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Brunt LJ, Rivalland A, Panek-Hudson Y, Krishnasamy M. An Integrative Review of the Support Needs of Informal Caregivers of Hematological Cancer Patients in the Period Immediately Following Discharge From Inpatient to Outpatient Care. Cancer Nurs 2023:00002820-990000000-00186. [PMID: 37962212 DOI: 10.1097/ncc.0000000000001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Preparing informal caregivers for a patient's transition to outpatient care is an important component of safe, quality hematological cancer care. The development of many novel therapies and emerging treatments has created opportunities to address the needs of informal caregivers following the discharge of patients from inpatient settings. OBJECTIVE To review and synthesize the literature on the needs of informal caregivers of patients with a hematological malignancy postdischarge from inpatient care. INTERVENTIONS/METHODS Integrative review methodology was used to explore the body of evidence available. This included a quality appraisal of qualitative, quantitative, and mixed-methods research findings, subsequent data extraction, and inductive thematic synthesis. RESULTS One thousand eight articles were screened with 10 included in the review. Key insights into the needs of caregivers entering the outpatient setting were identified and grouped into key subheadings: Encountering complex emotions knowing what to know, little time for yourself, and collateral impact. CONCLUSION Findings convey the complex and multiple needs of informal caregivers of hematological cancer patients. With a growing population of people with hematological malignancies and innovations in outpatient cancer therapies, there is a pressing need to codesign interventions to support their caregivers. IMPLICATIONS FOR PRACTICE This review has identified a need for more robust research to coproduce interventions in collaboration with caregivers. In addition, interventions developed from further research should be tested in quality implementation science studies to determine their feasibility, sustainability, and impact on outcomes that matter to hematological cancer caregivers.
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Affiliation(s)
- Laura J Brunt
- Author Affiliations: Department of Clinical Haematology, The Royal Melbourne Hospital, City Campus (Mss Brunt, Rivalland, and Panek-Hudson); and Department of Clinical Haematology (Mss Brunt, Rivalland, and Panek-Hudson) and Academic Nursing Unit (Dr Krishnasamy), Peter MacCallum Cancer Centre, Parkville; and Sir Peter MacCallum Departments of Oncology and Nursing, The University of Melbourne (Dr Krishnasamy); and Victorian Comprehensive Cancer Centre Alliance (Dr Krishnasamy), Melbourne, Victoria, Australia
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Ikeri K, Noles K, Dolma K, Roth T, Smithgall A, Skipper C, Zayek M. Optimizing the hospital discharge process to facilitate family-centered care for well newborns. J Perinatol 2023; 43:952-957. [PMID: 37328524 DOI: 10.1038/s41372-023-01703-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The perceptions of discharge readiness differ among caregivers and providers. An efficient planning process ensures timely attainment of discharge readiness. Our aim was to increase the percentage of discharge orders placed by 10 a.m. from 0.5% to 10% within 6 months thereby improving discharge readiness. METHODS We conducted a quality improvement initiative in the newborn nursery between March 2021 and June 2022 (n = 2307). We implemented a physician-led early discharge huddle and standardized the newborn screen (NBS) and circumcision process. RESULTS By 10 a.m., our primary outcome measure, discharge orders, improved from 0.5 to 19%. Our process measures also increased. NBS specimens collected improved from 56 % to 98 % and circumcision rates increased from 66 to 88%. Balancing measure of postpartum hospital days remained stable. CONCLUSIONS Optimizing family-centered discharge processes by addressing key drivers is essential and can be achieved without an increase in postpartum hospital days.
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Affiliation(s)
- Kelechi Ikeri
- University of South Alabama Children's and Women's Hospital, Mobile, AL, USA.
