Challenging the information gap – the patients transfer from hospital to home health care

Hellesø, Ragnhild; Lorensen, Margarethe; Sorensen, Lena

doi:10.1016/j.ijmedinf.2004.04.009

Cited by 53 publications

(44 citation statements)

References 28 publications

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“…A shorter length of hospital stay, the decrease in work-hours of health care providers, and the increasing number of patient transitions between departments and institutions requires effective patient handovers, especially those of frail patients with comorbidities [1]. Continuity of care at patient discharge from the hospital is a critical aspect of high quality patient care [2, 3]. Highly reliable care requires close cooperation between care providers across organisational boundaries, thereby establishing an interdisciplinary network [4].…”

Section: Introductionmentioning

confidence: 99%

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping

Hesselink¹,

Zegers²,

Vernooij‐Dassen

et al. 2014

BMC Health Serv Res

134

120

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BackgroundThere is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge.MethodsThe Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance.ResultsIneffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change.ConclusionsThis study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-389) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping

Hesselink¹,

Zegers²,

Vernooij‐Dassen

et al. 2014

BMC Health Serv Res

134

120

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“…Despite an increasing body of literature exploring safety in transfers, which ranged from individual handoffs15 16 to organisational transfers,17 18 there has been no research known to the authors that considers patient definitions of safety in OCTs. It is thought that patients can play a role in their own safety,19–25 with their definitions of safety differing to those of clinicians 26–28…”

Section: Introductionmentioning

confidence: 99%

Do older patients' perceptions of safety highlight barriers that could make their care safer during organisational care transfers?

2011

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BackgroundHealthcare is a series of complex, interwoven systems in which any discontinuities of care may affect the safety of patients, who have been reported to perceive safety differently to clinicians. This study aimed to explore patient perceptions of safety and identify how they can be used to construct additional barriers to reduce safety incidents within organisational care transfers, which are known to be high in risk.DesignAppreciative Inquiry (AI) methodology was used to develop semi-structured interviews, using the Discover and Dream processes of AI. Fourteen patients (four men, 10 women; average age 76.2 years) were purposively recruited from NHS community care teams, social care homes and private nursing homes based on their experience of going through organisational care transfers. Thematic analysis was used to highlight key themes, which participants verified.FindingsCommunication, responsiveness and avoidance of traditional safety risks were identified as being important for patients to feel safe. Communication and responsiveness were mapped onto the Swiss-Cheese model of safety, presenting two new barriers to safety incidents. Traditional risks and the role of trust are discussed in relation to patients feeling safe.ConclusionPerceptions of safety such as communication and responsiveness were similar to those found in previous studies. Mapping these perceptions onto the Swiss-Cheese model of safety identifies how further defences, barriers and safeguards can be constructed to make people feel safer by reinforcing communication and responsiveness. Traditional risks are widely published, but the identification by patients reinforces the role they can play in identifying and reporting these risks.

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“…These gaps are created as a direct result of the inability to capture and exchange fall-related information electronically in the EHR or via Health Information Exchanges (HIEs) [45]. Without explicit attention to fall-related information, such gaps can also be influenced by clinicians' understanding of the scope and content of the information to be exchanged according to their discipline, context, and healthcare organization they work in [46]. Importance of contextual data: Important contextual information such as those in the educational, social, and environmental domains (▶ Table 2) are critical to fall risk management, care workflows, and safer care practices in home care.…”

Section: Discussionmentioning

confidence: 99%

Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

Alhuwail

Koru

2016

Appl Clin Inform

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KeywordsHome health agencies, health information technology, quality of care, workflow, information management SummaryObjectives: To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians' information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions. Methods: A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians. Results: Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients' cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients' risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management. Conclusion:The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical for fall risk management. Findings from this study can help home health agencies better understand their information needs to manage fall risks. BackgroundHome healthcare, referred to as home care henceforth, is defined as episodic and intermittent secondary care services provided to home-bound patients in their homes. Serving mostly the elderly [1], home care involves skilled care services provided by nurses, physical therapists, occupational therapists, speech therapists, social workers, and home aides [2]. Home care is a critical component in the continuum of care for many patients who require recuperative and rehabilitative services after hospital discharges [3][4][5][6]. It enables patients to achieve better recovery, gain strength, regain functionality, and become independent more quickly [7]. Home care is an important component of the overall healthcare industry in the United States (US) with a projected increase in its utilization and expen...

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Challenging the information gap – the patients transfer from hospital to home health care

Cited by 53 publications

References 28 publications

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping

Improving patient discharge and reducing hospital readmissions by using Intervention Mapping

Do older patients' perceptions of safety highlight barriers that could make their care safer during organisational care transfers?

Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

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