A standard multiplex PCR offers comprehensive testing for respiratory viruses. However, it has traditionally been performed in a referral laboratory with a lengthy turnaround time, which can reduce patient flow through the hospital. We aimed to determine whether the introduction of a rapid PCR, but with limited targets (Cepheid Xpert Flu/RSV XC), was associated with improved outcomes for adults hospitalized with respiratory illness. A controlled quasi-experimental study was conducted across three hospitals in New South Wales, Australia. Intervention groups received standard multiplex PCR during the preimplementation, July to December 2016 (n ϭ 953), and rapid PCR during the postimplementation, July to December 2017 (n ϭ 1,209). Control groups (preimplementation, n ϭ 937, and postimplementation, n ϭ 1,102) were randomly selected from adults hospitalized with respiratory illness during the same periods. The outcomes were hospital length of stay (LOS) and microbiology test utilization (blood culture, urine culture, sputum culture, and respiratory bacterial and virus serologies). The introduction of rapid PCR was associated with a nonsignificant 8.9-h reduction in median LOS (95% confidence interval [CI], Ϫ21.5 h to 3.7 h; P ϭ 0.17) for all patients and a significant 21.5-h reduction in median LOS (95% CI, Ϫ36.8 h to Ϫ6.2 h; P Ͻ 0.01) among patients with positive test results in an adjusted difference-in-differences analysis. For patients receiving test results before disposition, rapid PCR use was associated with a significant reduction in LOS, irrespective of test results. Compared with standard PCR testing, rapid PCR use was significantly associated with fewer blood culture (adjusted odds ratio [aOR], 0.67; 95% CI, 0.5 to 0.82; P Ͻ 0.001), sputum culture (aOR, 0.56; 95% CI, 0.47 to 0.68, P Ͻ 0.001), bacterial serology (aOR, 0.44; 95% CI, 0.35 to 0.55, P Ͻ 0.001) and viral serology (aOR, 0.42; 95% CI, 0.33 to 0.53, P Ͻ 0.001) tests, but not with fewer urine culture tests (aOR, 0.94; 95% CI, 0.78 to 1.12, P ϭ 0.48). Rapid PCR testing of adults hospitalized with respiratory illnesses can deliver benefits to patients and reduce resource utilization. Future research should consider a formal economic analysis and assess its potential impacts on clinical decision making.
(Kachru, 1992), including countries such as India, Pakistan and Sri Lanka, where a different variety of English is spoken (AMC, 2009(AMC, , 2011(AMC, , 2012a(AMC, , 2012b.In addition to the challenges of working in an unfamiliar medical system, these doctors can also face considerable difficulties in daily communications with patients, families, and colleagues (Hall, Keely, Dojeiji, Byszewski, & Marks, 2004;McDonnell & Usherwood, 2008;Tipton, 2005). In addition to the more obvious language difficulties with vocabulary, grammar, pronunciation, and an understanding of accents and colloquialisms, they can also struggle with the less salient but vitally important interpersonal features of language use, such as how to build rapport and show empathy (Hall et al., 2004;McDonnell & Usherwood, 2008;Pilotto, Duncan, & Anderson-Wurf, 2007). Moreover, many may not be familiar with the demands of the patientcentred models of care expected in developed medical environments in Canada and Australia, but less common in developing countries where medical facilities are very stretched (Dahm, 2011b;Khalil & Bhopal, 2009).In this article we focus on the communication challenges facing doctors who trained in medical environments very different from those found in Canada and Australia using a language other than English, in order to inform communications training designed specifically for doctors from language backgrounds other than English, and to illustrate how a close analysis of professional discourse can be transferred to ESL classes preparing for work environments beyond the medical world. We draw on clinical role-plays performed by practicing locally trained native English-speaking (NES) doctors and nonnative English-speaking (NNES) IMGs to identify the communication features of the kind of patient-centred approach to medical communication that will be expected of them. Although specific features and approaches to communication in Canada and Australia likely differ in some minor respects, our aims are to highlight features that are relevant in both cultures and to illustrate how discourse data can be used to identify culturally appropriate ways of communicating in a medical setting in order to provide an accurate evidence base from which culturally appropriate medical communication courses for IMGs may be developed.
