Patients In Acute Care Setting Research Articles

Uses of infrared thermography in acute illness: a systematic review.

Infrared thermography (IRT) is a non-contact, non-ionising imaging modality, providing a visual representation of temperature distribution across a surface. We conducted a systematic search of indexed and grey literature for studies investigating IRT applications involving patients in acute care settings. Studies were categorised and described along themes identified iteratively using narrative synthesis. Quality appraisal of included studies was performed using the Quality Assessment tool for Diagnostic Accuracy Studies. Of 1,060 unique records, 30 studies were included. These were conducted in emergency departments and intensive care units involving adult, paediatric and neonatal patients. IRT was studied for the diagnosis, monitoring or risk stratification of a wide range of individual conditions. IRT was predominantly used to display thermal change associated with localised inflammation or microcirculatory dysfunction. Existing research is largely at an early developmental stage. We recommend that high quality diagnostic validation studies are now required for some clinical applications. IRT has the potential to be a valuable tool in the acute care setting and represents an important area for future research particularly when combined with advances in machine learning technology. CRD 42022327619 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327619).

'It helps you forget your worries': A pilot study exploring music therapy in the acute hospital aged care setting.

Few studies have explored music therapy (MT) in an acute aged care inpatient setting. We aimed to assess feasibility and patient/staff perceptions of an 8-week MT program on an acute geriatric ward. An 8-week in-person MT program, comprising brief receptive musical interventions up to twice-weekly. All patients admitted to the aged care ward were eligible for inclusion. A hard copy survey was used to assess patient and staff perceptions of MT. Themes raised in free-text responses were manually coded within a thematic analysis approach. A mixed methods approach was used to obtain and analyse data relating to feasibility and patient and staff perceptions of the MT intervention. The 8-week program ran to completion and was delivered to a median of 11 patients (IQR 9-12) each session (median 8 new/day). In total, 10 patients completed surveys, mean age 81.1 (SD 7.7); 60% were women and all had cognitive impairment. Following an MT session, eight of eight responding patients reported feeling happy and eight of eight reported they would recommend MT. Staff respondents (n = 19) reported patients appeared happy (19/19), relaxed (13/19) and all would recommend MT to other patients. Common themes were that MT was followed by improved patient behaviour and mood, and stimulated patients. An acute aged care inpatient MT program proves feasible and well-received by staff and patients. Future research may focus on more robust data collection in larger sample sizes, specific types of MT and more in-depth exploration of the patient and carer experiences.

The Effect of the Stopping Elderly Accidents, Deaths, and Injuries Program on Falls Prevention in Neurosurgical Patients.

BACKGROUND: Despite the negative consequences of falls among neurosurgery patients in acute care settings, there is a lack of high-quality evidence for successful fall prevention programs. This study was conducted to evaluate the effectiveness of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) program on falling prevention compared with routine falling protocol in neurosurgical patients in Jordan. METHODS: A prospective quasi-experimental design was used in this study. The sample comprised 70 neurosurgical patients from a major university-affiliated hospital in Jordan. The study sample was assigned into a control group (35 patients) and an intervention group (35 patients). A demographics questionnaire, and different fall risk screening tools and tests were used in this study as recommended by the STEADI program. RESULTS: Multivariate analysis of variance results showed a significant effect ( P = .001) of the STEADI program on the linear combination of outcome measures. Independent samples t tests further confirmed the program's effectiveness, with statistically significant mean differences in most outcome measures between the intervention and control groups post intervention. After implementing the study intervention, participants in the intervention group had a statistically significant lower risk for falls. CONCLUSION: The findings indicate potential effectiveness in improving neurosurgery patients' outcomes and reducing the risk of falls. Implementing the study recommendations can enhance patient safety and promote evidence-based fall prevention interventions in neurosurgery patients.

Evaluating minority representation across health care settings in hidradenitis suppurativa and psoriasis.

