Discharge Planning Research Articles

Commonalities and differences in injured patient experiences of accessing and receiving quality injury care: a qualitative study in three sub-Saharan African countries

ObjectivesTo understand commonalities and differences in injured patient experiences of accessing and receiving quality injury care across three lower-income and middle-income countries.DesignA qualitative interview study. The interviews were audiorecorded, transcribed...

Discharge Perfection: Assessing Documentation Quality at Mardan Medical Complex, Pakistan (2024 Audit Debut).

Background Patient discharge summaries not only play a vital role in ensuring continuity of care and patient safety but also serve as a communication tool between the primary and tertiary care settings. However, despite their paramount importance, most discharge summaries are either inaccurate or miss essential clinical information, posing considerable danger to patients. This clinical audit assesses the quality of discharge summaries at Mardan Medical Complex, Mardan, Pakistan, to identify areas for improvement. Aim The aim of this study is to assess the discharge summaries of patients at Mardan Medical Complex in Mardan, Pakistan, with a focus on their completeness, accuracy, and timeliness. Methods A cross-sectional, observational, and retrospective study was carried out in the Medical A ward of Mardan Medical Complex, Mardan, Pakistan, from September 2023 to October 2023. Out of the 897 discharge slips, a sample size of 105 participants was determined using Epi Info software. A systematic random sampling technique was used. Data was extracted from the hospital management information system and evaluated using a clinical audit tool based on standard guidelines from the Royal College of Physicians, Islamabad Healthcare Regulatory Authority, and Khyber Pakhtunkhwa Health Care Commission. To analyze the data, descriptive statistics were applied. Results The clinical audit revealed significant deficiencies in discharge summaries. Important patient demographics, such as contact details and safety alerts, were completely absent in 100% of the cases, and 48% of the summaries lacked the father's name. Admission details were similarly inadequate, with nearly all summaries missing critical information like admission time and reasons for admission. Clinical summaries and procedural details were absent in 73% and 87% of the cases, respectively. Discharge planning also showed major gaps, as special instructions according to the primary diagnosis and discharge destination were frequently neglected. Follow-up visits were recommended in only 71% of cases. Additionally, there were significant errors in in-home medication prescriptions, with 61% missing medication doses, 28% missing the route of administration, and 20% lacking the duration of treatment. Conclusions This clinical audit identified critical areas for improvement by revealing significant errors in the quality of discharge summaries at Mardan Medical Complex. It is recommended that standardized discharge slip templates be implemented, healthcare workers receive proper training, and thorough monitoring be conducted before patients are discharged. These measures aim to enhance the standard of documentation. Additionally, regular future clinical audits are essential for tracking the impact of these interventions and ensuring patient safety and continuity of care.

Postoperative Care and Outcomes in Solid-Organ Transplant Patients Undergoing Lower Extremity Fracture Treatment.

To determine the postoperative outcomes in solid-organ transplant (SOT) patients undergoing operative treatment of lower extremity fractures. Retrospective comparative study. Academic Level 1 trauma center. Patients who underwent SOT and operative treatment of lower extremity fracture from 2013 to 2021 were identified, excluding pathologic fractures. Postoperative complications, length of stay, time to death, 90-day and 1-year readmission rates, readmission causes, discharge location, and immunosuppressive regiments. Sixty-one patients with an average age of 67 years (range 29-88) were included. The mortality rate was 37.7%. The average follow-up was 15.2 months (range of 2 weeks-10 years). The majority of patients (32.8%) had received a liver transplant, and femoral neck fractures constituted the largest fracture group. The average length of stay was 10 days, with the shortest being 1 day and the longest being 126 days (SD 18). The majority of patients (57.3%) were not discharged home. Only 2 suffered from a postoperative complication requiring another procedure: hardware removal and liner exchange for periprosthetic joint infection, respectively. There was a 27.9% 90-day readmission rate with 2 deaths within that period with the most common being altered mental status (29.4%), genitourinary infections (17.6%), repeat falls (11.8%), and low hemoglobin requiring transfusion (11.8%). The longest average time to death analyzed by transplant type was found among lung transplant patients (1076 days, 62.5% mortality), followed by liver transplant patients (949 days, 35.0% mortality), and then kidney transplant patients (834 days, 38.9% mortality). The shortest time to death was 71 days from index procedure. Family members of SOT patients undergoing operative treatment of lower extremity fractures should be made aware of the high risk for 90-day readmission postoperatively (27.9%) and overall mortality (12.5%). Providers should be aware of the need for multidisciplinary involvement for inpatient care, monitoring postoperative complications, and facilitating discharge planning. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A Survey Study on Discharge Process of Critically Ill Patients: for Residents at a Tertiary Hospital in Korea

