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Post-discharge interventions

Lívia Falcão Lima, Bruna Cristina Cardoso Martins, Francisco Roberto Pereira de Oliveira, Rafaela Michele de Andrade Cavalcante, Vanessa Pinto Magalhães, Paulo Yuri Milen Firmino, Liana Silveira Adriano, Adriano Monteiro da Silva, Maria Jose Nascimento Flor, Eugenie Desirée Rabelo Néri
Objective: To describe and analyze the pharmaceutical orientation given at hospital discharge of transplant patients. Methods: This was a cross-sectional, descriptive and retrospective study that used records of orientation given by the clinical pharmacist in the inpatients unit of the Kidney and Liver Transplant Department, at Hospital Universitário Walter Cantídio, in the city of Fortaleza (CE), Brazil, from January to July, 2014. The following variables recorded at the Clinical Pharmacy Database were analyzed according to their significance and clinical outcomes: pharmaceutical orientation at hospital discharge, drug-related problems and negative outcomes associated with medication, and pharmaceutical interventions performed...
July 2016: Einstein
Cedric Mabire, Andrew Dwyer, Antoine Garnier, Joanie Pellet
BACKGROUND: Inadequate discharge planning for the growing elderly population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing's role or the specific components of these interventions. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be proven in practice. OBJECTIVES: To determine the best available evidence on the effectiveness of discharge planning interventions involving at least one nurse on health-related outcomes for elderly inpatients discharged home and to assess the relative impact of individual components of discharge planning interventions...
September 2016: JBI Database of Systematic Reviews and Implementation Reports
N Berndt, H de Vries, L Lechner, F Van Acker, E S Froelicher, F Verheugt, A Mudde, C Bolman
BACKGROUND: Without assistance, smokers being admitted to the hospital for coronary heart disease often return to regular smoking within a year. OBJECTIVE: This study assessed the 12-month effectiveness of a telephone and a face-to-face counselling intervention on smoking abstinence among cardiac patients. Differential effects for subgroups varying in their socioeconomic status and intention to quit smoking were also studied. METHODS: A randomised controlled trial was used...
October 17, 2016: Netherlands Heart Journal
Zeinab Tabanejad, Marzieh Pazokian, Abbas Ebadi
Introduction: Recent studies suggest that liaison nurse intervention might be effective to solve the gap between intensive care unit and wards, but little studies are known about the effect of this intervention. The aim of this study was to investigate the effect of liaison nurse service on patient outcomes after discharging from intensive care unit. Methods: In this single blinded randomized controlled trial, a total of 80 patients were selected by convenience sampling method from two teaching hospitals located in Tehran, Iran...
September 2016: Journal of Caring Sciences
Amira Mustafa, Samar Mahgoub
Delays in the discharge of hospital patients cause a backlog for new admissions from the Emergency Departments (ED), outpatient clinics, and transfers from the Intensive Care Units (ICU). A variety of initiatives have been reported on previously which aim to tackle this problem with variable success. In this quality improvement project, we aimed to increase the proportion of discharged patients who leave the paediatric unit by 12:00 Noon from 7% to 30% by May 2015. A baseline discharge process map was studied to understand the possible causes of the delays...
2016: BMJ Quality Improvement Reports
Derenda Lovelace, Diane Hancock, Sabrina S Hughes, Phyllis R Wyche, Claire Jenkins, Cindy Logan
BACKGROUND: In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%...
November 2016: Professional Case Management
Sooyeon Kim, Sage P Kramer, Adam J Dugan, David J Minion, John C Gurley, Daniel L Davenport, Victor A Ferraris, Sibu P Saha
BACKGROUND: Iliac arterial stenting is performed both in the operating room (OR) and the catheterization lab (CL). To date, no analysis has compared resource utilization between these locations. METHODS: Consecutive patients (n = 105) treated at a single center were retrospectively analyzed. Patients included adults with chronic, symptomatic iliac artery stenosis with a minimum Rutherford classification (RC) of 3, treated with stents. Exclusion criteria were prior stenting, acute ischemia, or major concomitant procedures...