Females and minorities have been underrepresented in clinical research despite legislative efforts, including in hidradenitis suppurativa (HS) and psoriasis (PsO) clinical trials. To identify differences in demographic breakdowns of HS and PsO patients between health care settings to uncover any causative health disparities. This study reports racial, ethnic, and sex of HS and PsO patient populations across the emergency department (ED), inpatient, clinical trial, and registry settings. In addition, 95% confidence intervals are used as proxies of statistical significance to compare demographics between settings. Female, Hispanic, and Black patients were underrepresented in HS clinical trials compared to their population prevalence (female: 63.7% vs 73.5%; Hispanic: 3.8% vs 12.0%; Black: 9.1% vs 20.3%). Female and Black patients were underrepresented in PsO trials compared to their population prevalence (female: 33.0% vs 54.8%; Black: 2.2% vs 5.7%). Black patients were overrepresented in the inpatient and ED settings in HS (inpatient vs ED vs population prevalence: 49.9% vs 49.9% vs 20.3%) and in the inpatient setting in PsO (inpatient vs population prevalence: 19.8% vs 5.7%). The main limitation is the reliability and generalizability of the published studies used to compare demographics across settings. Underrepresentation of females and minorities in HS and PsO clinical trials is consistent with published literature. Overrepresentation of Black patients in acute care settings is likely multifactorial.

Comanagement of Surgical Pediatric Patients in the Acute Care Inpatient Setting.

The care of children with primary surgical diagnoses in acute care units often involves a shared surgical and medical model ("comanagement"). There are no formal guidelines for how such programs should be structured or care provided. We used a modified Delphi process, including national experts in pediatrics and pediatric medical subspecialties, pediatric surgical specialties, and pediatric anesthesiology, to develop recommendations for best practices for comanagement programs in community and tertiary care settings.

Experience of Care Among Adults With Acute Leukemia Near the End of Life: A Scoping Review.

Background: Acute leukemia is a cancer of the blood and bone marrow with a high symptom burden and a high mortality rate in adults. The quality of end-of-life care among this patient population is deemed to be low based on health care administrative data, though the patient experience is not included in this evaluation. Objective: This scoping review aims at exploring and mapping the current research literature on the experience of care among adults with incurable acute leukemia near the end of life. Design: The JBI framework guided our scoping review, and the protocol was prospectively registered in the Open Science Forum. Results: A total of 5661 unique articles were screened for title and abstract, and 44 were selected for full text. After a manual search, five studies published in seven articles were selected for data extraction, including three qualitative and two quantitative studies. Two studies used family caregivers as patient proxies, two studies engaged patients directly, whereas one study obtained data from patients and family caregivers. Patient care in acute settings was reported in all studies, with most patients dying in acute care settings. Patients and family caregivers often valued an open and honest approach, with sufficient time for dialogue with their providers. Discussions about prognosis, palliative care, and hospice care were often late or incomplete. The medicalization of end-of-life care, including intensive care unit admissions and invasive medical procedures, were viewed as the norm by some providers, though perceived as distressing for both patients and their loved ones. Conclusions: Adults with acute leukemia face significant challenges in accessing high-quality end-of-life care brought about by the complex nature of their disease and its treatment. A systematic exploration of the end-of-life experience among these patients through direct patient engagement or by way of patient reporting proxies is needed.

Change to hospitalist providers had a minimal influence on overall antibiotic use in a VA long-term care setting

Background: In long-term care settings, practice patterns among practitioners are stronger determinants of antibiotic use than resident characteristics. In July 2021, hospitalists from the acute medicine service replaced geriatricians and assumed the care of residents in a 110-bed community living center (CLC) at a large academic Veterans Affairs (VA) medical center. We assessed changes in antibiotic use associated with that change of practitioners to guide stewardship efforts. We hypothesized that antibiotic use in the CLC would shift, reflecting the practice pattern of practitioners accustomed to treating patients in acute-care settings. Methods: We conducted a retrospective cohort study from July 1, 2020, through June 30, 2022, 1 year before and after the change of practitioners on July 1, 2021. We assessed resident characteristics and the following metrics of antibiotic use at monthly intervals: days of therapy (DOT) per 1,000 bed days of care (BDOC), antibiotic starts per 1,000 BDOC, and mean length of therapy (LOT) in days. We also compared the DOT per 1,000 BDOC for various antibiotics, in groups and individually. Results: In the years before and after the change of practitioners on July 1, 2021, the characteristics of CLC residents were comparable. Before and after July 1, 2021, monthly DOT per 1,000 BDOC (Fig. 1A), antibiotic starts per 1,000 BDOC, and mean LOT (Fig. 1B) were similar. After July 1, 2021, the use of fluoroquinolones decreased (14.31 vs 5.83 DOT per 1,000 BDOC; P < .01), and variations in anti-MRSA, narrow-spectrum, and broad-spectrum hospital agents were small, whereas the use of broad-spectrum community agents increased (29.42 vs 47.81 DOT per 1,000 BDOC; P < .01) (Fig. 2A). Within this group, there was increased use of doxycycline (7.42 vs 19.13 DOT per 1,000 BDOC; P < .01), ertapenem (2.03 vs 4.58 DOT per 1,000 BDOC; P < .01), and, modestly, azithromycin (0.40 vs 1.80 DOT per 1,000 BDOC) (Fig. 2B). Conclusions: The overall use of antibiotics, as measured by DOT, antibiotic starts, and LOT did not change after hospitalists assumed care of CLC residents. However, a notable decrease was observed in the use of fluoroquinolones, and an increase was observed in the use of doxycycline and ertapenem. Stewardship that is tailored to the type of provider and incorporates their practice patterns is needed to reinforce the prudent use of antibiotics.Disclosures: None

