Proposed Workflow for Rehabilitation in a Field Hospital Setting during the COVID‐19 Pandemic

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156218/2/pmrj12405_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156218/1/pmrj12405.pd

Implementation of Primary Care Pandemic Plan: Respiratory Clinic Model

Implementation articleObjective: In an effort to keep our patients and staff safe while providing necessary care, we implemented phases 2 and 3 of the Primary Care Pandemic Plan as described by Krist et al.1 We consolidated clinics, we converted nearly all visits to virtual visits and separated the remaining face to face visits into sick and well patient cohorts.https://deepblue.lib.umich.edu/bitstream/2027.42/154742/1/Respiratory clinic for Amb Care during COVID_ revised_FINAL.pdfDescription of Respiratory clinic for Amb Care during COVID_ revised_FINAL.pdf : Main Articl

A taxonomy and cultural analysis of intra‐hospital patient transfers

Existing research on intra‐hospital patient transitions focuses chiefly on handoffs, or exchanges of information, between clinicians. Less is known about patient transfers within hospitals, which include but extend beyond the exchange of information. Using participant observations and interviews at a 1,541‐bed, academic, tertiary medical center, we explored the ways in which staff define and understand patient transfers between units. We conducted observations of staff (n = 16) working in four hospital departments and interviewed staff (n = 29) involved in transfers to general medicine floors from either the Emergency Department or the Medical Intensive Care Unit between February and September 2015. The collected data allowed us to understand transfers in the context of several hospital cultural microsystems. Decisions were made through the lens of the specific unit identity to which staff felt they belonged; staff actively strategized to manage workload; and empty beds were treated as a scarce commodity. Staff concepts informed the development of a taxonomy of intra‐hospital transfers that includes five categories of activity: disposition, or determining the right floor and bed for the patient; notification to sending and receiving staff of patient assignment, departure and arrival; preparation to send and receive the patient; communication between sending and receiving units; and coordination to ensure that transfer components occur in a timely and seamless manner. This taxonomy widens the study of intra‐hospital patient transfers from a communication activity to a complex cultural phenomenon with several categories of activity and views them as part of multidimensional hospital culture, as constructed and understood by staff.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145512/1/nur21875.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145512/2/nur21875_am.pd

Development of the Socioeconomic Screening, Active Engagement, Follow-up, Education, Discharge Readiness, and Consistency (SAFEDC) Model for Improving Transitions of Care: Participatory Design

BackgroundTransition to home after hospitalization involves the potential risk of adverse patient events, such as knowledge deficits related to self-care, medication errors, and readmissions. Despite broad organizational efforts to provide better care transitions for patients, there are challenges in implementing interventions that effectively improve care transition outcomes, as evidenced by readmission rates. Collaborative efforts that require health care professionals, patients, and caregivers to work together are necessary to identify gaps associated with transitions of care and generate effective transitional care interventions. ObjectiveThis study aims to understand the usefulness of participatory design approaches in identifying the design implications of transition of care interventions in health care settings. Through a series of participatory design workshops, we have brought stakeholders of the health care system together. With a shared understanding of care transition and patient experience, we have provided participants with opportunities to generate possible design implications for care transitions. MethodsWe selected field observations in clinical settings and participatory design workshops to develop transitional care interventions that serve each hospital’s unique situation and context. Patient journey maps were created and functioned as tools for creating a shared understanding of the discharge process across different stakeholders in the health care environment. The intervention sustainability was also assessed. By applying thematic analysis methods, we analyzed the problem statements and proposed interventions collected from participatory design workshops. The findings showed patterns of major discussion during the workshop. ResultsOn the basis of the workshop results, we formalized the transition of care model—the socioeconomic, active engagement, follow-up, education, discharge readiness tool, and consistency (Integrated Michigan Patient-centered Alliance in Care Transitions transition of care model)—which other organizations can apply to improve patient experiences in care transition. This model highlights the most significant themes that should necessarily be considered to improve the transition of care. ConclusionsOur study presents the benefits of the participatory design approach in defining the challenges associated with transitions of care related to patient discharge and generating sustainable interventions to improve care transitions

Commentary: Special care considerations in older adults hospitalized with COVID-19

http://deepblue.lib.umich.edu/bitstream/2027.42/175336/2/Commentary Special care considerations in older adults hospitalized with COVID-19.pdfPublished versio

Predictors for patients understanding reason for hospitalization

<div><p>Objective</p><p>To examine predictors for understanding reason for hospitalization.</p><p>Methods</p><p>This was a retrospective analysis of a prospective, observational cohort study of patients 65 years or older admitted for acute coronary syndrome, heart failure, or pneumonia and discharged home.</p><p>Primary outcome was complete understanding of diagnosis, based on post-discharge patient interview. Predictors assessed were the following: jargon on discharge instructions, type of medical team, whether outpatient provider knew if the patient was admitted, and whether the patient reported more than one day notice before discharge.</p><p>Results</p><p>Among 377 patients, 59.8% of patients completely understood their diagnosis. Bivariate analyses demonstrated that outpatient provider being aware of admission and having more than a day notice prior to discharge were not associated with patient understanding diagnosis. Presence of jargon was not associated with increased likelihood of understanding in a multivariable analysis. Patients on housestaff and cardiology teams were more likely to understand diagnosis compared to non-teaching teams (OR 2.45, 95% CI 1.30–4.61, p<0.01 and OR 3.83, 95% CI 1.92–7.63, p<0.01, respectively).</p><p>Conclusions</p><p>Non-teaching team patients were less likely to understand their diagnosis. Further investigation of how provider-patient interaction differs among teams may aid in development of tools to improve hospital to community transitions.</p></div