Purpose: The number of severely ill patients requiring post-acute care has been increasing. Careful discharge planning minimizes unplanned emergency room visits and readmissions. This study aimed to survey the knowledge, experience, confidence, and obstacles faced by medical residents and fellows regarding the discharge process of severely ill patients.Methods: A survey consisting of 27 questions was sent electronically to residents and fellows who had experience in discharging severely ill patients from a tertiary hospital in Korea. The survey was conducted over a two-week period from September 29, 2022.Results: A total of 98 residents and fellows responded to the survey. Of these, 94% experienced difficulties related to the discharge process. The main obstacle was changes in the patient’s condition during discharge planning (92.3%). Although 95% of the respondents acknowledged the need for providing discharge information, only 53.1% of the residents and fellows practiced this. Only 42.9% of the respondents and 20.4% of residents and fellows explained local community healthcare and welfare resources to patients because of a lack of relevant knowledge (69.7%) and feeling no responsibility to explain (40.4%).Conclusion: This study revealed that residents and fellows experienced difficulties in devising discharge plans and providing post-acute care related information, despite recognizing the importance of these. These gaps result from the lack of a discharge planning curriculum regarding critically ill patients and appropriate training in the discharge process. This suggests that an integrated discharge planning curriculum should be developed and adopted in residents’ training programs for the differentiated treatment of critically ill patients.

Kajian Hidrologi dan Analisis Kapasitas Pengaliran Penampang Sungai Way Kuripan terhadap Bencana Banjir Wilayah Bandar Lampung Berbasis Hec Ras

This study aimed to determine flood height and also the area of flood in Way Kuripan River. The first step of this study is used hydrological analysis to obtain the maximum flow rate of Way Kuripan River a return periods of 2 years, 5 years, 10 years, 25 years, 50 years, and 100 years. Furthermore, to know capacities and water level of Way Kuripan River is required the hydraulic simulation process that is made easier by using Hydrologic Engineering Center-River Analysis System (HEC-RAS) program through 8 cross-sectional points. The HEC-RAS program can help be model the river flows in existing conditions with using steady flow options and input datas in the form of maximum discharge data. The output of the modeling using the HEC-RAS program can be seen in figure and tables form that present the characteristics of the Way Kuripan river cross section. The analysis of results of the HEC RAS with simulation till discharge plan when a return period of 100 years have been flood at 3 point cross section that is Sta. 4.6 and 7. In the cross section Sta. 6 has been flood as high as 1.94 meters on the right side. The flood areas include: Pesawahan, Kota Karang, Kuripan, Gedong Pakuon, Talang, Sukarame II, Negeri Olok Gading, Sumur Putri and Perwata. Keywords: Flood, HEC RAS, Way Kuripan River.

The impact of geriatric-specific variables on long-term outcomes in patients with hepatopancreatobiliary and colorectal cancer selected for resection

BackgroundPreoperative geriatric-specific variables (GSV) influence short-term morbidity in surgical patients, but their impact on long-term survival in elderly patients with cancer remains undefined. Study designThis observational cohort study included patients ≥65 years who underwent hepatopancreatobiliary or colorectal operations for malignancy between 2014 and 2020. Individual patient data included merged ACS NSQIP data, Procedure Targeted, and Geriatric Surgery Research variables. Patients were stratified by age: 65–74, 75–84, and ≥85 and presence of these GSVs: mobility aid, preoperative falls, surrogate signed consent, and living alone. Bivariable and multivariable analyses were used to evaluate 1-year mortality and postoperative discharge to facility. Results577 patients were included: 62.6 % were 65–74 years old, 31.7 % 75–84, and 5.7 % ≥ 85. 96 patients were discharged to a facility with frequency increasing with age group (11.4 % vs 22.4 % vs 42.4 %, respectively, p < 0.001). 73 patients (12.7 %) died during 1-year follow-up, 32.9 % from cancer recurrence. One-year mortality was associated with undergoing hepatopancreatobiliary operations (p = 0.017), discharge to a facility (p = 0.047), and a surrogate signing consent (p = 0.035). Increasing age (p < 0.001), hepatopancreatobiliary resection (p = 0.002), living home alone (p < 0.001), and mobility aid use (p < 0.001) were associated with discharge to a facility. ConclusionGeriatric-specific variables, living alone and use of a mobility aid, were associated with discharge to a facility. A surrogate signing consent and discharge to a facility were associated with 1-year mortality. These findings underscore the importance of preoperative patient selection and optimization, efficacious discharge planning, and informed decision-making in the care of elderly cancer patients.

