First US MERS-CoV Cases Underscore Need for Preparedness

Malani, Preeti

doi:10.1001/jama.2014.6019

Cited by 4 publications

(3 citation statements)

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“…Third, the inpatient team members extended the cycle of care by taking over responsibility of patient care during the hospitalization phase of care for patients who were randomized to the intervention group. This allowed the IPU to address readmission risk factors in a systematic and concerted effort early in the care cycle [26] and the inclusion of pre-discharge transitional care concepts could have accounted for the difference between our results and Dhalla et al [10]. Low health literacy and medication adverse events are known risk factors for 30-day hospital utilization post discharge [27, 28].…”

Section: Discussionmentioning

confidence: 99%

Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial

et al. 2017

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BackgroundEmerging evidence from the virtual ward care model showed that multidisciplinary case management are inadequate to reduce readmissions or death for high risk patients. There is consensus that interventions should encompass both pre-hospital discharge and post-discharge transitional care to be effective. Integrated practice units (IPU) had been proposed as an approach of restructuring the organization and work processes of multidisciplinary teams to achieve value in healthcare. Our primary objective is to evaluate if the novel application of the IPU concept to organize a modified virtual ward model incorporating pre-hospital discharge transitional care can reduce readmissions of patients at highest risk for readmission.MethodsWe conducted an open label, assessor blinded randomized controlled trial on patients with one or more unscheduled readmissions in the prior 90 days and LACE score ≥ 10. 840 patients were randomized in 1:1 ratio and blocks of 6 to the intervention program (n = 420) or control (n = 420). Allocation concealment was effected via an off-site telephone service maintained by a hospital administrator. Intervention patients received discharge planning, medication reconciliation, coaching on self-management of chronic diseases using standardized action plans and an individualized care plan complete with written discharge instructions, appointments schedule, medication changes and the contact information of the outpatient VW nurse before discharge. At discharge, care is handed over to the outpatient VW team. Patients were closely monitored in the VW for three months that included a telephone review within 72 hours of discharge, home assessment, regular telephone reviews to identify early complications and early review clinics for patients who destabilize. The VW meet daily to discuss new patients and review care plans for patients. Control patients received standard hospital care that included a standardized patient copy of the hospital discharge summary listing their medical diagnoses and medications; and follow up is arranged with a primary care provider or specialist as considered necessary. The primary outcome was the unplanned readmission rate to any hospital within 30 days of discharge. Secondary outcomes included the unplanned readmission rate, emergency department (ED) attendance rate to any hospital and the probability without readmission or death up to 180 days of discharge. Length of stay and mortality rate at 90-day were compared between the two groups. Outcome data were objectively retrieved from the hospital and National Electronic Health Records by a blinded outcome assessor.FindingsAll patients’ outcomes were included in an intention-to-treat analysis. The characteristics of both study groups were similar. Patients in the intervention group had a significant reduction in the number of 30-day readmissions, IRR 0.67 (95% CI, 0.52 to 0.86, p = 0.001) and the number of 30-day emergency department attendances, IRR 0.60 (95% CI, 0.46 to 0.79, p<0.001) compared to those receiving stan...

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Section: Discussionmentioning

confidence: 99%

Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial

et al. 2017

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“…The second patient got nosocomial infection without travel history [10]. In 2014, the first human infection in USA was reported and this brought several attentions from medical scientist due to the migration of disease to the western hemisphere [11,12]. The case was a physician who imported disease from the Middle East.…”

Section: Existence Of Mers Outside the Middle Eastmentioning

confidence: 99%

Korean MERS: A new cross continent emerging infectious disease

Wiwanitkit¹,

Wiwanitkit

2015

Asian Pacific Journal of Tropical Disease

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“…A review of a cluster of SARS cases among health care workers in Toronto showed that poor decisions about the use of PPE during aerosol-generating procedures, inconsistent use of PPE, fatigue, and inadequate infection-control training were associated with transmission. 10 But the 2014 outbreak of Ebola virus in West Africa 11 and the subsequent handling of Ebola patients have garnered unprecedented media attention to nurses' use of PPE. 7 Still, compliance with even more basic infectioncontrol practices such as hand hygiene and standard precautions-the minimal infection-control practices in caring for patients, regardless of their diagnosis-is often suboptimal in many settings.…”

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confidence: 99%

Clinical Challenges in Isolation Care

Beam

Gibbs

Hewlett

et al. 2015

AJN, American Journal of Nursing

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In 2014, the authors published the results of a study investigating nurses' use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne precautions. The 24 participants were video-recorded as they donned and doffed PPE. Variations in practices that had the potential to cause contamination were noted. In this article, the authors comment on those variations, analyzing each element of proper PPE protocols and examining why the behaviors are a safety concern for the nurse and a potential risk for disease transmission in the hospital or other clinical area. The authors note that making use of reflective practice for complicated care situations such as infection control may help nurses improve decision making in isolation care.

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First US MERS-CoV Cases Underscore Need for Preparedness

Cited by 4 publications

References 0 publications

Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial

Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial

Korean MERS: A new cross continent emerging infectious disease

Clinical Challenges in Isolation Care

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