Follow-up Calls Research Articles

Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial

PurposeAdolescent emergency department (ED) patients have unmet social needs that contribute to ED use. This study aimed to evaluate the effect of social needs navigation for adolescents on subsequent ED visits and community resource use and to identify characteristics associated with elevated social risk. MethodsBetween July 2017 and August 2019, we used a random date generator to establish intervention and control group enrollment dates. All adolescents completed a social needs survey. Adolescents enrolled on intervention dates received in-person, risk-tailored social needs navigation. Those enrolled on control dates received a preprinted resource guide. We used chart review and follow-up calls to assess 12-month ED revisits and community resource use. Logistic regression was used to compare these outcomes between groups. We measured the association between ≥3 reported unmet needs and characteristics hypothesized a priori to be associated with elevated social risk (nonurgent visits, obesity, or any of nine “socially sensitive” chief complaints) using logistic regression. ResultsA total of 399 adolescents were randomized. There was no difference between groups in the number of ED revisits. There was increased community resource use in the intervention group (adjusted odds ratio [aOR]: 3.5 [95% confidence interval {CI}: 1.5, 8.2]). Adolescents with a socially sensitive chief complaint had increased odds of ≥3 unmet needs (aOR: 2.2 [95% CI: 1.3, 3.6]), as did those with food insecurity in a post hoc analysis (aOR: 9.9 [95% CI: 4.0, 24.6]). DiscussionSocial needs navigation increased community resource use but not subsequent ED visits. Adolescents with socially sensitive chief complaints or food insecurity reported increased unmet needs.

Engaging Older Adults and Families Using the IDEAL Discharge Protocol: A Quality Improvement Initiative to Improve Outcomes and Reduce Readmissions.

Older adults have challenges understanding newly prescribed medications after discharge and must be more adherent with medications and follow up with their primary care provider. A collaborative discharge process is critical to improving patient outcomes and reducing avoidable readmission rates. This quality improvement (QI) initiative engaged 44 patients and families in the IDEAL Discharge Protocol-an evidence-based collaborative care process focused on discussion, education, and post-discharge follow up. Post-discharge follow up resulted in the completion of 52.2% of follow-up calls and 45.5% of follow-up appointments scheduled, and a 4% reduction in readmission rates. Medication adherence was assessed and found to be 93.3%, and 100% of participants received education while engaged in the study. The IDEAL Discharge Protocol aided in improving the discharge process to better equip patients with the tools to transition home successfully after discharge. [Journal of Gerontological Nursing, 49(10), 13-19.].

Effect of Maternal and Newborn Care Intervention on Maternal Functioning of Primiparous Mothers

Primiparous mother is confronted with many physical and psychosocial changes during the postpartum period which consequently affect her maternal functioning. To deal with these changes positively, the maternal functioning of postpartum mothers should be enhanced by the provision of maternal and newborn care intervention (MNCI). A quasi-experimental research pretest post-test comparison group design was used to study the effect of MNCI on the maternal functioning of primiparous mothers. This study was conducted in Mandalay Central Women’s Hospital, Myanmar. A total of 72 primiparous mothers (control group=36, intervention group=36) were recruited by consecutive sampling. The MNCI was given to the intervention group in the form of direct nursing care, individual and group teaching and demonstration using audio-visual materials and an educational booklet, discussion in “Peer Viber Support Group” and follow-up telephone calls. Baseline assessment was done at antenatal 32nd to 36th weeks to assess postpartum self-care knowledge, maternal newborn care knowledge, and social support. At six weeks postpartum, self-efficacy and maternal functioning of participants were assessed in addition to baseline assessment. Descriptive statistics, paired t-test, independent t-test, and Chi-square test were used to analyze the data. The results showed that maternal functioning was significantly improved in the intervention group than the control group at postpartum six weeks (p < 0.05). The improvement was also found in postpartum self-care knowledge, maternal newborn care knowledge, social support, and postpartum self-efficacy of primiparous mothers at postpartum six weeks (p < 0.001). This study highlighted that the MNCI was effective in enhancing the maternal functioning of the primiparous mothers. Further studies are recommended to determine the effectiveness of the MNCI upon health outcomes of postpartum mothers and babies in hospitals and community settings.

