Exchange Of Clinical Information Research Articles

INNOVATION AND DIGITAL TRANSFORMATION IN HEALTHCARE. PROCESS OPTIMIZATION OF REHABILITATION ACTIVITIES IN IN REHABILITATION CARDIOLOGY IN SUPPORT OF PATIENT AND TEAM

Abstract Physical activity is a treatment for preventing and treating a wide range of diseases; its prescription must be precise and accurate in order to optimize the effects avoiding at the same time clinical risks due to frequent patients’ frailty.To deploy a “comprehensive digital rehabilitation” means to digitalize the whole process: from clinical and instrumental evaluations to the subsequent coherent prescriptions of the rehabilitation and care–related activities, from the case management planning – described in the individual rehabilitative project – to the individual rehabilitative program – that takes shape in semi–automated scheduling and in digitalized reporting. The deployed software must be easy to use and reliable, and must ensure safety, guaranteeing the exchange of clinical information among the team members. For all these reasons, we have pre–set pathways that, starting from the main and secondary clinical diagnosis (using the ICD classification) and based thereafter on the WHO ICF classification, the rehabilitation processes are governed in a standardized tailored granularity for each single patient by the aid of a computerized expert system. Even if it what just stated appears an oxymoron, thanks to the digital transformation and the adoption of the Internet of Things, it is possible to easily implement a personalized rehabilitation program through a shared and standardized ontology, providing benefits both to the patient and to the rehabilitation team. Based on this, the rehabilitation services that can be provided have been defined, providing not only those provided for by national and regional nomenclators but also those peculiar to the activities in our Institutes. The digital gym goes beyond the concept of equipment in a gym space; the gym space becomes both physical and virtual. The goal is the networking of "basic" and innovative rehabilitation equipment, even placed in different environments, through the philosophy of IoT, that path of technological development whereby, through the Internet network, potentially every object of daily experience acquires its own identity in the digital world. All this will allow for real–time feedback of data and measurements for the development of a personalized digital record. The digital platform, telemedicine and cloud computing, begin to enable an integration of people, equipment and data.

Knowledge, Attitude, and Practice of Teledentistry in Periodontal Diagnosis Among Dental Interns at a College in Sebha, Libya: A Cross-Sectional Questionnaire Study.

Background Teledentistry, a subspecialty of telemedicine dedicated to dentistry, has shown promise in improving access to dental care, particularly in rural and isolated areas.It integrates digital and telecommunication technology with dentistry, allowing for the remote distance exchange of relevant clinical information and digital dental imaging for dental consultation and treatment planning. Periodontal disease diagnosis is crucial for effective treatment and prevention of irreversible loss of periodontal structures. Early identification of periodontal disease can be pivotal in preventing periodontal tissue destruction and tooth loss and improving the overall quality of patients' lives. Sebha is a city located in the Fezzan region of southwestern Libya. It is the capital of the Sabha District and the Sabha Governorate. The city is situated in the Libyan part of the Sahara desert and is known for its strategic location as a gateway to the Sahara desert. However, there is a lack of information on the use of teledentistry in Libya in general and the use of teleperiodontics, especially in periodontal diagnosis. Hence, the aim of this questionnaire study was to evaluate knowledge, attitudes, and practice of teledentistry among dental interns at Sebha, Libya. Materials and methods A paper-based questionnaire consisting of 28 close‑ended Likert scale questions, including sections assessing the knowledge, attitude, and practice of teledentistry and teleperiodontics, was administered to dental interns at the Faculty of Dentistry, Sebha University, Sebha, Libya. Results The study surveyed 42 dental interns of the Faculty of Sebha, Libya, in total, with an 82.35% response rate among them. The majority of participants (59.5%) felt that teledentistry is reliable in arriving at periodontal diagnosis. The majority of participants (64.3%%) also had acceptable levels of trust in teledentistry equipment. However, over 45% percent of dental practitioners voiced their worries about patient privacy. Most of the participants suggested using teledentistry in some form in their future practice. Conclusion Teledentistry and its branch teleperiodontics are recent developments and its penetration among dental healthcare workers, and their knowledge, attitude, and practice remain to be thoroughly understood. The changing trends in attitudes and practice as a consequence of changes in Internet and technological awareness and the effects of the pandemic warrant closer observation and study.

