerably over the past 10-15 years, and now offer far more than just their primary function. HEJ editor Jonathan Baillie discussed, with several leading UK-based suppliers, some of the available technologies, considered their pros and cons, and asked senior personnel how they see nurse call systems developing in the short to medium term as demand for an ever wider range of features, and convergence with other equipment, continue to grow.