Utility of models to predict 28-day or 30-day unplanned hospital readmissions: an updated systematic review.

Objective: To update previous systematic review of predictive models for 28-day or 30-day unplanned hospital readmissions. Design: Systematic review. Setting/data source: CINAHL, Embase, MEDLINE from 2011 to 2015. Participants: All studies of 28-day and 30-day readmission predictive model. Outcome measures Characteristics of the included studies, performance of the identified predictive models and key predictive variables included in the models. Results: Of 7310 records, a total of 60 studies with 73 unique predictive models met the inclusion criteria. The utilisation outcome of the models included all-cause readmissions, cardiovascular disease including pneumonia, medical conditions, surgical conditions and mental health condition-related readmissions. Overall, a wide-range C-statistic was reported in 56/60 studies (0.21–0.88). 11 of 13 predictive models for medical condition-related readmissions were found to have consistent moderate discrimination ability (C-statistic ≥0.7). Only two models were designed for the potentially preventable/avoidable readmissions and had C-statistic >0.8. The variables ‘comorbidities’, ‘length of stay’ and ‘previous admissions’ were frequently cited across 73 models. The variables ‘laboratory tests’ and ‘medication’ had more weight in the models for cardiovascular disease and medical condition-related readmissions.Conclusions: The predictive models which focused on general medical condition-related unplanned hospital readmissions reported moderate discriminative ability. Two models for potentially preventable/avoidable readmissions showed high discriminative ability. This updated systematic review, however, found inconsistent performance across the included unique 73 risk predictive models. It is critical to define clearly the utilisation outcomes and the type of accessible data source before the selection of the predictive model. Rigorous validation of the predictive models with moderate-to-high discriminative ability is essential, especially for the two models for the potentially preventable/avoidable readmissions. Given the limited available evidence, the development of a predictive model specifically for paediatric 28-day all-cause, unplanned hospital readmissions is a high priority

Integrated clinical pathways for lower limb orthopaedic surgeries: An updated systematic review

Objective The objective of the study was to comprehensively synthesise the components of integrated clinical pathways (ICPs) and post-operative outcomes of patients undergone total hip and knee arthroplasty (THA & TKA) and hip fracture surgeries. Background Previous systematic reviews examined components and effectiveness of ICPs for lower limb joint replacement and hip fracture surgeries. Design and Methods An updated systematic review guided by the Whittemore and Knafl (2005) framework. Electronic databases, Ovid MEDLINE, EBSCOhost-CINAHL, the Cochrane Reviews and Trails, EMBASE and PubMed, were searched from 2007 to 31 January 2021. Due to the heterogeneity of the methods and data collection tools of included studies, pooling of the quantitative data was not possible. Therefore, the included studies were synthesised and presented narratively under subthemes of arthroplasty and hip fracture surgeries. The PRISMA checklist for systematic reviews was used. Results Twenty-four studies met selection criteria with 11 examined ICPs for hip fracture and 13 for the THA and TKA. Twenty-one ICPs were reviewed, and 33 components were extracted. The most frequently included components for hip fracture subgroup were ‘discharge disposition arrangement’ and ‘dedicated personnel and resources’. ‘Exercise plan’ and ‘pain management’ were for the arthroplasty subgroup. A significant reduction in the length of stay and post-operative complications were associated with the ICPs. Results were mixed for the effectiveness of ICPs in reducing unplanned hospital admissions, mortality rates, post-operative complications and hospital costs. Conclusion The number of ICP components varied across studies. This review could not recommend a one size-fits-all ICP that could be adapted for use for patients undergoing hip fracture and joint replacement surgeries. Relevance for clinical practice This review identified research evidence-based components considered as essential for the inclusion in ICP’s for hip fracture and arthroplasty surgeries. Further research is suggested to determine the patient experience and healthcare providers’ acceptance of ICPs

Family-centred care for hospitalised children aged 0-12 years (Review)

