“In Safe Hands” – A costly integrated care program with limited benefits in stroke unit care

Jala, Sheila; Giaccari, Sarah; Passer, Melissa; Bertmar, Carin; Day, Susan; Griffith, Dayna; Krause, Martín

doi:10.1016/j.jocn.2018.10.135

Cited by 3 publications

(6 citation statements)

References 15 publications

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“…Although Stein et al 8 and others 13,14,18 implemented SIBR on a daily basis, we believed that twice‐weekly SIBR was more sustainable. Time restrictions, heavy workloads, increased paperwork, funding cuts, and lack of motivation may undermine daily rounds.…”

Section: Discussionmentioning

confidence: 82%

“…Qualitative studies of SIBR have reported mostly positive outcomes 17‐19 . However, most of the quantitative studies have reported no significant effects on LOS, 9,13‐15,18 in‐hospital adverse events, 9,14,20 or readmission rates beyond 7 days 13,15 . Although Stein et al 8 reported a significant decrease in LOS and in‐hospital mortality within a restructured ward, both outcomes were unadjusted and the study did not isolate the impact of SIBR from other unit reforms.…”

Section: Introductionmentioning

confidence: 97%

“…The use of SIBR has been widely implemented across a variety of hospital settings in the United States, 9,13 Australia 14,15 and the United Kingdom 16 . Qualitative studies of SIBR have reported mostly positive outcomes 17‐19 .…”

Section: Introductionmentioning

confidence: 99%

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Twice‐Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients

Basic

Huynh

Gonzales

et al. 2021

J American Geriatrics Society

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Background/Objective Ineffective interdisciplinary communication has negative impacts on patient outcomes. The use of regular structured interdisciplinary bedside rounds (SIBR), where each patient interaction lasts 3–5 minutes, is a model of care that improves interdisciplinary communication. We evaluated the impact of SIBR on in‐hospital falls. Design Prospective before‐after study of older people hospitalized with acute illness. Setting Two side‐by‐side aged care wards in a university hospital in Sydney, Australia. Participants A total of 3,673 consecutive inpatients of mean age 83.8 ± 7.7 years, with 1,703 before SIBR compared with 1,970 after SIBR. No patients were excluded from potential participation. Intervention Twice‐weekly SIBR. Measurements Falls data were manually extracted from a mandatory institutional incident reporting database. Medical diagnoses were based on the Australian Refined Diagnosis Related Groups classification system. Injuries due to falls were corroborated using the institutional electronic medical record (Cerner PowerChart). Generalized estimating equations were used to evaluate the incidence rate ratio (IRR) of falls and fall‐related injuries. A negative binomial distribution and a logarithmic link function were used to linearize regression equations. Results After SIBR, there were 7.4 falls per 1,000 occupied bed days (OBD), compared with 10.6 falls per 1,000 OBD before SIBR (P < .001). The implementation of SIBR reduced falls (IRR = 0.67, 95% CI = 0.52–0.85), after adjusting for age, gender, cognitive impairment, behavioral and psychological symptoms of dementia, deconditioning and frailty, but not fall‐related injuries (IRR = 0.79, 95% CI = 0.52–1.20). Conclusion This study is the first to investigate the effect of SIBR on in‐hospital falls. It provides evidence that a sustainable, twice‐weekly intervention is associated with a reduction in falls. It has the potential to be used in other settings where falls are frequent.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Twice‐Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients

Basic

Huynh

Gonzales

et al. 2021

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…As mentioned above, our research is one of the few studies with an integrated care perspective to investigate the acute phase of stroke care. When compared to studies focusing on (the transition to) longer term care, acute studies seem to be more centred on attainment of health outcomes or certain cost measures rather than patient or staff satisfaction [ 62 63 64 65 ]. Moreover, acute interventions tend to have a stronger focus on the organisational and provider side rather than on aspects such as person-centeredness, patient involvement or shared decision-making [ 62 63 64 65 ].…”

