Impact of structured interdisciplinary bedside rounding on patient outcomes at a large academic health centre

Sunkara, Padageshwar; Islam, Tareq; Bose, Abhishek; Rosenthal, Gary E.; Chevli, Parag A; Jogu, Hanumantha R; Tk, Luqman Arafath; Huang, Chi‐Cheng; Chaudhary, Dipendra; Beekman, Daniel; Dutta, Abhishek; Menon, Suma; Speiser, Jaime L.

doi:10.1136/bmjqs-2019-009936

Cited by 19 publications

(14 citation statements)

References 14 publications

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“…Hospital readmissions are a worldwide, major health-care burden, with a negative impact on patient health, public health, and healthcare systems' associated national financial burden. Previous publications describe the heavy toll of hospital (non-surgical) re-admissions while the same researchers and others attempted various strategies for either predicting the risk for readmission and proactively reducing it (albeit with conflicting results) [5][6][7][8][9][10].…”

Section: The Need For Internal Medicine Personalization Hospital Lenmentioning

confidence: 99%

Frailty and Sarcopenia Assessment upon Hospital Admission to Internal Medicine Predicts Length of Hospital Stay and Re-Admission: A Prospective Study of 980 Patients

Anani

Goldhaber

Brom

et al. 2020

JCM

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Background: Frailty and sarcopenia are associated with frequent hospitalizations and poor clinical outcomes in geriatric patients. Ascertaining this association for younger patients hospitalized in internal medicine departments could help better prognosticate patients in the realm of internal medicine. Methods: During a 1-year prospective study in an internal medicine department, we evaluated patients upon admission for sarcopenia and frailty. We used the FRAIL questionnaire, blood alanine-amino transferase (ALT) activity, and mid-arm muscle circumference (MAMC) measurements. Results: We recruited 980 consecutive patients upon hospital admission (median age 72 years (IQR 65–79); 56.8% males). According to the FRAIL questionnaire, 106 (10.8%) patients were robust, 368 (37.5%) pre-frail, and 506 (51.7%) were frail. The median ALT value was 19IU/L (IQR 14–28). The median MAMC value was 27.8 (IQR 25.7–30.2). Patients with low ALT activity level (<17IU/L) were frailer according to their FRAIL score (3 (IQR 2–4) vs. 2 (IQR 1–3); p < 0.001). Higher MAMC values were associated with higher ALT activity, both representing robustness. The rate of 30 days readmission in the whole cohort was 17.4%. Frail patients, according to the FRAIL score (FS), had a higher risk for 30 days readmission (for FS > 2, HR = 1.99; 95CI = 1.29–3.08; p = 0.002). Frail patients, according to low ALT activity, also had a significantly higher risk for 30 days readmission (HR = 2.22; 95CI = 1.26–3.91; p = 0.006). After excluding patients whose length of stay (LOS) was ≥10 days, 252 (27.5%) stayed in-hospital for 4 days or longer. Frail patients according to FS had a higher risk for LOS ≥4 days (for FS > 2, HR = 1.87; 95CI = 1.39–2.52; p < 0.001). Frail patients, according to low ALT activity, were also at higher risk for LOS ≥4 days (HR = 1.87; 95CI = 1.39–2.52; p < 0.001). MAMC values were not correlated with patients’ LOS or risk for re-admission. Conclusion: Frailty and sarcopenia upon admission to internal medicine departments are associated with longer hospitalization and increased risk for re-admission.

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Section: The Need For Internal Medicine Personalization Hospital Lenmentioning

confidence: 99%

Frailty and Sarcopenia Assessment upon Hospital Admission to Internal Medicine Predicts Length of Hospital Stay and Re-Admission: A Prospective Study of 980 Patients

Anani

Goldhaber

Brom

et al. 2020

JCM

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“…International studies demonstrate that improved communication in interdisciplinary healthcare teams improves patients' depressive symptoms [4], reduces risks of postoperative complications and mortality [5], and improves assessment and patient management practices in oncology settings [6]. A recent study in acute care settings showed that enhancing communication between healthcare providers, patients, and their families using formal interactions significantly reduced 7-day readmission rates [7]. In contrast to informal communications (e.g., spontaneous discussions on the hallway), formal communications are planned and scheduled meetings to discuss and make decisions about care.…”

Section: Introductionmentioning

confidence: 99%

Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes—the INFORM cluster-randomized controlled trial

et al. 2020

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Background Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect of simple and two higher intensity levels of feedback based on goal-setting theory on improving formal staff communication in NHs. Methods This pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating in TREC (translating research in elder care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4641 care aides and 1693 nurses cared for 8766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on goal-setting theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up. Results Baseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p = 0.021) and enhanced groups ([0.01; 0.33], p = 0.035). We found no difference in this outcome between the two higher intensity groups. Conclusions Theoretically informed feedback was superior to simple feedback in improving care aides’ involvement in formal communications about resident care. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested. Trial registration ClinicalTrials.gov (NCT02695836), registered on March 1, 2016

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“…International studies demonstrate that improved communication in interdisciplinary healthcare teams improves patients' depressive symptoms [4], reduces risks of postoperative complications and mortality [5] and improves assessment and patient management practices in oncology settings [6]. A recent study in acute care settings showed that enhancing communication between healthcare providers, patients and their families using formal interactions signi cantly reduced 7-day readmission rates [7]. In contrast to informal communications (e.g., spontaneous discussions on the hallway), formal communications are planned and scheduled meetings to discuss and make decisions about care.…”

Section: Introductionmentioning

confidence: 99%

Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes – The INFORM cluster-randomized controlled trial

Hoben

Ginsburg

Easterbrook

et al. 2020

Preprint

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Background: Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect of simple and two higher intensity levels of feedback based on Goal Setting Theory on improving formal staff communication in NHs.Methods: This pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating in TREC (Translating Research in Elder Care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4,641 care aides and 1,693 nurses cared for 8,766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on Goal Setting Theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up.Results: Baseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2,428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2,387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1,584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p=0.021) and enhanced groups ([0.01; 0.33], p=0.035). We found no difference in this outcome between the two higher intensity groups.Conclusions: Theoretically informed feedback was superior to simple feedback in improving care aides’ involvement in formal communications about resident care. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested.Trial registration: ClinicalTrials.gov (NCT02695836), https://clinicaltrials.gov/ct2/show/NCT02695836, registered on March 1, 2016

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Impact of structured interdisciplinary bedside rounding on patient outcomes at a large academic health centre

Cited by 19 publications

References 14 publications

Frailty and Sarcopenia Assessment upon Hospital Admission to Internal Medicine Predicts Length of Hospital Stay and Re-Admission: A Prospective Study of 980 Patients

Frailty and Sarcopenia Assessment upon Hospital Admission to Internal Medicine Predicts Length of Hospital Stay and Re-Admission: A Prospective Study of 980 Patients

Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes—the INFORM cluster-randomized controlled trial

Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes – The INFORM cluster-randomized controlled trial

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