Aims To increase the quality and safety of patient care, many hospitals have mandated that nursing clinical handover occur at the patient's bedside. This study aims to improve the patient‐centredness of nursing handover by addressing the communication challenges of bedside handover and the organizational and cultural practices that shape handover. Design Qualitative linguistic ethnographic design combining discourse analysis of actual handover interactions and interviews and focus groups before and after a tailored intervention. Methods Pre‐intervention we conducted interviews with nursing, medical and allied health staff (n = 14) and focus groups with nurses and students (n = 13) in one hospital's Rehabilitation ward. We recorded handovers (n = 16) and multidisciplinary team huddles (n = 3). An intervention of communication training and recommendations for organizational and cultural change was delivered to staff and championed by ward management. After the intervention we interviewed nurses and recorded and analyzed handovers. Data were collected from February to August 2020. Ward management collected hospital‐acquired complication data. Results Notable changes post‐intervention included a shift to involve patients in bedside handovers, improved ward‐level communication and culture, and an associated decrease in reported hospital‐acquired complications. Conclusions Effective change in handover practices is achieved through communication training combined with redesign of local practices inhibiting patient‐centred handovers. Strong leadership to champion change, ongoing mentoring and reinforcement of new practices, and collaboration with nurses throughout the change process were critical to success. Impact Ineffective communication during handover jeopardizes patient safety and limits patient involvement. Our targeted, locally designed communication intervention significantly improved handover practices and patient involvement through the use of informational and interactional protocols, and redesigned handover tools and meetings. Our approach promoted a ward culture that prioritizes patient‐centred care and patient safety. This innovative intervention resulted in an associated decrease in hospital‐acquired complications. The intervention has been rolled out to a further five wards across two hospitals.
Background: This study examined the health literacy demands of My Health Record (MyHR) in the context of preparing for a government-announced opt-out system by repeating two studies of health information and usability conducted in 2016. Objective: To examine whether Australia’s MyHR meets the information and usability needs of people at risk of low health literacy and changes since 2016. Method: Content analysis: Informed by the 2016 methods and findings, measures of information quality, themes and target audiences were recorded and reported for each online consumer-facing health information resource. Heuristic evaluation: An evaluation of the MyHR and supporting information website was conducted using a predetermined checklist of usability criteria. A list of usability violations for both websites was identified. Results: Total number of resources grew from 80 in 2016 to 233 in 2018. There was little change since 2016 to average readability levels, target audiences, presentation style, links between resources and usability of MyHR. Compared to 2016, this study demonstrated increases in resources from non-government organisations; video resources; translated resources; and resources with themes of privacy, security and post-registration use. Conclusion: This study identified some improvements in information quality since 2016, but gaps remain in information quality and usability which may negatively impact the ability for people with low health literacy to access and use MyHR. Implications: This study provides a framework for ongoing monitoring and evaluation of the suitability of MyHR for people at risk of low health literacy.
Using discourse analytical methods, this article examines the interactional accomplishment of trust. Focusing on a case study drawn from a corpus of 28 surgical consultations collected in a gastro-intestinal clinic, it traces the trust-building process in a specific, communicatively challenging encounter where the patient is seeking a second opinion following an operation that she deems unsuccessful. Discourse analytical findings make visible the doctor’s strategic interactional work to build interpersonal trust with the patient and to regain her trust in the surgical profession. This work extends beyond interaction with the patient to include dictation of a letter to the referring doctor in the patient’s presence. Close analysis of the encounter reveals how this co-constructed consultation letter is deployed to strengthen the fragile patient–doctor trust engendered thus far. The article therefore provides insights into the discursive processes of trust building that could potentially be of considerable practical relevance to the medical profession.
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