Hospital Home Care Research Articles

Patients in transition--improving hospital-home care collaboration through electronic messaging: providers' perspectives.

To explore how the use of electronic messages support hospital and community care nurses' collaboration and communication concerning patients' admittance to and discharges from hospitals. Nurses in hospitals and in community care play a crucial role in the transfer of patients between the home and the hospital. Several studies have shown that transition situations are challenging due to a lack of communication and information exchange. Information and communication technologies may support nurses' work in these transition situations. An electronic message system was introduced in Norway to support patient transitions across the health care sector. A descriptive, qualitative interview study was conducted. One hospital and three adjacent communities were included in the study. We conducted semi-structured interviews with hospital nurses and community care nurses. In total, 41 persons were included in the study. The analysis stemmed from three main topics related to the aims of e-messaging: efficiency, quality and safety. These were further divided into sub-themes. All informants agreed that electronic messaging is more efficient, i.e. less time-consuming than previous means of communication. The shift from predominantly oral communication to writing electronic messages has brought attention to the content of the information exchanged, thereby leading to more conscious communication. Electronic messaging enables improved information security, thereby enhancing patient safety, but this depends on nurses using the system as intended. Nurses consider electronic messaging to be a useful tool for communication and collaboration in patient transitions. Patient transitions are demanding situations both for patients and for the nurses who facilitate the transitions. The introduction of information and communication technologies can support nurses' work in the transition situations, and this is likely to benefit the patients.

Coordinated hospital-home care for kidney patients on hemodialysis from the perspective of nursing personnel.

OBJECTIVE: To examine, from the nursing perspective, the needs and challenges of coordinated hospital-home care for renal patients on hemodialysis. METHODS: A qualitative analysis was conducted with an ethnographic approach in a hemodialysis unit in San Luis Potosi, Mexico. Semistructured interviews were conducted with nine nurses, selected by purposeful sampling. Structured content analysis was used. RESULTS: Nurses recounted the needs and challenges involved in caring for renal patients. They also identified barriers that limit coordinated patient care in the hospital and the home, mainly the work overload at the hemodialysis unit and the lack of a systematic strategy for education and lifelong guidance to patients, their families and caregivers. CONCLUSIONS: This study shows the importance and necessity of establishing a strategy that goes beyond conventional guidance provided to caregivers of renal patients, integrating them into the multidisciplinary group of health professionals that provide care for these patients in the hospital to establish coordinated hospital-home care that increases therapeutic adherence, treatment substitution effectiveness and patient quality of life.

Determining The Reasons for Taking Care of and The Services Provided for The Elderly Individuals age 65 and Over who take care from The Balıkesir State Hospital Home Care Unit

Giris: Bu calismanin amaci; Balikesir Devlet Hastanesi Evde Bakim Hizmeti Birimi (EBHB)'nden hizmet alan yaslilarin bakim alma nedenlerini ve saglanan hizmetleri belirlemektir. Gerec ve Yontem: Tanimlayici tipteki bu calismada; EBHB'nden hizmet alan 377 yasliya ait evde bakim verisi kullanilmistir. Arastirmada orneklem secimi yapilmamis olup, calisma grubunu EBHB kayitlarinda yer alan 65 yas uzeri (n=377) tum yaslilar olusturmustur. Kayitlardaki veriler sayi ve yuzde olarak degerlendirilmistir. Bulgular: Calisma grubunun %68.7'si kadin ve yas ortalamasi 80.09 ± 7.35 yil olup, %10.6’sinin saglik guvencesi yoktur. Yaslilarin %23.3'u kardiyovaskuler hastaliklar ve hemipleji tanisi ile bakim almaktadirlar. Son alti ayda EBHB'den 65 yas uzeri yataga bagimli yaslilarin %46'si sadece fizik muayene, %40.4'u fizik muayene ile birlikte laboratuar testlerinden yararlanmistir. Sonuc: Ikinci basamak saglik kurumuna bagli olarak Balikesir'de EBHB'de tedavi edici saglik hizmetlerinin agirlikta oldugu bir bakim verilmektedir.

Collaboration of Hospital Case Managers and Home Care Liaisons When Transitioning Patients

Collaboration of Hospital Case Managers and Home Care Liaisons When Transitioning Patients