How Are Patients Who Legally Use Medical Marijuana Treated When Hospitalized?

The majority of U.S. states have legalized marijuana for medical use and some states have legalized marijuana for recreational use; yet, marijuana remains illegal federally. Given the misalignment between state and federal policies, this paper seeks to explore how hospitals handle inpatients' medical marijuana use in states where medical marijuana is legal. To examine this phenomenon, we conducted an anonymous, online, cross-sectional survey of nurse leaders working in acute care inpatient settings in states that had legalized medical marijuana. Using descriptive statistics, we report on these nurse leaders' experiences. There were 811 survey responses-291 who worked in an acute care inpatient setting in a state that had legalized medical marijuana. Among those respondents, only a small percentage reported that inpatients had some access to their medical marijuana: 5.8% reported that the drug was kept in the pharmacy and dispensed like other prescriptions; another 3.4% indicated that patients kept the medical marijuana in their rooms and took it, as needed. Most respondents (55.6%) reported that patients were switched to an alternative medication during their inpatient hospital stays. Almost half (49.4%) of the nurse leaders who reported that alternative medications were used, reported that opioids were substituted, and the majority reported that the marijuana was safer than the opioids. These findings are concerning given the increase in opioid overdose deaths.

Aromatherapy in conjunction with physical/occupational therapy in an acute care setting: Early results

Pain and nausea are common complaints by patients in acute care settings and these symptoms can prevent participation in their physical or occupational therapy sessions. Because mobilization during acute care hospitalization is important for reducing the length of stay, postoperative complications, risk for deep vein thrombosis, pneumonia, and pressure ulcers, implementing non-pharmacological solutions to engage patients in mobilization is worth investigating. It is hypothesized that the use of inhaled essential oils may improve patients’ perception of pain and their coping with nausea, enabling a patient to have active participation in physical or occupational therapy. This participation can minimize hospitalization-related risks as well as potentially reduce the length of stay in the hospital. This IRB-approved study is an early feasibility, single-site, randomized, placebo-controlled clinical trial utilizing three essential oils: lavender, mandarin, and peppermint. These oils are administered via an inhalation patch affixed to the chest region of the subject’s gown. Perceived pain or nausea levels are assessed before and after the use of aromatherapy during which the subject participates in their planned physical or occupational therapy session. While it is too early to determine the effects of aromatherapy, preliminary results suggest the use of lavender oil may have a positive effect on pain.

Social return on investment economic evaluation of supportive care for lung cancer patients in acute care settings in Australia

BackgroundUnmanaged consequences of cancer and its treatment are high among patients with lung cancer and their informal carers, resulting in avoidable healthcare use and financial burden. Provision of cancer supportive care addressing the impacts of cancer and its treatment has demonstrated efficacy in mitigating these consequences; however, globally, there is a lack of investment in these services. Paucity of robust economic evidence regarding benefit of cancer supportive care has limited policy impact and allocation of resources. This study therefore utilised a Social Return on Investment (SROI) methodology to conduct a forecast evaluation of lung cancer supportive care services, to ascertain potential social value and return on investment.MethodsAn SROI economic evaluation model was developed using qualitative stakeholder consultations synthesised with published evidence to develop the inputs, outcomes and financial value associated with the delivery of a hypothetical model of quality lung cancer supportive care services over a one and five year period. SROI ratios were generated to determine the social value and cost savings associated per every $1AUD invested in cancer supportive care for both the healthcare system and patients. Deadweight, drop off and attribution were calculated, and sensitivity analysis was performed to confirm the stability of the model.ResultsThe value generated from modelled supportive care service investments in a one-year period resulted in an SROI ratio of 1:9; that is, for every dollar invested in supportive care, AUD$9.00 social return is obtained when savings to the healthcare system and benefits to the patients are combined. At five-years, these same investments resulted in greater cumulative value generated for both the patient and the healthcare system, with a SROI ratio of 1:11.ConclusionOur study provides strong evidence for policy makers, clinicians and consumers to advocate for further investment in cancer supportive care, as demonstrated cost savings could be achieved through implementation of the proposed supportive care service model, with these accruing over a five-year period. The SROI model provides a comprehensive framework detailing supportive care services and the health workforce necessary to achieve value-based outcomes for patients and the healthcare system.