Stroke – The Patient Journey: using healthcare simulation scenarios in series to facilitate interprofessional student learning in the longitudinal care of a stroke patient

Introduction Multidisciplinary teamwork addresses the demands of the modern healthcare system. It enables collaboration between medical, nursing and allied health practitioners to deliver high-quality, patient-centred care. In a rural Australian setting, an interprofessional training programme, developed over the past decade, used healthcare simulation to deliver immersive student learning experiences. A three-part, half-day simulation programme allowed students to experience and learn from phases of care through, ‘Stroke – the patient journey’, including emergency management, allied health assessments and discharge planning. Methods Twenty students from six different disciplines participated in the programme. Three assessments were used. Knowledge of participants’ health disciplines was assessed pre- and post-training. A focus group was used to elicit student reflections on their learning experience. The individual Teamwork and Observational Feedback Tool was used by peers and tutors alike to assess in-exercise observable behaviours. Results No increase in discipline-specific knowledge was demonstrated following the training. The focus group identified five key themes: (1) Understanding patient priorities; (2)Enhancing patient autonomy; (3) Observation of discipline-specific contributions to care; (4) Understanding the role of multidisciplinary team discussions and (5) Value of leadership in team-based care. The average scores were 70% for ‘Shared decision-making’ and 75% for ‘Working in a team’. ‘Leadership’ was demonstrated by 70% of students and ‘Patient safety’ by 55%. Discussion This study has demonstrated the value of the use of sequential healthcare simulation episodes to increase student understanding of acute and chronic management of a patient with a stroke. Learners understood that effective multidisciplinary communication and teamwork are essential in the care of a complex patient.

Reduced Functioning After Hospitalization for COVID-19 Infection

Background and Purpose: COVID-19 infection is associated with persistent physical problems, and approximately 2% of the &gt;100 million people in the United States with COVID-19 infection have required hospitalization. The purpose of this review is to identify problems with activity and participation persisting during the first 6 months after hospitalization for COVID-19. Methods: A comprehensive search of 5 bibliographic databases was performed for cohort studies examining activity limitations and participation restrictions assessed within 6 months of hospitalization in adults hospitalized with COVID-19 infection. Two reviewers screened titles, abstracts, and full text to determine eligibility. Study methodological quality was assessed using the SIGN Methodology Checklist 3. Study methods, design, and participant outcomes were extracted. Results were summarized in narrative synthesis, and meta-analysis was conducted for 6-minute walk test. Results: Titles (n = 2670) were screened, and 26 acceptable to high-quality studies satisfied all eligibility criteria. Within the first 6 months following hospitalization for COVID-19 people experienced activity limitations and participation restrictions, including 16% reduction in 6-minute walk test distance (compared to age and gender-matched norms) and 59% return to employment rate. Discussion and Conclusion: The first 6 months following hospitalization for COVID-19 infection are associated with significant reductions in exercise capacity and return to work. Problems associated with post-intensive care syndrome cannot be ruled out as contributing to these findings. Recognition of these problems is essential and should inform hospital discharge planning and rehabilitation services.

Discharge planning for daddy's little girl.

Discharge planning for daddy's little girl.

Consistency of Physical Therapist Discharge Recommendations in Acute Care

Introduction: Physical therapists assist with discharge planning for hospitalized patients by making recommendations regarding a patient’s optimal discharge location and ongoing rehabilitation needs. The purpose of this study was to examine the consistency of discharge recommendations made by physical therapists with experience working in an acute care setting, when provided with a set of clinical vignettes describing hospitalized patients. Review of Literature: Considering the complex/multifactorial nature of making discharge recommendations, one would expect there to be inconsistencies among physical therapists. However, we are not aware of a previous study examining the level of consistency for discharge recommendations made by physical therapists, when reviewing a set of clinical vignettes. Subjects: Nineteen physical therapists working in an acute care setting. Methods: The physical therapists were provided with 10 clinical vignettes describing hospitalized patients via an electronic survey distributed across three rehabilitation departments. Each vignette described the patient’s medical condition, past medical history, prior level of function, living situation, key examination findings, and other general characteristics. After independently reviewing each case, the physical therapists selected a discharge recommendation from a list of standard options. Fleiss’ kappa was examined to assess the level of agreement among the physical therapists. Results: Overall, Fleiss’ kappa was 0.28, which reflects fair agreement among the physical therapists. Discussion and Conclusion: The 19 physical therapists who participated in this study only exhibited fair agreement with respect to their discharge recommendations. This relatively low level of agreement suggests that efforts to improve the consistency of discharge recommendations should be explored.