Survey on infectious disease telephone hotlines in primary care: General practitioners’ satisfaction and compliance with advice

ObjectivesInfectious disease (ID) advice is a major part of antimicrobial stewardship programs. The objective of this study was to assess general practitioners’ (GPs)’ opinions and compliance with advice given by ID hotlines. Patients and methodsThis multicenter survey was based on the 7-day assessment of initial advice requested by GPs to a hotline set up by volunteer hospital ID teams to record advice for 3 years. The primary endpoint was the GPs’ satisfaction with the advice given by ID specialists. ResultsTen ID teams participated in the study and recorded 4138 requests for advice, of which 1325 requests included a proposal for antibiotic therapy and justified a follow-up call at seven days. Only 398 follow-up calls (30%) were carried out because many GPs were not reachable.GPs were very satisfied with ID hotlines: 58% considered them indispensable and 38% very useful. The recommendations provided by ID specialists were followed by GPs in more than 80% of cases. The two main motivations for GPs to call the hotline were to get quick advice (86%) and to receive help in managing a patient (76%). ConclusionsThe ID telephone consultations and advice systems for GPs are highly appreciated and are effective in terms of following the recommendations.

ThTP6.10 A multi-specialty clinical audit to assess true surgical site infection incidence at a district general hospital in Kent

Abstract A surgical site infection (SSI) is a healthcare-associated infection which occurs within 30 days of surgery, or within 90 days of surgical implantation. SSIs cause significant morbidity and mortality. 3 types of SSI are recognised: superficial incisional, deep incisional and organ/space. Our audit aim was to assess our hospital performance against established national targets: SSI rates <1% following clean procedures and <10% following clean-contaminated surgery. Retrospective data collection was carried out. Patients who underwent surgery in theatres throughout 12/7/22 - 31/8/22 were included. Clinical records were reviewed, and follow-up telephone calls were made to capture any additional SSIs. 955 patients were included in the 1st cycle. Overall SSI rate was 14.5% (n = 138). This varied across specialties, being 18.1% for general surgery (n = 45/249) to 4.3% for paediatric surgery (n = 2/47). Incidence of SSIs in the elective and emergency settings for general surgery were 12.84% (n = 14/109) and 22.14% (n = 31/140) respectively. SSI rates also varied within each specialty according to procedure type. Within orthopaedics, Spearman’s correlation coefficient for procedure type and association with SSI showed statistical significance, Rs 0.961, P < 0.001. 38 SSIs were identified from follow-up telephone calls. This audit has demonstrated that the true incidence of SSIs is likely to be significantly higher than anticipated if hospital admission is the only criteria to capture data. Our results show there is scope for improvement to reduce SSIs. We have since implemented Oxford’s 8-point SSI reduction bundle. A re-audit is scheduled for 2023.

Does a proactive procedure lead to a higher uptake of predictive testing in families with a pathogenic BRCA1/BRCA2 variant? A family cancer clinic evaluation.

The uptake of genetic counseling and predictive genetic testing by family members at risk for hereditary tumor syndromes is generally below 50%. To address this issue, a new guideline was introduced in the Netherlands in 2019 that aims to improve the sharing of information within families. In addition to cascade screening supported by follow-up telephone calls with the proband, municipal records were accessed to allow the geneticist to contact at-risk family members directly. We evaluated this procedure in 32 families with a (likely) pathogenic germline BRCA1/BRCA2 variant diagnosed at our hospital between May 1, 2020, and July 31, 2021, comparing current uptake with outcomes achieved for 33 families diagnosed in 2014. Fifteen months after diagnostic testing of the proband, the uptake was 43% (120/277), comparable to the 44% (87/200) registered previously. Among a subgroup of women at 50% risk aged 25-75 years, 71% (47/66) were tested, comparable to an earlier uptake of 69% (59/86). Of the 34 at-risk relatives we contacted directly, 17 (50%) underwent predictive testing. In conclusion, we found no evidence that the new procedure leads to a substantially increased uptake. Future research should be primarily aimed at understanding intrafamilial communication barriers.