Collective leadership to improve professional practice, healthcare outcomes and staff well-being.

Collective leadership is strongly advocated by international stakeholders as a key approach for health service delivery, as a response to increasingly complex forms of organisation defined by rapid changes in health technology, professionalisation and growing specialisation. Inadequate leadership weakens health systems and can contribute to adverse events, including refusal to prioritise and implement safety recommendations consistently, and resistance to addressing staff burnout. Globally, increases in life expectancy and the number of people living with multiple long-term conditions contribute to greatercomplexity of healthcare systems. Such a complex environment requires the contribution and leadership of multiple professionals sharing viewpoints and knowledge. OBJECTIVES: To assess the effects of collective leadership for healthcare providers onprofessional practice, healthcare outcomes and staff well-being, when compared with usual centralised leadership approaches. We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 5 January 2021. We also searched grey literature, checked references for additional citations and contacted study authors to identify additional studies. We did not apply any limits on language. Two groups of two authors independently reviewed, screened and selected studies for inclusion; the principal author was part of both groups to ensure consistency. We included randomised controlled trials (RCTs) that compared collective leadership interventions with usual centralised leadership or no intervention. Three groups of two authors independently extracted data from the included studies and evaluated study quality; the principal author took part in all groups. We followed standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We used the GRADE approach to assess the certainty of the evidence. We identified three randomised trials for inclusion in our synthesis. All studies were conducted in acute care inpatient settings; the country settings were Canada, Iran and the USA. A total of 955 participants were included across all the studies. There was considerable variation in participants, interventions and measures for quantifying outcomes. We were only able to complete a meta-analysis for one outcome (leadership) and completed a narrative synthesis for other outcomes. We judged all studies as having an unclear risk of bias overall. Collective leadership interventions probably improve leadership (3 RCTs, 955 participants). Collective leadership may improve team performance (1 RCT, 164 participants). We are uncertain about the effect of collective leadership on clinical performance (1 RCT, 60 participants). We are uncertain about the intervention effect on healthcare outcomes, including health status (inpatient mortality) (1 RCT, 60 participants). Collective leadership may slightly improve staff well-being by reducing work-related stress (1 RCT, 164 participants). We identified no direct evidence concerning burnout and psychological symptoms. We are uncertain of the intervention effects on unintended consequences, specifically on staff absence (1 RCT, 60 participants). AUTHORS' CONCLUSIONS: Collective leadership involves multiple professionals sharing viewpoints and knowledge with the potential to influence positively the quality of care and staff well-being. Our confidence in the effects of collective leadership interventions on professional practice, healthcare outcomes and staff well-being is moderate in leadership outcomes, low in team performance and work-related stress, and very low for clinical performance, inpatient mortality and staff absence outcomes. The evidence was of moderate, low and very low certainty due to risk of bias and imprecision, meaning future evidence may change our interpretation of the results. There is a need for more high-quality studies in this area, with consistent reporting of leadership, team performance, clinical performance, health status and staff well-being outcomes.

The assessment of point-of-care-ultrasound (POCUS) in acute care settings is benefitted by early medical school integration and fellowship training.