A user-friendly deep learning application for accurate lung cancer diagnosis.

Accurate diagnosis and subsequent delineated treatment planning require the experience of clinicians in the handling of their case numbers. However, applying deep learning in image processing is useful in creating tools that promise faster high-quality diagnoses, but the accuracy and precision of 3-D image processing from 2-D data may be limited by factors such as superposition of organs, distortion and magnification, and detection of new pathologies. The purpose of this research is to use radiomics and deep learning to develop a tool for lung cancer diagnosis. This study applies radiomics and deep learning in the diagnosis of lung cancer to help clinicians accurately analyze the images and thereby provide the appropriate treatment planning. 86 patients were recruited from Bach Mai Hospital, and 1012 patients were collected from an open-source database. First, deep learning has been applied in the process of segmentation by U-NET and cancer classification via the use of the DenseNet model. Second, the radiomics were applied for measuring and calculating diameter, surface area, and volume. Finally, the hardware also was designed by connecting between Arduino Nano and MFRC522 module for reading data from the tag. In addition, the displayed interface was created on a web platform using Python through Streamlit. The applied segmentation model yielded a validation loss of 0.498, a train loss of 0.27, a cancer classification validation loss of 0.78, and a training accuracy of 0.98. The outcomes of the diagnostic capabilities of lung cancer (recognition and classification of lung cancer from chest CT scans) were quite successful. The model provided means for storing and updating patients' data directly on the interface which allowed the results to be readily available for the health care providers. The developed system will improve clinical communication and information exchange. Moreover, it can manage efforts by generating correlated and coherent summaries of cancer diagnoses.

A study on the status and applicability of Korean medicine EMR for establishment of Korean medicine standard EMR certification criteria: Through surveys of Korean medical institutions and Korean medicine EMR companies

Objectives: The aim of this study is to explore and investigate the status of EMR currently used in Korean medical institutions and the suitability of the existing certification criteria for Korean medicine EMR certification.Methods: The survey was conducted using a related questionnaire from September to October 2022. The survey for current status and the suitability of the existing certification criteria was conducted separately between Korean medical institutions and Korean medicine EMR companies.Results: In a survey of Korean medical institutions on the current status of EMR, more than 80% answered that the imaging system and Korean medicine EMR could be linked. Most medical institutions did not exchange clinical information between institutions. When asked about the intention to develop standard EMR of Korean medicine in the future, 57% of institutions answered ‘yes’. In future, if Korean medicine EMR certification criteria are developed, all EMR companies are willing to develop the EMR that satisfy them. Looking at the satisfaction survey of the existing EMR certification criteria of the Korean medicine EMR system, it was found that high/low satisfaction was shown in various areas, and in particular, the overall clinical information exchange function was insufficient.Conclusion: In order to introduce the Korean medicine EMR certification criteria, it must be considered of the current status of EMR and applicability of Korean medicine EMR for establishment of Korean medicine standard EMR certification criteria. By developing Korean medicine EMR certification criteria, high-quality medical services can be provided to medical consumers who want Korean medical treatment.

Highlights from the 12th congress of the international pediatric transplant association, Austin, Texas 2023.