Section: Discussionmentioning

confidence: 99%

“…When compared to studies focusing on (the transition to) longer term care, acute studies seem to be more centred on attainment of health outcomes or certain cost measures rather than patient or staff satisfaction [ 62 63 64 65 ]. Moreover, acute interventions tend to have a stronger focus on the organisational and provider side rather than on aspects such as person-centeredness, patient involvement or shared decision-making [ 62 63 64 65 ]. There are a few recent studies investigating these latter aspects in acute stroke care [ 66 67 68 69 ].…”

Section: Discussionmentioning

confidence: 99%

Patient Pathways During Acute in-Hospital Stroke Treatment: A Qualitative Multi-Method Study

Busetto

Hoffmann

Stang

et al. 2022

International Journal of Integrated Care

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Introduction:Patients experiencing acute ischemic stroke should access treatment as soon as possible to increase their chances for survival without severe disability. Given the increased complexity of stroke treatment from the provider and patient perspective, this study provides an overview of the pathways followed by stroke patients during in-hospital treatment.Methods: This qualitative study combined twenty-seven observations and fifteen staff interviews at a German comprehensive stroke center providing endovascular treatment ("EVT hospital"). Analysis was based on the COMIC Model for the comprehensive evaluation of complex health care interventions and a grounded theory approach. Results:The patient pathways during in-hospital treatment span the phases (1) admission to hospital, (2) receiving recanalization therapies, and (3) in-patient treatment. Before admission to the EVT hospital, interactions between staff members from the EVT hospital and patients take place as part of the telestroke consultations during which the EVT hospital's ED neurologist meets the patient via a video-and audio-based connection. During the second phase, when IVT and/or EVT are provided to the patient, three teams (ED, neuroradiology and ICU team) with direct patient interactions intersect at the angiography suite until mechanical recanalisation treatment ends and the patient is transferred to the SU or ICU. In the third phase, the patients are treated on the SU or ICU and staff members interact with them according to a pre-defined schedule as well as based on individual needs. Discussion: Our results show that most direct staff-patient interactions are focussed within one phase, with a smaller number of interactions extending to other phases, and no professional (group) with direct patient interactions cover more than two phases of the acute stroke pathway. Future research should investigate how the pathways described here are experienced from the patient perspective, including how the organisation of visible care processes may influence patient satisfaction. Findings can be translated to accessible patient information resources as well as input for digitalisation efforts, provider orientation and training.

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Comparisons of Adaptations in Grounded Theory and Phenomenology: Selecting the Specific Qualitative Research Methodology

Urcia

2021

International Journal of Qualitative Methods

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The most widely used qualitative research methodologies are grounded theory and phenomenology. Both methodologies have expanded over time to several adaptations aligning with different paradigms, complex philosophical assumptions, and varying methodological strategies. Novice researchers either mistakenly mix the strategies of both methodologies or blend specific assumptions of methodologies’ different adaptations. Choosing the appropriate methodology and the specific adaptation in line with research inquiry and congruent with the researchers’ worldview is crucial in undertaking rigorous qualitative study. To date, there is limited literature that compared and contrasted the varying philosophical underpinnings of the two methodologies’ different adaptations. The purpose of this methodological paper is to provide a general overview of the two methodologies’ different adaptations to illustrate how they differ in approach. By immersing into the origins, philosophical assumptions, and utility of the two methodologies’ adaptations, novice researchers will develop a general overview of the foundations that support those specific adaptations. Finally, the considerations in choosing a specific adaptation of a methodology are discussed and applied by underpinning a research question on the care experiences of patients in the Accountable Care Unit. Thus, this methodological paper may assist novice researchers in deciding which specific adaptation of the two methodologies is the appropriate qualitative methodology for their research.

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“In Safe Hands” – A costly integrated care program with limited benefits in stroke unit care

Cited by 3 publications

References 15 publications

Twice‐Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients

Twice‐Weekly Structured Interdisciplinary Bedside Rounds and Falls among Older Adult Inpatients

Patient Pathways During Acute in-Hospital Stroke Treatment: A Qualitative Multi-Method Study

Comparisons of Adaptations in Grounded Theory and Phenomenology: Selecting the Specific Qualitative Research Methodology

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