October 12, 2016: International Journal of Surgery
M Teulón González, M Martínez Pillado, M M Cuadrado Martín, M J Rivero Martín, J F Cerezuela Requena
OBJECTIVE: To implement a program of early hospital discharge after an uncomplicated birth, in order to improve the effectiveness, as well as ensuring clinical safety and patient acceptability. MATERIAL AND METHODS: Descriptive study of the effectiveness of an early discharge program after uncomplicated delivery between February 2012 and September 2013. The populations are post-partum women and newborns admitted to the University Hospital of Fuenlabrada, with a duration of less than 24h after uncomplicated delivery that met the defined inclusion criteria...
October 13, 2016: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
Kimberly Giraud, Megan Pontin, Linda D Sharples, Paul Fletcher, Tim Dalgleish, Allaina Eden, David P Jenkins, Alain Vuylsteke
Introduction: Post-operative delirium remains a significant problem, particularly in the older surgical patient. Previous evidence suggests that the provision of supplementary visual feedback about ones environment via the use of a mirror may positively impact on mental status and attention (core delirium diagnostic domains). We aimed to explore whether use of an evidence-based mirrors intervention could be effective in reducing delirium and improving post-operative outcomes such as factual memory encoding of the Intensive Care Unit (ICU) environment in older cardiac surgical patients...
2016: Frontiers in Aging Neuroscience
Robin E Gearing, Kathryne B Brewer, Irfan Mian, Kiara Moore, Prudence Fisher, Jane Hamilton, James Mandiberg
AIM: The timely identification and treatment of psychosis are increasingly the focus of early interventions, with research targeting the initial high-risk period in the months following first-episode hospitalization. Ongoing treatment after stabilization is also essential in the years following a first-episode psychosis (FEP), but has received less research attention. In this study, variables that could impact continued psychiatric service utilization by adolescents following their FEP and temporal patterns in service utilization are examined...
October 11, 2016: Early Intervention in Psychiatry
Hao Wang, Carol Johnson, Richard D Robinson, Vicki A Nejtek, Chet D Schrader, JoAnna Leuck, Johnbosco Umejiego, Allison Trop, Kathleen A Delaney, Nestor R Zenarosa
BACKGROUND: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission...
October 10, 2016: BMC Health Services Research
Harlan M Krumholz, Angela Hsieh, Rachel P Dreyer, John Welsh, Nihar R Desai, Kumar Dharmarajan
BACKGROUND: The risk of rehospitalization is elevated in the immediate post-discharge period and declines over time. It is not known if the extent and timing of risk vary across readmission diagnoses, suggesting that recovery and vulnerability after discharge differ by physiologic system. OBJECTIVE: We compared risk trajectories for major readmission diagnoses in the year after discharge among all Medicare fee-for-service beneficiaries hospitalized with heart failure (HF), acute myocardial infarction (AMI), or pneumonia from 2008-2010...
2016: PloS One
Kirkby D Tickell, Donna M Denno
OBJECTIVE: To understand how the World Health Organization's (WHO's) guidelines on the inpatient care of children with complicated severe acute malnutrition may be strengthened to improve outcomes. METHODS: In December 2015, we searched Google scholar and WHO's website for WHO recommendations on severe acute malnutrition management and evaluated the history and cited evidence behind these recommendations. We systematically searched WHO International Clinical Trials Registry Platform, clinicaltrials...
September 1, 2016: Bulletin of the World Health Organization
Mike Wu, Marzyeh Ghassemi, Mengling Feng, Leo A Celi, Peter Szolovits, Finale Doshi-Velez
BACKGROUND: The widespread adoption of electronic health records allows us to ask evidence-based questions about the need for and benefits of specific clinical interventions in critical-care settings across large populations. OBJECTIVE: We investigated the prediction of vasopressor administration and weaning in the intensive care unit. Vasopressors are commonly used to control hypotension, and changes in timing and dosage can have a large impact on patient outcomes...