The 12th Congress of the (IPTA) event in Austin, Texas, had over 400 attendees from 40 countries. The attendees included a diverse mix of pediatric transplant professionals from several specialties including physicians, surgeons, scientists, nurses, organ procurement personnel, advance transplant providers, pharmacists, administrators, fellows, residents, and students. The 4-day event featured nearly 200 abstracts, 90 oral presentations, 24 mini oral presentations, and more than 80 poster presentations. All of these presentations encouraged vibrant discussions and supported the exchange of new clinical and basic science information regarding clinical care management, basic science research, socioeconomic, and ethical and organ donation issues relevant to pediatric transplantation. We briefly describe here the highest scored presented abstracts at IPTA 2023 that are divided into two categories: clinical and basic sciences.

Teledentistry in the Management of Patients with Dental and Temporomandibular Disorders.

Telemedicine is a subunit of telehealth, and it uses telecommunication technology, video, digital images, and electronic medical records to allow the exchange of clinical information and images over remote distances for dental consultation, diagnosis, and treatment planning. Dental clinical practice requires face-to-face interaction with the patients, and therefore, during the COVID-19 pandemic, it has mostly been suspended. In this view, teledentistry offers the opportunity to continue dental practice, avoiding the face-to-face examination that put patients and healthcare professionals at infection risk. Teledentistry encompasses several subunits such as teleconsultation, telediagnosis, telemonitoring, and teletriage. To date, there are several experiences described in literature that suggest that teledentistry could be applied to support traditional care of different oral diseases. However, there are some issues that need to be addressed. Reimbursement concerns, costs, license regulations, limits in physical examinations, and expert equipment are principal issues that should be overcome in telemedicine and in teledentistry. In this narrative review, we provide an overview of the different teledentistry approaches in the care of patients with dental and temporomandibular disorders, as well as discussing the issues that need to be addressed to implement this approach in clinical practice.

Development of a Mobile Application for Smart Clinical Trial Subject Data Collection and Management

Wearable devices and digital health technologies have enabled the exchange of urgent clinical trial information. We developed an application to improve the functioning of decentralized clinical trials and performed a heuristic evaluation to reflect the user demands of existing clinical trial workers. The waterfall model of the software life cycle was used to guide the development. Focus group interviews (N = 7) were conducted to reflect the needs of clinical research professionals, and Wizard of Oz prototyping was performed to ensure high usability and completeness. Unit tests and heuristic evaluation (N = 11) were used. Thematic analysis was performed using the focus group interview data. Based on this analysis, the main menu was designed to include health management, laboratory test results, medications, concomitant medications, adverse reactions, questionnaires, meals, and My Alarm. Through role-playing, the functions and configuration of the prototype were adjusted and enhanced, and a heuristic evaluation was performed. None of the heuristic evaluation items indicated critical usability errors, suggesting that the revised prototype application can be practically applied to clinical trials. The application is expected to increase the efficiency of clinical trial management, and the development process introduced in this study will be helpful for researchers developing similar applications in the future.

Contextualizing the Content of Clinical Communications: A Learning Point

Suboptimal communication or inadequate exchange of important clinical information can be peculiarly perilous in subspecialties like cardiac anesthesia that are characterized by a highly predisposed working environment.[1] [2] [3] While the fraternity acknowledges an effective communication to be at the cornerstone of minimizing the susceptibility to avoidable perioperative critical events, as George Bernard Shaw aptly puts it: the major problem with communication is precisely the illusion that it has taken place.[1] [4]

Advanced EMR functionalities and Frontline Staff’s Perception of Clinical Proces Integration

Electronic Medical Records (EMR) is considered to facilitate care integration, as EMRs can enable information flow and care coordination. Yet, evidence also suggests negative consequences such as increased provider burden. Research has yet to identify whether and in what way EMRs can promote care integration. This research studied the association between EMR functionalities, designed to enhance the alignment and exchange of clinical information across health care facilities, and clinical process integration within and outside health systems as perceived by staff of health system affiliated primary care practices. Using survey methods, we collected data from 700 primary care staff members in 48 practice sites within 18 physician organizations affiliated with 13 health systems. To examine associations between EMR functionalities and perceived care integration, we used multi-level linear regression models, weighting staff survey data for differences in response rate by discipline. Among distinguishing EMR functionalities, clinical decision support (?=0.23, p=0.02), medication management (?=0.22, p=0.04), and electronic messaging (?=0.32, p<0.01) were significantly associated with higher levels of perceived clinical process integration within health system, but not outside the system. Our findings provide guidance to health systems in efforts to improve clinical process integration.