Prehabilitation for frail patients undergoing total hip or knee replacement: protocol for the Joint PREP feasibility randomised controlled trial

BackgroundApproximately, 8% of community-based adults aged ≥ 50 years in England are frail. Frailty has been found to be associated with poorer outcomes after joint replacement. Targeting frailty preoperatively via exercise and protein supplementation has the potential to improve outcomes for people undergoing joint replacement. Prior to proceeding with a randomised controlled trial (RCT), a feasibility study is necessary to address key uncertainties and explore how to optimise trial design and delivery.MethodsThe Joint PRehabilitation with Exercise and Protein (Joint PREP) study is a feasibility study for a multicentre, two-arm, parallel group, pragmatic, RCT to evaluate the clinical and cost-effectiveness of prehabilitation for frail patients undergoing total hip or knee replacement. Sixty people who are ≥ 65 years of age, frail according to the self-reported Groningen Frailty Indicator, and scheduled to undergo total hip or knee replacement at 2–3 hospitals in England and Wales will be recruited and randomly allocated on a 1:1 ratio to the intervention or usual care group. The usual care group will receive the standard care at their hospital. The intervention group will be given a daily protein supplement and will be asked to follow a home-based, tailored daily exercise programme for 12 weeks before their operation, in addition to usual care. Participants will be supported through six follow-up calls from a physiotherapist during the 12-week intervention period. Study questionnaires will be administered at baseline and 12 weeks after randomisation. Embedded qualitative research with patients will explore their experiences of participating, reasons for nonparticipation, and/or reasons for withdrawal or treatment discontinuation. Primary feasibility outcomes will be eligibility and recruitment rates, adherence to the intervention, and acceptability of the trial and the intervention.DiscussionThis study will generate important data regarding the feasibility of a RCT to evaluate a prehabilitation intervention for frail patients undergoing total hip and knee replacement. A future phase-3 RCT will determine if preoperative exercise and protein supplementation improve the recovery of frail patients after primary joint replacement.Trial registrationISRCTN11121506, registered 29 September 2022.

Effectiveness of home-based exercise in breast cancer survivors: a randomized clinical trial

BackgroundBreast cancer patients are recommended to engage in regular exercise. In developing countries, where there is a lack of facilities to offer specialized, supervised exercise for this population, regularly exercising might be a challenge. We aimed to evaluate the effectiveness of a home-based intervention in this population.MethodsBreast cancer survivors were randomly assigned to either the home-based exercise program or the usual care group. Exercise intervention included walking, balance, and stretch exercises, along with weekly follow-up telephone calls. Quality of life (QOL) was evaluated using EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires and the predicted VO2 peak was measured using the Ebbeling submaximal treadmill test.ResultsEighty-nine patients were enrolled in the study. Reported minutes of exercise gradually increased from 40.7 min per week in week 1 to 116.9 min per week in week 12. This intervention improved global QOL (P = 0.001), social functioning (P = 0.04), and the predicted VO2 peak (P = 0.01).ConclusionThis home-based exercise regime effectively increased quality of life and physical activity levels.Trial registryIranian Registry of Clinical Trials identifier: IRCT20140810018746N1, prospectively registered 08/01/2018, https://en.irct.ir/trial/27959.

The effect of progressive and individualised sport-specific training on the prevalence of injury in football and handball student athletes: a randomised controlled trial.

To evaluate the effectiveness of communication and coordination combined with designing a progressive and individualised sport-specific training program for reducing injury prevalence in youth female and male football and handball players transitioning to a sports academy high school. An additional aim was to investigate the characteristics of the reported injuries. Forty-two Norwegian athletes were randomised into an intervention or control group. Mean age, height, weight and BMI was 15.5 ± 0.5 years, 178.6 cm ± 6.3 cm, 71.3 ± 9.8 kg, 22.3 ± 2.7 BMI for the intervention group (IG) (n = 23), and 15.4 ± 0.5 years, 175.6 cm ± 6.6 cm, 67.1 ± 9.8 kg, 21.7 ± 2.4 BMI for the control group (CG) (n = 19). During the summer holiday, the intervention group received weekly progressive, individualised sport-specific training programs and weekly follow-up telephone calls from the researchers. All athletes completed a baseline questionnaire and a physical test battery. Training data and injuries were recorded prospectively for 22 weeks using the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). A two-way chi-square (χ2) test of independence was conducted to examine the relationship between groups and injury. Average weekly prevalence of all injuries was 11% (95% CI: 8%-14%) in IG and 19% (95% CI: 13%-26%) in CG. Average weekly prevalence of substantial injuries was 7% (95% CI: 3%-10%) in IG and 10% (95% CI: 6%-13%) in CG. The between-group difference in injuries was significant: χ2 (1, N = 375) = 4.865, p = .031, φ = .114, with 1.8 times higher injury risk in CG vs. IG during the first 12 weeks after enrolment. For student athletes transitioning to a sports academy high school, progressive individualised, sport-specific training programs reduced the prevalence of all-complaint injuries following enrolment. Clubs and schools should prioritise time and resources to implement similar interventions in periods where student athletes have less supervision, such as the summer holidays, to facilitate an optimal transition to a sports academy high school.