Características de la pielonefritis aguda en una unidad de corta estancia

ObjectivesTo analyze the epidemiological characteristics of the population admitted to a short-stay medical unit (SSMU) during 2005 due to acute pyelonephritis. To describe and analyze microbiological aspects recorded in these infections and their clinical implication. Material and methodA retrospective study was carried out in a cohort of 208 patients admitted in the SSMU during 2005 because of acute pyelonephritis. Epidemiological, clinical and microbiological data were collected. The statistical analysis was done with the SPSS v. 14.0. Results208 patients were included, 74% of whom were females. Average age was 43.6 (16-87). Mean length of stay was 4.7±1.2 days and 96.6% of patients were discharged successfully from SSMU. Urine culture was valid in 173 patients, 51.4% of which were positive. Escherichia coli was isolated in 93.2% of urine cultures. Blood cultures were valid in 178 cases and in 37 of which were positive. E. coli was isolated in 64.8% of these. In E. coli urine samples, resistance rate to ampicillin was 68.7%, to co-trimoxazole 22.9%, to ciprofloxacin 18.1%; to amoxicillin/clavulanic acid 16.9% and to fosfomycin 2.4. Seven patients were transferred to hospital home care, there being no deaths. ConclusionsAcute pyelonephritis with admission criteria can be managed successfully in the SSMU with the applicable therapeutics guidelines with regard to the most common microbiological aspects registered and the low incidence of complications.

Colecistectomía laparoscópica ambulatoria: resultados iniciales de una serie de 200 casos

Outpatient laparoscopic cholecystectomy (CL) has not been generalised due to the fear of complications by the surgeon and preference of patients for hospitalisation. This situation could be changed by setting up strict selection criteria and providing hospital home care. The aims of this study are to find out what percentage of our population fulfil these criteria, confirm their validity and find out if the surgical process should be improved before being introduced. A retrospective analysis was carried out on the first 200 elective CL cases dating from January 2006. The exclusion criteria were as follows: pre-operative criteria (social causes, age $ 70 years, unstable ASA III or ASA IV, an associated pathology or admission due to biliopancreatic patho-logy), intra-operative criteria (conversion, surgical time lasting longer than 90 minutes, non-identification or bleeding of the cystic artery, application of haemostatic material, haemorrhaging in the entrance ports, intra-abdominal bile spillage, drainage, difficulties in removing the gallbladder, anaesthetic and/or surgical complications) and post-operative (haemodynamic instability, excessive pain, nausea, and /or vomiting). Out of the 200 cases, 53 (26.5%) patients fulfilled the criteria. The outpatient system was preferred predominantly by females and by those younger in age. Post-operative incidents occurred in 9.4% of the cases and these were dealt with by the hospital home care team. Ambulatory CL procedure is safe. Patients of advanced age or with associated pathologies limit the inclusion. Hospital home care can solve any possible complications and contribute to the speedy discharge in those patients without criteria.

CARE TRANSITION FOR HOSPITALIZED DEPENDENT AGED PERSONS

According to the theory of transition during the hospital entry-stayleave sequence there are favorable moments to guide the sick person and his family about care and its continuity back home. Objective: To describe the transition process from hospital care to the dependent aged person house. Methodology: Focused ethnography. Thirty semi structured interviews were performed with aged people, relatives and professionals from five public and private institutions. In Medellín, Bello and Rionegro (Antioquia, Colombia) 25 participating observations were performed in 9 hospital wards and data was manually analyzed according to ethnographic guidelines. Results: The “sick aged people and their families: Much more than the illness” theme was highlighted to describe how people feel they are subjects demanding integral care rather the “patients”; the cared subject objectivation of the interaction loss between sick person and caring person and how the transition between hospital and home took place. Conclusions: The aged person leaves hospital without knowledge about how to follow the treatment at home. Accordingly it is necessary that the caring personnel give adequate consideration to the hospital-home care transition process.

The experience of families with the home care of children after spinal fusion surgery

Summary The lack of evidence on appropriate discharge planning preparations, specifically for spinal fusion surgery patients, has led the orthopaedic nursing team to ask: How can we better prepare families to care for their child following discharge home? A descriptive case study design was used. A non-probability, convenience sample of English speaking parents was selected. Inclusion criteria included parents of children up to 18 years of age who had spinal fusion surgery. Six mothers participated in the study. Although mothers stated that the overall experience of caring for their child at home was generally good, the care-giving tasks they faced were complex and time consuming. The hospital discharge and home care experience comprised two main themes: challenges and resources. The results highlight the complex reasoning and behavioural processes required of caregivers. Mothers perceived that they were expected to be proficient caregivers to their child; however, they also felt that some of these expectations were beyond their level of expertise. Mothers developed information seeking strategies as a way to address their learning needs. Clinical implications such as starting the discharge process earlier, incorporating teaching at the bedside, and recognizing the special needs of out-of-town families were discussed.

