Ward Rounds Research Articles

An exploration of the reception and expectations of medical information among hospitalized elderly patients and their primary caregivers in Taiwan: a mixed-methods study

Objectives Adults older are increasing in Taiwan. The receipt of information and expectations related to informational messages provided to hospitalized elders have not been studied. The study aim is to explore the status of receipt of information and expectations among hospitalized elders and their care providers in Taiwan. Methods A descriptive, cross-sectional and mixed-methods study design was used in in a geriatric ward in a medical center. The participants were 60 patients of 65 years and their care providers were obtained by convenience sampling. The data were collected using a semi-structured questionnaire and checklists. Physician messages and the data for each participant were collected in one regular ward round. Results Twenty-eight patients (46.7%) could not repeat the messages. The message repetition rate was 21.9% the first hour and was 62.9% after hinting. The total message repetition rate of the main care providers was 36.0% and was 80.3% after hinting. “Desire to know the reasons for discomfort” and “discharge date” were the messages most expected by the patients. “None,” “conditions associated with the progress of the illness,” “discharge date” and “relevant information of examination results” were the messages most expected by their care providers. Conclusions The majority of the hospitalized elderly and their care providers could not repeat medical messages conveyed by the physicians. The informed messages should be sorting, and the reminder should be repeated within a short time. Keywords: receipt of information, expectation, hospitalized elders, care providers, Taiwan.

Surgery’s Rosetta Stone: Natural language processing to predict discharge and readmission after general surgery

BackgroundThis study aimed to examine the accuracy with which multiple natural language processing artificial intelligence models could predict discharge and readmissions after general surgery. MethodsNatural language processing models were derived and validated to predict discharge within the next 48 hours and 7 days and readmission within 30 days (based on daily ward round notes and discharge summaries, respectively) for general surgery inpatients at 2 South Australian hospitals. Natural language processing models included logistic regression, artificial neural networks, and Bidirectional Encoder Representations from Transformers. ResultsFor discharge prediction analyses, 14,690 admissions were included. For readmission prediction analyses, 12,457 patients were included. For prediction of discharge within 48 hours, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.86 and 0.86 for Bidirectional Encoder Representations from Transformers, 0.82 and 0.81 for logistic regression, and 0.82 and 0.81 for artificial neural networks. For prediction of discharge within 7 days, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.82 and 0.81 for Bidirectional Encoder Representations from Transformers, 0.75 and 0.72 for logistic regression, and 0.68 and 0.67 for artificial neural networks. For readmission prediction within 30 days, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.55 and 0.59 for Bidirectional Encoder Representations from Transformers and 0.77 and 0.62 for logistic regression. ConclusionModern natural language processing models, particularly Bidirectional Encoder Representations from Transformers, can effectively and accurately identify general surgery patients who will be discharged in the next 48 hours. However, these approaches are less capable of identifying general surgery patients who will be discharged within the next 7 days or who will experience readmission within 30 days of discharge.

Integrated medical and nursing ward rounds in a patient with myelodysplastic syndrome

Integrated medical and nursing ward rounds in a patient with myelodysplastic syndrome

Integrated medical and nursing ward rounds in a patient with gastrointestinal dysfunction after gastric cancer surgery

Integrated medical and nursing ward rounds in a patient with gastrointestinal dysfunction after gastric cancer surgery

Nursing care of a patient with cholelithiasis based on integrated medical and nursing ward rounds model

Nursing care of a patient with cholelithiasis based on integrated medical and nursing ward rounds model

Research progress and present situation of integrated medical and nursing ward rounds

Research progress and present situation of integrated medical and nursing ward rounds

Humanistic nursing with characteristics of Traditional Chinese Medicine in the nursing ward rounds of a patient after total knee arthroplasty

Humanistic nursing with characteristics of Traditional Chinese Medicine in the nursing ward rounds of a patient after total knee arthroplasty

Nursing ward rounds in a patient with cancer-related pain treated with holographic scraping combined with five-tone therapy