Developing Faith-Based Messaging and Materials for Colorectal Cancer Screening: Application of Boot Camp Translation Within the African Methodist Episcopal Church

Purpose of the study: Colorectal cancer (CRC) is the 2nd leading cause of cancer-related death in Black and African American people in the United States. We created culturally appropriate and locally relevant faith-based CRC screening messages and materials for African Methodist Episcopal (AME) church communities in Atlanta, Georgia. Methods: We used boot camp translation (BCT), a validated community based participatory strategy, to elicit input from AME congregants to 1) develop faith-based CRC screening messages that resonate with the AME community and 2) identify the role of the church in bringing CRC information to the AME community. Eligible participants were members of the AME Atlanta East District churches, ages 45 to 75 years, and willing to participate in one 5-hour in-person meeting and two follow-up video-conferencing calls. The in-person session, conducted in the church sanctuary and fellowship hall, consisted of expert presentations by a national leader on colorectal cancer and screening, a local leader well-versed in barriers to screening and community resources, and a prominent figure within the church clergy. Additionally, we held interactive small group sessions to create messages and identify dissemination methods. Results: A total of 27 adults participated in the in-person session (17 women and 10 men). Participants preferred CRC screening messages that incorporated faith-based concepts including “honoring God by taking care of one's body”_ and “choosing faith over fear of screening.”_ Other key themes focused on increasing awareness and knowledge of CRC screening, taking control of one's own health, and sharing personal stories with one's community to reduce stigma and inspire action. Favored dissemination channels within the church were Sunday service, print (e.g., flyers, pamphlets, message cards) distributed at church, and digital materials (e.g., videos) shown during service. Desired community channels included cancer awareness events and social media platforms. Conclusions: Churches serve as key partners in delivering health information as they are among the most trusted institutions within the Black and African American community. Using BCT, we successfully incorporated participant feedback to create faith-based CRC screening messages and identified appropriate channels for sharing information within the AME community.

Understanding the Role of Staff Nurses in Hypertension Management in Primary Care Facilities in India: A Time-Motion Study.

India is facing a shortage of staff nurses; thus, a better understanding of nurses' workloads is essential for improving and implementing noncommunicable disease (NCD) control strategies. We estimated the proportion of time spent by staff nurses on hypertension and other NCD activities in primary care facilities in 2 states in India. We conducted a cross-sectional study in 6 purposively selected primary care facilities in Punjab and Madhya Pradesh during July through September 2021. We used a standardized stopwatch to collect data for time spent on direct hypertension activities (measuring blood pressure, counseling, recording blood pressure measurement, and other NCD-related activities), indirect hypertension activities (data management, patient follow-up calls), and non-NCD activities. We used the Mann-Whitney U test to compare the median time spent on activities between facilities using paper-based records and the Simple mobile device-based app (open-source software). Six staff nurses were observed for 213 person-hours. Nurses spent 111 person-hours (52%; 95% CI, 45%-59%) on direct hypertension activities and 30 person-hours (14%; 95% CI, 10%-19%) on indirect hypertension activities. The time spent on blood pressure measurement (34 minutes) and documentation (35 minutes) was the maximum time on any given day. Facilities that used paper records spent more median time (39 [IQR, 26-62] minutes) for indirect hypertension activities than those using the Simple app (15 [IQR, 11-19] minutes; P < .001). Our study found that hypertension activities required more than half of nurses' time in India's primary care facilities. Digital systems can help to reduce the time spent on indirect hypertension activities.

