Discharge Instructions Research Articles

Parental caregivers' perception of their transition from hospital to home in children with cerebral palsy who have undergone orthopedic surgery

PurposeEvaluate parental perception of the quality of discharge teaching, readiness for discharge, and the impact of these on post discharge coping difficulty and resource utilization in children with cerebral palsy (CP) following surgery. Design and methodsProspective cohort study conducted from September 2017–March 2021 at a pediatric academic medical center. Demographics were collected pre-operatively. Parents completed the Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS) within four hours of discharge. Four weeks post-discharge, parents completed the Post-discharge Coping Difficulty Scale (PDCDS). Utilization of healthcare resources were extracted from the electronic health record for 90 days post-operatively. Associations among demographics, RHDS, QDTS, PDCDS and resource utilization were assessed using general linear models; PDCDS's open-ended questions were analyzed using directed content analysis. Results114 parental caregivers participated. Post discharge coping was significantly associated with additional resource utilization: length of stay (p = 0.046), readmissions (p = 0.001), emergency department visits (p = 0.001), clinic calls (p = 0.001) and unplanned clinic visits (p = 0.006). PDCDS was negatively correlated with the QDTS Quality of Teaching Delivered subscale (r = −0.32; p = 0.004) and three of five RHDS subscales: 1) Child's Personal Status (r = −0.24; p = 0.02); 2) Knowledge (r = −0.30; p = 0.005); and 3) Coping Ability (r = −0.39; p < 0.001). Four themes explicated parental coping difficulties. ConclusionParents experiencing coping difficulties were more likely to have difficulty managing their child's care needs at home and required additional health care resources. Practice implicationsRecognizing that parents' readiness for discharge may not reflect their coping abilities post-discharge requiring nurses to coordinate pre- and post-discharge education and support services.

Patient perceptions of care quality and discharge information following same-day cardiac catheterization laboratory procedures: A mixed-methods study.

To examine patients' perceptions of care quality following a same-day procedure in the cardiac catheterization laboratory and understand the extent to which they were prepared for discharge. Single-centre, mixed-methods study. Postdischarge, online survey of patients who underwent a same-day procedure in the cardiac catheterization laboratory (n= 150) and one-on-one interviews with 13 of these patients. Survey responses were positive with mean scores between 4.39-4.83 out of five and 63.3% of respondents (n= 95) extremely likely to recommend the service to others. Interview data analysis identified three themes: the care experience, information and education for safe discharge, and follow-up needs. Participants spoke highly of their interactions with clinicians and were satisfied with their care experience. Mode and content of information delivered varied, with some participants lacking guidance about postdischarge health management and clarity about follow-up plans. Participants were patients.

Assessing patients’ comprehension of discharge instructions from the emergency department (ED) in Makkah, Saudi Arabia; do emergency department patients receive appropriate instructions before discharge?

Assessing patients’ comprehension of discharge instructions from the emergency department (ED) in Makkah, Saudi Arabia; do emergency department patients receive appropriate instructions before discharge?

Using Comic-Based Concussion Discharge Instructions to Address Caregiver Health Literacy in the Emergency Department

IntroductionThis study compared the effectiveness of comic-based with text-based concussion discharge instructions on improving caregiver knowledge. This study also examined the role of social determinants of health on comprehension instructions. MethodsThis was an observational study of the caregivers of pediatric concussion patients. Caregivers' health literacy and demographics related socioeconomic factors were obtained. After the patients’ evaluation in the emergency department, caregivers were given printed comic-based concussion discharge instructions. Caregivers were contacted 3 days later and tested overall knowledge of discharge instructions’ content. These survey results were compared with historical controls who received text-based instructions. ResultsA total of 120 participants were recruited, and 86 participants completed follow-up procedures. When comparing the caregivers’ recall ability with a comic-based vs traditional text-based instructions, caregivers with comic-based content were more likely to accurately recall overall discharge instructions (77.5% vs 44%, P < .001), particularly physical rest and activity restrictions (86.5% vs 63%, P < .001). Caregivers also were less likely to misidentify a red flag symptom (7.5% vs 19%, P < .04). Comic-based instructions did not increase recall of cognitive rest instructions or postconcussive symptoms. When examining demographic factors, caregivers who could not recall 3 postconcussive symptoms were more likely to be Hispanic or Black, less likely to be college educated, and more likely to have low health literacy. DiscussionNovel methods should be explored to adequately prepare caregivers for continuing postconcussive care at home. Discharge instructions must be tailored to address caregivers’ baseline health literacy and how caregivers digest and retain information.

