Specific Areas Of Care Research Articles

Long-Term Care Healthcare-Associated Infections in 2023: An Analysis of 23,970 Reports

Background The Pennsylvania Patient Safety Reporting System (PA-PSRS) is the largest database of patient safety event reports in the United States. In addition to over 4.7 million acute care reports, the PA-PSRS database contains more than 420,000 long-term care (LTC) healthcare-associated infection (HAI) reports. Methods LTC HAI data from PA-PSRS were extracted on March 1, 2024. Infection counts were calculated based on report submission date and rates were calculated based on infection confirmation date. Reports submitted by LTC facilities and specific care areas were included for infection rates each month if resident and device days were also entered in PA-PSRS for the facility and care area. Results A total of 23,970 infection reports were submitted by Pennsylvania’s LTC facilities in 2023, representing an 18.6% increase from 2022. The overall infection rate increased by 11.4%, from 0.88 in 2022 to 0.98 in 2023, and all six regions of the state had an increase in infection rate. The Northeast region had the highest rate, with 1.28 reports per 1,000 resident days, and the Southeast region had the lowest rate, at 0.72. The overall rate increase was driven by rates of urinary tract infection (UTI) and skin and soft tissue infection (SSTI), which increased by 20.1% and 17.4%, respectively. Within the UTI infection type, symptomatic urinary tract infection (SUTI) rates increased by 21.1% and catheter-associated urinary tract infection (CAUTI) rates increased by 11.8%. Conclusion There was an increase in the total number and rate of infections reported to PA-PSRS in 2023.

Long-Term Care Healthcare-Associated Infections in 2022: An Analysis of 20,216 Reports

Background The Pennsylvania Patient Safety Reporting System (PA-PSRS) is the largest database of patient safety event reports in the United States. In addition to over 4.5 million acute care reports, the PA-PSRS database contains more than 396,000 long-term care (LTC) healthcare-associated infection (HAI) reports. Methods LTC HAI data from PA-PSRS were extracted on March 1, 2023. Reports submitted by LTC facilities and specific care areas were included for infection rates each month if resident and device days were also entered in PA-PSRS for the facility and care area. Results A total of 20,216 infections were reported in 2022, representing a 12.5% increase from 2021. Overall, the reporting rate from LTC facilities increased from 0.77 in 2021 to 0.87 in 2022. Over half (56%) of the increase in overall rate is due to an increase in the respiratory tract infection rate, with another 27% due to an increase in the gastrointestinal infection rate. All six regions of the state had an increase in overall infection rate from 2021 to 2022. The North Central region of the state had the highest overall rate, as well as the largest increase in rate, with 1.14 reports per 1,000 resident days in 2022, which is an increase of 21.3% over the 2021 rate of 0.94. The Southeast region had the lowest overall rate, at 0.67, which is an 8.1% increase from 2021. The number of reports increased for all five infection types from 2021 to 2022, with gastrointestinal infections increasing the most percentagewise, by 67.7%. Of the 14 infection subtypes, 11 had an increase in number of reports from 2021 to 2022, with influenza showing the largest increase of 857 reports. Norovirus had a larger percentage increase of 942.9%, going from 70 reported infections in 2021 to 730 in 2022. The three subtypes that decreased in number had relatively smaller changes than the increases, with the largest of the decreases occurring with C. diff, which dropped by 29 reports from 2021 to 2022. Conclusions There was an increase in the total number and rate of infections reported to PA-PSRS in 2022. Patient Safety Authority infection preventionists continue to note operational challenges in LTC facilities and are providing ongoing education and guidance to enhance infection prevention and surveillance strategies and improve reporting of HAIs.

Robotics and artificial intelligence in healthcare during COVID-19 pandemic

This paper will present the use of robotics and artificial intelligence in healthcare during COVID-19 pandemic. The types of robots to be discussed are autonomous mobile platforms that can assist with a broad range of tasks, including remote monitoring, on-site rescue and logistics. A case study is presented to illustrate how an artificial intelligence network application enabled healthcare providers to plan for the staffing levels of specific care areas while taking into account other constraints such as security and connectivity issues during a pandemic event. Robotics have become ubiquitous in human society in recent years due to their ability to perform repetitive tasks with minimal supervision, thus freeing up humans for more important activities or providing them relief from monotonous work that is physically demanding or exhausting.