Post-SNF Follow-Up Calls and Appointments Trend Toward Decreased Readmissions

Post-SNF Follow-Up Calls and Appointments Trend Toward Decreased Readmissions

Long-Term Effects of a COMPASS Program on the Caregiving Journey: 1-Year Follow-Up in a Randomized Controlled Trial

Introduction: The number of older adults requiring long-term care (LTC) is increasing rapidly worldwide. The primary family caregivers of LTC recipients experience ongoing burdens and various challenges in their caregiving that adversely affect their own health and also the quality of caring that they provide to their loved ones. As a country becoming a super-aged society, South Korea has been making considerable efforts to improve the long-term effects on caregivers by providing them with support intervention programs. Methods: This study was designed to assess the long-term effects of a COMPASS program at a national level. The short-term and long-term benefits were compared for the full COMPASS program (comprising 6 individual visits, 3 group-support sessions, and 2 telephone calls) provided to 203 caregivers, as were the long-term benefits between the full COMPASS program and its short form (comprising 3 individual visits and 1 group-support session) provided to 213 caregivers. The effects of the program on the family caregivers were evaluated by measuring their levels of social support received, self-efficacy, depression, burden, and risk to health. Results: The long-term effects of the COMPASS program were greater than those of its short-term effects in reducing depression and risk to health (p = 0.013 and p = 0.002, respectively), whereas there were no significant differences between the short-term and long-term effects of the full COMPASS program on social support, self-efficacy, or burden. Comparing the long-term effects between the two forms of the COMPASS program revealed that the depression of caregivers was improved more by the full program than by the short form (p = 0.022), while there were no significant differences for social support, self-efficacy, burden, or risk to health. Conclusion: This study supports providing COMPASS programs to obtain long-term benefits for family caregivers of LTC recipients. Potential approaches that could optimize the long-term benefits of the COMPASS program include supporting caregivers to participate in arts-related hobbies and maintaining follow-up telephone calls after program completion.

Many a Slip Twixt the Intake Form and the Living Donation.

Many a Slip Twixt the Intake Form and the Living Donation.

The interprofessional collaboration between police and crisis response team in managing suicide-related cases in Singapore

Introduction The Crisis Response Team (CRT) is an interprofessional collaboration between the Singapore Police Force (SPF) and the Mental Health Helpline (MHH) of the Institute of Mental Health (IMH). Supported by a multidisciplinary team comprising of the SPF, IMH psychiatrists, community psychiatric nurses and crisis counsellors, and community partners, this intervention aims to support suicidal individuals, depending on their risk severity, residing in the community. Objectives To present the CRT work process and to explore the characteristics and outcomes of suicide-related cases referred. Methods In this descriptive research study, a quantitative approach is adopted. An Excel file shared across the helpline counsellors is used to collate information of the referred cases. Data collected from October 2021 to August 2022 were evaluated using the IBM SPSS Statistics for Windows v28.0. Descriptive statistics were used to summarise the characteristics and outcomes of the cases. Results Figure 1 shows the CRT work process. To standardise the method of assessing both suicide ideation and behaviour, the Columbia-Suicide Severity Rating Scale (C-SSRS) is utilised. As compared to other suicide ideation and behaviour scales, the C-SSRS has demonstrated good convergent and divergent validity, high sensitivity and specificity for suicidal classifications, and moderate to strong internal consistency (Cronbach’s α: 0.73 - 0.95) (Posner et al. AJP 2011; 168(12) 1266-1277). A total of 3,386 suicide-related cases was referred. The age range of the suicide-related cases range from 8 – 97 years old (M = 36, SD = 17.33). Of these 3,386 cases, 627 cases were discharged back to their family members/employer/friend/partner and with follow-up check-in calls by the MHH counsellors, 416 cases were sent to the restructured hospitals for organic workup, 2,268 cases were brought back to IMH, 55 cases were discharged back to the SPF for further investigation, and 20 cases warranted CRT home visit activations. Figure 2 shows the total number of referred cases and outcome of these cases in each month. Image: Image 2: Conclusions The CRT intervention could mitigate suicide risk and pressure on the mental health system (i.e., reduce unnecessary emergency room visits and hospital admissions), create greater mental health awareness, and facilitate individuals’ connection to mental healthcare services (i.e., in hospitals and/or in the community) as evidenced by the increasing number of cases referred, and increased collaboration with the various stakeholders, ensuring timely intervention and necessary follow-ups thereafter. Disclosure of Interest None Declared