| | - Kristen Noles
- University of South Alabama Children's and Women's Hospital, Mobile, AL, USA
| | - Kalsang Dolma
- University of South Alabama Children's and Women's Hospital, Mobile, AL, USA
| | - Tracy Roth
- University of South Alabama Children's and Women's Hospital, Mobile, AL, USA
| | - Ashley Smithgall
- University of South Alabama Children's and Women's Hospital, Mobile, AL, USA
| | - Caitlin Skipper
- University of South Alabama Children's and Women's Hospital, Mobile, AL, USA
| | - Michael Zayek
- University of South Alabama Children's and Women's Hospital, Mobile, AL, USA
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Right on Schedule: Improving the Rate of Clinic Appointments Scheduled Prior to Hospital Hospital Discharge. Pediatr Qual Saf 2022; 7:e507. [PMID: 35071950 PMCID: PMC8782113 DOI: 10.1097/pq9.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 08/11/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Children with cancer and blood disorders have many healthcare needs that often require inpatient and outpatient management. There is potential for a lapse in care when patients frequently transition between these settings. We aimed to improve the process and increase the rate of scheduled outpatient follow-up appointments at the time of inpatient discharge for all pediatric hematology-oncology patients from a baseline of 68–80%. Methods: A multidisciplinary team developed several Plan-Do-Study-Act cycles to standardize and improve the process of scheduling follow-up appointments, communication to schedulers, and discussion of discharge planning. QI Macros for Excel Version 2019.06 was used for statistical analysis. Our primary outcome was displayed over time with a p-chart. Results: Plan-Do-Study-Act interventions had a statistically significant impact in increasing the percentage of patients with follow-up outpatient appointments scheduled at the time of inpatient discharge from a baseline of 68% to consistently over 80%. Conclusions: This study demonstrates that standardization of care processes and reminders and education of healthcare providers about the new approaches can improve the rates of outpatient follow-up appointments scheduled at the time of hospital discharge from inpatient care.
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Kucharczuk C, Lightheart E, Kodan A, Haynes C, Rabatin S, Burke J, Senger J, Lee L, Brinley S, Decena MA, Cruz JM, Hirsh R, McCauley K. Standardized Discharge Planning Tool Leads to Earlier Discharges and Fewer Readmissions. J Nurs Care Qual 2022; 37:54-60. [PMID: 33734187 DOI: 10.1097/ncq.0000000000000558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In an inpatient setting, aspects of discharge planning are often left to the provider's memory, leading to errors, inefficiencies, and avoidable costs. METHODS A multidisciplinary team of oncology practitioners used process improvement methodologies to redesign the discharge planning process. INTERVENTIONS The primary intervention was an evidence-based discharge planning tool, called the discharge navigator, used from admission through discharge. RESULTS Thirty-day unplanned readmission rates decreased by 29.0% from preimplementation (March 2017 through August 2017) to postimplementation (September 2017 through March 2020). The percentage of patients discharged before noon increased 76.2%. A comparable service not utilizing the intervention saw lesser or no improvement in these measures. CONCLUSION The tool provided a systematic approach to discharge planning. Key design elements included a centralized location within the electronic health record and an electronic shortcut to populate the tool. Although developed for a specialized population, most elements are applicable to any hospitalized patient.
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Affiliation(s)
- Colleen Kucharczuk
- Departments of Advanced Practice (Dr Kucharczuk and Mss Kodan, Haynes, Rabatin, Senger, Lee, and Decena), Quality and Safety (Ms Lightheart), Inpatient Pharmacy (Dr Brinley), Clinical Resource Management (Ms Cruz), and Medicine (Dr Hirsh), Hospital of University of Pennsylvania, Philadelphia; Division of Hospital Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (Ms Burke); and University of Pennsylvania School of Nursing, Philadelphia (Dr McCauley)
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Franklin BJ, Gandhi TK, Bates DW, Huancahuari N, Morris CA, Pearson M, Bass MB, Goralnick E. Impact of multidisciplinary team huddles on patient safety: a systematic review and proposed taxonomy. BMJ Qual Saf 2020; 29:1-2. [PMID: 32265256 DOI: 10.1136/bmjqs-2019-009911] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 02/16/2020] [Accepted: 03/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite significant advances, patient safety remains a critical public health concern. Daily huddles-discussions to identify and respond to safety risks-have been credited with enhancing safety culture in operationally complex industries including aviation and nuclear power. More recently, huddles have been endorsed as a mechanism to improve patient safety in healthcare. This review synthesises the literature related to the impact of hospital-based safety huddles. METHODS We conducted a systematic review of peer-reviewed literature related to scheduled, multidisciplinary, hospital-based safety huddles through December 2019. We screened for studies (1) in which huddles were the primary intervention being assessed and (2) that measured the huddle programme's apparent impact using at least one quantitative metric. RESULTS We identified 1034 articles; 24 met our criteria for review, of which 19 reflected unit-based huddles and 5 reflected hospital-wide or multiunit huddles. Of the 24 included articles, uncontrolled pre-post comparison was the prevailing study design; we identified only two controlled studies. Among the 12 unit-based studies that provided complete measures of statistical significance for reported outcomes, 11 reported statistically significant improvement among some or all outcomes. The objectives of huddle programmes and the language used to describe them varied widely across the studies we reviewed. CONCLUSION While anecdotal accounts of successful huddle programmes abound and the evidence we reviewed appears favourable overall, high-quality peer-reviewed evidence regarding the effectiveness of hospital-based safety huddles, particularly at the hospital-wide level, is in its earliest stages. Additional rigorous research-especially focused on huddle programme design and implementation fidelity-would enhance the collective understanding of how huddles impact patient safety and other targeted outcomes. We propose a taxonomy and standardised reporting measures for future huddle-related studies to enhance comparability and evidence quality.