Long-Term Care Healthcare-Associated Infections in 2021: An Analysis of 17,971 Reports

Background: The Pennsylvania Patient Safety Reporting System (PA-PSRS) is the largest repository of patient safety data in the United States. In addition to over 4.2 million acute care reports, the PA-PSRS database contains more than 375,000 long-term care (LTC) healthcare-associated infection (HAI) reports. Methods: LTC HAI data from PA-PSRS were extracted on February 10, 2022. Reports submitted by LTC facilities and specific care areas were included for infection rates each month if resident and device days were also entered in PA-PSRS for the facility and care area. Results: A total of 17,971 infections were reported in 2021, representing a 31.7% decrease from the prior year. Overall, the reporting rate from LTC facilities decreased notably, from 1.06 in 2020 to 0.78 in 2021, due in large part to a drop in respiratory tract infections, which had an infection rate of 0.431 in 2020 and 0.191 in 2021. The North Central region of the state had the highest overall infection rate, with 0.94 reports per 1,000 resident days, and the Southeast region had the lowest rate at 0.62. The number of reports decreased for all five infection types from 2020 to 2021, with respiratory tract infections decreasing the most, by 58.4%. The number of reports for all infection subtypes decreased as well, with the exception of scabies, which increased by 7.1%. Among all infection subtypes, the number of reports for lower respiratory tract infections decreased the most, with 2,553 fewer reports in 2021 than in 2020. In terms of percentage, influenza-like illness decreased the most, dropping 93.9% from 2020 to 2021. In terms of infection rate, catheter-associated urinary tract infections showed the greatest decrease, and infections involving cellulitis, soft tissue, and wounds showed the greatest increase. Conclusions: In 2021, there were notable decreases in both the infection rate and the number of infection reports submitted by Pennsylvania LTC facilities. Currently, it is unknown whether these decreases are reflective of fewer infections in LTC facilities or a lack of identifying and reporting infections, or a combination of both. Patient Safety Authority infection preventionists (IPs) continue to work with LTC IPs to provide support, education, and tools to assist them in their role.

Same baby, different care: variations in practice between neonatologists and pediatric intensivists.

Our study identified major differences in respiratory and hemodynamic care, sedation and analgesia, and vascular access between NICU and PICU physicians, resulting from field-specific consensus guidelines and practice traditions. We suggest to establish joint committees from both professions, aimed at finding the optimal treatment for this vulnerable population - be it in the NICU or in the PICU. • Variability in neonatal care between the neonatal and the pediatric intensive care units has been previously described. • This scenario-based survey study identified major differences in respiratory and hemodynamic care, sedation and analgesia, and vascular access between neonatologists and pediatric intensivists, resulting from lack of evidence-based literature to guide neonatal care, field-specific consensus guidelines, and practice traditions. • These findings indicate a need for joint committees, combining the unique skills and literature from both professions, to conduct clinical trials focusing on these specific areas of care, aimed at finding the optimal treatment for this vulnerable population - be it in the neonatal or the pediatric intensive care unit.

Patterns of use and perceived value of social media for population health among population health stakeholders: a cross-sectional web-based survey