Teledentistry: A Boon Amidst COVID-19 Lockdown-A Narrative Review.

The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease (COVID-19) has caused widespread public health concerns. Despite huge efforts to contain the disease spread, it is still on the rise because of the community spread pattern of this infection. In order to prevent the community spread, a nationwide lockdown was implemented, due to which many restrictions were imposed on movements of citizens within the country. Since the dental professionals were at the forefront of acquiring the infection, the majority of the dental clinics were shut for routine dental procedures. Only emergency treatment was provided to the patients. However, due to restrictions in movement, it was difficult for the patients to visit the clinics for routine check-ups. This was overcome by the advancements in technology which has a major impact on medicine. Due to increased usage of smartphones and related software applications, the clinical data exchange was facilitated between patients and clinicians which has been termed as “teledentistry.” Teledentistry is a combination of telecommunications and dentistry, involving the exchange of clinical information and images for dental consultation and treatment planning. This technology served as a boon for the dentists to manage dental emergencies during the lockdown period. This narrative review discusses teledentistry and its applications in general and specialty dental practice amidst the COVID-19 lockdown.

The Cosmos Collaborative: A Vendor-Facilitated Electronic Health Record Data Aggregation Platform.

ObjectiveLearning healthcare systems use routinely collected data to generate new evidence that informs future practice. While implementing an electronic health record (EHR) system can facilitate this goal for individual institutions, meaningfully aggregating data from multiple institutions can be more empowering. Cosmos is a cross-institution, single EHR vendor-facilitated data aggregation tool. This work aims to describe the initiative and illustrate its potential utility through several use cases.MethodsCosmos is designed to scale rapidly by leveraging preexisting agreements, clinical health information exchange networks, and data standards. Data are stored centrally as a limited dataset, but the customer facing query tool limits results to prevent patient reidentification.ResultsIn 2 years, Cosmos grew to contain EHR data of more than 60 million patients. We present practical examples illustrating how Cosmos could further efforts in chronic disease surveillance (asthma and obesity), syndromic surveillance (seasonal influenza and the 2019 novel coronavirus), immunization adherence and adverse event reporting (human papilloma virus and measles, mumps, rubella, and varicella vaccination), and health services research (antibiotic usage for upper respiratory infection).DiscussionA low barrier of entry for Cosmos allows for the rapid accumulation of multi-institutional and mostly de-duplicated EHR data to power research and quality improvement queries characteristic of learning healthcare systems. Limitations are being vendor-specific, an “all or none” contribution model, and the lack of control over queries run on an institution’s healthcare data.ConclusionCosmos provides a model for within-vendor data standardization and aggregation and a steppingstone for broader intervendor interoperability.

The use of teledentistry in pediatric dental practice amidst COVID-19 lockdown: A literature review

The recent spread of coronavirus disease (COVID-19) has caused widespread public health concerns. All the countries of the world are taking necessary measures to prevent the community spread of this disease. In doing so, many countries have imposed lockdowns to restrict the movements of its citizens within the country. Realizing the severity of outcomes associated with this disease, dentists who were estimated to be at high risk of acquiring the disease rendered only emergency treatments to their patients. However, due to nationwide lockdown, it was difficult for the patients to visit the clinics for routine check-ups. This was overcome by the recent advancements in the field of technology. Today, in the age of smartphones, clinical data exchange was facilitated with the help of mobile cameras and video conferencing applications. These types of virtual consultations formed the basis of teledentistry. Teledentistry is a combination of telecommunications and dentistry, involving the exchange of clinical information and images for dental consultation and treatment planning. This technology served as a boon for the pediatric dentists to manage dental health concerns of children during the lockdown period. This review discusses about teledentistry and its applications in pediatric dental practice among the COVID-19 lockdown.