Cost Analysis of Home Care with Activity-Based Costing(ABC)

This study was carried out to substantiate the application process of activity-based costing on the current cost of hospital home care (HHC) service. The study materials were documents, 120 client charts, health insurance demand bills, salary of 215 HHC nurses, operating expense, 6 HHC agencies, and 31 HHC nurses. The research was carried out by analyzing the HHC activities and then collecting labor and operating expenses. For resource drivers, HHC activity performance time and workload were studied. For activity drivers, the number of HHC activity performances and the activity number of visits were studied. The HHC activities were classified into 70 activities. In resource, the labor cost was 245 won per minute, operating cost was 9,570 won per visit and traffic expense was an average of 12,750 won. In resource drivers, education and training had the longest time of 67 minutes. Average length of performance for activities was 13.7 minutes. The workload was applied as a relative value. The average cost of HHC was 62,741 won and the cost ranged from 55,560 won to 74,016 won. The fixed base rate for a visit in the current HHC medical fee should be increased. Exclusion from the current fee structure or flexible operation of traveling expenses should be reviewed.

Acute? care at home. The health and cost effects of substituting home care for inpatient acute care: a review of the evidence.

PURPOSE: To review the evidence regarding the health and cost effects of providing acute care at home in lieu of hospital care. BACKGROUND: The acute hospital represents the current paradigm and gold standard of care for acutely and seriously ill patients. However, the hospital environment may not be ideal for older patients. Iatrogenic complications are common and their incidence increases with age. 1 Older persons commonly experience functional decline in the acute hospital environment, increasing the risk of becoming dependent. 2 In addition, hospital care is very expensive. Given the potential adverse effects of hospitalization on older persons, alternatives to usual hospital care have been developed. Hospital-based models such as Acute Care for the Elderly (ACE) units attempt to make the inpatient hospital experience more friendly for older people. 3 Alternatively, models that have substituted acute care at home for usual hospital inpatient care have been developed. These programs have been referred to as hospital in home, hospital at home, hospital in the home, and home hospital (HH). Semantics in the home care literature has always been challenging, and at times the literature has suffered for combining disparate home care models together for the purposes of analysis. The case of HH is no different. The nature of HH programs has varied greatly and has included programs that substitute entirely for an inpatient admissions and, more commonly, those that facilitate early hospital discharge by providing services that many in the United States would consider standard postacute-hospital-discharge home care. Some programs have focused solely on patients following surgeries such as total knee or hip replacement or hernias, others have targeted older patients with certain medical conditions, still others have combined several surgical and medical conditions into a single study. In addition, other programs have focused on pediatric or psychiatric populations or high-technology programs. These studies have come mainly from the United Kingdom and Australia, countries with national health insurance schemes. This mix of program types is important to keep in mind when reviewing the evidence on HH, and especially when reviewing reviews of HH. This being said, a recent review of HH versus inpatient hospital care in 1997 and updated in 1999 found five studies that met methodological selection criteria. 4 No studies testing models that substituted entirely for an inpatient hospital stay were included. Patients discharged early from hospital to hospital-at-home following surgery had higher satisfaction while caregivers had lower levels of satisfaction. The one study that assessed cost differences found none. DATA SOURCES: Trials eligible for inclusion in the current analysis met the following selection criteria: publication between 1975 and 1998, evaluation of an acute home care program for people at least 1 8 years old with a non-psychiatric health condition who were not receiving terminal care, and use of a control group to evaluate the health and cost effects of the trial. DATA EXTRACTION: Of 1,970 articles published on home care between 1975 and 1998, only 22 met the selection criteria. Two articles were excluded because they were early evaluations of home care for conditions for which later research showed day surgery to he more appropriate. The remaining 20 articles reported on evaluations of 14 different programs.

Home Care Quilt Fundraiser a Success!

Bristol Hospital Home Care Agency Bristol, Connecticut Editor’s note: The N ursing Practice Guidelines for the Cardiac Home Care Patient can be obtained from the Home Healthcare Nurses Association at 228 Seventh Street, SE, Washington, DC 20003 or by calling (202) 547-7424 or (800) 558-HHNA. Home Healthcare Nurse encourages feedback from its readers. Send your comments to: The Editor, 3904 Therina Way, Louisville, Kentucky 40241; via e-mail: [email protected]

Application of the Omaha System in acute care.

Although effective as a standardized language for documentation in community and public health settings, the Omaha System has not been evaluated in acute care settings. The purpose of this study was to evaluate the utility of the Omaha System to code the terms used by nurses when documenting hospital care. The nursing documentation in 30 hospital records was content analyzed for signs and symptoms, patient problems, and nursing interventions, then coded into the categories of the Omaha System. Degree of match was evaluated using concept match scores, and utility was determined using empirical, operational, and pragmatic criteria. Study findings suggest several strengths (i.e., high reliability, coded 97% of the problems, easy to use) and some limitations (lack of mutual exclusivity among terms, lack of semantic clarity, the need for three new problems). This study has important implications in demonstrating the utility of the Omaha System for possible expansion into acute care to standardize communication between the hospital setting and home care.

Specialist palliative care and patients with noncancer diagnoses: the experience of a service.