BackgroundAlthough existing studies have described patterns of social media use in healthcare, most are focused on health professionals in one discipline. Population health requires a multi-disciplinary approach to ensure diversity and to include diverse stakeholders. To date, what is known about using social media in population health is focused on its potential as a communication tool. This study aims to investigate patterns of use and perceived value of social media usage among stakeholders in population health practice, policy, or research.MethodsWe conducted a web-based survey of delegates attending the Singapore Population Health Conversations and Workshop. We designed a 24-item questionnaire to assess 1) social media use in terms of type of platform and frequency of use; 2) perceptions of social media relevance and impact on population health; and 3) top three areas in population health that would benefit from social media. We used descriptive and logistic regression analyses to assess the relationships between variables.ResultsOf the 308 survey respondents, 97.7% reported that they use social media in some form. Messaging (96.8%) was the most dominant activity when using social media. Challenges in implementing social media for population health were time investment by health care professionals (56.2%) and patient adoption (52.9%). The top three population health areas that would benefit most from using social media were the promotion of healthy behaviors (60.7%), community engagement (47.7%), and preventive care (40.6%). Older respondents (> = 40 years) were less likely to view social media as useful for the promotion of healthy behaviors (OR = 0.34; 95% CI: 0.19–0.60). Non-social/healthcare professionals were more likely to consider social media to be useful for community engagement (OR = 1.74; 95% CI: 1.10–2.76). For preventive care, older respondents (OR = 0.51; 95% CI: 0.32–0.82) and non-social/healthcare professionals were less likely to view social media as useful (OR = 0.61; 95% CI: 0.38–0.97).ConclusionsOur findings suggest that it may be important to select the specific care areas that would benefit most from using social media. The time investment needed by population health professionals should be fully addressed in planning to maximize the application and potential value of social media.

Identifying practical approaches to the normalisation of interprofessional collaboration in rural hospitals: A qualitative study among health professionals

ABSTRACT This qualitative study explores the ideas and experiences of interprofessional collaboration (IPC) among health professionals in rural public hospitals and to propagate its normalization into practice by identifying existing or suggested solutions. The literature focuses largely on the barriers and facilitators to IPC in metropolitan areas and there is room to identify more practical responses for implementing solutions. Semi-structured interviews were conducted with 13 healthcare professionals (October 2018-March 2019). Interviews were audio-recorded, transcribed and underwent thematic analysis to identify themes derived from the dataset. Using the lens of the Normalization Process Theory (NPT) allowed for amalgamation of participant ideas and identification of solutions to implement IPC in practice. Participants’ definitions of IPC and Interprofessional Teamwork were incongruous with the current literature, however when provided with formal definitions, participants agreed that they both participated and observed IPC with varying degrees of success. Factors influencing this success included good working relationships and positive workplace cultures, having an understanding of each professions’ roles and needs and the hierarchy of professions in conjunction with attitudes of senior healthcare professionals. Solutions to improved IPC and its normalization included induction processes and informal introductions, formalized interprofessional interactions, interprofessional education and positive leadership, such as the ‘assertive followership model’. Analyzed in the framework of the normalization process theory, this research shows that IPC is increasingly becoming a coherent, integrated aspect of the healthcare system but there is room for improvement, and cognitive participation in IPC varies across healthcare professionsals. In order to facilitate the normalization process, program and policy makers, hospital administrations and professional associations could consider formalized interprofessional team interactions, formalizing IPC through simple introductions, interprofessional education and positive leadership. Future research could explore through the NPT specific areas of care that benefit from IPC implementation such as community aged-care.

Patient Misidentification Events in the Veterans Health Administration: A Comprehensive Review in the Context of High-Reliability Health Care.

The Veterans Health Administration maintains national patient safety event reporting and root cause analysis (RCA) databases. These were reviewed to understand the prevalence of and provide insight into patient misidentification. The results were compared with a high-reliability health care framework. We reviewed patient safety reports and RCA reports to identify and categorize patient identification-related events from October 1, 2016, to September 30, 2018. We analyzed 3232 patient safety reports and 67 RCAs, aggregated the findings, and compared them against The Joint Commission's High Reliability Health Care Maturity Model. Patient misidentification occurred in both inpatient and outpatient settings, for which the ratio of adverse events to close calls was similar. The ratio of adverse events to close calls varied for specific care areas. The most common RCA event characteristic was Two identifiers not used (39%). The most common failure mode was Procedure performed on wrong patient (31%). Issues related to policy and processes accounted for 42% of the root causes. Actions taken were primarily related to policy, process, and staff training/education (56%); these actions were rated as effective by the reporting facilities. Patient misidentification is prevalent in both the inpatient and outpatient settings. However, specific care areas reported more close calls, an indicator of good safety culture. There were associations between policy and process issues, consistent use of 2 identifiers, and misidentification events. This review provides insight from the Veterans Health Administration national databases that health care institutions can use to improve their systems.

Burn service costing using a mixed model methodology.

