Patient and nurse preferences for implementation of bedside handover: Do they agree? Findings from a discrete choice experiment

Objective: To describe and compare patients' and nurses' preferences for the implementation of bedside handover. Design: Discrete choice experiment describing handover choices using six characteristics: whether the patient is invited to participate; whether a family member/carer/friend is invited; the number of nurses present; the level of patient involvement; the information content; and privacy. Setting: Two Australian hospitals. Participants: Adult patients (n=401) and nurses (n=200) recruited from medical wards. Main outcome measures: Mean importance scores for handover characteristics estimated using mixed multinomial logit regression of the choice data. Results: Both patient and nurse participants preferred handover at the bedside rather than elsewhere (P<.05). Being invited to participate, supporting strong two-way communication, having a family member/carer/friend present and having two nurses rather than the nursing team present were most important for patients. Patients being invited to participate and supporting strong two-way communication were most important for nurses. However, contrary to patient preferences, having a family member/carer/friend present was not considered important by nurses. Further, while patients expressed a weak preference to have sensitive information handed over quietly at the bedside, nurses expressed a relatively strong preference for handover of sensitive information verbally away from the bedside. Conclusions: All participants strongly support handover at the bedside and want patients to participate although patient and nurse preferences for various aspects of bedside handover differ. An understanding of these preferences is expected to support recommendations for improving the patient hospital experience and the consistent implementation of bedside handover as a safety initiative

Process redesign for time-based emergency admission targets

Purpose: Hospitals have used process redesign to increase the efficiency of the emergency department (ED) to cope with increasing demand. While there are published studies suggesting a positive outcome, recent reviews have reported that it is difficult to conclude that these approaches are effective as a result of substandard research methodology. The purpose of this paper is to explore the perceptions of hospital staff on the impact of a process redesign initiative on quality of care. Design/methodology/approach: A retrospective qualitative case study examining a Lean Six Sigma (LSS) initiative in a large metropolitan hospital from 2009 to 2010. Non-probability sampling identified interview subjects who, through their participation in the redesign initiative, had a detailed understanding of the implementation and outcomes of the initiative. Between April 2012 and January 2013 26 in-depth semi-structured interviews were conducted and analysed with thematic content analysis. Findings: There were four important findings. First, when asked to comment on the impact of the LSS implementation, without prompting the staff spoke of quality of care. Second, there was little agreement among the participants as to whether the project had been successful. Third, despite the recognition of the need for a coordinated effort across the hospital to improve ED access, the redesign process was not successful in reducing existing divides among clinicians and among managers and clinicians. Finally, staff expressed tension between production processes to move patients more quickly and their duty of care to their patients as individuals. Originality/value: One of the first studies to explore the impact of process redesign through in-depth interviews with participating staff, this study adds further evidence that organisation implementing process redesign must ensure the supporting management practices are in place

Inter-rater reliability of welfare outcomeassessment by an expert and farmers of SouthTyrolean dairy farming

The implementation of an animal welfare assurance programme for dairy cattle in South Tyrol (Eastern Italian Alps) faces particular feasibility constraints due to the outstanding volume of travel associated with routine on-farm audits of remote mountain farms. Therefore, this study aims to estimate the inter-rater reliability of the expert’s and farmers’ welfare outcome assessment regarding recommendations to involve milk producers in animal welfare assurance within South Tyrolean dairy farming. A formal training programme containing a classroom session and an on-farm observation became mandatory for all 188 participating farmers, which was offered by the expert, applied as reference standard. On-farm data collected on the farmers’ cows (dataset of 1719 dairy cows) were compared at animal level. Cohen’s kappa, respectively, weighted kappa, examined for several welfare indicators, range from slight to moderate agreement(k=0.018-0.416;Kw=0.163-0.310). These findings are further confirmed by results at farmlevel (ICC=0.018-0.577). Continuous repeatability checks as part of routine audits are therefore proposed to substantially reduce the variability between the raters and to avoid significant bias in the welfare outcome assessment. In this way, the competence for regular and standardised monitoring could be increasingly transferred to dairy farmers in order to reduce the need for costly and time-consuming inspections by external auditors, which are in long-term perspective also harmful to the alpine environment. Additionally, the promotion of welfare assessment as an instructive management tool would intensify farmers’ commitment to the assessment process

Genetic and environmental risk factors in the non-medical use of over-the-counter or prescribed analgesics, and their relationship to major classes of licit and illicit substance use and misuse in a population-based sample of young adult twins