Effect of interventional follow-up phone calls on health-related quality of life in adult patients with heart failure in Saudi Arabia: a pilot study

Abstract Aim. To determine the eff ects of interventional follow-up phone calls on the health-related quality of life (HRQOL) in adult patients with heart failure (HF). Material and methods. This quasi-experimental with a one-group pretest-posttest design was conducted on 30 patients with HF receiving interventional follow-up phone calls by a cardiology nurse from an internationally recognized healthcare organization in Saudi Arabia. Data were collected by sociodemographic and clinical surveys and Minnesota Living with Heart Failure Questionnaire. A paired sample t-student test was conducted to measure the eff ectiveness of the follow-up calls on the HRQOL pretest and posttest. Results. A statistically significant difference was found between the pre-intervention and post-intervention mean scores of the total HRQOL scale and all the subscales: physical, emotional/psychological, and socio-economic (p&lt;0.001). The diff erence between the mean pretest-posttest scores was 31.08 (SD=11.09), which was statistically significant at t(29)=14.29 (p&lt;0.001). The participants’ overall HRQOL increased significantly after the intervention (Mean=39.04, SD=1.66). Conclusions. Interventional follow-up phone calls were found to be eff ective in improving the HRQOL of patients with HF. However, a larger study – a multi-center one, is needed to confirm the findings of this study. By providing empirical evidence, this research may motivate cardiology nurses to pursue such programs in this population.

Clinical and electrocardiographic outcomes evaluated by telemedicine of outpatients with clinical suspicion of COVID-19 treated with chloroquine compounds in Brazil†.

To evaluate clinical and electrocardiographic outcomes of patients with COVID-19, comparing those using chloroquine compounds (chloroquine) to individuals without specific treatment. Outpatients with suspected COVID-19 in Brazil who had at least one tele-electrocardiography (ECG) recorded in a telehealth system were enrolled in two arms (Group 1: chloroquine and Group 2: without specific treatment) and one registry (Group 3: other treatments). Outcomes were assessed through follow-up calls (phone contact, days 3 and 14) and linkage to national mortality and hospitalization databases. The primary outcome was composed of: hospitalization, intensive care admission, mechanical ventilation, and all-cause death, and the ECG outcome was the occurrence of major abnormalities by the Minnesota code. Significant variables in univariable logistic regression were included in 4 models: 1-unadjusted; 2-adjusted for age and sex; 3-model 2 + cardiovascular risk factors and 4-model 3 + COVID-19 symptoms. In 303 days, 712 (10.2%) patients were allocated in group 1, 3,623 (52.1%) in group 2 and 2,622 (37.7%) in group 3; 1,969 had successful phone follow-up (G1: 260, G2: 871, and G3: 838). A late follow-up ECG was obtained for 917 (27.2%) patients [group 1: 81 (11.4%), group 2: 512 (14.1%), group 3: 334 (12.7%)]. In adjusted models, chloroquine was independently associated with greater chance of the composite clinical outcome: phone contact (model 4): OR = 3.24 (95% CI 2.31-4.54), p < 0.001. Chloroquine was also independently associated with higher mortality, assessed by phone + administrative data (model 3): OR = 1.67 (95% CI 1.20-2.28). However, chloroquine did not associate with the occurrence of major ECG abnormalities [model 3; OR = 0.80 (95% CI 0.63-1.02, p = 0.07)]. Abstracts with partial results of this work was accepted in the American Heart Association Scientific Sessions, November 2022, in Chicago, IL, USA. Chloroquine was associated with a higher risk of poor outcomes in patients suspected to have COVID-19 when compared to those who received standard care. Follow-up ECGs were obtained in only 13.2% of patients and did not show any significant differences in major abnormalities amongst the three groups. In the absence of early ECG changes, other side effects, late arrhythmias or deferral of care may be hypothesized to explain the worse outcomes.