The escalating cost of modern healthcare is threatening the fundamental "free at the point of delivery" principle of the UK National Health Services. A new remuneration system using a fixed tariff for pre-assigned diagnostic groups caters poorly for the heterogeneity of burn injuries. This study was to develop a system for Patient Level Costing (PLC), the first steps of which were to determine the true cost of burn care at service level. Detailed interrogation was conducted of the cost of care in our Burns & Plastic Surgery Department. Costs were determined through the amalgamation of two fundamental methodologies: (1) Top-Down Costing (from detailed budgetary analysis for the hospital) and (2) Bottom-Up Costing (detailed itemised costing of staff, equipment, drugs, consumables & maintenance). These costs were categorised & using various apportionment tools, traced to specific care areas. We demonstrated that the accuracy of costs derived by host organisations cannot be relied upon (our Burn Service was 62% more expensive than estimated by our host organisation), which therefore questions the accuracy of most published work on burn care costing based upon these assumptions. Using our costing model, an analysis was made of the cost of running the Department with zero activity but "open & ready for business". Costs such as drugs and consumables were thus removed. This demonstrated that despite no clinical activity, costs still remained at 90% of full occupancy cost and are thus fixed costs. We hope application of this new system of Patient Level Costing to burn care will avoid the threatened viability of burn services imposed by changes in remuneration, although it will inevitably be an iterative process. A fuller understanding of the true cost of healthcare, facilitates service development and planning, both at a local and national level.

Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the...

Proposed ATP Benchmark Values by Patient Care Area

BACKGROUND Optimal cleaning and disinfection of environmental surfaces in healthcare facilities is paramount to limit the impact of healthcare-associated infections (HAIs). Adenosine triphosphate (ATP) bioluminescence assay systems are widely used as a method for objectively measuring environmental cleanliness. However, there is no current consensus on standardized pass/fail values. The objective of this study was to establish benchmark ATP assay values in specific care areas to be used as a measure to improve environmental disinfection in healthcare settings. METHODS Environmental samples were collected in a 115-bed acute care community hospital in Texas over a 68-month period. Surface samples were collected for the presence of ATP using an ATP bioluminescence monitor and reported as Relative Light Units (RLU). Sampled surfaces were selected at random from locations within the hospital that included emergency department (ED), operating rooms (OR), and near patient areas. All results were entered into a Microsoft Excel database to determine arithmetic means. RESULTS A total of 1300 samples were collected: 172, 177, 951 in ED, OR, and near patient areas respectively. Measurements were taken when no patients or medical staff were in the areas and after the locations had been cleaned by hospital environmental service (EVS) personnel. The mean values were, 70 RLU for ED, 25 RLU for OR, and 92 RLU for near patient areas. CONCLUSIONS Maintaining a high standard of cleanliness and lowering the risk of HAIs is essential in all healthcare facilities. This study has provided provisional benchmarks by care area that may be used for monitoring and improving environmental disinfection.

Algunas reflexiones sobre “la Bolsa Única” de contratación del Sistema Andaluz de Salud y las Áreas Específicas

A estas alturas, no quiero abundar más en la necesidad de una especialización para enfermería nefrológica, asunto que se ha tratado ya en esta editorial años atrás. Lo más curioso de todo, es que la especialización de enfermería en algunas áreas asistenciales concretas, no es una necesidad los profesionales, sino de los pacientes. Es decir, la Especialidad de Matrona no se creó para satisfacer a un grupo de profesionales de enfermería que tenían esa aspiración, se crea para atender una necesidad sanitaria muy concreta de una parte de la población. Tan difícil de entender es esto por parte de los responsables de la sanidad en este país?.