Background and Aims: The non-medical use of over-the-counter or prescribed analgesics (NMUA) is a significant public health problem. Little is known about the genetic and environmental etiology of NMUA and how these risks relate to other classes of substance use and misuse. Our aims were to estimate the heritability NMUA and sources of genetic and environmental covariance with cannabis and nicotine use, cannabis and alcohol use disorders and nicotine dependence in Australian twins. Design: Biometrical genetic analyses or twin methods using structural equation univariate and multivariate modeling. Setting: Australia. Participants: A total of 2007 young adult twins [66% female; μ\ua0=\ua025.9, standard deviation (SD)\ua0=\ua03.6, range\ua0=\ua018–38] from the Brisbane Longitudinal Twin Study retrospectively assessed between 2009 and 2016. Measurements: Self-reported NMUA (non-opioid or opioid-based), life-time nicotine, cannabis and opioid use, DSM-V cannabis and alcohol use disorders and the Fagerström Test for Nicotine Dependence. Findings: Life-time NMUA was reported by 19.4% of the sample. Univariate heritability explained 46% [95% confidence interval (CI)\ua0=\ua00.29–0.57] of the risks in NMUA. Multivariate analyses revealed that NMUA is moderately associated genetically with cannabis (r\ua0=\ua00.41) and nicotine (r\ua0=\ua00.45) use and nicotine dependence (r\ua0=\ua00.34). In contrast, the genetic correlations with cannabis (r\ua0=\ua00.15) and alcohol (r\ua0=\ua00.07) use disorders are weak. Conclusions: In young male and female adults in Australia, the non-medical use of over-the-counter or prescribed analgesics appears to have moderate heritability. NMUA is moderately associated with cannabis and nicotine use and nicotine dependence. Its genetic etiology is largely distinct from that of cannabis and alcohol use disorders

Improving the Estimation of Risk-Adjusted Grouped Hospital Standardized Mortality Ratios Using Cross-Jurisdictional Linked Administrative Data: A Retrospective Cohort Study.

Background: Hospitals and death registries in Australia are operated under individual state government jurisdictions. Some state borders are located in heavily populated areas or are located near to major capital cities. Mortality indicators for hospital located near state borders may not be estimated accurately if patients are lost as they cross state borders. The aim of this study was to evaluate how cross-jurisdictional linkage of state hospital and death records across state borders may improve estimation of the hospital standardized mortality ratio (HSMR), a tool used in Australia as a hospital performance indicator. Method: Retrospective cohort study of 7.7 million hospital patients from July 2004 to June 2009. Inhospital deaths and deaths within 30 days of hospital discharge from four state jurisdictions were used to estimate the standardized mortality ratio of hospital groups defined by geography and type of hospital (grouped HSMR) under three record linkage scenarios, as follows: (1) cross-jurisdictional person-level linkage, (2) within-jurisdictional (state-based) person-level linkage, and (3) unlinked records. All public and private hospitals in New South Wales, Queensland, Western Australia, and public hospitals in South Australia were included in this study. Death registrations from all four states were obtained from state-based registries of births, deaths, and marriages. Results: Cross-jurisdictional linkage identified 11,116 cross-border hospital transfers of which 170 resulted in a cross-border inhospital death. An additional 496 cross-border deaths occurred within 30 days of hospital discharge. The inclusion of cross-jurisdictional person-level links to unlinked hospital records reduced the coefficient of variation among the grouped HSMRs from 0.19 to 0.15; the inclusion of 30-day deaths reduced the coefficient of variation further to 0.11. There were minor changes in grouped HSMRs between cross-jurisdictional and within-jurisdictional linkages, although the impact of cross-jurisdictional linkage increased when restricted to regions with high cross-border hospital use. Conclusion: Cross-jurisdictional linkage modified estimates of grouped HSMRs in hospital groups likely to receive a high proportion of cross-border users. Hospital identifiers will be required to confirm whether individual hospital performance indicators change

What is needed to prepare speech pathologists to work in adult palliative care?