Dementia “e”-consults for Behavioral and Psychological Symptoms of Dementia: Improving access to specialty dementia care for rural Veterans

ABSTRACT Objectives This paper characterizes a telephone-based e-consult program designed to assess and treat behavioral and psychological symptoms of dementia (BPSD) for older rural Veterans. Methods E-consults required geriatricians to conduct chart review and telephone calls to caregivers to determine behavior triggers, prior management attempts, and medications. Pharmacologic and non-pharmacological recommendations were provided with follow-up calls as needed. Results Evaluation of 364 Veterans (M age = 80.8, 32% in rural/distal clinics) showed 97% (n = 355) of E-consult interventions included caregiver dementia education to prepare them for managing disease progression and provide non-pharmacological strategies for BPSD. Ninety-four percent (n = 244) of Veterans received medication guidance. A total of 37,504 travel miles was saved, with an average of 108 miles for each Veteran. Conclusions Findings support continued implementation of telephone and other virtual modalities of assessing and treating BPSD for older Veterans, thereby increasing access to dementia specialists, especially for rural older adults and their caregivers. A limitation to e-consults is the time needed to provide services compared to the maximum workload credit allowed. Clinical Implications Virtual care improves access to Geriatric specialists and semi-urgent care that otherwise is not available. E-consults are effective in providing primary care providers guidance for diagnosis and management of dementia.

An Audit of Inpatient Consultation-Liaison Psychiatry Services at an Inner New York City Safety Net Hospital.

Background Our study's primary objective is to audit the resource utilization of a consultation-liaison (CL) psychiatry service in an inner New York City safety net hospital. This cross-sectional, observational study was conducted as a subset of a quality improvement project at the hospital to investigate the characteristics of the emergent nature of consults, types, and the specialty from which the referral was placed to the CL services. This study aims to improve the efficacy of our consult process by improving the appropriateness and precision of consult requests. Methodology This cross-sectional, observational study was reviewed and approved by the Institutional Review Board under a quality improvement exemption. The study investigated the EPIC electronic medical record data for characteristics of consult referrals in the third quarter of 2019 from July 1, 2019, to September 30, 2019. A total of 629 consults were recorded during this period. We excluded follow-up calls, duplicate data rows, and patients with missing data points; the final consults were 421. Patients who required more than one new consult (follow-up excluded) within 90 days were considered; thus, the total number of patients who were included in the study was 327. Results Of the 421 consults identified in the dataset for review, only 45.8% were valid consults, 32.8% were not valid, and 21.4% were uncertain. Further, the most common department from which consults were placed was Medicine (73.2%), followed by Surgery (12.8%), Obstetrics/Gynecology (9%), Critical Care (3.6%), and, finally, Pediatrics (1.4%). Conclusions The study overviews the quality of general consults for the CL psychiatry service and how the CL staff manages it. It also provides an idea about the number of consults that can be comprehensively addressed.

Intensive Care Unit Diaries: A Nurse-Led Program.

Following intensive care unit stays, patients with post-intensive care syndrome can experience mental health symptoms that impact quality of life. Intensive care unit diaries have been shown to improve outcomes for patients and their families. Identification of limited support for high volumes of intensive care unit patients and families led to implementation of an intensive care unit diary program in a 24-bed adult medical-surgical intensive care unit. Patients requiring mechanical ventilation with an expected intensive care unit stay of more than 24 hours were provided intensive care unit diaries. Nursing staff and patients' families entered daily descriptive narratives of patients' progress during the stay. After intensive care unit discharge, patients and families reviewed the diaries to improve acceptance of their intensive care unit experience. Project evaluation included review of patient and family follow-up calls, a staff nurse feedback survey, and project champion debriefing sessions to gauge implementation success and feasibility. Twenty diaries were completed and distributed to patients or families at intensive care unit discharge. Follow-up calls illustrated support and gratitude for diaries regardless of patient outcomes. Patients reported that diaries helped fill memory gaps between intensive care unit admission and discharge. Nurse surveys and project champion debriefings confirmed that completion of intensive care unit diary entries had minimal impact on workload, eased communication, and improved staff members' coping skills. Successful intensive care unit diary program implementation has the potential to benefit patients, families, and nursing staff for little organizational cost.