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1.
Orv Hetil ; 160(44): 1735-1743, 2019 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-31657253

RESUMO

Introduction: The most common reason for the adverse events in healthcare is communication. Due to the development of health technologies and the increasing specialization of care, more and more healthcare professionals are involved in the treatment of patients, resulting in an increasingly important role and risk for patient handover. Aim: To present the current state of knowledge of patient handover through the results of an international project. Method: Self-developed, anonymous questionnaires with single and multiple choice questions were used to investigate handover knowledge among healthcare workers in 3 Hungarian and 3 Polish hospitals. The frequency of responses was analyzed according to their correctness. The factors that can influence the knowledge were studied using a regression model in the Hungarian sample. Results: The questionnaire was completed by 63% of the 2963 employees who received the questionnaires. In the two countries, there was no significant difference in the proportion of correct responses. Nearly half of the responders (49.4%-45.7%) gave the right answers to the question about the definition of patient handover. The lowest rate of correct answers (14.4%-11.1%) was given to elements of patient handover techniques. The difficulty of the questions also showed a similar pattern. Conclusion: Based on the results, it can be concluded that knowledge of handover needs to be improved in both countries. Although healthcare providers have some knowledge about handover, it cannot be considered accurate and complete. It is important to promote the knowledge and practice of handover together for the safety of patients and healthcare providers. Orv Hetil. 2019; 160(44): 1735-1743.


Assuntos
Comunicação , Conhecimentos, Atitudes e Prática em Saúde , Transferência da Responsabilidade pelo Paciente/organização & administração , Assistência Centrada no Paciente/métodos , Atitude do Pessoal de Saúde , Humanos , Hungria , Polônia , Inquéritos e Questionários
2.
Medicine (Baltimore) ; 98(40): e17459, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577774

RESUMO

To determine the impact of the implementation of a hand-off bundle on medical errors at an inpatient unit of an academic community teaching hospital. Our secondary objective was to determine the research utility of the use of an all-electronic data collection system for medical errors.A retrospective review was conducted of 1290 admissions 6 months before and after implementation of an improved computerized hand-off tool and training bundle. The study took place at an academic community teaching hospital on a Family Medicine inpatient service caring for patients of all ages. The comparison focused on preventable and non-preventable adverse events.A significant decrease in medical errors was noted. Medical error rate dropped from 6.0 (95% CI, 4.2-8.3) to 2.2 (95% CI, 1.2-3.7) per 100 admissions (P < .001). Preventable medical errors dropped from 0.65 (95% CI, 0.18-1.67) to 0.15 (95% CI, 0.03-0.82) per 100 admissions (P = .194). Non-intercepted potential adverse events dropped from 1.30 (95% CI, 0.56-2.57) to 0.44 (95% CI, 0.09-1.30) per 100 admissions (P = .131). Intercepted potential adverse events dropped from 0.98 (95% CI 0.36-2.13) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .766) and errors with little potential for harm dropped from 2.77 (95% CI 1.61-4.43) to 0.74 (95% CI 0.24-1.7) per 100 admissions (P = .009).Implementation of a standardized hand-off bundle was associated with a reduction in medical errors despite a low overall event rate. Further studies are warranted to determine the generalizability of this finding, to examine the overall epidemiology of medical errors and the reporting of such events within general medical teaching units.


Assuntos
Medicina de Família e Comunidade , Internato e Residência , Erros Médicos/prevenção & controle , Pacotes de Assistência ao Paciente , Transferência da Responsabilidade pelo Paciente/organização & administração , Centros Médicos Acadêmicos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos
5.
J Clin Nurs ; 28(17-18): 3262-3270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31066144