Inclusion of the Brisbane 2000 Terminology of Liver Anatomy and Resections Within SNOMED Clinical Terminology

Introduction: At the IHPBA meeting in Brisbane in 2000 the Brisbane 2000 Terminology of Liver Anatomy and Resections was accepted as the official terminology of the IHPBA. SNOMED-CT (Systematized Nomenclature of Medicine - Clinical Terminology) is the most comprehensive, multilingual clinical healthcare terminology in the world, and is an important standard in the recording and interchange of coded clinical information. It was initially released in 2002, and is in use in over 80 countries. Up until now SNOMED-CT hasn´t included all of the clinical terms and concepts contained within the Brisbane nomenclature. Methods: The clinical terms and concepts contained within the Brisbane terminology are mapped to the current SNOMED-CT clinical terms. New SNOMED-CT terms and relationships are proposed to enable a full representation of the Brisbane terminology within SNOMED-CT. Results: The new terms and relationships are presented and the process for endorsement by SNOMED International is discussed. Conclusions: Clinical information is increasingly stored electronically. Standards for clinical information exchange such as FHIR (Fast Healthcare Interoperability Resources) depend heavily on SNOMED-CT for coded clinical information. It is important therefore that the consensus of wisdom encapsulated within the Brisbane terminology is represented in SNOMED-CT.

Is Health Information Exchange Use by Hospitals and Home Health Agencies Associated with Lower Readmission Rates?

For older adults transitioning from the hospital to home health agencies (HHAs), clinical information exchange is key for optimal transitional care. Hospital and HHA participation in regional health information exchanges (HIEs) could address fragmented communication and improve patient outcomes. We examined differences in characteristics and outcomes for patients with either Medicare or Medicare Advantage (MA) insurance who transitioned from hospitals to HHAs based on HIE participation with 2014-2018 data from the Colorado All Payer Claims Database. We performed analyses including chi square and t tests to compare patient characteristics and 30-day readmission rates for high versus lower HIE use, determined by HIE participation (+) and non-participation (-) among HHAs and hospitals: High HIE use dyads (Hospital+/HHA+) were compared to lower HIE use dyads (Hospital+/HHA-, Hospital-/HHA+, Hospital-/HHA-). We identified 57,998 care transitions from 123 acute care hospitals to 71 HHAs. On average, patients were 75 years old, had a three day hospital length of stay, over half were female (58%), 82% had Medicare and 18% had MA insurance. Although most characteristics were similar between high versus lower HIE use dyads, high HIE use dyads had a higher proportion of Medicare patients compared to the lower HIE use dyads (85% vs 79%, p <0.001). Thirty-day readmissions were 12.4% for care transitions that occurred among high HIE use dyads (n=27,784) compared to 12.8% among lower HIE use dyads (n=32,929, p=0.102). For adults transitioning from hospitals to HHAs among high HIE use dyads, a trend toward lower 30-day readmission rates was identified.

The Premise and Development of CHECK IN-Check-In for Exchange of Clinical and Key Information to Enhance Palliative Care Discussions for Patients With Limited English Proficiency.

Communication regarding serious illness is challenging in most circumstances. Patients with Limited English Proficiency (LEP) have unique language and cultural needs that often require collaboration with a trained medical interpreter, especially when the clinical encounter involves serious illness decision making or elucidation of patient goals, preferences, and values. Although there is mounting evidence to support interpreter/clinician huddles before a serious illness communication encounter, no current initiatives exist to operationalize this evidence. We are currently in the process of developing, evaluating, and implementing a formal interpreter/clinician huddle process to promote high quality care for patients with LEP. Our huddle guide, called the Check-In for Exchange of Clinical and Key Information (CHECK-IN), is designed to facilitate collaboration between an interpreter and clinician during a serious illness encounter by prompting exchange of relevant sociocultural and clinical information between clinicians and interpreters.