October 5, 2016: Journal of the American Medical Informatics Association: JAMIA
David McNeil, Roger Strasser, Nancy Lightfoot, Raymond Pong
The transition from hospital to home is a vulnerable period for patients with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the post-discharge period. Care transition interventions are seen as effective care coordinating mechanisms for reducing avoidable adverse events associated with the transition of the patient from the hospital to the home. A study was undertaken to evaluate the effectiveness of a care transition intervention involving a hand-off between a hospital-based care transitions nurse and a community-based rapid response nurse...
2016: Healthcare Quarterly
Stacy Mathew, Carol Chamberlain, Kristin S Alvarez, Carlos A Alvarez, Monal Shah
Background: Pain is a major health problem affecting more than 15% of adults in the United States. In a multidisciplinary pain management team, pharmacists can optimize pharmacotherapy quality by ensuring safe and appropriate medication use. Objective: Assess the impact of a pharmacy pain medication management service on pain-related outcomes in an adult inpatient population. Methods: This retrospective study evaluated patients who were admitted from November 2009 through November 2011 and received a pharmacy pain consult...
September 2016: Hospital Pharmacy
L M Almond, V Charalampakis, P Mistry, J Hodson, J Matthews, R Singhal, P Super
INTRODUCTION: Laparoscopic anti-reflux surgery is conventionally performed using two 10/12 mm ports. While laparoscopic procedures reduce post-operative pain, the use of larger ports invariably increases discomfort and affects cosmesis. We describe a new all 5 mm ports technique for laparoscopic anti-reflux surgery and present a review of our initial experience with this approach. METHODS: All patients undergoing laparoscopic fundoplication over a 35 month period from February 2013 under the care of a single surgeon were included...
September 30, 2016: International Journal of Surgery
Yangyang R Yu, Paulette I Abbas, Carolyn M Smith, Kathleen E Carberry, Hui Ren, Binita Patel, Jed G Nuchtern, Monica E Lopez
PURPOSE: As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. METHODS: Process maps were created using medical record time stamps...
September 15, 2016: Journal of Pediatric Surgery
Janet F Jensen, Ingrid Egerod, Morten H Bestle, Doris F Christensen, Ask Elklit, Randi L Hansen, Heidi Knudsen, Louise B Grode, Dorthe Overgaard
PURPOSE: The aim of this randomized controlled trial (RCT) was to test the effectiveness of a post-ICU recovery program compared to standard care during the first year after ICU discharge. METHODS: A pragmatic, non-blinded, multicenter, parallel-group RCT was conducted between December 2012 and December 2015, at ten intensive care units (ICUs) in Denmark. We randomly assigned 386 adult patients (≥18 years) after receiving mechanical ventilation (≥48 h) to standard care (SC) plus a nurse-led intensive care recovery program or standard care alone after ICU discharge (190 intervention, 196 SC)...
September 30, 2016: Intensive Care Medicine
Peter A Najjar, Arin L Madenci, Cheryl K Zogg, Eric B Schneider, Christian A Dankers, Marc T Pimentel, Amrita S Chabria, Joel E Goldberg, Gaurav Sharma, Gregory Piazza, Ronald Bleday, Dennis P Orgill, Allen Kachalia
BACKGROUND: Prophylactic anticoagulation is routinely used in the inpatient setting; however, the risk of VTE remains elevated after discharge. Extensive evidence and clinical guidelines suggest post-discharge VTE prophylaxis is critical in at-risk populations but it remains severely underutilized in practice. STUDY DESIGN: We performed a single institution retrospective, non-randomized, pre- and post-intervention analysis of a systematic post-discharge pharmacological prophylaxis program against the primary outcome, post-discharge symptomatic VTE...
September 27, 2016: Journal of the American College of Surgeons
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