Point-of-care ultrasound (POCUS) has widespread utilization in multiple clinical settings. It has been shown to positively influence clinician confidence in diagnosis and can help appropriately manage patients in acute care settings. There has been a growing trend of increased emphasis on incorporating POCUS training in the first 2years of the medical school curriculum. This article aims to analyze the clinical use ofPOCUS in acute settings and how training early in medical school may strengthen clinician confidence and utilization. An anonymous 10-question survey on POCUS use was conducted via a secure online platform and distributed to board-certified practicing physicians (MDs and DOs) with educational agreements with Midwestern University (MWU) across acute care specialties. This included preceptors within the MWU graduate medical education clinical consortium. Survey questions were aimed at assessing frequency of use, machine type, reasons for utilizing POCUS, initial ultrasound training, confidence in performing/interpreting POCUS, and perceived impact on patient outcomes. Surveys less than 50% complete were excluded. All surveys returned were more than 50% complete and thus included in the study. Statistical analyses were conducted utilizing the statistical software R version 4.0. Surveys were sent out to 187 participants with 68responses (36.4% response rate). The survey results demonstrated a relationship between learning POCUS earlier in one's medical career (medical school, residency, or fellowship) to increased use in acute settings when compared tolearning POCUS during clinical practice. Of the 68 respondents, 65 (95.6%) indicated that they agree or strongly agree that POCUS use improves patient care, and 64 (94.1%) indicated that they agree or strongly agree that the use of POCUS can improve patient outcomes. Our survey of acute care physicians indicated that most respondents utilize POCUS daily or weekly (90.8%), and this was related to fewer years of practice (under 10years from medical school graduation, 94.6%). Moreover, POCUS was utilized primarily in acute care settings for procedures (25%, n=17/68 respondents). These survey results indicate that early integration of POCUS education in osteopathic medical school curricula and throughout fellowship training could likely enhance POCUS utilization in acute care settings.

Variation in detected adverse events using trigger tools: A systematic review and meta-analysis

Adverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely. This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence. Systematic review and meta-analysis. To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review. Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9-37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4-164.7. Overall studies' risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation. Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation.

A systematic review of patient-reported dignity and dignified care during acute hospital admission.

To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care from the perspective of hospitalized patients. The secondary aim was to examine the relationship between dignity and demographic, clinical and psychological characteristics of patients. A systematic review based on the protocol of the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for reporting systematic reviews. Five electronic databases (PubMed, CINAHL, Embase, PsycINFO, AgeLine) were searched in February 2021, followed by backward-forward searching using Web of Science and Scopus databases. Potentially eligible articles were scrutinized by two reviewers. Articles that met the eligibility criteria were appraised for quality using the Critical Appraisal Tool for Cross-Sectional Studies. Two reviewers extracted data for the review and resolved differences by consensus. Out of 3052 potentially eligible studies, 25 met the inclusion criteria. Levels of dignity for hospitalized patients vary widely across geographic locations. Patients' dignity is upheld when healthcare professionals communicate effectively, maintain their privacy, and provide dignity therapy. Patients' perceptions of dignity were, in some studies, reported to be associated with demographic (e.g. age, marital status, gender, employment, educational status), clinical (e.g. hospitalization, functional impairment, physical symptoms) and psychological (e.g. depression, anxiety, demoralization, coping mechanisms) variables whilst other studies did not observe such associations. Patients in acute care settings experience mild to a severe loss of dignity across different geographic locations. Patients' dignity is influenced by several demographic, clinical and psychological characteristics of patients. The findings of the review support impetus for improvement in dignified care for hospitalized patients, addressing factors that facilitate or impede patients' dignity. Measures aimed at alleviating suffering, fostering functional independence and addressing patients' psychosocial needs can be used to promote dignity.

Implementing an interprofessional user-centered design approach to develop a bedside leg exercise device.

Early mobilization is important to improve critically ill patients' outcomes, but barriers to its implementation are common. A suitable in-bed device to exercise patients' legs might facilitate early mobilization. The aim of this study was to develop an in-bed leg press that would facilitate early mobilization and enhance strength training of patients in acute care settings. A user-centered design approach was applied to develop the device. The process was assessed by different instruments: the system usability scale (SUS) questionnaire, the Kano model questionnaire and interviews with end-users. Through several iterations of a user-centered design process, the prototype of an in-bed leg press was developed and tested. The assessment, based on SUS, Kano and interviews, indicates high usability and demonstrates the advantages of a user-centered design process. An interprofessional user-centered design approach was successfully implemented to develop a medical device. The early involvement of end-users resulted in a design that already shows a high degree of production readiness. The resulting device fulfilled all core requirements from a therapeutic point of view and included key features related to its practical use.

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Characteristics, treatment and delirium incidence of older adults hospitalized with COVID-19: a multicentre retrospective cohort study.