Measuring the impact of clinically relevant interprofessional education on undergraduate medical and nursing student competencies: A longitudinal mixed methods approach

ABSTRACTInterprofessional education (IPE) to improve collaborative competencies is essential for delivering high-quality care. Yet creating clinically relevant IPE and linking it to improvements in behaviours remains challenging, and few objective measurement instruments are available. We developed a process for creating IPE and objective observational tools through collaborative care best practice models (CCBPMs). These models describe the professional and interprofessional behaviours needed for specific patient populations, illnesses, and care settings. Four IPE workshops based on CCBPMs were implemented for all medical and nursing students during their clinical/clerkships years. Students in Cohort 1 completed two IPE workshops: rapid response and end-of-life. For Cohort 2, students completed four IPE workshops, adding chronic paediatric illness and transitions for the cognitively impaired. Valid and reliable collaborative behaviors observational assessment tools (CBOATs) derived from CCBPMs for the rapid response and end-of-life workshops were developed. CBOATs were used in the longitudinal assessment of student learning for both cohorts during two Interprofessional Teamwork Objective Structured Clinical Examinations (ITOSCEs) conducted before and after the students completed the IPE workshops. Over a 2-year period, 457 students completed the IPE simulations and ITOSCEs. Both medical and nursing students demonstrated significant improvement in CBOAT scores. Comparisons between the cohorts showed that participation in four versus two IPE experiences did not significantly improve most CBOAT scores. We conclude that undergraduate IPE simulation experiences based on CCBPMs result in measurable improvements in learner behaviours necessary for effective collaborative and team-based practice in specific care areas.

Validierung und erste Ergebnisse des deutschen QUOTE-IBD zur Erfassung der Behandlungsqualität aus Sicht der Patienten mit chronisch-entzündlichen Darmerkrankungen

The quality of care is especially relevant to patients with inflammatory bowel disease (IBD) and may be used in the context of quality management and for evaluation of interventions in health services research. To the best of our knowledge no German disease-specific and validated tool exists to measure the quality of the care that IBD patients receive. QUOTE-IBD is a validated questionnaire to assess the disease-specific quality of care from an IBD patient's perspective. It was translated into German and validated after being answered by 100 patients of our IBD outpatient clinic. To assess convergent validity a visual analogue scale and the Qualiskope-A questionnaire measuring patient satisfaction regardless of disease was used. Furthermore, we evaluated quality of care in the patient collective analysed for validation. The German QUOTE-IBD questionaire was very well accepted by patients and showed reliability in measuring overall satisfaction. Good correlations between overall satisfaction and the visual analogue scale as well as patient satisfaction measured by the Qualiskope A could be demonstrated. The mean overall satisfaction among the analysed patient collective was very high. Statements on importance or deficits in specific areas of care can hardly be given because of insufficient reliability and validity at the scale level. With the German QUOTE-IBD questionaire there is now a reliable and valid instrument available for measuring quality of care and satisfaction from the perspective of patients with chronic inflammatory bowel disease.

Using a Trigger Tool to Assess Adverse Drug Events in a Children's Rehabilitation Hospital

Some of the most common actions after an adverse drug event (ADE) have been carefully listed, studied, and described as "triggers." Trigger-based tools for finding and evaluating ADEs have been validated in varied patient populations. A recent article described the frequency and severity of ADEs in hospitalized children in tertiary care children's hospitals. Our objective was to discover whether children in a pediatric rehabilitation setting are at higher risk for ADEs because of polypharmacy, or at a lower risk because of relative overall clinical stability. A pediatric inpatient trigger tool was used in 3 groups of children hospitalized in a pediatric rehabilitation setting. ADE frequencies and patient characteristics were compared with values from a multicenter study using the same tools in pediatric tertiary care hospitals. Changes in ADE frequency over time were assessed (2005, n=20; 2006, n=20; 2008, n=19). No serious ADEs were newly discovered using the trigger tool. Nearly all of the ADEs (16 of 17) discovered by the trigger tool had not been voluntarily reported to the hospital's event reporting program. ADE frequencies expressed per patient were higher than those seen in tertiary care children's hospitals. Longer lengths of stay resulted in lower ADE frequencies when expressed per day. ADE frequency increased in the institution over time, reflecting increases in the acuity and complexity of patients cared for at this facility. Many ADEs affected bowel frequency. Systematic chart review using a trigger tool discovered ADEs that had not been voluntarily reported or evaluated. ADEs in pediatric rehabilitation patients occurred less often than those in tertiary pediatric care when expressed as rates per day, but were more frequent when expressed per patient or per medication. Types and severity of ADEs in pediatric rehabilitation can guide monitoring and attention to specific areas of care.