This is an update of the Cochrane systematic review of family-centred care published in 2007 (Shields 2007). Family-centred care (FCC) is a widely used model in paediatrics, is thought to be the best way to provide care to children in hospital and is ubiquitous as a way of delivering care. When a child is admitted, the whole family is affected. In giving care, nurses, doctors and others must consider the impact of the child's admission on all family members. However, the effectiveness of family-centred care as a model of care has not been measured systematically. To assess the effects of family-centred models of care for hospitalised children aged from birth (unlike the previous version of the review, this update excludes premature neonates) to 12 years, when compared to standard models of care, on child, family and health service outcomes. In the original review, we searched up until 2004. For this update, we searched: the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library, Issue 12 2011); MEDLINE (Ovid SP); EMBASE (Ovid SP); PsycINFO (Ovid SP); CINAHL (EBSCO Host); and Sociological Abstracts (CSA). We did not search three that were included in the original review: Social Work Abstracts, the Australian Medical Index and ERIC. We searched EMBASE in this update only and searched from 2004 onwards. There was no limitation by language.\ua0We performed literature searches in May and June 2009 and updated them again in December 2011. We searched for randomised controlled trials (RCTs) including cluster randomised trials in which family-centred care models are compared with standard models of care for hospitalised children (0 to 12 years, but excluding premature neonates). Studies had to meet criteria for family-centredness. In order to assess the degree of family-centredness, we used a modified rating scale based on a validated instrument, (same instrument used in the initial review), however, we decreased the family-centredness score for inclusion from 80% to 50% in this update. We also changed several other selection criteria in this update: eligible study designs are now limited to randomised controlled trials (RCTs) only; single interventions not reflecting a FCC model of care have been excluded; and the selection criterion whereby studies with inadequate or unclear blinding of outcome assessment were excluded from the review has been removed. Two review authors undertook searches, and four authors independently assessed studies against the review criteria, while two were assigned to extract data. We contacted study authors for additional information. Six studies found since 2004 were originally viewed as possible inclusions, but when the family-centred score assessment was tested, only one met the minimum score of family-centredness and was included in this review. This was an unpublished RCT involving 288 children post-tonsillectomy in a care-by-parent unit (CBPU) compared with standard inpatient care.The study used a range of behavioural, economic and physical measures. It showed that children in the CBPU were significantly less likely to receive inadequate care compared with standard inpatient admission, and there were no significant differences for their behavioural outcomes or other physical outcomes. Parents were significantly more satisfied with CBPU care than standard care, assessed both before discharge and at 7 days after discharge. Costs were lower for CPBU care compared with standard inpatient care. No other outcomes were reported. The study was rated as being at low to unclear risk of bias. This update of a review has found limited, moderate-quality evidence that suggests some benefit of a family-centred care intervention for children's clinical care, parental satisfaction, and costs, but this is based on a small dataset and needs confirmation in larger RCTs. There is no evidence of harms. Overall, there continues to be little high-quality quantitative research available about the effects of family-centred care. Further rigorous research on the use of family-centred care as a model for care delivery to children and families in hospitals is needed. This research should implement well-developed family-centred care interventions, ideally in randomised trials. It should investigate diverse participant groups and clinical settings, and should assess a wide range of outcomes for children, parents, staff and health services

Family-centered care for hospitalized children aged 0-12 years: a systematic review of qualitative studies

The foundation for a family-centered approach to pediatric health care is the belief that a child'semotional and developmental needs, and overall family wellbeing are best achieved when the service system supports the ability of the family to meet the needs of their child by involving families in their child’s care. There are a range of potential benefits and difficulties associated with the provision of family centred care, e.g. role negotiation, parental expectations in regard to participation in their child’s care, and issues relating to power and control. Currently, however, there is limited systematic information on how the principles of family-centered care are implemented in the delivery of care to the hospitalized child and their family, and the impact on the family and the health care providers

Development of predictive models for paediatric unplanned hospital readmissions: A mixed-methods sequential explanatory study at a tertiary children’s hospital in Western Australia

A mixed-methods sequential explanatory research design, collecting quantitative and qualitative data, examined paediatric unplanned hospital readmissions and nurse-caregiver communication of hospital-to-home transition information at a tertiary children’s hospital in Western Australia. The thesis is presented as seven peer-reviewed journal publications, including three comprehensive literature analyses and four primary studies. Research outcomes confirmed the complexities associated with developing predictive models, inconsistent content and delivery of transition information and the need to implement a comprehensive transition framework

International trends in research publications by perioperative nurses: A comparative analysis of three international perioperative nursing journals