RESUMO

AIMS AND OBJECTIVES: To investigate patients' satisfaction with care, 2 years after the introduction of person-centred handover (PCH) in an oncological inpatient setting, and to describe patients' perceptions of individualised care. BACKGROUND: To obtain higher levels of patient satisfaction, bedside nursing handovers have been evaluated with positive results. One such model is PCH, which blends aspects of person-centred care with the bedside report and provides the opportunity for nursing staff and patients to perform the handover together. DESIGN: A survey-based design was used with one data collection period. Patient satisfaction scores were compared with baseline data from a previous study that has been conducted in the same wards. METHOD: Patient satisfaction was measured with the EORTC IN-PATSAT32 questionnaire, and individualised care was assessed with the Individualized Care Scale. A total of 120 adult patients with cancer were invited to participate from August 2017-March 2018. Of these, 90 chose to participate. The STROBE checklist for cross-sectional studies was used when preparing the paper. RESULTS: Compared to the previous study, statistically significant improvements in patient satisfaction were observed in the subscales "Exchange of information between caregivers" and "Nurses' information provision" postimplementation of PCH. Regarding patients' perceptions of individualised care, the highest scores were in the ICS-A subscale "Clinical situation" and ICS-B "Decisional control," while "Personal life situation" scored the lowest overall. CONCLUSIONS: Person-centred handover seems to have sustainable positive effects on important outcomes regarding patient satisfaction. A novel finding is the positive impact on nurses' information provision, indicating that PCH can facilitate effective information exchange between patients and nurses. RELEVANCE TO CLINICAL PRACTICE: Person-centred handover seems to improve patients' satisfaction with nurses' provision and exchange of information. Nurses and managers should carefully consider the implementation process of PCH and evaluate its long-term effects. PCH can be recommended in the oncology inpatient setting.


Assuntos
Neoplasias/enfermagem , Transferência da Responsabilidade pelo Paciente/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Relações Enfermeiro-Paciente , Assistência Centrada no Paciente/métodos , Inquéritos e Questionários
6.
J Clin Nurs ; 28(15-16): 3001-3011, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30938014

RESUMO

AIMS AND OBJECTIVES: To evaluate (a) the perceived effects of the training provided to nurses under a standardised Connect, Ask, Respond and Empathise (CARE) protocol; (b) the ability to enhance the effectiveness of the ISBAR checklist; (c) any increase in nurses' spoken interactions and/or improved comprehension of the patient conditions upon the transfer of responsibility. BACKGROUND: Nursing handover is a pivotal act of communication with effects on both patient safety and risk management. Previous studies of critical incidents have highlighted ineffective communication, including a lack of interaction and incomplete and unstructured handovers, as a major contributor to patient harm. DESIGN: A pre- and post evaluation study involving a questionnaire survey before and after the 3-hours training. METHODS: Forty-nine randomly selected bilingual nurses with no previous professional development experience in handover communication were trained according to the CARE protocol, and their perceptions of nursing handovers were assessed before and after training using questionnaire. The STROBE checklist is used (See File S1). RESULTS: Training of the CARE protocol improved key areas of the handover process. All participating nurses exhibited significant improvements in their perceptions of effective handover from before to after training. Particularly, improvements were observed in the interactive frequency and quality and completeness of the presented patient information per handover. CONCLUSIONS: The nurses reported a deeper understanding of their perceptions of handover after a patient-centred intervention, a better quality of interactions (e.g., querying and checking by incoming nurses), a greater focus when managing handovers and a more complete and comprehensive transfer of information between nurses. RELEVANCE TO CLINICAL PRACTICE: CARE protocol-based training yielded significant improvements in nursing handover practice.


Assuntos
Recursos Humanos de Enfermagem no Hospital/educação , Transferência da Responsabilidade pelo Paciente/organização & administração , Avaliação de Programas e Projetos de Saúde , Adulto , Lista de Checagem/métodos , Lista de Checagem/normas , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Multilinguismo , Segurança do Paciente/normas , Percepção , Inquéritos e Questionários , Adulto Jovem
8.
J Clin Nurs ; 28(9-10): 1999-2008, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30706557