Perioperative Care Planning for a Down's Syndrome Patient

Introduction This article will be looking specifically at caring for a Down's syndrome patient, and will focus on the specialist care that they may require throughout the perioperative environment. This article will therefore explain Down's syndrome and include the related characteristics and health problems associated with this condition, which will then be used to highlight specific areas of care which may need to be improvised in order to accommodate this condition within the operating theatre.

A triad of evidence for care of women with genital piercings

To add three further dimensions of evidence for the care of women with genital piercings (GPs). Following a literature review, a cross-sectional study replicated previous work, using a web-based survey. This triad of evidence provides (a) descriptive quantitative data (N = 240) about women with GPs, (b) qualitative data about women with GPs, as well as (c) clinical observations from 60 healthcare providers (HCPs) who have cared for women with GPs. Three important findings about women with GPs were validated: (a) GPs were deliberate actions, sought for personal and sexual expression; (b) women with GPs treat piercings as a normal, meaningful part of their lives which produce sexual enhancement and expression; and (c) they continue to seek information about GP care from nonhealth providers. New data indicate that they have experienced depression (47%), abuse (physical 18%; emotional, 27%; sexual, 14%), and forced sexual activity (35%) in their lives. Several unsubstantiated assumptions about women with GPs are challenged with these data. GPs should not delay important health care. Health-protective, as well as health promotion, behaviors are important to reduce risks. Nurse practitioners (NPs) can become effective and resourceful advocates in three specific areas of care: (a) responsiveness to women with GPs, (b) collaborative decision making for the removal of jewelry, and (c) promotion of applicable patient education.

The S.T.A.B.L.E.® Program

The S.T.A.B.L.E. Program is the first neonatal continuing education program to focus exclusively on the post-resuscitation/pre-transport stabilization care of sick infants. Neonatal Resuscitation Program provides the requisite education for healthcare providers to safely and systematically resuscitate neonates. However, those infants who require resuscitation also require ongoing care to decrease the risk of morbidity and mortality. The S.T.A.B.L.E. Program provides all members of the neonatal healthcare team with the knowledge needed to render necessary care to infants who are under post-resuscitation or pre-transport stabilization care. Utilizing an organized approach, the S.T.A.B.L.E. Program facilitates the care process by prompting healthcare providers to focus on specific areas of care. This article provides an overview of (1) the history of the S.T.A.B.L.E. Program, (2) the philosophy and goals of the program, (3) a course overview of individual modules, (4) acceptance and recognition of the program in the healthcare community, (5) the target audience, and (6) administration of the course.

A review of the activity and effects of nurse‐led care in diabetes

To identify systematically, summarize and critically appraise the current evidence regarding the activity and effects of nurse-led care in diabetes. A diverse range of nurse-led models of care exist in diabetes. Primary studies have been conducted evaluating these models, but review and synthesis of the findings from these studies has not been undertaken. Systematic searches of CINAHL, MEDLINE and British Nursing Index from 1996 until June 2006. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles. Twenty-two relevant publications were identified and included findings from both primary and secondary care. The evidence indicates that nurses are involved in specific areas of care including education, individualized care, patient safety, promotion of self-care, acquisition of physical skills and psychological support. Improved glycemic control, diabetic symptoms, cost-effectiveness and decreased length of hospital stay are the main benefits of nurse-led interventions in diabetes care. Disease management protocols are the main mechanism by which nurses adjust and titrate medicines for patients with diabetes. Patient evaluations of nurse-led care report improved self-care and patient knowledge. Findings of the review are generally positive. However, there are methodological weaknesses and under researched issues e.g. poor descriptions of the nurse interventions, the educational needs of nurses and the prescription of medicines by nurses for patients with diabetes, that point to a need for further rigorous evaluation. Nurse-led care is an integral element of the diabetes service offered to patients. This review highlights the effect of this care and the issues that require consideration by those responsible for the development of nurse-led models in diabetes care.

Developing cardiac services for patients with arrhythmias: the next chapter

Developing cardiac services for patients with arrhythmias: the next chapter