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Affiliation(s)
- Brian J Franklin
- University of Michigan Medical School, Ann Arbor, Michigan, USA .,Harvard Business School, Boston, Massachusetts, USA
| | | | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nadia Huancahuari
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Charles A Morris
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Michelle Beth Bass
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Goralnick
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ryan S, Ward M, Vaughan D, Murray B, Zena M, O'Connor T, Nugent L, Patton D. Do safety briefings improve patient safety in the acute hospital setting? A systematic review. J Adv Nurs 2019; 75:2085-2098. [PMID: 30816565 DOI: 10.1111/jan.13984] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 12/01/2022]
Abstract
AIMS To synthesize current knowledge about the impact of safety briefings as an intervention to improve patient safety. BACKGROUND Improving safety in health care remains an ongoing challenge. There is a lack of evidence underpinning safety enhancing interventions. DESIGN Mixed method multi-level synthesis. DATA SOURCES Four health literature databases were searched (Cinahl, Medline, Scopus and Health Business Elite) from January 2002 - March 2017. REVIEW METHODS Thomas and Harden approach to mixed method synthesis. RESULTS Following quality appraisal, 12 studies were included. There was significant heterogeneity in study aims, measures, and outcomes. Findings showed that safety briefings achieved beneficial outcomes and can improve safety culture. Outcomes included improved risk identification, reduced falls, enhanced relationships, increased incident reporting, ability to voice concerns, and reduced length of stay. CONCLUSION Healthcare leaders should embrace the potential of safety briefings by promoting their effective use whilst allowing for local adaptation.
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Affiliation(s)
- Sharon Ryan
- Children's University Hospital, Dublin, Ireland
| | - Marie Ward
- Children's University Hospital, Dublin, Ireland
| | | | - Bridget Murray
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Moore Zena
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom O'Connor
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Does grip strength decrease in the very early stages of hematological treatment? Support Care Cancer 2017; 26:333-335. [DOI: 10.1007/s00520-017-3932-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/11/2017] [Indexed: 12/21/2022]
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Montero AJ, Stevenson J, Guthrie AE, Best C, Goodman LM, Shrotriya S, Azzouqa AG, Parala A, Lagman R, Bolwell BJ, Kalaycio ME, Khorana AA. Reducing Unplanned Medical Oncology Readmissions by Improving Outpatient Care Transitions: A Process Improvement Project at the Cleveland Clinic. J Oncol Pract 2016; 12:e594-602. [DOI: 10.1200/jop.2015.007880] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Reducing 30-day unplanned hospital readmissions is a national policy priority. We examined the impact of a quality improvement project focused on reducing oncology readmissions among patients with cancer who were admitted to palliative and general medical oncology services at the Cleveland Clinic. Methods: Baseline rates of readmissions were gathered during the period from January 2013 to April 2014. A quality improvement project designed to improve outpatient care transitions was initiated during the period leading to April 1, 2014, including: (1) provider education, (2) postdischarge nursing phone calls within 48 hours, and (3) postdischarge provider follow-up appointments within 5 business days. Nursing callback components included symptom management, education, medication review/compliance, and follow-up appointment reminder. Results: During the baseline period, there were 2,638 admissions and 722 unplanned 30-day readmissions for an overall readmission rate of 27.4%. Callbacks and 5-day follow-up appointment monitoring revealed a mean monthly compliance of 72% and 78%, respectively, improving over time during the study period. Readmission rates declined by 4.5% to 22.9% (P < .01; relative risk reduction, 18%) during the study period. The mean direct cost of one readmission was $10,884, suggesting an annualized cost savings of $1.04 million with the observed reduction in unplanned readmissions. Conclusion: Modest readmission reductions can be achieved through better systematic transitions to outpatient care (including follow-up calls and early provider visits), thereby leading to a reduction in use of inpatient resources. These data suggest that efforts focused on improving outpatient care transition were effective in reducing unplanned oncology readmissions.
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