RESUMO

AIMS AND OBJECTIVES: To explore how the hospital and home care nurses talk about and experience cross-sectoral collaboration related to the transitional care of frail older patients. BACKGROUND: Effective communication and collaboration between nurses involved in care transition are crucial for a safe patient handover. Organisational systems to support cross-sectoral collaboration have been developed but do not always promote the intended dialogue and precise and useful exchange of information. Other factors may also be of importance to an effective and constructive cross-sectoral nurse collaboration. DESIGN: A qualitative design using thematic analysis. METHODS: Data were extracted from 24 focus group interviews conducted with registered nurses from eight hospital wards and six municipalities and a total of 165 hr of observations conducted in three hospital wards and three municipalities. The study was reported according to the COREQ guidelines. RESULTS: The perception of nursing and care differed across sectors. The nurses expressed having shared goals for the patients-however, these goals derived from different values, the perception of nursing and approach to the patients. The lack of knowledge of each other's working conditions created assumptions and preconceptions, which affected communication and collaboration related to planning and executing care transition negatively. CONCLUSIONS: The nurses perceived the hospital and home care as" two worlds". The collaboration between the nurses was characterised by insufficient communication and preconceptions rather than concrete knowledge and different cultures and professional identities. It can be questioned whether cross-sectoral collaboration between nurses should be characterised as interprofessional rather than intraprofessional collaboration as the features of the nurses' collaboration. RELEVANCE TO CLINICAL PRACTICE: Organisational and political systems should recognise that nurses in different sectors are taking care of various aspects of nursing when planning on policies to support cross-sectoral collaboration. More possibilities for nurses across sectors to meet should be made available.


Assuntos
Comportamento Cooperativo , Relações Interprofissionais , Transferência da Responsabilidade pelo Paciente/organização & administração , Cuidado Transicional/organização & administração , Enfermagem em Saúde Comunitária/organização & administração , Feminino , Grupos Focais , Humanos , Recursos Humanos de Enfermagem no Hospital/organização & administração , Pesquisa Qualitativa
10.
Clin Teach ; 16(2): 114-119, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29600582

RESUMO

BACKGROUND: Emergency Medicine (EM) and Hospital Medicine (HM) providers frequently interact when transitioning patients from the emergency department (ED) to the inpatient unit; however, there is infrequent collaboration between these subspecialties, and effective communication in EM-HM provider handover is an area for improvement. Shared mental models can enhance communication and safety. The purpose of this article is to describe the implementation of an interdisciplinary conference to allow providers to create shared mental models, and to assess the impact on attitudes and behaviours towards communication and collaboration outside the competing attentions of patient care environments. METHODS: The authors instituted a quarterly interactive case-based conference at an academic tertiary care children's hospital in which EM and HM subspecialty trainees co-facilitate evidence-based interactive presentations of clinical, diagnostic or management dilemmas. The conferences were evaluated via repeated cross-sectional surveys of EM and HM providers, as well as session evaluations. Surveys included multiple-choice, Likert-scale and free-text responses to assess the degree of interaction and collaboration between the divisions and provider attitudes toward changes in clinical practice. RESULTS: Assessment of the EM-HM collaborative conferences demonstrated trends towards increased interaction between divisions and increased discussion about management decisions among colleagues. Two-thirds of individuals who attended at least one conference felt that having attended an interdisciplinary conference influenced future management decisions. Effective communication in EM-HM provider handover is an area for improvement CONCLUSIONS: Interdisciplinary conferences provide a forum for cross-specialty communication to discuss management differences in a low-stress educational environment, and allow providers to develop shared mental models for effective, safe patient care.


Assuntos
Medicina de Emergência/educação , Medicina Hospitalar/educação , Relações Interprofissionais , Modelos Psicológicos , Transferência da Responsabilidade pelo Paciente/organização & administração , Centros Médicos Acadêmicos/organização & administração , Comunicação , Comportamento Cooperativo , Estudos Transversais , Tomada de Decisões , Hospitais Pediátricos/organização & administração , Humanos , Transferência da Responsabilidade pelo Paciente/normas
11.
J Clin Nurs ; 28(5-6): 1010-1021, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30230083

