Hospital-based Health Professionals Research Articles

Systems and people under pressure: the discharge process in an acute hospital

To understand the perspective of hospital-based health professionals with regard to preparing patients for discharge from an acute hospital in England. The hospital experience in England over recent years is characterised by increasing admission rates and decreasing length of stay. Legislation and policy initiatives have also focussed upon the need to reduce delayed discharges. Discharge preparation is known to be a complex intervention with multiple obstacles within and outside of the hospital setting. Qualitative. Posters were displayed within a hospital asking health professionals to take part in a focus group. Maximum variation, in terms of job titles, was sought for within the sample. Focus groups were held in December 2006. Six senior members of staff divided into pairs to run them. All groups were taped and transcribed verbatim and analysed using a framework approach. Three focus groups were conducted, which involved 11 nurses, 15 allied health professionals, five social workers and one doctor. Analysis identified the following themes and sub themes: 1 Conflicting pressures on staff: Keeping patients in hospital vs. getting them out; Striving for flexibility within a system; A paucity of intermediary provision. 2 Casualties arising from conflicting pressures: Professionals losing their sense of professionalism; Patients being 'systematised'. Pressures described during focus groups stemmed from five main sources: external targets placed upon the system, internal hospital inflexibility and poor communication, the dominance of the medical model of care, a desire to address the complex needs of individuals and a lack of community services. Staff felt themselves to be victims of these competing pressures and that many of the solutions were beyond their influence. Staff described the dehumanising effect of sometimes having to ignore patient concerns, wishes and choices. Understanding of the pressures surrounding discharge could inform relevant service improvements.

Validation of a Spanish Questionnaire to Evaluate Habits, Attitudes, and Understanding of Exposure to Sunlight: “The Beach Questionnaire”

Background Questionnaires are the usual method for investigating sun-related behavior. However, such tools must be validated through evaluation of their measurement properties. The aim of the present study was to assess the validity and reliability of a Spanish questionnaire evaluating habits, attitudes, and understanding of exposure to sunlight. Patients and Methods In a cross-sectional study, the questionnaire was administered to a sample of 422 participants found on beaches. For the test-retest analysis, 70 hospital-based health professionals were interviewed on 2 separate occasions. The construct validity, internal consistency, and reproducibility were analyzed. Results Factorial analysis of the principal components confirmed the construct validity with commonalities and factor saturations >0.50, and revealed multiple dimensions with Cronbach α values > 0.70. The items on habits and understanding showed intraclass correlation and δ coefficient values > 0.70, but those on attitude had lower stability values (0.50-0.80). Conclusions This is the first Spanish questionnaire with demonstrated validity and reliability for evaluating habits, attitudes, and understanding of exposure to sunlight. It will be a useful instrument for future epidemiologic studies and research into the prevention of skin cancer in Spain.

Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home.

It is known that many patients encounter a variety of problems in the first weeks after they have been discharged from hospital to home. In recent years many projects have addressed discharge planning, with the aim of reducing problems after discharge. Telephone follow-up (TFU) is seen as a good means of exchanging information, providing health education and advice, managing symptoms, recognising complications early, giving reassurance and providing quality aftercare service. Some research has shown that telephone follow-up is feasible, and that patients appreciate such calls. However, at present it is not clear whether TFU is also effective in reducing postdischarge problems. To assess the effects of follow-up telephone calls in the first month post discharge, initiated by hospital-based health professionals, to patients discharged from hospital to home. We searched the following databases from their start date to July 2003, without limits as to date of publication or language: the Cochrane Consumers and Communication Review Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), PubMed, EMBASE (OVID), BiomedCentral, CINAHL, ERIC (OVID), INVERT (Dutch nursing literature index), LILACS, Picarta (Dutch library system), PsycINFO/PsycLIT (OVID), the Combined Social and Science Citation Index Expanded (SCI-E), SOCIOFILE. We searched for ongoing research in the following databases: National Research Register (http://www.update-software.com/nrr/); Controlled Clinical Trials (http://www.controlled-trials.com/); and Clinical Trials (http://clinicaltrials.gov/). We searched the reference lists of included studies and contacted researchers active in this area. Randomised and quasi-randomised controlled trials of TFU initiated by a hospital-based health professional, for patients discharged home from an acute hospital setting. The intervention was delivered within the first month after discharge; outcomes were measured within 3 months after discharge, and either the TFU was the only intervention, or its effect could be analysed separately. Two review authors independently assessed studies for inclusion and for methodological quality. The methodological quality of included studies was assessed using the criteria from the Cochrane Effective Practice and Organisation of Care Review Group. The data-extraction form was based on the template developed by the Cochrane Consumers and Communication Review Group. Data was extracted by one review author and checked by a second author. For as far it was considered that there was enough clinical homogeneity with regard to patient groups and measured outcomes, statistical pooling was planned using a random effects model and standardised mean differences for continuous scales and relative risks for dichotomous data, and tests for statistical heterogeneity were performed. We included 33 studies involving 5110 patients. Predominantly, the studies were of low methodological quality. TFU has been applied in many patient groups. There is a large variety in the ways the TFU was performed (the health professionals who undertook the TFU, frequency, structure, duration, etc.). Many different outcomes have been measured, but only a few were measured across more than one study. Effects are not constant across studies, nor within patient groups. Due to methodological and clinical diversity, quantitative pooling could only be performed for a few outcomes. Of the eight meta-analyses in this review, five showed considerable statistical heterogeneity. Overall, there was inconclusive evidence about the effects of TFU. The low methodological quality of the included studies means that results must be considered with caution. No adverse effects were reported. Nevertheless, although some studies find that the intervention had favourable effects for some outcomes, overall the studies show clinically-equivalent results between TFU and control groups. In summary, we cannot conclude that TFU is an effective intervention.

