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Sison SDM, John J, Mac C, Ruopp M, Driver JA. Coordinated-Transitional Care (C-TraC) for Veterans from Subacute Rehabilitation to Home. J Am Med Dir Assoc 2023; 24:1334-1340. [PMID: 37302797 DOI: 10.1016/j.jamda.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To adapt a successful acute care transitional model to meet the needs of veterans transitioning from post-acute care to home. DESIGN Quality improvement intervention. SETTING AND PARTICIPANTS Veterans discharged from a subacute care unit in the VA Boston Healthcare System's skilled nursing facility. METHODS We used the Replicating Effective Programs framework and Plan-Do-Study-Act cycles to adapt the Coordinated-Transitional Care (C-TraC) program to the context of transitions from a VA subacute care unit to home. The major adaptation of this registered nurse-driven, telephone-based intervention was combining the roles of discharge coordinator and transitional care case manager. We report the details of the implementation, its feasibility, and results of process measures, and describe its preliminary impact. RESULTS Between October 2021 and April 2022, all 35 veterans who met eligibility criteria in the VA Boston Community Living Center (CLC) participated; none were lost to follow-up. The nurse case manager delivered core components of the calls with high fidelity-review of red flags, detailed medication reconciliation, follow-up with primary care physician, and discharge services were discussed and documented in 97.9%, 95.9%, 86.8%, and 95.9%, respectively. CLC C-TraC interventions included care coordination, patient and caregiver education, connecting patients to resources, and addressing medication discrepancies. Nine medication discrepancies were discovered in 8 patients (22.9%; average of 1.1 discrepancies per patient). Compared with a historical cohort of 84 veterans, more CLC C-TraC patients received a post-discharge call within 7 days (82.9% vs 61.9%; P = .03). There was no difference between rates of attendance to appointments and acute care admissions post-discharge. CONCLUSIONS AND IMPLICATIONS We successfully adapted the C-TraC transitional care protocol to the VA subacute care setting. CLC C-TraC resulted in increased post-discharge follow-up and intensive case management. Evaluation of a larger cohort to determine its impact on clinical outcomes such as readmissions is warranted.
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Affiliation(s)
- Stephanie Denise M Sison
- Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Joyanne John
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA
| | - Chi Mac
- Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA
| | - Marcus Ruopp
- Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA.
| | - Jane A Driver
- Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA, USA
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Salehi M, Chaudry S, Newman RB, Hartnett J, Rose SJ, Homayounrooz F. Home Oxygen and Monitoring for COVID-19 Patients: A Multidisciplinary Team Approach. J Community Hosp Intern Med Perspect 2023; 13:21-27. [PMID: 37877049 PMCID: PMC10593172 DOI: 10.55729/2000-9666.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction During the initial COVID-19 pandemic peak, Stamford Hospital implemented a home oxygen program (HOP) to create a comprehensive, multi-disciplinary outpatient initiative without sacrificing a safe discharge. Primary care physicians monitored program participants, whose only indication for remaining admitted was an oxygen requirement. We retrospectively examined participant co-morbidities and outcomes, including death and readmission rates to evaluate HOP safety. Methods A retrospective analysis of program participants discharged between April 2020-Janurary 2021 was performed. Variables included demographics, oxygen requirement, days enrolled in the HOP, and major comorbidities such as cardiovascular disease (CVD), diabetes (DM), hypertension (HTN), obesity, chronic kidney disease, malignancies and underlying chronic obstructive pulmonary disease (COPD). Results Among the 138 HOP participants, ages ranged from 23 to 96 (Mean 65.5), with 47.1% female and 52.9% male. The most represented ethnicity included White (48.6%), Hispanic (29.7%), and Black (15.2%). Patients' average time in the HOP was 19 days, requiring an average of 1.7 L/min of home oxygen. Thirteen patients (9.4%) were readmitted to the hospital with 2.9% secondary to worsening COVID-19 hypoxia, but no deaths occurred at home. A significant relationship was found between age and highest home oxygen need. Patients with COPD, HTN, and DM had significantly higher oxygen requirements (P-value <0.05). Conclusion Increasing age, underlying COPD, HTN, and DM were associated with higher oxygen requirements in participants. Given limited availability of hospital beds, and no occurrences of death at home, Stamford Hospital HOP safely helped provide care for sicker patients and enhanced resource allocation.
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Affiliation(s)
- Mahta Salehi
- St. Louis University Hospital, Hematology Oncology Division, 3655 Vista Avenue, St. Louis, MO 63110,
USA
| | - Shehrose Chaudry
- Hartford HealthCare Medical Group at St. Vincent's Health & Wellness Center, 199 Cherry Street, Milford, CT 06460,
USA
| | - Rebecca B. Newman
- Department of Medicine, Stamford Hospital / Columbia University, One Hospital Plaza, Stamford, CT 06902,
USA
| | - Josette Hartnett
- Department of Research and Discovery, Stamford Hospital, One Hospital Plaza, Stamford, CT 06902,
USA
| | - Suzanne J. Rose
- Department of Research and Discovery, Stamford Hospital, One Hospital Plaza, Stamford, CT 06902,
USA
| | - Forugh Homayounrooz
- Department of Medicine, Stamford Hospital / Columbia University, One Hospital Plaza, Stamford, CT 06902,
USA
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Blöndal K, Sverrisdóttir SH, Hafberg A, Ragnarsdóttir ED, Ingadóttir B, Hafsteinsdóttir EJG, Zoëga S, Jónsdóttir H. Confronting the unknown-Nursing surveillance of COVID-19-infected patients through remote telephone calls and in an on-site urgent clinic. J Adv Nurs 2022; 78:3782-3794. [PMID: 35975315 PMCID: PMC9538875 DOI: 10.1111/jan.15355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/14/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
Aim To describe nursing surveillance of coronavirus disease 2019 (COVID‐19)‐infected patients through remote telephone calls and in an on‐site urgent clinic during the first wave of the pandemic as experienced by nurses providing the care. Design Qualitative descriptive study. Methods Data were collected through seven semi‐structured, audio‐recorded, focus group interviews with 24 nurses. Interviews were conducted in May and June 2020, transcribed and analysed using deductive and inductive content analysis into an overarching category, main categories and subcategories. Reporting followed the COREQ guidelines. Results Nurses relied on intensive listening when assessing and caring for COVID‐19‐infected patients. They realized that the patients had complex needs for nursing and healthcare which was beyond the scope of a tentatively prescribed assessment scheme. They designed their care to ensure holistic care, reflected in the overarching category, ‘Confronting an unfamiliar health condition in unprecedented circumstances’ and the categories: ‘Digging into the unknown’ and ‘Ensuring holistic nursing care’. The category ‘Contributing to averting catastrophe’ reflects the wealth of knowledge, support and experience that the nurses used to independently deliver care, albeit in interdisciplinary collaboration, working to their greatest potential. They were proud of the significance of their work. Conclusion Novel nursing surveillance through remote telephone calls and in an on‐site urgent care clinic delivered to COVID‐19 patients self‐managing at home resulted in holistic nursing care during the first wave of the pandemic. This has relevance for professionalism in nursing. Impact Findings give a unique insight into nursing surveillance of COVID‐19‐infected patients provided through telephone calls and in on‐site urgent care clinics. The potential of intensive listening as conducted in the study suggests that it may be feasible to assess and holistically take care of COVID‐19‐infected patients, and other patient groups as well, with this form of healthcare. This has relevance for healthcare beyond crisis management during pandemics. Patient or Public Contribution There was no patient or public contribution as the study only concerned the providers of the service, i.e. the nurses themselves.
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Affiliation(s)
- Katrín Blöndal
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Anna Hafberg
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Brynja Ingadóttir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Sigríður Zoëga
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Helga Jónsdóttir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Nyman MA, Jose T, Croghan IT, Parkulo MA, Burger CD, Schroeder DR, Hurt RT, O'Horo JC. Utilization of an Electronic Health Record Integrated Risk Score to Predict Hospitalization Among COVID-19 Patients. J Prim Care Community Health 2022; 13:21501319211069748. [PMID: 35068257 PMCID: PMC8796071 DOI: 10.1177/21501319211069748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: To evaluate the performance of an Electronic Health Record (EHR) integrated risk score for COVID-19 positive outpatients to predict 30-day risk of hospitalization. Patients and Methods: A retrospective observational study of 67 470 patients with COVID-19 confirmed by polymerase chain reaction (PCR) test between March 12, 2020 and February 8, 2021. Risk scores were calculated based on data in the chart at the time of the incident infection. Results: The Mayo Clinic COVID-19 risk score consisted of 13 components included age, sex, chronic lung disease, congenital heart disease, congestive heart failure, coronary artery disease, diabetes mellitus, end stage liver disease, end stage renal disease, hypertension, immune compromised, nursing home resident, and pregnant. Univariate analysis showed all components, except pregnancy, have significant (P < .001) association with admission. The Mayo Clinic COVID-19 risk score showed a Receiver Operating Characteristic Area Under Curve (AUC) of 0.837 for the prediction of admission for this large cohort of COVID-19 positive patients. Conclusion: The Mayo Clinic COVID-19 risk score is a simple score that is easily integrated into the EHR with excellent predictive performance for severe COVID-19. It can be leveraged to stratify risk for severe COVID-19 at initial contact, when considering therapeutics or in the allocation of vaccine supply.
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Affiliation(s)
| | - Thulasee Jose
- Mayo Clinic, Rochester, MN, USA.,Baptist Hospitals of Southeast Texas, Beaumont, TX, USA
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Jónsdóttir H, Sverrisdóttir SH, Hafberg A, Ómarsdóttir G, Ragnarsdóttir ED, Ingvarsdóttir S, Ingadóttir B, Hafsteinsdóttir EJG, Zoëga S, Blöndal K. "There was no panic"-Nurse managers' organising work for COVID-19 patients in an outpatient clinic: A qualitative study. J Adv Nurs 2021; 78:1731-1742. [PMID: 34931713 PMCID: PMC9306803 DOI: 10.1111/jan.15131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
Aim To provide insight into the contribution of nursing to the establishment and running of a hospital‐based outpatient clinic for COVID‐19 infected patients, and thereby to inform the development of similar nursing care and healthcare more generally. Design Qualitative descriptive study centred on collaboration between nurse managers and researchers. Methods Drawing on Donabedian’s model of quality health services and the work of Allen on “Nurses’ organising work”, data were collected using four semi‐structured, audio‐recorded, focus group interviews with five nurse managers. The interviews were conducted in May and June 2020, transcribed, and subsequently analysed using deductive and inductive content analysis into an overarching category, main categories, and sub‐categories. Results “There was no panic – challenged by the unprecedented” was a strong thread, which was reflected in two categories: (a) Everyone walked in step, containing the sub‐categories: Public officials set the tone, Creating order in disorder, and Mutual respect and teamwork, and (b) Inspired by extraordinary accomplishments, encompassing the sub‐categories: Realising one's potential and Unexpectedly rewarding. In exceptional circumstances the nurse managers’ decision‐making authority grew, material and manpower resources were sufficient, promptly constructed work procedures were in place, and tasks were completed instantly in trusting and respectful interdisciplinary collaboration. With sound support and trust from hospital directors, the nurse managers utilised their expertise to the fullest and they were proud of their work. Conclusion The findings portray the almost invisible work of nurse managers in organising complex care. Although the circumstances were exceptional the findings speak to the accomplishments that can be gained when nurse managers have autonomy and the opportunity to utilise their professional capacity to the fullest. Impact The findings reveal the almost invisible work of nurses in organising complex care and can inform the establishment of outpatient clinics for patients infected with COVID‐19 and of healthcare development more generally.
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Affiliation(s)
- Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Anna Hafberg
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Geirný Ómarsdóttir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Brynja Ingadóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Sigríður Zoëga
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Katrín Blöndal
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
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Duvall J, Grindle GG, Kaplan J, Marks D, Sylvers L, Patel J, Lain M, Bagay A, Chung CS, Cooper RA. VA TECHNOLOGY TRANSFER PROGRAM RESPONDS TO COVID-19 PANDEMIC. TECHNOLOGY AND INNOVATION 2021; 22:173-179. [PMID: 35096277 DOI: 10.21300/22.2.2021.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic stressed healthcare systems all over the world. Two primary challenges that healthcare systems faced were a shortage of personal protective equipment and the need for new technologies to handle infection prevention for staff and patients. The Department of Veteran's Affairs (VA) Technology Transfer Program responded by prioritizing the development of innovations in the Technology Transfer Assistance Project which addressed the pandemic. This paper describes several innovations that addressed the needs of the VA healthcare system during the pandemic and how they were rapidly developed.
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Affiliation(s)
- Jonathan Duvall
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Garrett G Grindle
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Kaplan
- Office of Research and Development Technology Transfer Program, Department of Veterans Affairs, Washington D.C., USA
| | - David Marks
- Office of Research and Development Technology Transfer Program, Department of Veterans Affairs, Washington D.C., USA
| | - Lee Sylvers
- Office of Research and Development Technology Transfer Program, Department of Veterans Affairs, Washington D.C., USA
| | - Jenish Patel
- Office of Research and Development Technology Transfer Program, Department of Veterans Affairs, Washington D.C., USA
| | - Michael Lain
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Andrea Bagay
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - C S Chung
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory A Cooper
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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Yang Y, Mehta NM. "Closing the chasm" - guidelines bridge the gap from evidence to implementation. Pediatr Investig 2021; 5:163-166. [PMID: 34589672 PMCID: PMC8458711 DOI: 10.1002/ped4.12296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Youyang Yang
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s Hospital, and Harvard Medical SchoolBostonMA
- Perioperative & Critical CareCenter for Outcomes ResearchBoston Children’s HospitalBostonMA
| | - Nilesh M. Mehta
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s Hospital, and Harvard Medical SchoolBostonMA
- Perioperative & Critical CareCenter for Outcomes ResearchBoston Children’s HospitalBostonMA
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