Nursing ward rounds in a patient with cancer-related pain treated with holographic scraping combined with five-tone therapy

Integrated medical and nursing ward rounds in a case of severe pneumonia

Integrated medical and nursing ward rounds in a case of severe pneumonia

The application mode and quality improvement of the integrated medical and nursing ward rounds

The application mode and quality improvement of the integrated medical and nursing ward rounds

Integrated Traditional Chinese and Western medicine nursing and ward rounds based on medical-nursing integrated mode in a patient with heart failure

Integrated Traditional Chinese and Western medicine nursing and ward rounds based on medical-nursing integrated mode in a patient with heart failure

Integrated medical and nursing ward rounds in the rehabilitation of cerebrovascular disease: A case report

Integrated medical and nursing ward rounds in the rehabilitation of cerebrovascular disease: A case report

Integrated medical and nursing ward rounds for an elderly patient with chronic renal failure guided by Traditional Chinese Medicine theory

Integrated medical and nursing ward rounds for an elderly patient with chronic renal failure guided by Traditional Chinese Medicine theory

Integrated medical and nursing ward rounds in a patient with hemorrhagic stroke

Integrated medical and nursing ward rounds in a patient with hemorrhagic stroke

Refining the practice of nursing ward rounds and improving the clinical competence

Refining the practice of nursing ward rounds and improving the clinical competence

Application of medical-nursing integrated model and PDCA management in Traditional Chinese Medicine nursing ward rounds for a patient with chronic obstructive pulmonary disease

Application of medical-nursing integrated model and PDCA management in Traditional Chinese Medicine nursing ward rounds for a patient with chronic obstructive pulmonary disease

Development of individual competencies and team performance in interprofessional ward rounds: results of a study with multimodal observations at the Heidelberg Interprofessional Training Ward.

Interprofessional training wards (IPTW) aim to improve undergraduates' interprofessional collaborative practice of care. Little is known about the effects of the different team tasks on IPTW as measured by external assessment. In Heidelberg, Germany, four nursing and four medical undergraduates (= one cohort) care for up to six patients undergoing general surgery during a four-week placement. They learn both professionally and interprofessionally, working largely on their own responsibility under the supervision of the medical and nursing learning facilitators. Interprofessional ward rounds are a central component of developing individual competencies and team performance. The aim of this study was to evaluate individual competencies and team performance shown in ward rounds. Observations took place in four cohorts of four nursing and four medical undergraduates each. Undergraduates in one cohort were divided into two teams, which rotated in morning and afternoon shifts. Team 1 was on morning shift during the first (t0) and third (t1) weeks of the IPTW placement, and Team 2 was on morning shift during the second (t0) and fourth (t1) weeks. Within each team, a tandem of one nursing and one medical undergraduate cared for a patient room with three patients. Ward round observations took place with each team and tandem at t0 and t1 using the IP-VITA instrument for individual competencies (16 items) and team performance (11 items). Four hypotheses were formulated for statistical testing with linear mixed models and correlations. A total of 16 nursing and medical undergraduates each were included. There were significant changes in mean values between t0 and t1 in individual competencies (Hypothesis 1). They were statistically significant for all three sum scores: "Roles and Responsibilities", Patient-Centeredness", and "Leadership". In terms of team performance (Hypothesis 2), there was a statistically significant change in mean values in the sum score "Roles and Responsibilities" and positive trends in the sum scores "Patient-Centeredness" and "Decision-Making/Collaborative Clinical Reasoning". Analysis of differences in the development of individual competencies in the groups of nursing and medical undergraduates (Hypothesis 3) showed more significant differences in the mean values of the two groups in t0 than in t1. There were significant correlations between individual competencies and team performance at both t0 and t1 (Hypothesis 4). The study has limitations due to the small sample and some sources of bias related to the external assessment by means of observation. Nevertheless, this study offers insights into interprofessional tasks on the IPTW from an external assessment. Results from quantitative and qualitative analysis of learners self-assessment are confirmed in terms of roles and responsibilities and patient-centeredness. It has been observed that medical undergraduates acquired and applied skills in collaborative clinic reasoning and decision-making, whereas nursing undergraduates acquired leadership skills. Within the study sample, only a small group of tandems remained constant over time. In team performance, the group of constant tandems tended to perform better than the group of random tandems. The aim of IPTW should be to prepare healthcare team members for the challenge of changing teams. Therefore, implications for IPTW implementation could be to develop learning support approaches that allow medical and nursing undergraduates to bring interprofessional competencies to team performance, independent of the tandem partner or team.