Improving Nursing Knowledge and Patient Education About Aprepitant's Effects on Hormonal Contraception: A Performance Improvement Project

The purpose of this project was to improve the consistency of verbal and written discharge instructions for women of childbearing age (13-55 years) taking hormonal contraceptives who receive aprepitant perioperatively, to address the need to use a secondary form of birth control for 28 days, as well as to increase the knowledge and confidence of Registered Nurses when providing discharge instructions. This quality improvement project used a pre-/postdesign to evaluate two separate groups of patients and registered nurses. The patient sample consisted of 30 total women of childbearing age who received aprepitant during the perioperative period (15 pre and 15 post). The PACU nurse sample included 15 ambulatory surgery center nurses and 58 main hospital nurses for a combined sample of 73 PACU nurses. The PACU nurses were provided with educational in-service regarding information about aprepitant and its drug interactions. PACU nurses were additionally instructed to provide patient discharge instructions using both a written and verbal format. Patients were called postoperatively before and after both the written after visit summary (AVS) changes and the PACU nurse in-services, PACU nurses were evaluated on their knowledge, confidence, and frequency of discharge teaching before and after their educational in-service. The PACU nurses were surveyed 90 days after the intervention to assess their long-term knowledge retention. There was a significant increase in nurse knowledge about aprepitant from preimplementation to postimplementation (61.39% vs 81.95%, P < .001). Nursing knowledge showed a nonsignificant decline at 90-days postimplementation (81.95% vs 73.68%, P=.096) although remained significantly higher than preimplementation scores (73.68% vs 61.39%, P=.003). There was an overall 33.3% increase in the percentage of patients who were able to recall receiving aprepitant and the need to use a secondary form of birth control when comparing the preintervention group to the postintervention group (26.7% vs 60%, P=.123). The findings suggest that providing a standardized presentation about aprepitant may improve the PACU nurses' ability to verbalize key information about aprepitant, including the need for patients to use a secondary form of birth control. This increase in nursing knowledge and confidence, along with improved written discharge instructions, may have led to improved patient comprehension of aprepitant discharge education. Additionally, there was an increase in the percentage of patients who were able to recall the need to use a secondary form birth control for 28 days, to reduce the likelihood of an unintentional pregnancy.

Transição do cuidado à mulher no período puerperal na alta hospitalar

Abstract Objective to describe nurses’ activities in transition of care for puerperal women from hospital care to other services in the health care network. Method exploratory-descriptive research, developed in the rooming-in of a federal university hospital in southern Brazil. Data were collected remotely, between November and December 2020, through a semi-structured questionnaire via the SurveyMonkey electronic platform with five nurses and four resident nurses. Analysis followed Bardin’s content structure with the support of Qualitative Data Analysis Miner software. Results the activities carried out by nurses in transition of care for puerperal women included discharge guidelines and educational actions for puerperal women. Elements such as lack of communication between rooming-in professionals and other services in the Health Care Network and nurses’ workload were considered barriers to transition of care to puerperal women. Conclusion and implications for practice although nurses undertake efforts in transition of care to puerperal women through guidance and education for discharge, it is essential to outline management strategies in order to implement a set of systematized actions to ensure continuity of care for puerperal women.