RESUMO

AIM: To examine nursing handover of vital signs during patient care transition from the emergency department (ED) to inpatient wards. BACKGROUND: Communication failures are a leading cause of patient harm making communication through clinical handover an international healthcare priority. The transition of care from ED to ward settings is informed by nursing handover. Vital sign abnormalities in the ED are associated with clinical deterioration following hospital admission. Understanding the role and perceived value of vital sign content in clinical handover is important for patient safety. METHODS: An integrative design was used. A search of electronic databases was undertaken using MEDLINE, CINAHL, EMBASE, Cochrane, Web of Science and SCOPUS. Identified records were screened to elicit further studies for inclusion. A comprehensive peer-review screening process was performed. Studies were included that described the surrounding issues of handover, vital signs, ED, transition of care and ward. RESULTS: Five studies were included in the final review, one specific to nursing and four specific to emergency medicine. Vital signs were perceived to be an important inclusion in clinical handover, and the communication of vital signs in handover was perceived to be indicators for patient safety and risk factors for future clinical deterioration. The ED environment had an influence on effective communication within handover. CONCLUSIONS: Vital signs were an important inclusion for clinical handover. Deficiencies in vital sign content were perceived to be risk factors for patient adverse events following hospital admission. The quality of vital sign information in clinical handover may be important for accurate decision-making. RELEVANCE TO CLINICAL PRACTICE: Vital signs are an important component of clinical handover and are perceived to be indicators for patient safety and risk of future adverse events.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Transferência de Pacientes/métodos , Sinais Vitais , Hospitalização , Humanos , Segurança do Paciente/normas
13.
Ann Emerg Med ; 73(3): 248-254, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30287122

RESUMO

STUDY OBJECTIVE: Patient handoffs at shift change in the emergency department (ED) are a well-known risk point for patient safety. Numerous methods have been implemented and studied to improve the quality of handoffs to mitigate this risk. However, few have investigated processes designed to decrease the number of handoffs. Our objective is to evaluate a novel attending physician staffing model in an academic pediatric ED that was designed to decrease patient handoffs. METHODS: A multidisciplinary team met in August 2012 to redesign the attending physician staffing model. The team sought to decrease patient handoffs, optimize provider efficiency, and balance workload without increasing total attending physician hours. The original model required multiple handoffs at shift change. This was replaced with overlapping "waterfall" shifts. This was a retrospective quality improvement study of a process change that evaluated the percentage of intradepartmental handoffs before and after implementation of a new novel attending physician staffing model. In addition, surveys were conducted among attending physicians and charge nurses to inquire about perceived impacts of the change. RESULTS: A total of 43,835 patient encounters were analyzed. Immediately after implementation of the new model, there was a 25% reduction in the proportion of encounters with patient handoffs, from 7.9% to 5.9%. A survey of physicians and charge nurses demonstrated improved perceptions of patient safety, ED flow, and job satisfaction. CONCLUSION: This new emergency physician staffing model with overlapping shifts decreased the proportion of patient handoffs. This innovative system can be implemented and scaled to suit EDs that have more than single-physician coverage.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Segurança do Paciente/normas , Admissão e Escalonamento de Pessoal/organização & administração , Criança , Hospitais de Ensino , Humanos , Tempo de Internação/estatística & dados numéricos , Pediatria , Melhoria de Qualidade , Estudos Retrospectivos , Gestão de Riscos , Inquéritos e Questionários
14.
Clin Teach ; 16(1): 58-63, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29508531

RESUMO

BACKGROUND: Handovers in patient care are increasingly common occurrences in medicine and are highly susceptible to communication failures. Intraoperative anaesthesiology handovers are especially challenging because of concurrent management of the patient. Our goal was to develop and use an electronic handover checklist as an educational tool to teach anaesthesiology trainees a standardised method of handing over a case intraoperatively. We hypothesised that the use of the checklist would systematically enhance the transfer of accurate and complete information. METHODS: Thirty-four anaesthesia trainees were observed giving an intraoperative handover without the checklist, and then again with the checklist at a later time. An observational handover assessment tool was used by investigators to mark each item as either spontaneously relayed by the giver, elicited by the receiver, not discussed or not applicable to the case. After the use of the checklist, each handover giver filled out a survey related to his or her perceptions of the checklist. RESULTS: The proportion of items spontaneously relayed increased from 54% without the checklist to 98% when using the checklist (p < 0.0001). More than 90% of participants felt that the checklist increased handover efficiency and communication skills. All participants stated that the handovers were more thorough with the checklist and that they would incorporate it into their daily practice. Intraoperative anaesthesiology handovers are especially challenging because of concurrent management of the patient DISCUSSION: With the intervention of the checklist, our results show that the use of a standardised intraoperative checklist improved the transfer of important patient information among anaesthesia trainees.