It is well known that the translation of nursing research is becoming increasingly important as institutions aim towards providing best practice and improving quality care. Dissemination of new knowledge resulting from research through publication in journals is, therefore, vital to ensure utilisation of findings. This, in turn, will have an impact on the quality of care and the growth of the perioperative nursing speciality. As peer-reviewed journal articles undergo critical appraisal and can be widely accessed, they are regarded as the major, valid source of knowledge and evidence about best practice in our speciality. In addition, nursing publications are regarded as an essential component of continuing education for the nursing profession. Given the significance of the publication of recent research outcomes, this paper builds on a previous study by Della, Michael and Zhou, and reports on a comparative analysis of the research outputs in three major, international perioperative nursing journals for the five-year period spanning from June 2006 to June 2011. The findings revealed the ACORN Journal had the highest yearly percentage of research publication during the review period, as well as the highest percentage (41.1%) for the total of five years. This trend was followed by the AORN Journal, with the greatest number of research publications in the years 2006, 2008, 2010 and the percentage of 13.9% for the total amount of publications for the five years. The Journal of Perioperative Practice (JPP) published more research papers than the ACORN Journal in the years 2007, 2009 and 2011, but had a percentage of 12.8% for the total of the five years.The dominant research topic in all three journals focused on perioperative nursing practice followed by safety and quality. Although there was an increase in research publications in the JPP in 2011, there was a dramatic decrease in the ACORN and AORN Journals. Due to these results it is evident an increase in research publications in perioperative nursing journals is urgently required

Effective surgical hand preparation: An integrative research review

The aim of this paper is to present an integrative literature review on the effectiveness of surgical hand preparation. Six electronic databases were searched between the years 2000 and 2011. During this time, 21 studies were included as they presented detailed and substantive information about any aspect on effective surgical hand preparation. Effectiveness was measured in a reduction of surgical site infection (SSI)/bacterial counts. Topics were clustered around the following categories: choice of surgical hand preparation solutions, surgical hand preparation techniques, and duration required for surgical hand preparation. Outcomes of the integrative research review (IRR) found, firstly, chlorhexidine surgical scrub solution is more effective than povidone-iodine in reducing 551/bacteria counts. Secondly, there is no difference in reduction of 551/bacteria counts when performing a surgical scrub with brushes. Thirdly, there is no difference in durations of applying surgical hand preparation solutions (two, three, five or 10 minutes). There are no consistent results from studies that examined surgical hand preparation techniques of scrub versus rubs. It is suggested that the application of universal practice guidelines are needed to ensure the effectiveness of surgical hand preparation. Further research is required to determine the effectiveness of surgical hand rubs in comparison to surgical scrubs

The effectiveness of the Surgical Safety Checklist as a means of communication in the operating room

This paper reports an integrative research review (IRR) on the effectiveness of implementing the Surgical Safety Checklist (SSC) as a means of communication in the operating room. A total of11 studies conducted in 2012 were included in this review. Two main themes with subthemes emerged from the analysis. The first theme is Administration of the SSC with two subthemes: Compliance rate with the SSC and Completion of the SSC. The second theme was titled Outcomes of implementing the SSC with a subsequent four subthemes arising: Verification of information, Mortality and complications, Adverse events, and Incidents. This IRR revealed that implementation of the SSC had consistent positive outcomes in the reduction of preventable harm to patients undergoing surgeries. It is, however, recommended that further training in utilising the SSC and strategies is needed to ensure full compliance and completion rate with the SSC

The ideal of family-centred care: what the evidence tells us

Background/Aims: Family-centred care is an ideal espoused widely in paediatrics. In family-centred care, when a child comes into hospital, care is planned around the whole family instead of restricting it to the individual child. This presentation explores the evidence about family-centred care for children in hospital.\ud \ud Methods: Three systematic reviews were undertaken and we summarise and present their findings.\ud \ud Results: The two reviews of quantitative studies (Cochrane and Johanna Briggs Institute)found only one quasi-experimental study for inclusion. That study provides insufficient evidence about the effectiveness of family-centred care within a hospital setting. A review of qualitative studies (Johanna Briggs Institute) included 14 studies which showed that family-centred care is poorly implemented around the world.\ud \ud Conclusion: Whilst family centred care is regarded as the ideal, it remains difficult to articulate exactly what that means in practice. Further research is required to explore the complexities of implementing family-centred care