Improving Patient Satisfaction with the Virtual Handoff Process through the Utilization of Educational Pamphlets in the Emergency Department

Boarding patients in the emergency room while waiting to transfer the patient to the proper unit can be harmful to clinical care and have significant financial opportunity costs. At one local hospital it was found that on average patients were being boarded in the emergency room (ED) for approximately 85 minutes waiting to be transferred. Several barriers that caused this delay were found including, delay in room cleaning, nurse staff shortage, and inability to give report to the nurse receiving the patient. In an attempt to combat this delay which may be caused by a difficulty in giving patient report, this organization is rolling out a virtual bedside handoff process. While virtual technology is not a new concept, there are many patients that may not be comfortable with the technology. The purpose of the evidence-based project was to provide a written educational pamphlet that details the how’s and why’s of the virtual handoff process to the patient to be given upon admission. The goal of the educational pamphlet was to increase the patients’ satisfaction with the process. A pre-survey was given to a group of patients after they experienced the virtual handoff process to assess their comfort level. These results were compared to the post-survey results of patients that received the educational pamphlet prior to experiencing the virtual handoff process. Ten pre-surveys and seven post-surveys were analyzed utilizing SPSS and descriptive statistics. The analysis concluded that the participants who received the educational pamphlet felt more prepared for the virtual handoff process

Realist evaluation of the impact of paediatric nurse practitioner clinics, specialist paediatric nurses, and a children’s community nursing team in deflecting attendance at emergency departments and urgent care centres by children with long-term conditions

In 2018, the Greater Manchester Children’s Health and Wellbeing Board developed a 10-point strategy to achieve its objectives, the sixth of which was to reduce unnecessary hospital attendances and admissions for children with long term conditions such as asthma, diabetes and epilepsy. Funding was secured from Manchester Academic Health Science Centre to commission an exploration of the impact of the Paediatric Nurse Practitioner Clinic within the context of the Family Services Model and the impact that the service was having on reducing attendance at urgent care centres or admission to hospital. Alternatives to taking children to the ED/UCC can be a preference. An integrated system, with elements able to book directly into others, with rapid access, information, health promotion, and follow-up were essential to success. Extra consultation time for proactive intervention, with sufficient nurses to provide a seven-days service were valued. Advertisement of the service to the public and to professionals is vital for uptake by professionals and the public

The Veterans Health Administration: Implementing Patient-Centered Medical Homes in the Nation's Largest Integrated Delivery System

Describes the implementation of a model that organizes care around an interdisciplinary team of providers who work to identify and remove barriers to access and clinical effectiveness in primary care clinics. Outlines two case studies and lessons learned

Nurses\u27 Perception of Family Presence During Resuscitation

Background Family witnessed resuscitation (FWR) is the concept of allowing family members at bedside during cardiopulmonary resuscitation. Studies have shown that the lack of standard policies by hospitals regarding FWR forces nurses to make different decisions regarding family presence at bedside during resuscitation. The framework for this study is Sandman\u27s teleological model. Objectives To examine nurses\u27 perceptions of having family members present during adult cardiac resuscitation. Methods A descriptive study of 57 registered nurses (n = 57) from northern California was conducted. Participants completed a mailed survey consisting of a 22-item Likert scale questionnaire titled Family Presence Risk-Benefit Scale. Results Analysis from the questionnaire showed that the majority of participants were between the ages of 40-63 and had more than 20 years of working experience. About 51.9% worked in units with no formal policy on FWR and 71.7% had participated in a cardiac resuscitation. Study results show that nurses had varied opinions, but there were no statistically significant results to indicate that the majority of nurses favor FWR. Conclusions The study found there was no statistically significant data to conclude there was any consensus among nurses about the risks or benefits of families at bedside. This study concludes that nurses want to be present in the room if their loved ones were being resuscitated. To help nurses with decision-making guidelines during resuscitation, it is recommended that health-care institutions establish standard policies regarding FWR. Further studies need to be conducted to investigate nurses\u27 perceptions regarding FWR

Care Management of Patients With Complex Health Care Needs

Explores how patients' complexity of healthcare needs, vulnerability, and age affect the cost and quality of their health care. Examines the potential for care management to improve quality of care and reduce costs, elements of success, and challenges

Evaluation of the organisation and delivery of patient-centred acute nursing care

In 2002, a team of researchers from the School of Nursing, University of Salford were commissioned by Bolton Hospitals NHS Trust to evaluate the delivery and organisation of patient-centred nursing care across the acute nursing wards within the Royal Bolton Hospital. The key driver for the commissioning of this study arose from two serious untoward incidents that occurred in the year 2000. Following investigation of both these events the Director of Nursing in post at that time believed that poor organisation and delivery of care may have been a contributory factor. Senior nurses in the Trust had also expressed their concern that care may not be organised in a way that made best use of the skills available