Assuntos
Anestesiologia/educação , Lista de Checagem/normas , Internato e Residência/organização & administração , Cuidados Intraoperatórios/normas , Transferência da Responsabilidade pelo Paciente/organização & administração , Comunicação , Eficiência Organizacional , Humanos , Internato e Residência/normas , Equipe de Assistência ao Paciente/organização & administração , Transferência da Responsabilidade pelo Paciente/normas
15.
J Clin Nurs ; 28(1-2): 80-88, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30092619

RESUMO

AIMS AND OBJECTIVES: To examine clinical handover practices in acute care services in Ireland. Objectives were to examine clinical handover practices between and within teams and between shifts, to identify resources and supports to enhance handover effectiveness and to identify barriers and facilitators of effective handover. BACKGROUND: Clinical handover is a high-risk activity, and ineffective handover practice constitutes a risk to patient safety. Evidence suggests that handover effectiveness is achieved through staff training and standardised handover protocols. DESIGN: The study design was qualitative-descriptive using inductive analysis. METHODS: The study involved a series of focus group discussions and interviews among a sample of healthcare practitioners recruited from 12 urban and regional acute hospitals in Ireland. A total of 116 healthcare professionals took part in 28 interviews and 13 focus group discussions. We analysed the data using the directed content analysis method. RESULTS: Data collection generated rich qualitative data, yielding five categories from which two broad themes emerged: "policy and practice" and "handover effectiveness." The themes and their associated categories indicate that there is limited organisational-level policy and limited explicit training in clinical handover, that medical and nursing handovers are separate activities with somewhat different purposes and different modes of execution, and that several factors in the acute care setting, including location, timing and documentation, act as either barriers or enablers to handover effectiveness. CONCLUSION: The evidence in the current study suggests that clinical handover merits increased level of prominence in hospital policies or operating procedures. Medical and nursing handover practices represent distinct activities in their content and execution that may be related to cultural and organisational factors. RELEVANCE TO CLINICAL PRACTICE: Achieving multidisciplinary team handover requires a change in embedded traditional practices. Several aspects of the clinical handover activities of nursing and medical staff appear to diverge from best-practice evidence.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Cuidados Críticos/organização & administração , Relações Interprofissionais , Transferência da Responsabilidade pelo Paciente/organização & administração , Segurança do Paciente/normas , Atitude do Pessoal de Saúde , Comunicação , Feminino , Grupos Focais , Humanos , Irlanda , Masculino , Pesquisa Qualitativa
16.
BMJ Open ; 8(12): e019553, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-30552238

RESUMO

OBJECTIVES: Ensure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration. DESIGN: Quality improvement before-after unblinded trial. SETTING: 430-bed Canadian community teaching hospital. PARTICIPANTS: All admitted adult medical-surgical patients in a before-after 12-month interventional study. INTERVENTION: Locally validated checklist (Modified Early Warning Score+urinary catheter in situ+nurse concern) with an intentional pause and explicit management options was deployed as a modification of an existing ward transfer of accountability fax report in the emergency department (ED). RESULTS: Following deployment of Emergency Room Safer Transfer of Patients (ER-STOP), the risk of an unexpected CCRT (critical care response team) response within 24 hours of admission from ED to adult medical and surgical wards was significantly decreased (OR 4.1, 95% CI 2.17 to 7.77). Mean (±SD) ED wait times (5.66±1.54vs 5.74±1.04 hours, p=0.30), intensive care unit admission rate (3.84%, n=233vs 4.61%, n=278, p=0.06) and cardiac care unit admission rate (9.51%, n=577vs 9.60%, n=579, p=0.198) were unchanged. CONCLUSIONS: ER-STOP improvement was out of proportion to the predictive value of the checklist component suggesting that effectiveness of this low-cost sustainable tool was related to increased situational awareness, empowering a culture of patient safety and repurposing of an adjacent ED medical short-stay unit use. Local adaptation within existing processes is essential to successful safety outcomes.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Hospitais Comunitários/organização & administração , Hospitais de Ensino/organização & administração , Transferência da Responsabilidade pelo Paciente/organização & administração , Segurança do Paciente , Transferência de Pacientes/organização & administração , Melhoria de Qualidade/organização & administração , Adolescente , Adulto , Idoso , Canadá , Lista de Checagem , Grupos Diagnósticos Relacionados , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Adulto Jovem
17.
BMJ Open ; 8(11): e024228, 2018 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-30498049

