Interprofessional communication with hospitalist and consultant physicians in general internal medicine : a qualitative study

This study helps to improve our understanding of the collaborative environment in GIM, comparing the communication styles and strategies of hospitalist and consultant physicians, as well as the experiences of providers working with them. The implications of this research are globally important for understanding how to create opportunities for physicians and their colleagues to meaningfully and consistently participate in interprofessional communication which has been shown to improve patient, provider, and organizational outcomes

Improving access to emergent spinal care through knowledge translation : an ethnographic study

Background: For patients and family members, access to timely specialty medical care for emergent spinal conditions is a significant stressor to an already serious condition. Timing to surgical care for emergent spinal conditions such as spinal trauma is an important predictor of outcome. However, few studies have explored ethnographically the views of surgeons and other key stakeholders on issues related to patient access and care for emergent spine conditions. The primary study objective was to determine the challenges to the provision of timely care as well as to identify areas of opportunities to enhance care delivery. Methods: An ethnographic study of key administrative and clinical care providers involved in the triage and care of patients referred through CritiCall Ontario was undertaken utilizing standard methods of qualitative inquiry. This comprised 21 interviews with people involved in varying capacities with the provision of emergent spinal care, as well as qualitative observations on an orthopaedic/neurosurgical ward, in operating theatres, and at CritiCall Ontario’s call centre. Results: Several themes were identified and organized into categories that range from inter-professional collaboration through to issues of hospital-level resources and the role of relationships between hospitals and external organizations at the provincial level. Underlying many of these issues is the nature of the medically complex emergent spine patient and the scientific evidentiary base upon which best practice care is delivered. Through the implementation of knowledge translation strategies facilitated from this research, a reduction of patient transfers out of province was observed in the one-year period following program implementation. Conclusions: Our findings suggest that competing priorities at both the hospital and provincial level create challenges in the delivery of spinal care. Key stakeholders recognized spinal care as aligning with multiple priorities such as emergent/critical care, medical through surgical, acute through rehabilitative, disease-based (i.e. trauma, cancer), and wait times initiatives. However, despite newly implemented strategies, there continues to be increasing trends over time in the number of spinal CritiCall Ontario referrals. This reinforces the need for ongoing inter-professional efforts in care delivery that take into account the institutional contexts that may constrain individual or team efforts

Peer support experiences and needs across the continuum of trauma care: a qualitative study of traumatic injury survivor, caregiver, and provider perspectives

Background: Traumatic injuries significantly impact individuals’ physical and mental health and are a leading cause of disability worldwide. Trauma recovery is complex and entails patients interacting with multiple places of care before returning to the community. Despite trauma recovery being optimized when patients’ psychosocial needs are addressed early on and throughout recovery, care remains overwhelmingly focused on physical and functional improvement. Peer support is a cost-effective way of providing emotionally and experientially-driven psychosocial support that complements usual patient care. Thus, we aimed to explore the experiences of trauma survivors, family caregivers, and healthcare providers (HCPs) with engaging in and facilitating peer support and to identify their priorities for a future peer support program. Methods: Qualitative descriptive approach. Trauma survivors, caregivers and HCPs were recruited from three major trauma centres in Ontario. We conducted one-one-one interviews with participants which were recorded and transcribed. Data was thematically analyzed by multiple analysts to reduce bias and enhance data reliability. Results: We interviewed n=16 trauma survivors, n=4 caregivers, and n=16 HCPs. We identified four themes: (1) “It's a major change”: Navigating life after injury is challenging and characterized by uncertainty; “I just needed somebody just to talk to:” Peer support helps trauma survivors feel like they're not alone; (3) “You can learn off each other”: Peer support is multi-faceted and facilitates recovery in ways that other supports cannot; and (4) “If other people say negative things…that makes things worse”: Tensions exist between the benefits of peer support and the risk of unintended negative consequences. Overall, to meet trauma survivors’ socialization needs and enhance the efficacy of interventions, it is recommended that peer support to be offered via a range of modalities. Conclusions: Our study demonstrates that peer support is valued across stakeholders and has the potential to positively impact the psychosocial health of trauma survivors throughout recovery. Future development of a cross-continuum peer support program will consider how to connect peers early on after injury and sustain these relationships into community recovery

Patient Safety in Internal Medicine

AbstractHospital Internal Medicine (IM) is the branch of medicine that deals with the diagnosis and non-surgical treatment of diseases, providing the comprehensive care in the office and in the hospital, managing both common and complex illnesses of adolescents, adults, and the elderly. IM is a key ward for Health National Services. In Italy, for example, about 17.3% of acute patients are discharged from the IM departments. After the epidemiological transition to chronic/degenerative diseases, patients admitted to hospital are often poly-pathological and so requiring a global approach as in IM. As such transition was not associated—with rare exceptions—to hospital re-organization of beds and workforce, IM wards are often overcrowded, burdened by off-wards patients and subjected to high turnover and discharge pressure. All these factors contribute to amplify some traditional clinical risks for patients and health operators. The aim of our review is to describe several potential errors and their prevention strategies, which should be implemented by physicians, nurses, and other healthcare professionals working in IM wards