Constipation services for children: the role of health visitor teams

Constipation among children is a prevalent condition, yet poorly understood. There is little empirical evidence for 'best possible' configurations of services. This article presents a survey of Walsall health visitor team members (HVTMs) which aimed to identify the types of advice and care provided to young children with constipation, pathways to care and ideas for service improvement. Most HVTM consultations were parent-initiated. Few GPs referred children to HVTMs. HVTMs most commonly provided advice about fluids and diet -- only one prescribed medication. HVTMs identified the need for early intervention, consistent information for parents and a clear pathway for all health professionals to follow. Currently, a team from the local primary and hospital NHS trusts is developing an integrated care pathway for paediatric constipation. Success of such pathways depends on their adoption by GPs and hospital-based health professionals, and on evidence of efficacy arising from their evaluation.

Liaison old age psychiatry

Older people are commonly encountered in general hospital settings, where they occupy two-thirds of all beds. There are high levels of psychiatric comorbidity in this population, with depression, dementia and delirium being particularly common. This psychiatric comorbidity results in poor outcomes for patients, carers and services alike. Traditionally, old age psychiatry input has been on a consultation basis, relying on general ward staff to detect problems and refer appropriately. This does not always work well, since general hospital staff often lack the necessary knowledge and skills to detect and manage psychiatric illness correctly, and this in turn contributes to the observed poor outcomes. In recognition of this, some areas have developed specialist old age liaison psychiatry services delivered by general hospital-based mental health professionals. These liaison services are able to respond more quickly to referrals than the traditional service model. Staff working in these services are able to develop specialist skills relevant to the psychiatric conditions found in general hospitals, thus improving the quality of the psychiatric input. More importantly, liaison staff spend time educating and training their general hospital colleagues to improve the core knowledge and skills, including better detection of psychiatric conditions, better delivery of basic care and recognition of the time to call for specialist psychiatric help. Although the evidence base for the efficacy and effectiveness of these services is limited, there is a groundswell of opinion that they are necessary to improve the care of older people with psychiatric problems on general hospital wards.

Smoking cessation interventions for in-patients: a selective review with recommendations for hospital-based health professionals.

A selective review of the literature was conducted to provide evidence-based recommendations for the clinical management of hospitalized smokers. The Cochrane library, in particular the Cochrane review of 'Interventions for smoking cessation in hospitalised patients', was the basis for the review and was supplemented with other clinical and non-clinical literature where the review did not inform clinicians sufficiently. Evidence was reviewed on issues considered by the authors to be of importance to health professionals interested in providing a smoking cessation intervention to their patients. The review suggests that effective hospital interventions: incorporate an in-patient intervention lasting greater than 20 minutes in duration with extended post discharge follow-up; consist of at least five intervention contacts; and be delivered over at least a 3-month period. Furthermore, interventions should include in-patient advice and counselling, the provision of nicotine replacement therapy and extended proactive post discharge telephone support. The review also indicates that cessation interventions are particularly effective when delivered to patients with a cardiovascular diagnosis. All health professionals may be effective in providing cessation treatments; however, the addition of a specialist smoking cessation counsellor appears to improve interventions in this setting. Finally, without the development of supportive systems, routine intervention with smoking patients by health professionals is unlikely. Recommendations for the delivery of effective smoking cessation interventions in hospitals are provided. [Wolfenden L, Campbell E, Walsh RA, Wiggers J. Smoking cessation interventions for in-patients: a selective review with recommendations for hospital-based health professionals.

Palliative care and the hospitalist: An opportunity for cross-fertilization

Most US citizens die in acute care hospitals, often in physical pain, without attention to emotional and spiritual suffering. This represents an ethical failure of our current health-care system. The field of palliative medicine aims to address the physical, emotional, and spiritual needs of patients with advanced disease. At the same time, a new specialty of hospitalists is emerging, providing care for acutely ill hospitalized patients, many of whom will die. Thus, the hospitalist may become the primary deliverer of palliative care. This presents many potential opportunities for dying patients and their families, including increased time and attention from a physician; enhanced knowledge and skills around the physical symptoms, and emotional and spiritual distress; perhaps more detached and therefore more accurate prognostication; and increased efficiency, leading to a more rapid discharge to home. Hospitalists could enhance the quality of care for the dying by emphasizing interdisciplinary communication and involvement of hospital-based health professionals to address emotional and spiritual distress and bereavement issues, as well as through specific quality-improvement efforts. Finally, hospitalists can provide strong role modeling of optimal care for dying patients and their families.When hospitalists are not selected and trained effectively around palliative care issues, the risks are great. Discontinuity of physicians can lead to miscommunication and misunderstanding (by professionals, patient, and family); disagreement about treatment focus (especially as it relates to a shift from curative to palliative); inappropriate deferring of advance care planning to the hospital setting; and, most worrisome, a lack of expertise in symptom control, communication skills, and attention to patient and family distress and the provision of emotional and spiritual support. This article evaluates the convergence of the 2 fields of palliative medicine and hospitalist medicine and reviews the opportunities for mutual education and improved patient care.