RESUMO

OBJECTIVES: There is considerable variation in non-conveyance rates between ambulance services in England. The aim was to explore variation in how each ambulance service addressed non-conveyance for calls ending in telephone advice and discharge at scene. DESIGN: A qualitative interview study. SETTING: Ten large regional ambulance services covering 99% of the population in England. PARTICIPANTS: Between four and seven interviewees from each ambulance service including managers, paramedics and healthcare commissioners, totalling 49 interviews. METHODS: Telephone semistructured interviews. RESULTS: The way interviewees in each ambulance service discussed non-conveyance within their organisation varied for three broad themes. First, ambulance service senior management appeared to set the culture around non-conveyance within an organisation, viewing it either as an opportunity or as a risky endeavour. Although motivation levels to undertake non-conveyance did not appear to be directly affected by the stability of an ambulance service in terms of continuity of leadership and externally assessed quality, this stability could affect the ability of the organisation to innovate to increase non-conveyance rates. Second, descriptions of workforce configuration differed between ambulance services, as well as how this workforce was used, trained and valued. Third, interviewees in each ambulance service described health and social care in the wider emergency and urgent care system differently in terms of availability of services that could facilitate non-conveyance, the amount of collaborative working between health and social care services and the ambulance service and complexity related to the numbers of services and healthcare commissioners with whom they had to work. CONCLUSIONS: This study suggests that factors within and outside the control of ambulance services may contribute to variation in non-conveyance rates. These findings can be tested in a quantitative analysis of factors affecting variation in non-conveyance rates between ambulance services in England.


Assuntos
Ambulâncias/estatística & dados numéricos , Entrevistas como Assunto , Alta do Paciente/estatística & dados numéricos , Ambulâncias/organização & administração , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/estatística & dados numéricos , Inglaterra , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Transferência da Responsabilidade pelo Paciente/organização & administração , Transferência da Responsabilidade pelo Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Encaminhamento e Consulta/estatística & dados numéricos , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos
18.
Orv Hetil ; 159(44): 1789-1793, 2018 Nov.
Artigo em Húngaro | MEDLINE | ID: mdl-30392410

RESUMO

INTRODUCTION: Transfer is a planned movement of patients and their medical records from one provider to another. Only a few data are available from real life in inflammatory bowel disease patients in this topic. AIM: Our aim was to retrospectively evaluate the results of the transfer of our patients without longitudinal transition. METHOD: Data of the transferred patients at the University of Szeged were analysed. Patients were diagnosed in paediatric care. Transfer strategy at our departments was detailed medical summary. RESULTS: 59 patients were enrolled in this study. 28.8% of the patients had mild to moderate disease activity and 71.2% was in remission at the time of transfer. Steroid therapy was initiated in 58% of the patients within an average of 9.1 months after the transfer. Anti-tumor necrosis factor therapy was given to 24% of the patients during the paediatric care and to an additional 23% in the adult care within an average of 28 months. Almost 70% of the patients received immunosuppressive therapy during paediatric and adult care. Surgery was required in 17% of the patients within an average 10.7 months after the transfer. CONCLUSION: Our results revealed that one-third of the paediatric patients have been transferred to adult care in active stage of disease. Shortly after the transfer 58% of the patients required corticosteroids and 17% surgery. Every fifth patient needed biological therapy to be initiated after the transfer. Longitudinal transition may have a potential to decrease the need for therapeutic change and the relatively high rate of surgery. Orv Hetil. 2018; 159(44): 1789-1793.