The Patient Experience of Ambulatory Cancer Treatment: A Descriptive Study

Background: Patient experience is often measured quantitatively, but that approach has limitations for understanding the entire experience. Qualitative methods can help to understand more complex issues most important to patients and their families. The purpose of the present work was to use a qualitative analysis examining the patient experience of ambulatory cancer care in Ontario to generate a deeper understanding of the patient experience and to lead to solutions for improvement. Methods: Data from the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) for 2013–2015 were used to conduct a qualitative content analysis. The aopss is a retrospective paper-based survey, mailed to patients who are currently receiving cancer treatment or who have received cancer treatment within the preceding 6 months, that is designed to capture their experiences. Patients who were surveyed were asked, “Is there anything else you would like to tell us about your cancer care services?” The National Research Corporation Canada’s patient-centred care framework was used to guide the analysis. Results: From the 5391 patients who responded, 7328 coded responses were generated, of which 3658 (49.9%) were related to the patient-centred care framework. New subthemes were identified: diagnosis sensitivity; emotional support resources; care delivery with care, compassion, and comfort; continuity of care between departments and in the community; access to cancer centre personnel; patient–health care provider communication; confidence in the health care provider; wait times; health care provider and treatment coordination; and parking. Conclusions: The results identify facilitators and barriers to the patient experience in the ambulatory cancer treatment setting from the patient perspective and identify opportunities to improve the patient experience.</jats:p

The Patient Experience of Ambulatory Cancer Treatment: A Descriptive Study

Background: Patient experience is often measured quantitatively, but that approach has limitations for understanding the entire experience. Qualitative methods can help to understand more complex issues most important to patients and their families. The purpose of the present work was to use a qualitative analysis examining the patient experience of ambulatory cancer care in Ontario to generate a deeper understanding of the patient experience and to lead to solutions for improvement. Methods: Data from the Ambulatory Oncology Patient Satisfaction Survey (AOPSS) for 2013–2015 were used to conduct a qualitative content analysis. The aopss is a retrospective paper-based survey, mailed to patients who are currently receiving cancer treatment or who have received cancer treatment within the preceding 6 months, that is designed to capture their experiences. Patients who were surveyed were asked, “Is there anything else you would like to tell us about your cancer care services?” The National Research Corporation Canada’s patient-centred care framework was used to guide the analysis. Results: From the 5391 patients who responded, 7328 coded responses were generated, of which 3658 (49.9%) were related to the patient-centred care framework. New subthemes were identified: diagnosis sensitivity; emotional support resources; care delivery with care, compassion, and comfort; continuity of care between departments and in the community; access to cancer centre personnel; patient–health care provider communication; confidence in the health care provider; wait times; health care provider and treatment coordination; and parking. Conclusions: The results identify facilitators and barriers to the patient experience in the ambulatory cancer treatment setting from the patient perspective and identify opportunities to improve the patient experience

Peer support for traumatic injury survivors: a scoping review

Peers are uniquely able to draw on their lived experiences to support trauma survivors’ recovery. By understanding the functions and outcomes of peer support and the factors that impact implementation, evidence can be mobilized to enhance its application and uptake into standard practice. As such, we aimed to review the literature on peer support for trauma survivors to: examine the role of peer support in recovery; describe the nature and extent of peer support; Examine the influence of peer support on health and well-being; and identify the barriers and facilitators to developing and implementing peer support. Scoping review methodology as outlined by Arksey and O’Malley. Ninety-three articles were reviewed. Peer support was highlighted as an important component of care for trauma survivors and provided hope and guidance for the future post-injury. Most peer support programs were offered in the community and provided one-on-one support from peer mentors using various modalities. Interventions were successful when they involved knowledgeable peer mentors and maintained participant engagement. Prior negative experiences and stigma/privacy concerns deterred trauma survivors from participating. Peer support fulfills several functions throughout trauma survivors’ recovery that may not otherwise be met within existing health care systems. Implications for rehabilitationBy understanding the functions and outcomes and the factors that impact implementation of peer support, evidence can be mobilized to enhance its application and uptake into standard practice.Peers provide trauma survivors with socioemotional support as well as assistance in daily management and life navigation post-injury.Peer support provided hope and guidance for the future after injury and improved self-efficacy amongst trauma survivors.Peer support programs are most likely to be successful when they involve knowledgeable peer mentors, are flexibly delivered, align with organizations’ values and priorities, and have adequate resources and funding to support their implementation. By understanding the functions and outcomes and the factors that impact implementation of peer support, evidence can be mobilized to enhance its application and uptake into standard practice. Peers provide trauma survivors with socioemotional support as well as assistance in daily management and life navigation post-injury. Peer support provided hope and guidance for the future after injury and improved self-efficacy amongst trauma survivors. Peer support programs are most likely to be successful when they involve knowledgeable peer mentors, are flexibly delivered, align with organizations’ values and priorities, and have adequate resources and funding to support their implementation.</p