This retrospective review was undertaken to identify the pattern of noncancer referrals to a specialist palliative care service, comprising a teaching hospital support team, home care, outpatients and inpatient hospice, over a 1-year period. Of 287 hospital ward referrals, 83 patients had a noncancer diagnosis (29%); they were referred predominantly for symptom control (92%), particularly of pain (84%). Of 130 outpatient referrals, 30 had a noncancer diagnosis (23%) and were also referred mainly for the management of pain (85%). Of 196 home care referrals, 18 had a noncancer diagnosis (9%); they tended to be referred for multiprofessional care of endstage disease. Of 421 hospice inpatient admissions, 17 were for patients with a noncancer diagnosis (4%) and were predominantly for respite care. These admissions accounted for 2% of occupied bed days. It is concluded that specialist palliative care skills are perceived to be transferable to patients with noncancer diagnoses. Resource implications focus on hospital and outpatient services, where shared care with medical teams is usual practice. Defining management goals at the outset is particularly important.

The Diabetes Center home care nurse: an integral part of the diabetes team.

The changing face of health care and the widely variable needs of families have forced practitioners to change the traditional education approaches for pediatric patients with diabetes. Initial management and education for pediatric patients with newly diagnosed type 1 diabetes is now moving to the outpatient setting. The Diabetes Center for Children (DCC) at The Children's Hospital of Philadelphia has created an innovative program using a diabetes home care nurse as its coordinator. The role of the home care nurse is to manage and coordinate all of the diabetes education done by the field nurses in the Children's Hospital home care department. This program has enabled the DCC to manage and educate families during an initial 3-day inpatient stay, providing a safe transition to home. With follow-up by trained home care nurses, the families receive advanced education and support in their homes. The evolution of this program over the last several years has shown that patient care can be moved safely from a complete inpatient format to one that includes a large outpatient component.

The chaplain as a member of the hospice team.

Hospice care is dedicated to the alleviation of pain. It is imperative for the interdisciplinary team to determine the presence of spiritual and/or religious pain in order to create a plan of care that will provide the necessary resources to meet patients' needs. Spiritual and/or religious wholeness or pain is a highly personal concept and concrete measurements are almost impossible to determine with consistent accuracy. However, it is important to include these assessments as part of the total patient assessment (Abington Memorial Hospital Home Care Hospice Manuual, 1998). The concept of spiritual care is an important for patients who receive home healthcare services as well as care through the hospice benefit. When possible, the valuable resources and expertise of a chaplain or faith community leader should be available to all patients. This may be possible through a referral process within the home care and hospice programs, or services may be available through a local ministerium association, contract, volunteer arrangement, pastoral care department of a local hospital, or by working with students from local religious educational facilities. A total patient assessment that includes the spiritual and religious needs and addresses all identified needs will enable patients and their families to meet their goals, even if the patient remains physically ill.

Chronic Disease Management: What Happens When Home Health Care Is Completed?

As the chronic illness population increases, health care organizations are looking for ways to help promote Wellness and prevent illness. The Chronic Disease Management Program (CDMP) was developed in a Midwest hospital's home care department to provide services. The target population was those chronically ill who were no longer eligible for skilled home care, but continued to require ongoing monitoring. Admission criteria and service provision protocols were developed. Patients were visited on an average of once a month by a nurse, free of charge, with a focus on the management of chronic disease. Outcome measurement included patient/physician satisfaction, quality of life measures, and a financial cost analysis. Results demonstrated a high level of satisfaction, stabilized or improved quality of life, and significant financial savings.

Creative Inservices to Meet Education Requirements

1Executive director of Abington Memorial Hospital Home Care, Willow Grove, Pennsylvania 2Director for Education and Quality Assessment/Improvement, Abington Memorial Hospital Home Care, Willow Grove, Pennsylvania

Benchmarking from a Home Health Care Perspective

Benchmarking and reengineering have been proceeded by the productivity efforts such as those of the Florida Hospital Home Care Association. Data collection and analysis by the 11 represented home care agencies resulted in the development of a practical book, Innovative Benchmarking: A Practical Approach to Improving Productivity. The practical applications, implications for the future, and appendices will provide a foundation for ongoing productivity and benchmarking efforts.

Hospital Home Care: Strategic Management for Integrated Care Delivery

Hospital Home Care: Strategic Management for Integrated Care Delivery

Case management of HIV-positive and AIDS patients

Elmhurst Hospital Home Care, which is one of six municipal home health agencies within New York City's Health and Hospital Corporation, is hospital based and operates within the structure of Elmhurst Hospital Center. Elmhurst Hospital Center is a major treatment center for patients with acquired immune deficiency syndrome (AIDS) in the borough of Queens. Finding resources to service underinsured and uninsured AIDS patients and patients who are positive for the human immunodeficiency virus (HIV) in a concentrated geographical area was initiated through a grant proposal. Awareness of the complex care needs created a model design emphasizing a clinical and coordinating relationship with the infectious disease department. The model ultimately achieved all original goals.