Palliative care and the hospitalist: an opportunity for cross-fertilization

Most US citizens die in acute care hospitals, often in physical pain, without attention to emotional and spiritual suffering. This represents an ethical failure of our current health-care system. The field of palliative medicine aims to address the physical, emotional, and spiritual needs of patients with advanced disease. At the same time, a new specialty of hospitalists is emerging, providing care for acutely ill hospitalized patients, many of whom will die. Thus, the hospitalist may become the primary deliverer of palliative care. This presents many potential opportunities for dying patients and their families, including increased time and attention from a physician; enhanced knowledge and skills around the physical symptoms, and emotional and spiritual distress; perhaps more detached and therefore more accurate prognostication; and increased efficiency, leading to a more rapid discharge to home. Hospitalists could enhance the quality of care for the dying by emphasizing interdisciplinary communication and involvement of hospital-based health professionals to address emotional and spiritual distress and bereavement issues, as well as through specific quality-improvement efforts. Finally, hospitalists can provide strong role modeling of optimal care for dying patients and their families. When hospitalists are not selected and trained effectively around palliative care issues, the risks are great. Discontinuity of physicians can lead to miscommunication and misunderstanding (by professionals, patient, and family); disagreement about treatment focus (especially as it relates to a shift from curative to palliative); inappropriate deferring of advance care planning to the hospital setting; and, most worrisome, a lack of expertise in symptom control, communication skills, and attention to patient and family distress and the provision of emotional and spiritual support. This article evaluates the convergence of the 2 fields of palliative medicine and hospitalist medicine and reviews the opportunities for mutual education and improved patient care.

P REHOSPITAL AND H OSPITAL-BASED H EALTH C ARE P ROVIDERS ' E XPERIENCE WITH A H UMAN P ATIENT S IMULATOR

Objectives. To ascertain the level of acceptance of a human patient simulator as a training tool among a diverse group of health care providers. Secondary objectives were to elucidate its most useful aspects for training and find ways to improve upon the simulation experience. Methods. A satisfaction survey was conducted regarding the use of a human patient simulator from July 1999 to February 2000. The survey consisted of five questions with a five-point Likert scale (5 being the most favorable score) and three questions that asked for qualitative written feedback on the simulator experience. The survey was handed to 78 consecutive participants immediately after their experiences and collected immediately after it was filled out to ensure a 100% response rate to the overall survey. Qualitative responses were placed into categories by theme, and a sum was calculated for each category. Results. There was a high level of acceptance for simulation training among this diverse group, with Likert scores for the first two questions regarding general satisfaction of 4.74 ± 0.126 (n = 77) and 4.77 ± 0.126 (n = 78). Regarding the usefulness of each specific area of simulator training, the scores were 4.53 ± 0.153 (n = 78) for patient assessment, 4.55 ± 0.182 (n = 47) for treatment options, and 4.70 ± 0.125 (n = 63) for response to treatment. There were 49 positive comments and nine negative comments. Realism (n = 26) and the ability to see response to treatment (n = 12) were the two most common positive comments. Negative comments focused on logistics of the simulator lab (n = 4) rather than the simulator itself. Conclusions. In this sample, prehospital and hospital-based health professionals were accepting of human patient simulation as a new teaching tool with multiple useful applications.

Response Inducing Techniques for Mail Surveys

SummaryA mail survey has been conducted to discover why certain hospital based health professionals did not reply to a previous mail survey. The results will assist in the design of future mail surveys for this group and may have a more general interest and applicability. Two return‐inducing techniques have been tested. Other such techniques, reported in the literature but untested in this study, are listed. The observed responses times are reported and some suggestions regarding timing are made.

Counselling in a hospital-based newborn screening service

The newborn screening and parent counselling service at Howard University Hospital is an integral component of services to newborn infants. The organization of this service presents a model that appears appropriately suited to the general organization of health-care delivery in the United States. Significant features of this service are: hospital-based planning and management of the service; integration of multiscreening components into a unified service; tight integration between screening, education, and counselling; a hospital-based team that provides coherent and in-depth counselling for all screening-related needs; a forum for orienting parents to the benefits of preventive health care; and a context in which to teach students the applied aspects of preventive health care based on early detection of disorders. If we are to have high quality newborn services in this area it may be incumbent on hospital-based health professionals to designate this as a required component of adequate hospital-based services for newborn infants rather than relinquishing the initiative to centralized health planners and legislators.