Background: Speech pathologists have a pivotal role in palliative care, assisting patients with swallowing and communication disorders, yet very little is known about the preparedness of speech pathologists to work in this field. Aims: To investigate the preparedness of speech pathologists for working in palliative care. The term ‘palliative care’ was viewed as an encompassing umbrella term incorporating the management/reduction of symptoms and improvement in a person's quality of life at any point of the disease progression. Methods & Procedures: Participants were Australian-trained speech pathologists who provided adult palliative care services. An online questionnaire was used to gather both quantitative and qualitative data from practising speech pathologists. Qualitative data were analysed and interpreted using conventional content analysis. Descriptive statistics were analysed via the Statistical Package for the Social Sciences (SPSS) for Windows Version 22. Non-parametric tests (chi-square and Mann–Whitney U-test) were used for further analysis. Outcomes & Results: The majority (70%) of participants indicated that their university training did not prepare them to practice in palliative care. Participants who received palliative care education at the tertiary level were significantly more prepared to work with palliative patients than those who had not; however, only a minority (27%) had received such training. Just over half (57%) reported having completed post-university professional development in palliative care. The speech pathologist's role in palliative care was also highlighted, with speech pathologists outlining their contribution to the assessment of patients’ communication and swallowing abilities. In addition, recommendations for palliative care content to be incorporated into university curriculum were suggested. Conclusions & Implications: Speech pathologists can make important contributions to end-of-life care, but there is much scope for improving the availability and quality of university and post-university palliative care training opportunities so that people receiving palliative care are best supported

Identifying paediatric nursing-sensitive outcomes in linked administrative health data

There is increasing interest in the contribution of the quality of nursing care to patient outcomes. Due to different casemix and risk profiles, algorithms for administrative health data that identify nursing-sensitive outcomes in adult hospitalised patients may not be applicable to paediatric patients. The study purpose was to test adult algorithms in a paediatric hospital population and make amendments to increase the accuracy of identification of hospital acquitted events. The study also aimed to determine whether the use of linked hospital records improved the likelihood of correctly identifying patient outcomes as nursing sensitive rather than being related to their pre-morbid conditions. Algorithm for nursing-sensitive outcomes used in adult populations have to be amended before application to paediatric populations. Using unlinked individual hospitalisation records to estimate rates of nursing-sensitive outcomes is likely to result in inaccurate rates

Effect of summer grazing on welfare of dairy cows reared in mountain tie-stall barns

Traditional mountain farms have an important economic, social and environmental role. The Alps management system for dairy cows consists of animals kept indoors from autumn to spring, mostly in tie-stalls, and moved to mountain pasture in summer. The aim of our study was to assess the effect of mountain summer grazing on the welfare of dairy cows housed in tie-stall barns. Twenty-four farms were considered. In twelve of them, animals were reared in tie-stalls and moved to mountain pasture for three months in summer; they were visited three times: (i) four weeks before grazing during the indoor period in the stall; (ii) about three weeks after the start of grazing; and (iii) in the stall, in autumn, at least three weeks after returning from grazing. The other twelve farms kept the animals in tie-stalls all year; they were visited once in autumn. Data were collected following a protocol that considers animal-based measures and structure information on the basis of Quality Welfare Consortium® indications. Data allowed the calculation of both the Animal Needs Index score (ANI 35L) and an overall assessment of the cows' welfare obtained from three general aspects: housing, animal's physical condition, and animal's behaviour. Summer grazing had a significant positive effect on injuries, lameness and animal's rising duration but a negative effect on faeces consistency. Moreover, a reduction of tongue playing was observed. The ANI 35L and the overall assessment did not show significant differences linked to summer grazing, which tended to have a positive but temporary effect on animal behaviour

Evaluating the need for an animal welfare assurance programme in South Tyrolean dairy farming

Animal welfare assurance is of great importance as dairy farming is recently under increasing pressure to meet societal and commercial expectations. Therefore, this study aims to determine the current welfare situation of dairy cattle housed in tie-stalls and free stalls in South Tyrol (Eastern Italian Alps) in order to evaluate the need for establishment of an animal welfare assurance programme. For reasons of research economy, a protocol was used for data collection that would also be applicable for practical use in an animal welfare assurance scheme. Analyses of resource-based and animal-based indicators recorded in 204 farms in North and South Tyrol (1891 dairy cows) reveal some important animal welfare problems mainly related to the provision of resources and the prevalence of skin alterations especially in tie-stall barns, which are still widely spread in mountain areas. Hence, the implementation of an animal welfare assurance scheme is urgently needed to reflect public concerns through regular and standardised monitoring of welfare indicators and continuous encouragement of improvements in dairy cattle welfare towards predefined targets. Concerning tie-stalls, interventions in stall design as well as the selective use of local breeds best adapted to the mountainous conditions appear to be appropriate measures to optimise dairy cattle health and welfare. These findings substantiate the high value of the data that would be collected as part of the assurance programme to gain insights, which could be used in preventive and corrective health plans to improve welfare-friendliness in dairy farming of South Tyrol