The prevalence of cocaine-associated chest pain in a London hospital

Objectives: To determine the prevalence of cocaine misuse in patients presenting to an Accident and Emergency department with chest pain. 4 of 12 FAEM abstracts www.emjonline.co

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis

Background Pharmacists play important role in ensuring timely care delivery at the ward level. The optimal level of pharmacist input, however, is not clearly defined. Objective To systematically review the evidence that assessed the outcomes of ward pharmacist input for people admitted with acute or emergent illness. Methods The protocol and search strategies were developed with input from clinicians. Medline, EMBASE, Centre for Reviews and Dissemination, The Cochrane Library, NHS Economic Evaluations, Health Technology Assessment and Health Economic Evaluations databases were searched. Inclusion criteria specified the population as adults and young people (age >16 years) who are admitted to hospital with suspected or confirmed acute or emergent illness. Only randomised controlled trials (RCTs) published in English were eligible for inclusion in the effectiveness review. Economic studies were limited to full economic evaluations and comparative cost analysis. Included studies were quality-assessed. Data were extracted, summarised. and meta-analysed, where appropriate. Results Eighteen RCTs and 7 economic studies were included. The RCTs were from USA (n=3), Sweden (n=2), Belgium (n=2), China (n=2), Australia (n=2), Denmark (n=2), Northern Ireland, Norway, Canada, UK and Netherlands. The economic studies were from UK (n=2), Sweden (n=2), Belgium and Netherlands. The results showed that regular pharmacist input was most cost effective. It reduced length-of-stay (mean= -1.74 days [95% CI: -2.76, -0.72], and increased patient and/or carer satisfaction (Relative Risk (RR) =1.49 [1.09, 2.03] at discharge). At £20,000 per quality-adjusted life-year (QALY)-gained cost-effectiveness threshold, it was either cost-saving or cost-effective (Incremental Cost Effectiveness Ratio (ICER) =£632/ QALY-gained). No evidence was found for 7-day pharmacist presence. Conclusions Pharmacist inclusion in the ward multidisciplinary team improves patient safety and satisfaction and is cost-effective when regularly provided throughout the ward stay. Research is needed to determine whether the provision of 7-day service is cost-effective.Peer reviewe

Unlocking skills in hospitals: better jobs, more care

Enabling less highly-trained hospital workers to play a bigger role could improve jobs for doctors and nurses, save public hospitals nearly $430 million a year and fund treatment for more than 85,000 extra people, argues this report. Overview Hospitals are under pressure. They face rising demand, a squeeze on funding and skills shortages in key areas. They have to change. One problem is that too many health professionals squander their valuable skills on work that other people could do. In most cases, it doesn’t take 15 years of post-school training to provide light sedation for a stable patient having a simple procedure. Nor does it take a three-year degree to help someone bathe or eat. But tradition, professional culture and industrial agreements often dictate that highly-trained health professionals spend their time doing straightforward work. This wastes money, makes professional jobs less rewarding and often does not improve care. There are many ways that hospitals can get a better match between workers and their work. This report looks at three examples. The first is using more nursing assistants to provide basic care to patients. The second is letting specialist nurses do common, low-risk procedures currently done by doctors. The third is employing more assistants to support physiotherapists and occupational therapists. These changes can maintain or improve the safety and quality of care. They are among the easiest to take up. Hospitals don’t have to be reorganised or new professions created. They would save public hospitals$430 million a year. That could fund treatment for more than 85,000 extra people. These ideas are supported by solid evidence. They have been tried successfully in Australia, with good results for patients. Hospital CEOs we surveyed for this report strongly support them. Despite all this, progress is painfully slow. Formidable barriers in the form of regulations, culture, tradition and vested interests stand in the way. We need a new mechanism to overcome these barriers – a way to get from isolated trials to broad change. Creating that mechanism is even more important than the examples in this report. People may disagree with specific examples. But no-one can argue that all hospital work is done by the right person, or that a good way currently exists to get change throughout the system. Two things are needed. Hospitals, regulators and professional bodies must improve rules and regulations. State governments must invest money and expertise in spreading good practices. If we don’t update workforce roles, there will be a cost. Hospitals already struggle to provide enough care. Waiting lists are long and demand is growing fast. It’s hard to keep some hospital workers in their jobs. Government budgets are also under pressure. If action isn’t taken to make hospitals more efficient, tougher decisions about who will miss out on care are inevitable. Current workforce roles were designed in the days of the horse and buggy. The choice to update them should be easy. It means more and better care, more rewarding jobs for hospital professionals and a more sustainable system