What Makes Effective Acute Geriatric Care? - A mixed Methods Study From Aotearoa New Zealand

Structured Objectives Current policies for older patients do not adequately address the barriers to effective implementation of optimal care models in New Zealand, partly due to differences in patient definitions and the in-patient pathway they should follow through hospital. This research aims to: (a) synthesise a definition of a complex older patient; (b) identify and explore primary and secondary health measures; and (c) identify the primary components of a care model suitable for a tertiary hospital in the midland region of the North Island of New Zealand.MethodThis mixed-methods study utilised a convergence model, in which qualitative and quantitative data were investigated separately and then combined for interpretation. Semi-structured interviews (n=11) were analysed using a general inductive method of enquiry to develop key codes, categories and themes. Univariate data analysis was employed using six years of routinely collected data of patients admitted to the emergency department and inpatient units (n=261,773) of the tertiary hospital.ResultsA definition of a complex older patient was determined that incorporates chronic conditions, comorbidities and iatrogenic complications, functional decline, activities of daily living, case fatality, mortality, hospital length of stay, hospital costs, discharge destination, hospital readmission and emergency department revisit and age – not necessarily over 65 years old. Well-performing geriatric care models were found to include patient-centred care, frequent medical review, early rehabilitation, early discharge planning, a prepared environment and multidisciplinary teams.ConclusionsThe findings of this New Zealand study increase understanding of acute geriatric care for complex older patients by filling a gap in policies and strategies, identifying potential components of an optimal care model and defining a complex geriatric patient.Implications for Public HealthThe findings of this study present actionable opportunities for clinicians, managers, academics and policymakers to better understand a complex older patient in New Zealand, with significant relevance also for international geriatric care and to establish an effective acute geriatric care model that leads to beneficial health outcomes and provides safeguard mechanisms.

A balance focused biometric does not predict rehabilitation needs and outcomes following total knee arthroplasty

BackgroundBoth length of hospital stay and discharge to a skilled nursing facility are key drivers of total knee arthroplasty (TKA)-associated spending. Identifying patients who require increased postoperative care may improve expectation setting, discharge planning, and cost reduction. Balance deficits affect patients undergoing TKA and are critical to recovery. We aimed to assess whether a device that measures preoperative balance predicts patients’ rehabilitation needs and outcomes after TKA.Methods40 patients indicated for primary TKA were prospectively enrolled and followed for 12 months. Demographics, KOOS-JR, and PROMIS data were collected at baseline, 3-months, and 12-months. Single-leg balance and sway velocity were assessed preoperatively with a force plate (Sparta Science, Menlo Park, CA). The primary outcome was patients’ discharge facility (home versus skilled nursing facility). Secondary outcomes included length of hospital stay, KOOS-JR scores, and PROMIS scores.ResultsThe mean preoperative sway velocity for the operative leg was 5.7 ± 2.7 cm/s, which did not differ from that of the non-operative leg (5.7 ± 2.6 cm/s, p = 1.00). Five patients (13%) were discharged to a skilled nursing facility and the mean length of hospital stay was 2.8 ± 1.5 days. Sway velocity was not associated with discharge to a skilled nursing facility (odds ratio, OR = 0.82, 95% CI = 0.27–2.11, p = 0.690) or longer length of hospital stay (b = -0.03, SE = 0.10, p = 0.738). An increased sway velocity was associated with change in PROMIS items from baseline to 3 months for global07 (“How would you rate your pain on average?” b = 1.17, SE = 0.46, p = 0.015) and pain21 (“What is your level of pain right now?” b = 0.39, SE = 0.17, p = 0.025) at 3-months.ConclusionPreoperative balance deficits were associated with postoperative improvements in pain and function after TKA, but a balance focused biometric that measured single-leg sway preoperatively did not predict discharge to a skilled nursing facility or length of hospital stay after TKA making their routine measurement cost-ineffective.

Patients in isolation, their physical, environmental and mental health: An exploratory study.

Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high-quality evidence for effective interventions to improve safety and quality of care for these patients. To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools. Design An exploratory mixed methods study. Setting A major metropolitan teaching hospital in Melbourne, Australia. Participants Patients in hospital isolation for transmissible infections. Data collection Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data. Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires. This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects. Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking. EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS). Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment.

Hospital Readmission in Patients with COVID-19

Background: During the Coronavirus Disease 2019 (COVID-19) pandemic, the demand for hospital beds has exceeded substantially. Thus, we aimed to conduct this study to identify factors associated with the risk of readmission in order to introduce the best discharge plan for patients with high risk of hospital readmission. Methods: This is a multicenter, case-control study including 1357 patients hospitalized with COVID-19 infection. Age-sex-matched case and control groups were paired at 1:2 ratios, and COVID-19 readmission rate was assessed. Moreover, the logistic regression analysis was applied to determine the factors associated with readmission. Results: Of the 1357 patients, 99 (7.29%) subjects were readmitted. The most common cause of readmission was respiratory distress. The median (interquartile) of the interval between hospital discharge and the second admission was 5 (2-16) days. Upon adjusting with the main risk factors, having at least one underlying disease and being treated with the corticosteroid were significantly associated with a higher rate of readmission (OR: 2.76, 95%CI: 1.30- 5.87) and (OR: 8.24, 95%CI: 3.72-18.22), respectively. Conclusion: Identification of risk factors of COVID 19 readmission will improve resource utilization and patient care.

Occupational therapy practice for post-acute COVID-19 inpatients requiring rehabilitation.

COVID-19 caused significant occupational disruption to people's life roles, with some people requiring an inpatient rehabilitation admission. Occupational therapists assessed and treated these patients using previous knowledge of similar conditions due to limited specificity in available guidelines to inform practice. The aim of this study was to investigate current practice with post-acute COVID-19 (PAC) patients within an inpatient rehabilitation setting in Australia, to better understand the role and impact of occupational therapy. A mixed-method study was conducted, including electronic medical record audits (October 2021 October 2022) and descriptive patient interviews at a large metropolitan subacute service. Descriptive statistics and qualitative analysis were used to summarise and interpret data. No involvement. A total of 24 patient electronic medical records were audited, and 10 patient interviews were completed. Three overarching categories were identified within the 685 occasions of occupational therapy service audited-occupational engagement, education provision and discharge planning. Patients identified the value of occupational therapy by reflecting on their lived experiences of engaging with occupational therapists and associated changes in occupational performance between COVID-19 diagnoses and discharge home. Occupational therapists possess a unique skill set that directly addresses the occupational needs and priorities of PAC patients. This study adds to the growing body of evidence supporting the contribution of occupational therapy to the management of COVID-19; however, further research is needed to develop evidence-based practice resources and advocate for system changes that improve quality of life for COVID-19 patients. During the COVID-19 pandemic, a lot of people got very sick. Some of these people needed more time and support to get better. Occupational therapists were important during this time because they helped these people to do their daily activities again. Because there were not many resources on how to do this, we looked into what occupational therapists were doing to help these people. We looked at patient hospital files and also talked to them to understand this better. We found that occupational therapists focused on three main areas: helping patients do activities that were important to them, teaching them about COVID-19 and helping them plan to leave the hospital. This study shows that occupational therapists are skilled at helping people with COVID-19. But more research is needed to make resources and also help with changing the healthcare system to further help people get better from COVID-19.

Optimizing the Team Approach: Designing a Clinical Care Pathway for Functional Neurological Disorder.

Functional neurological disorder (FND) sits at the intersection of neurology and psychology and has a variety of presentations, severity, and symptomatology. It affects a considerable number of pediatric patients and overwhelmingly influences healthcare spending. Diagnosis, treatment, and outcomes are varied, challenging, and lack standardization, often leading to frustration from patients, caregivers, and providers. Multidisciplinary care is essential though communication is often complex and disjunct. Using quality improvement tools and experiences from one institution, a team was established to ameliorate these concerns. A clinical care pathway was designed for the diagnosis and treatment of FND in the pediatric inpatient setting. This pathway was the result of the multidisciplinary team effort and an outcome, highlighting the need for early and intentional diagnosis with diagnosing provider specified, provider education and consistent language, patient and caregiver education, and clear and thorough discharge planning. Through the implementation of this pathway, it is anticipated that patient and provider satisfaction will improve as will the outcomes and care given to affected individuals. This work can be applied to the global treatment of FND and raise awareness to effectively managed care as well as the opportunity for clinicians to drive institutional change.

Analisis Hujan Ekstrim Probable Maximum Precipitation (PMP) menggunakan metode Hersfield dan Perhitungan Debit Banjir

Extreme rain is rain with the lowest intensity of 50 mm/24 hours or 20 mm/hour. River is an elongated surface water flow and flows from a higher place (upstream) to a lower place (downstream). The area of KIuet is 1429.93 km and the area of Kluet River is 163.51 km2 and the length of the river is 68.26 km. The problem is that Kluet Utara River experiences high rainfall, resulting in overflows that flatten agricultural land and submerge residential areas. The purpose of the study was to calculate the planned return period rainfall, analyze the PMP (probable Maximum Precipitation) value and analyze the flood discharge to evaluate the PMF (Probable Maximum Flood) value and the return flood discharge. The benefits of this research are used to see the PMF value and return period rainfall to analyze the frequency of flooding KIuet Utara Watershed (DAS). The scope of the research was to calculate rainfall and flood discharge in KIuet Utara Watershed and secondary data which includes 10 years rainfall data obtained from BMKG (Meteorology, Climatology and Geophysics Agency) Indrapuri Aceh Besar and watershed maps obtained from PT. Mediatama Indoconsult. Processing of rainfall data on return period used Log Pearson III Method and PMP used Hersfield Method while calculating the planned flood discharge using Melchior Method. The results of the research is the rainfall value for the return period for the lowest rainfall in the 2 year return period is as high as 211,836 mm and the highest rainfall for the 1000 year return period is 566,239 mm, so that the flood discharge plan for the return period for the lowest flood discharge in the 2 year return period is equal to 2061,342 m3/s and the highest flood discharge at the 1000 year return period is 5510,490 m3/s. The PMP value was obtained at 2128,432 mm so that the PMF was obtained at 20714,772 m3/s. Log Pearson III and PMP methods can be used to calculate the rainfall in KIuet Utara and the results from the rainfall are used to calculate the planned flood discharge using Melchior Method.

The kitchen assessment: an interactional analysis of assessment and feedback between an occupational therapist and a patient with aphasia post stroke

Purpose After stroke, patients undergo frequent multidisciplinary assessments. Little is known about patients’ experiences of being assessed and the impact of assessment interactions and feedback for ongoing engagement in rehabilitation. This research aims to stimulate reflection on clinical interactions, even during routine clinical assessments, and the provision of assessment feedback. Materials and methods This study involved a detailed analysis of an authentic kitchen assessment interaction between an occupational therapist and a patient with aphasia following stroke. It used a speech function analysis based on systemic functional linguistics resulting in both dynamic and synoptic data, and a consideration of interactive framing, to explore assessment explanation and feedback. Results The analysis revealed the clinician’s interactive dominance in terms of number and type of moves, and misalignment of interactional framing at different points in the exchange. The session appeared to result in patient disengagement related both to the clinician’s misjudged response to the patient’s aphasia, and the context of assessment itself, characterised by reliance on question-and-answer exchanges, and a tendency to highlight deficit. Conclusions Assessment sessions may be emotionally challenging for patients after stroke and feedback may be interpreted as bad news. Sensitive communication is required to support psychological wellbeing and engagement in rehabilitation. IMPLICATIONS FOR REHABILITATION After stroke, patients are assessed by the multidisciplinary team to inform intervention and discharge planning. Little is known about the feedback patients receive or their views of this feedback, including when it is perceived as bad news. The presence of aphasia can complicate how assessments are conducted and how feedback is delivered and received. Greater awareness is needed of how feedback following assessment might impact patients’ psychological wellbeing and engagement in rehabilitation.

Latin-American guidelines of recommendations at discharge from an acute coronary syndrome.

The diagnostic criteria, treatments at the time of admission, and drugs used in patients with acute coronary syndrome are well defined in countless guidelines. However, there is uncertainty about the measures to recommend during patient discharge planning. This document brings together the most recent evidence and the standardized and optimal treatment for patients at the time of discharge from hospitalization for an acute coronary syndrome, for comprehensive and safe care in the patient's transition between care from the acute event to the outpatient care, with the aim of optimizing the recovery of viable myocardium, guaranteeing the most appropriate secondary prevention, reducing the risk of a new coronary event and mortality, as well as the adequate reintegration of patients into daily life.

The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews

BackgroundAs the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons.MethodsA scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE.ResultsThirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality.ConclusionThe findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.