Effectiveness of interventions related to continuity of health care in five Latin America countries

Abstract Background Evaluation of interventions to improve continuity of care across care levels is scarce in Latin America. The Aim to analyse the impact of implemented interventions on the perception of continuity of care of chronic patients in public health care networks of five LA countries (Brazil, Chile, Colombia, Mexico, and Uruguay). Methods Quasi-experimental study (controlled before and after design). Comparable networks, one intervention (IN) and one control (CN) were selected in each country. Baseline (2015) and evaluation (2017) surveys were conducted applying CCAENA questionnaire® to a sample of patients with chronic conditions (392/network; 784/country/year). Result variables: information continuity (exchange of clinical information) and clinical management continuity (repetition of exams, accessibility of primary care (PC) and secondary care (SC), perception of agreement between PC and SC doctors and of collaboration between PC and SC doctors. Descriptive analysis were conducted, and chi-square test was calculated to determine significant changes. Results An increase in the perception of continuity of information between care levels was observed in the IN of all countries, but Colombia. Clinical management continuity: decrease in the repetition of exams and increase in accessibility of consultation with the specialist in all countries but Mexico. The accessibility of PC doctor decreased in the IN in all countries. No differences in the perception of agreement between PC and SC doctors regarding diagnosis, treatment and recommendations were found. The perception of collaboration between PC and SC doctors increased in the five countries. Conclusions Consistent with expected results, the level of perceived information continuity and clinical management continuity increased in the IN, with differences between countries. Further multivariate analyses will be conducted to explore the differences between the IN and CN. Key messages Provides a cross-country comparison of the perception of continuity of care in patients with chronic conditions. Contributes to fill the knowledge gap on the effectiveness of participatory interventions improving continuity of care.

Care continuity across levels of care perceived by patients with chronic conditions in six Latin-American countries

ObjectiveTo analyse the care continuity across levels of care perceived by patients with chronic conditions in public healthcare networks in six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and to explore associated factors. MethodCross-sectional study by means of a survey conducted to a random sample of chronic patients in primary care centres of the study networks (784 per country) using the questionnaire Cuestionario de Continuidad Asistencial Entre Niveles de Atención (CCAENA)©. Patients had at least one chronic condition and had used two levels of care in the 6 months prior to the survey for the same medical condition. Descriptive analysis and multivariable logistic regression were carried out. ResultsAlthough there are notable differences between the networks analysed, the results show that chronic patients perceive significant discontinuities in the exchange of clinical information between primary care and secondary care doctors and in access to secondary care following a referral; as well as, to a lesser degree, regarding clinical coherence across levels. Relational continuity with primary care and secondary care doctors and information transfer are positively associated with care continuity across levels; no individual factor is systematically associated with care continuity. ConclusionsMain perceived discontinuities relate to information transfer and access to secondary care after a referral. The study indicates the importance of organisational factors to improve chronic patients’ quality of care.

Patient preferences when searching for clinical trials and adherence of study records to ClinicalTrials.gov guidance in key registry data fields