Assuntos
Doenças Inflamatórias Intestinais/terapia , Comunicação Interdisciplinar , Transferência da Responsabilidade pelo Paciente/organização & administração , Transição para Assistência do Adulto/organização & administração , Adolescente , Medicina do Adolescente , Feminino , Humanos , Hungria , Masculino , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Tempo
19.
BMC Med Educ ; 18(1): 249, 2018 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-30390668

RESUMO

BACKGROUND: Handoff education is both formal and informal and varies widely across medical school and residency training programs. Despite many efforts to improve clinical handoffs, little evidence has shown meaningful improvement. The objective of this study was to identify residents' perspectives and develop a deeper understanding on the necessary training to conduct safe and effective patient handoffs. METHODS: A qualitative study focused on the analysis of cognitive task interviews targeting end-of-shift handoff experiences with 35 residents from three geographically dispersed VA facilities. The interview data were analyzed using an iterative, consensus-based team approach. Researchers discussed and agreed on code definitions and corresponding case examples. Grounded theory was used to analyze the transcripts. RESULTS: Although some residents report receiving formal training in conducting handoffs (e.g., medical school coursework, resident boot camp/workshops, and handoff debriefing), many residents reported that they were only partially prepared for enacting them as interns. Experiential, practice-based learning (i.e., giving handoffs, covering night shift to match common issues to handoff content) was identified as the most suited and beneficial for delivering effective handoff training. Six skills were described as critical to learning effective handoffs: identifying pertinent information, providing anticipatory guidance, applying acquired clinical knowledge, being concise, incorporating delivery strategies, and appreciating the styles/preferences of handoff recipients. CONCLUSIONS: Residents identified the immersive performance and the experience of covering night shifts as the most important aspects of learning to execute effective handoffs. Formal education alone can miss the critical role of real-time sense-making throughout the process of handing off from one trainee to another. Interventions targeting senior resident mentoring and night shift could positively influence the cognitive and performance capacity for safe, effective handoffs.


Assuntos
Continuidade da Assistência ao Paciente/normas , Assistência à Saúde/normas , Internato e Residência , Transferência da Responsabilidade pelo Paciente/normas , Segurança do Paciente/normas , Assistência à Saúde/métodos , Humanos , Transferência da Responsabilidade pelo Paciente/organização & administração , Estudos Prospectivos , Pesquisa Qualitativa
20.
Nurse Educ Pract ; 33: 107-113, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30273803

RESUMO

The aim of this study was to determine the effectiveness of an education intervention for the implementation of the clinical handover tool iSoBAR, in an acute setting. A quantitative, descriptive survey design, using pre and post survey data before and after the implementation of an education intervention was used. Twenty nine nurses, doctors and allied health personnel employed at the study site participated in the study. The educational intervention consisted of an electronic presentation plus simulated video recorded exemplars of clinical handover. Outcome measures were the efficacy of the education intervention on the confidence of practitioners using the iSoBAR handover tool. Participants' understanding of the iSoBAR tool using Mann-Whitney U test was 2.54 pre-intervention and 4.32 post-intervention. Confidence in using the tool also increased post educational intervention from 2.7 (pre-intervention) to 4.07 (post-intervention). Focus groups identified several factors relating to the implementation of iSoBAR, creating two dominant themes: challenges concerning patient factors and change management processes and systems. Opportunities were identified: Practice enhancement, patient centred care, professional practice, and grassroots initiatives. The use of an interprofessional educational program increased the confidence and understanding of a range of health care practitioners when using the clinical handover tool iSoBAR.


Assuntos
Protocolos Clínicos , Continuidade da Assistência ao Paciente/organização & administração , Pessoal de Saúde/educação , Hospitais , Transferência da Responsabilidade pelo Paciente/organização & administração , Adulto , Austrália , Feminino , Grupos Focais , Humanos , Masculino , Inquéritos e Questionários , Gravação em Vídeo/métodos
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