Background:The COVID-19 pandemic has affected older adults disproportionately, and delirium is a concerning consequence; however, the relationship between delirium and corticosteroid use is uncertain. The objective of the present study was to describe patient characteristics, treatments and outcomes among older adults hospitalized with COVID-19, with a focus on dexamethasone use and delirium incidence.Methods:We completed this retrospective cohort study at 7 sites (including acute care, rehabilitation and long-term care settings) in Toronto, Ontario, Canada. We included adults aged 65 years or older, consecutively hospitalized with confirmed SARS-CoV-2 infection, between Mar. 11, 2020, and Apr. 30, 2021. We abstracted patient characteristics and outcomes from charts and analyzed them descriptively. We used a logistic regression model to determine the association between dexamethasone use and delirium incidence.Results:During the study period, 927 patients were admitted to the acute care hospitals with COVID-19. Patients’ median age was 79.0 years (interquartile range [IQR] 72.0–87.0), and 417 (45.0%) were female. Most patients were frail (61.9%), based on a Clinical Frailty Scale score of 5 or greater. The prevalence of delirium was 53.6%, and the incidence was 33.1%. Use of restraints was documented in 20.4% of patients. In rehabilitation and long-term care settings (n = 115), patients’ median age was 86.0 years (IQR 78.5–91.0), 72 (62.6%) were female and delirium occurred in 17 patients (14.8%). In patients admitted to acute care during wave 2 of the pandemic (Aug. 1, 2020, to Feb. 20, 2021), dexamethasone use had a nonsignificant association with delirium incidence (adjusted odds ratio 1.38, 95% confidence interval 0.77–2.50). Overall, in-hospital death occurred in 262 (28.4%) patients in acute care settings and 28 (24.3%) patients in rehabilitation or long-term care settings.Interpretation:In-hospital death, delirium and use of restraints were common in older adults admitted to hospital with COVID-19. Further research should be directed to improving the quality of care for this population with known vulnerabilities during continued waves of the COVID-19 pandemic.

Barriers to Seasonal Influenza Vaccine Uptake in a Pediatric Inpatient Healthcare Setting After Implementation of Clinical Decision Support.

Every heatlhcare encounter is an opportunity to provide both acute care and health maintenance to children. A Clinical Decision Support (CDS) intervention was instituted in a tertiary pediatric health system to improve influenza vaccination rates during the 2019-2020 season among eligible children receiving care in an acute care inpatient healthcare setting. This study explores reasons for low vaccine uptake following implementation of a CDS aimed at improving vaccine administration as well as identifying possible solutions to improve flu vaccine coverage.

Implementing delirium screening in the emergency department: a quality improvement project

IntroductionDelirium is a serious medical condition that is common in older adults in acute settings. Clinical practice guidelines recommend that all older patients in acute care settings should be screened...

The German version of the Cultural Competence Assessment (CCA-G): cross-cultural adaptation and validation study in Austrian acute care settings

BackgroundAdapting practices to respond sensitively to increasingly culturally diverse patients can be challenging. Therefore, cultural competence among nurses needs to be assessed to evaluate their current cultural competence and the need for interventions to improve daily nursing practice. Little is known about cultural competence of nurses in German-speaking countries, including Austria, as there is currently no validated tool in German to assess cultural competence in nurses. The aims of this study were to translate and cross-culturally adapt the Cultural Competence Assessment scale in German and to evaluate its psychometric properties.MethodsThis is a methodology study with a cross-sectional design. Conducting a convenience sampling, Austrian nurses working in the direct care of patients in acute care settings were invited to participate in this study. Data collection was conducted in March 2021. The translation and cross-cultural adaptation were conducted by following the guidelines of Sousa et al. (J Eval Clin Pract 17:268-74, 2011) and Beaton et al. (Spine 25:3186-91, 2000). The face and content validity, structural validity, and internal consistency reliability of the Cultural Competence Assessment scale, which consists of 25 items, was evaluated. Data were analysed using content validity index, confirmatory factor analyses as well as McDonald’s Omega. Descriptive statistics were computed with the statistical software IBM SPSS Statistics 26, while the confirmatory factor analysis was conducted with the R package Lavaan.ResultsOverall, 915 nurses completed the questionnaire. Twenty items had an acceptable item content validity index. Using confirmatory factor analyses, a two-factor model with 14 items yielded a good fit (x2/df = 3.16; CFI = .923; TLI = .908; RMSEA = .055 (.049–.062) and SRMR = .039). Internal consistency reliability was found to be acceptable, as indicated by a Omega of .87.ConclusionThe German version of the Cultural Competence Assessment scale (CCA-G) can be recommended for measuring cultural competence behaviour of nurses in acute care settings. The 14-item scale showed strong construct validity and acceptable internal consistency. Further research using repeated measures could determine the cultural sensitivity and indicate if the tool is applicable in other healthcare settings and for other healthcare professionals.