ClinicalTrials.gov was started with the intention to create a consumer-friendly database for patients and others in search of information on clinical trials. However, there is no research on whether the content of ClinicalTrials.gov aligns with patient preferences. The TransCelerate Clinical Research Access & Information Exchange Initiative convened patient advisory boards and conducted a global online survey (N = 1070) to determine patient preferences when searching for clinical trials for participation. Patient feedback and ClinicalTrials.gov guidance documents were used to construct instruments to assess patient focus and guidance adherence of the Brief Title (a short lay title of the clinical trial) and Brief Summary (a high-level summary of study features) data fields in a representative sample (N = 346) of ClinicalTrials.gov records of interventional trials. When searching for clinical trials, survey participants rated condition (66.4%), trial location (57.0%), trial dates (52.9%), age and gender (48.6%), and health measurements (i.e., what the study measures) (45.5%) as the most important items. When presented with a list of trials from an initial search, participants saw condition, brief summary, study drug name, and brief title as the most helpful items. In a Brief Title, they wanted condition, health measurements, participant age, and study drug name. For Brief Summaries, participants preferred additional information on treatment duration, condition, study goal, health measurements, and frequency of visits. The assessment of patient focus in a representative sample of current ClinicalTrials.gov records showed that patient focus was underdeveloped as study records achieved only 52% (brief titles) and 50% (brief summaries) of the best possible score. The analysis of adherence to ClinicalTrials.gov guidance showed better scores (brief titles 69%, brief summaries 66%). We identified key information elements for registry users when evaluating clinical trials for participation. We found that aspects of patient focus are not common in current ClinicalTrials.gov entries. To support more user-friendly study records, we developed a tool to assess the quality of the plain language fields in study records prior to submission.

Design and Psychometric Evaluation of the 'Clinical Communication Self-Efficacy Toolkit'.

Nursing students experience difficulties when communicating in clinical practice. Their self-efficacy in clinical communication should be explored as part of their competence assessment before they are exposed to real human interactions in the clinical setting. The aim of this study was to design and psychometrically evaluate a toolkit to comprehensively assess nursing students’ self-efficacy in clinical communication. The study followed an observational cross-sectional design. A sample of 365 nursing students participated in the study. The ‘Clinical Communication Self-Efficacy Toolkit’ (CC-SET) was comprised of three tools: the ‘Patient-Centered Communication Self-efficacy Scale’ (PCC-SES), the ‘Patient clinical Information Exchange and interprofessional communication Self-Efficacy Scale’ (PIE-SES), and the ‘Intrapersonal communication and Self-Reflection Self-Efficacy Scale’ (ISR-SES). The tools’ reliability, validity (content, criterion, and construct) and usability were rigorously tested. The Cronbach’s alpha coefficient of the three tools comprising the CC-SET was very high and demonstrated their excellent reliability (PCC-SES = 0.93; PIE-SES = 0.87; ISR-SES = 0.86). The three tools evidenced to have excellent content validity (scales’ content validity index > 0.95) and very good criterion validity. Construct validity analysis demonstrated that the PCC-SES, PIE-SES, and ISR-SES have a clear and theoretically-congruent structure. The CC-SET is a comprehensive toolkit that allows the assessment of nursing students’ self-efficacy in interpersonal, interprofessional, and intrapersonal communication.

Mapping the care transition from hospital to skilled nursing facility.

Care transitions between hospitals and skilled nursing facilities (SNFs) are often associated with breakdowns in communication that may place patients at risk for adverse events. Less is known about how to address these issues in the context of busy patient care settings. We used process mapping to examine hospital discharge and SNF admission processes to identify opportunities for improvement. A quality improvement (QI) team worked with frontline staff to create a process map illustrating the sequence of events involved with hospital discharge and SNF admission. The project was completed at an academic medical centre and two local SNFs in the north-eastern United States. Participants represented the care management, medicine, nursing, admissions, and physical therapy services. The data informed hospital QI interventions seeking to improve the quality and safety of hospital-SNF transfers and reduce unplanned hospital readmissions. The final process map highlighted numerous activities that need to be coordinated between care teams, including the time-sensitive exchange of clinical and administrative information. Participants shared insights about how care teams reach critical decisions about patient disposition and post-acute care utilization. Process mapping highlighted specific opportunities for improving communication between care teams. Participants advocated for earlier assessments of patients' functional status and support systems, including reliable at-home services. They also reasoned that improved communication would help patients and providers reach decisions together, coordinate work efforts, and better prepare for hospital discharge and SNF admission. This information can be used to improve patient care transitions between hospitals and SNFs.