Evaluation of the feasibility of a video-transmitted surgical ward round: a proof of concept study

BackgroundSurgical ward rounds are key element to point-of-care interprofessional postoperative treatment and technical and communicational aspects are relevant for the patient’s safety and satisfaction. Due to COVID-19 restrictions, the training opportunity of experiencing a face-to-face surgical ward round was massively hampered and thus, we developed a digital concept. This study aims to investigate the feasibility of video-transmitted ward rounds integrating surgical and communicational aspects with live streaming from wards. Further, medical students were asked for their satisfaction and their subjective learning success.MethodsThe proof-of-concept study consisted of self-reported subjective evaluation of competences in ward round skills. Qualitative feedback was collected to gain deeper insight and students’ empathy was rated by using the student version of the Jefferson Empathy Scale (JES).ResultsOne hundred three medical students participated. The students were satisfied with the video-transmitted ward round (M = 3.54; SD = 1.22). In the subjective evaluation students’ ward round competencies rose significantly (p < .001, Mpre = 3.00, SD = 0.77; Mpost = 3.76, SD = 0.75). The surgeon was rated as empathic (M = 119.05; SD = 10.09). In the qualitative feedback they named helpful aspects like including an expert for communication. However, they preferred the face-to-face setting in comparison to the digital concept.ConclusionsIt was feasible to implement a video-transmitted ward round within a pandemic. The format worked technically, was well-accepted and also led to a subjective rise in the students’ competencies. Video-transmitted ward rounds may be integrated to support the medical education, though, they cannot replace the face-to-face setting.

26 Audit of osteoporosis treatment in patients undergoing Orthogeriatric rehabilitation

Abstract Background There was a perceived under-prescribing of osteoporosis treatment in this population. The transition from acute hospital to rehabilitation unit presented an opportunity to check medications and institute change. Methods Retrospective audit of patients’ medication charts. All patients on the rehabilitation ward under the care of an Ortho-geriatrician were included. Data was anonymised and recorded in an excel file. Prescription of calcium and vitamin D (single agent or combination) and targeted osteoporosis medications were recorded. Data collection performed by the specialist registrar on a ward round with the consultant. Interventions included education of Non-Consultant Hospital Doctors (NCHDs) to encourage proactive prescribing and documentation of the bone protection plan on the transfer summary. A re-audit was undertaken at a two month interval using the same methodology. Results 12 medication charts were examined as part of the initial audit. 10/12 had a neck of femur fracture and 2/12 had fragility fractures of the tibia/fibula requiring surgery. Zero patients were prescribed calcium alone, two vitamin D alone and 9/12 were on combination calcium and vitamin D. No patients were prescribed targeted osteoporosis treatment. 1/12 patients had a documented plan regarding bone protection. Re-audit examined 10 medication charts. 9/10 had a neck of femur fracture, 1/10 had a fracture of both the distal femur and the proximal humerus. Zero patients were prescribed calcium alone, three vitamin D alone and 6/10 were on combination calcium and vitamin D. 2/10 were prescribed oral bisphosphonate, 5/10 denosumab and 1/10 intravenous bisphosphonate. The remaining two patients did not yet have osteoporosis treatment prescribed. Conclusion Despite all of the initial patients being &amp;gt;14 days post-operative the majority did not have a plan or prescription for bone protection representing a missed opportunity to prevent further fractures. Re-audit post education demonstrated an 80% improvement in prescription of osteoporosis treatment.

Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial

ObjectiveDiscussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre...