What is already known on this topic? Self-management of health conditions does not occur in isolation but in the context of patients' physical, social, and family environment. What is added by this report? Implementation efforts should emphasize universal social screening during routine emergency department visits, with careful evaluation for potential bias and stigma among staff, providers, and patients. What are the implications for public health practice? Universal screening, referral, and aggregation of clinical and social resource data are possible by using existing resources, but training and the views of those engaged in screening and referrals need to be carefully considered in efforts to implement universal social needs screening.
Background Despite the importance of social determinants in health outcomes, little is known about the best practices for screening and referral during clinical encounters. This study aimed to implement universal social needs screening and community service referrals in an academic emergency department (ED), evaluating for feasibility, reach, and stakeholder perspectives. Methods Between January 2019 and February 2020, ED registration staff screened patients for social needs using a 10-item, low-literacy, English-Spanish screener on touchscreens that generated automatic referrals to community service outreach specialists and data linkages. The RE-AIM framework, specifically the constructs of reach and adoption, guided the evaluation. Reach was estimated through a number of approaches, completed screenings, and receipt of community service referrals. Adoption was addressed qualitatively via content analysis and qualitative coding techniques from (1) meetings, clinical interactions, and semi-structured interviews with ED staff and (2) an iterative “engagement studio” with an advisory group composed of ED patients representing diverse communities. Results Overall, 4608 participants were approached, and 61% completed the screener. The most common reason for non-completion was patient refusal (43%). Forty-seven percent of patients with completed screeners communicated one or more needs, 34% of whom agreed to follow-up by resource specialists. Of the 482 participants referred, 20% were reached by outreach specialists and referred to community agencies. Only 7% of patients completed the full process from screening to community service referral; older, male, non-White, and Hispanic patients were more likely to complete the referral process. Iterative staff (n = 8) observations and interviews demonstrated that, despite instruction for universal screening, patient presentation (e.g., appearance, insurance status) drove screening decisions. The staff communicated discomfort with, and questioned the usefulness of, screening. Patients (n = 10) communicated a desire for improved understanding of their unmet needs, but had concerns about stigmatization and privacy, and communicated how receptivity of screenings and outreach are influenced by the perceived sincerity of screening staff. Conclusions Despite the limited time and technical barriers, few patients with social needs ultimately received service referrals. Perspectives of staff and patients suggest that social needs screening during clinical encounters should incorporate structure for facilitating patient-staff relatedness and competence, and address patient vulnerability by ensuring universal, private screenings with clear intent. Trial registration ClinicalTrials.gov, NCT04630041.
The quality of discharge teaching is statistically linked to decreased readmission rates. Nursing most often bears the major responsibility of patient and caregiver teaching. Currently, discharge teaching is complicated by problems including time constraints, patient and caregiver overload, and coexisting comorbidities that add complexity to the patient's care needs at home. Not only are readmissions a preventable cost, more importantly, but they also are a negative patient experience signifying to our patients that they are unable to optimally care for themselves or that their disease or healing is not something they can care for alone. The following is a review of Agency for Healthcare Research and Quality's IDEAL discharge process, common problems in discharge teaching, and nursing's responsibilities with assessing a patient and his or her caregiver for discharge readiness. IDEAL is a structured discharge process with tools to help healthcare organizations improve their discharge process to decrease readmissions rates.
A clear positive correlation was found between the function of parents and the function of their children with CP. Although a cross-sectional study does not demonstrate the direction of the relationship, it seems reasonable to conclude that clinicians who are attempting to directly maximize child function should also consider the potential value of interventions that support and improve parent function, particularly mental health.
Background: Care management roles and responsibilities are frequently called out in leading white papers and exemplars; yet, the actual roles and responsibilities are poorly defined. Method: A qualitative content analysis using 6 landmark white papers and exemplars from national organizations to collect emerging care management and coordination roles and responsibilities. Results: Three major themes emerged from the content analysis: (1) care management is about complex systems and complex medical and social needs, (2) nurses are central to the interdisciplinary team, and (3) informatics is vital to support and enhance care management. Implications for Practice: Care managers need to be experienced with complex systems of care as well as complex diagnoses and conditions that our clients and their caregiver's experience. A nurse being central to the clients and embedded within the interdisciplinary team aids in diminishing the burden of negotiating the trajectory of a condition/illness as well as improves the interdisciplinary communication and teamwork. This review of literature has defined the complexity of care management and the discreet roles and responsibilities, as well as how informatics is vital for care managers to target and monitor key populations needing care management.
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