Emergency Management of Traumatic Brain Injuries Current Guideline and New Developments

Annually, traumatic brain injury keeps afflicting millions of individuals around the world. Traumatic brain injury may manifest in various forms from minor changes in consciousness to persistent comatoseness and death. The entirety of the brain is impacted by a diffused type of injury and edema in the most severe form of traumatic brain injury. Depending on the degree of the injury, there are many different treatment options, ranging from regular cognitive therapy sessions to invasive surgical procedures like bilateral decompressive craniectomies. Clinical practice guidelines have been developed to standardize assessment, discharge education, and referral of traumatic brain injury patients in order to achieve best practice management. Guidelines are described as propositions derived from research and used to direct clinicians and patients in making decisions about the highest degree of care and best practices in clinical practice. In order to minimise the risk of secondary brain injury and maximise the prognosis, early detection and therapy of severe traumatic brain injury are essential. The methodical evaluation and management of life-threatening situations that result from this is followed by invasive steps to control the airway, respiratory physiology, and hemodynamics, all with the main objective of maintaining a sufficient level of cerebral perfusion. Preventing secondary injury is the fundamental goal of early therapy of severe traumatic brain injury, specifically by preventing hypotension and hypoxia. The purpose of this research is to review the available information about the emergency management of traumatic brain injury current guideline and new developments

The Effect of Self-Care Education on Adherence to Treatment in Elderly Patients with Heart Failure: A Randomized Clinical Trial.

Noncompliance with treatment in the elderly with Heart Failure (HF) may result in a lack of recovery, a decrease in longevity, rehospitalization, and additional costs. Therefore, this study was conducted to determine the effect of self-care education on adherence to treatment among elderly patients with HF. This study was a parallel clinical trial on 90 elderly people over 60 years of age who were hospitalized in cardiac wards. Data were collected using a demographic characteristics form and the adherence to treatment questionnaire. Individuals who met the study inclusion criteria were randomly allocated to the intervention and control groups. The intervention group training was performed before and after discharge. The adherence to treatment questionnaire was completed again by both groups 2 months after discharge. Data were analyzed using Chi-squared test; ex. (?2 = 3.95, df = 1, p = 0.046), paired and independent t-tests, and analysis of covariance. The mean (standard deviation) total score of adherence to treatment in the intervention group was 39.71 (4.51) and 78.72 (10.47) before and after the self-care education, respectively. Paired t-test showed a significant difference in both groups after the intervention compared to before the intervention, and independent t-test showed a significant difference between the groups after the intervention (p = 0.001). Self-care education before discharge and home-based education were effective in promoting adherence to treatment among patients with HF. Therefore, self-care education before discharge may improve adherence to treatment among elderly patients with HF.

Surgeon compassion may mitigate quality of life disparities associated with health literacy

ObjectivesPatients with health literacy (HL) disparities are less likely to comprehend hospital discharge instructions and less satisfied with physician communication. In this prospective cohort study, we sought to examine the...

Variation in diagnosis and management of allergic reactions among emergency medicine and allergy immunology providers

Background: Children with anaphylaxis often emergently present for treatment. Providers' adherence to the principles of optimal management according to the most recent national guidelines is unknown. Objective: To assess the variation in management approaches for allergic reactions and anaphylaxis between allergy/immunology (AI) and emergency medicine (EM) providers. Methods: This was a cross-sectional survey study of AI and EM providers in the University of Colorado affiliated hospitals and Colorado Asthma and Allergy Society. The survey consisted of six cases of patients with allergic reactions, with four cases that represented patients with anaphylaxis that resolved by the time of discharge. For each vignette, the participants were asked about preferred initial therapy, adjunctive therapies, monitoring, outpatient prescription medications, and discharge instructions provided. Survey derivation and validation was accomplished by a multidisciplinary team of experts by using a modified Delphi process. Results: A total of 413 clinicians were contacted, of whom 194, (47%) responded, including 69 pediatric EM, 50 general EM, and 49 AI providers, and 26 did not identify a provider type. There were no statistically significant differences in correct recognition of anaphylaxis between the AI and EM providers. For each case, statistically significant differences were noted in the use of corticosteroids during and after resolution of anaphylaxis: AI providers reported giving fewer prescriptions than did the EM providers for corticosteroids in all cases of anaphylaxis (p < 0.001). The AI providers were less likely to prescribe scheduled antihistamines than were the EM providers in half of the cases (p < 0.02). Conclusion: Across the specialties, there were high rates of recognition of epinephrine as first-line treatment for anaphylaxis. The majority of the EM providers prescribed scheduled corticosteroids and antihistamines after resolution of anaphylaxis, whereas most of the AI providers did not prescribe scheduled corticosteroids. Analysis of the current data suggests against the routine use of corticosteroids in the management of anaphylaxis, particularly continued use after resolution of symptoms. AI involvement in the creation of EM and hospital protocols for allergic reactions could improve overall care.

A review to access knowledge, attitudes, and practices among nurses of cardiac medicine for heart failure patients to prevent readmission in hospitals

This research paper conducts an in-depth evaluation in order to improve nurses' comprehension of self-care management and patient discharge education for patients with Heart Failure (HF). It also discusses the reasons and obstacles to nurses for increasing their knowledge, attitude, and practice to support improved health outcomes and reduce readmission. In order to prevent readmission and re-hospitalization through discharge training, this study aims to raise awareness about the gaps in knowledge, practice, and attitude among nurses working with patients admitted with heart failure. The study evaluates the nurses' knowledge and aids in the education that heart failure patients must receive. By using effective medication management and post-discharge instructions, heart failure symptoms and disease progression can be controlled. Therefore, effective medication management following discharge is crucial for improving the quality of life, controlling symptoms, avoiding deterioration that triggers hospital readmission, and reducing death. Additionally, it is not always possible for healthcare team members to exchange enough accurate information with one another effectively. Numerous nations have emphasised the importance of the right health practices, optimistic attitudes, and suitable education among healthcare professionals to dispel misconceptions, increase confidence in providing support, and promote effective treatment.

Discharge process challenges of an academic vascular surgery service: A qualitative study.

Vascular surgery patients have a high incidence of unplanned hospital readmissions and complications. Previous research has not fully examined specific elements of the hospital discharge process for vascular surgery patients to identify issues that may contribute to readmissions. The objective of this qualitative descriptive study was to explore challenges identified by healthcare providers and patients regarding the discharge process from an academic vascular surgery service. Data were collected from eight focus group interviews and analyzed for relevant themes. Patients and healthcare providers identified several challenges within the standard discharge process, including ineffective communication, insufficient time for discharge education, and limitations accessing providers with post-discharge concerns. These obstacles may be ameliorated in part by specialized coordinators, caregiver support, and use of adaptive strategies outside of the current discharge process. The discharge challenges described by study participants likely contribute to adverse post-hospitalization outcomes, including unplanned hospital readmissions. A multifaceted approach that incorporates standardized discharge processes, as well as informal problem-solving strategies, is recommended to improve hospital discharge and outcomes for vascular surgery patients.

Discharge readiness and its associated factors among first-time mothers undergoing cesarean section in China.

Helping first-time mothers who have just undergone cesarean section and transitioning from hospital to home with their infant is a complex process. Therefore, understanding what contributes to discharge readiness is necessary. This study aimed to determine discharge readiness level and its associated factors among first-time mothers who have undergone cesarean section. A descriptive cross-sectional study was conducted among 233 first-time mothers who had undergone cesarean sections selected using quota sampling from the two largest referral centers in China. Data were collected from March to June 2021 using a demographic characteristics form, Readiness for Hospital Discharge Scale-New Mother Form (RHDS-NMF), and Quality Discharge Teaching Scale-New Mother Form (QDTS-NMF). Descriptive and inferential statistics were used for data analysis. The discharge readiness of the respondents was at a moderate level. Age (r = -0.129, p = 0.049) and complications after cesarean section (r = -0.136, p = 0.038) had a negative correlation with discharge readiness. In contrast, the subscales of QDTS-NMF, particularly the content (r = 0.519, p = 0.000) and delivery (r = 0.643, p = 0.000), had a positive correlation with discharge readiness. The findings enable nurses, midwives, and other healthcare professionals to understand discharge readiness and its related factors among first-time mothers undergoing cesarean section. It is also suggested that the quality of discharge teaching with a comprehensive assessment of first-time mothers preparing for discharge from the hospital and following the guideline to prevent post-cesarean section complications should be reinforced.

CD8+ T cells mediate antiviral response in severe fever with thrombocytopenia syndrome.

Severe fever with thrombocytopenia syndrome (SFTS), which is caused by a novel Bunyavirus, has gradually become a threatening infectious disease in rural areas of Asia. Studies have identified a severe cytokine storm and impaired humoral immune response in SFTS. However, the cellular immune response to SFTS virus (SFTSV) infection remains largely unknown. Here we report that SFTS patients had a cytokine storm accompanied by high levels of chemokines. CD8+ T cells in peripheral blood mononuclear cells of SFTS patients exhibited a more activated phenotype and enhanced the antiviral responses. They increased the expression of CD69 and CD25, secreted a higher level of IFN-γ and granzyme, and had a stronger proliferative ability than in healthy controls. In convalescent SFTS patients, the expression of CD69 and CD25 on CD8+ T cells was reduced. In addition, we found the ratio and cellularity of CD14+ CD16+ intermediate monocytes were increased in peripheral blood of SFTS patients. Both the expression of C-X-C motif chemokine ligand 10 (CXCL10) on CD14+ CD16+ intermediate monocytes and the expression of C-X-C motif chemokine receptor 3 (CXCR3) on CD8+ T cells increased dramatically in SFTS patients. Our studies reveal a potential pathway that CD8+ T cells rapidly activate and are mostly recruited by intermediate monocytes through CXCL10 in SFTSV infection. Our results may be of clinical relevance for further treatment and discharge instructions in SFTSV infections.

558. Increasing Safety Net Antibiotic Prescriptions (SNAP) for Acute Otitis Media Treatment in Pediatric Urgent Care Clinics

Abstract Background Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in pediatrics. National guidelines recommend offering a safety net antibiotic prescription (SNAP) to select patients, to be filled if symptoms worsen or do not improve within 48-72 hours. However, clinicians continue to prescribe immediate antibiotics for most cases of AOM. Our goal was to increase the percentage of eligible patients diagnosed with AOM in our pediatric urgent care (PUC) clinics who are offered a SNAP from our baseline of 7.7% to 40% within nine months. Methods A multidisciplinary team of PUC clinicians, an Infectious Diseases physician, and a data analyst, used quality improvement (QI) methodology to identify barriers to offering SNAP (Figure 1). Patients without chronic ear conditions were considered eligible for SNAP if they had no or mild otalgia for &amp;lt; 48 hours, fever &amp;lt; 39oC, no otorrhea, and for patients ≤ 24 months old, if they had only unilateral AOM. We analyzed all encounters of patients ≥ 6 months old with a discharge diagnosis of AOM from three PUC clinics during baseline (October 2020 – September 2021) and study (October 2021 – March 2022) periods. Interventions included clinician education, standardized discharge instructions, electronic health record updates to improve documentation, and educational flyers for clinicians and families. Our outcome measure was the percentage of eligible encounters during which SNAP was offered. Our process measure was the percentage of AOM encounters in which SNAP eligibility was documented. Our balancing measure was the percentage of patients returning with AOM symptoms within 14 days. Results We reviewed 12,502 encounters from October 2020 through March 2022. At baseline, clinicians documented SNAP eligibility in 5.5% of AOM encounters and offered SNAP to 7.7% of eligible patients. By March 2022, clinicians documented SNAP eligibility in 58.9% of AOM encounters and offered SNAP to 40.7% of eligible patients (Figure 2). There was no change in our balancing measure. UCL: Upper control limit. LCL: Lower control limit. Conclusion Using QI methodology, we increased the percentage of eligible patients with AOM who were offered SNAP, reducing antibiotic exposure in PUC clinics. Efforts are ongoing to further improve this process. Disclosures Brian R. Lee, PhD, MPH, CDC: Grant/Research Support|Merck: Grant/Research Support.

Patient experiences of, and preferences for, surgical wound care education.

The aim of this study was to describe patients' experiences of, and preferences for, surgical wound care discharge education and how these experiences predicted their ability to self-manage their surgical wounds. A telephone survey of 270 surgical patients was conducted across two hospitals two weeks after discharge. Patients preferred verbal (n=255, 94.8%) and written surgical wound education (n=178, 66.2%) from medical (n=229, 85.4%) and nursing staff (n=211, 78.7%) at discharge. The most frequent education content that patients received was information about follow-up appointments (n=242, 89.6%) and who to contact in the community with wound care concerns (n=233, 86.6%). Using logistic regression, patients who perceived that they participated in surgical wound care decisions were 6.5 times more likely to state that they were able to manage their wounds at home. Also, patients who agreed that medical and/or nursing staff discussed wound pain management were 3.1 times more likely to report being able to manage their surgical wounds at home. Only 40% (107/270) of patients actively participated in wound-related decision-making during discharge education. These results uncovered patient preferences, which could be used to optimise discharge education practices. Embedding patient participation into clinical workflows may enhance patients' self-management practices once home.

Nurses' Experiences Implementing e PED : An iPad Application to Guide Quality Discharge Teaching.

Quality discharge teaching prepares patients and families to transition safely from hospital to home. Technology can enhance and support quality discharge teaching by promoting patient family engagement during the transition. The purpose of this mixed methods study was to explore clinical nurses' experience with using Engaging Parents in Education for Discharge, an iPad application to guide quality discharge teaching. Twelve nurses at a large Midwestern Children's Hospital participated in small focus groups after use of the Engaging Parents in Education for Discharge application and completed a questionnaire on their perception of the acceptability and feasibility of the app. Findings revealed three themes: (1) development and deployment issues focused on the importance of training and support by the study team during implementation; (2) workflow integration centered on the importance of incorporating use of the app into current workflows and to preserve effective communication strategies with parents to optimize use in the healthcare setting; and (3) nurses perceived value in the use of the Engaging Parents in Education for Discharge app for beneficial scripting, questions on discharge topics often forgotten, and guidance for complex patients. Results of this study offer insight into key components for consideration when implementing and integrating technology to aid nursing practice.

Relation Between Discharge Instructions Compliance and Quality of Life among the Patients Post Hip Arthroplasty Surgery

Relation Between Discharge Instructions Compliance and Quality of Life among the Patients Post Hip Arthroplasty Surgery

Effect of Discharge Teaching Quality on Women's Discharge Readiness and Post Cesarean Section Outcomes

Effect of Discharge Teaching Quality on Women's Discharge Readiness and Post Cesarean Section Outcomes

The Revised Identification of Seniors At Risk screening tool predicts readmission in older hospitalized patients: a cohort study

BackgroundThe Identification of Seniors at Risk (ISAR) screening tool is a widely-used risk stratification tool for older adults in the emergency department (ED). Few studies have investigated the use of ISAR to predict outcomes of hospitalized patients. To improve usability a revised version of ISAR (ISAR-R), was developed in a quality improvement project. The ISAR-R is also widely used, although never formally validated. To address these two gaps in knowledge, we aimed to assess the ability of the ISAR-R to predict readmission in a cohort of older adults who were hospitalized (admitted from the ED) and discharged home.MethodsThis was a secondary analysis of data collected in a pre-post evaluation of a patient discharge education tool. Participants were patients aged 65 and older, admitted to hospital via the ED of two general community hospitals, and discharged home from the medical and geriatric units of these hospitals. Patients (or family caregivers for patients with mental or physical impairment) were recruited during their admission. The ISAR-R was administered as part of a short in-hospital interview. Providers were blinded to ISAR-R scores. Among patients discharged home, 90-day readmissions were extracted from hospital administrative data. The primary metrics of interest were sensitivity and negative predictive value. The Area Under the Curve (AUC) was also computed as an overall measure of performance.ResultsOf 711 attempted recruitments, 496 accepted, and ISAR-R was completed for 485. Of these 386 patients were discharged home with a complete ISAR-R, the 90-day readmission rate was 24.9%; the AUC was 0.63 (95% CI 0.57,0.69). Sensitivity and negative predictive value at the recommended cut-point of 2 + were 81% and 87%, respectively. Specificity was low (40%).ConclusionsThe ISAR-R tool is a potentially useful risk stratification tool to predict patients at increased risk of readmission. Its high values of sensitivity and negative predictive value at a cut-point of 2 + make it suitable for rapid screening of patients to identify those suitable for assessment by a clinical geriatric team, who can identify those with geriatric problems requiring further treatment, education, and follow-up to reduce the risk of readmission.