Emergency Department

OBJECTIVES To determine whether the implementation of an Internet-based communication system improves the amount of essential information conveyed between a skilled nursing facility (SNF) and the emergency department (ED) during patient care transitions. DESIGN: Interventional; before and after. SETTING ED of an urban teaching hospital with approximately 55,000 visits per year and a 55-bed subacute free-standing rehabilitation facility (the SNF). PARTICIPANTS All patients transferred from the SNF to the ED over 16 months. INTERVENTION An Internet-based communication network with SNF-ED transfer form for communication during patient care transitions. MEASUREMENTS Nine elements of patient information assessed before and after intervention through chart review. Secondary outcomes: changes in efficiency of information transfer and staff satisfaction. RESULTS Two hundred thirty-four of 237 preintervention and all 276 postintervention care transitions were reviewed. The Internet communication network was used in 78 (26%) of all care transitions, peaking at 40% by the end of the study. There was more critical patient information (1.85 vs 4.29 of 9 elements; P<.001) contained within fewer pages of transfer documents (24.47 vs 5.15; P<.001) after the intervention. Staff satisfaction with communication was higher among ED physicians after the intervention. CONCLUSION The use of an Internet-based system increased the amount of information communicated during SNF-ED care transitions and significantly reduced the number of pages in which this information was contained.

August 7, 2019

An internet-based communication network for information transfer during patient transitions from skilled nursing facility to the emergency department

OBJECTIVES To determine whether the implementation of an Internet-based communication system improves the amount of essential information conveyed between a skilled nursing facility (SNF) and the emergency department (ED) during patient care transitions. DESIGN: Interventional; before and after. SETTING ED of an urban teaching hospital with approximately 55,000 visits per […]
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OBJECTIVES To determine whether the implementation of an Internet-based communication system improves the amount of essential information conveyed between a skilled nursing facility (SNF) and the emergency department (ED) during patient care transitions. DESIGN: Interventional; before and after. SETTING ED of an urban teaching hospital with approximately 55,000 visits per year and a 55-bed subacute free-standing rehabilitation facility (the SNF). PARTICIPANTS All patients transferred from the SNF to the ED over 16 months. INTERVENTION An Internet-based communication network with SNF-ED transfer form for communication during patient care transitions. MEASUREMENTS Nine elements of patient information assessed before and after intervention through chart review. Secondary outcomes: changes in efficiency of information transfer and staff satisfaction. RESULTS Two hundred thirty-four of 237 preintervention and all 276 postintervention care transitions were reviewed. The Internet communication network was used in 78 (26%) of all care transitions, peaking at 40% by the end of the study. There was more critical patient information (1.85 vs 4.29 of 9 elements; P<.001) contained within fewer pages of transfer documents (24.47 vs 5.15; P<.001) after the intervention. Staff satisfaction with communication was higher among ED physicians after the intervention. CONCLUSION The use of an Internet-based system increased the amount of information communicated during SNF-ED care transitions and significantly reduced the number of pages in which this information was contained.
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.02864.x/abstract

August 7, 2019

The relationship between patient safety culture and the implementation of organizational patient safety defenses at emergency departments

OBJECTIVE The objective of this study was to investigate the association between 11 patient safety culture dimensions and the implementation of 7 organizational patient safety defenses. DESIGN Data were gathered within a cross-sectional, retrospective survey. SETTING Emergency departments (EDs) in the Netherlands. PARTICIPANTS Thirty-three EDs of non-academic hospitals, which belong […]
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OBJECTIVE The objective of this study was to investigate the association between 11 patient safety culture dimensions and the implementation of 7 organizational patient safety defenses. DESIGN Data were gathered within a cross-sectional, retrospective survey. SETTING Emergency departments (EDs) in the Netherlands. PARTICIPANTS Thirty-three EDs of non-academic hospitals, which belong to the clientele of Dutch largest medical liability insurer. MAIN OUTCOME MEASURES Implementation of the separate organizational patient safety defenses (0 = insufficient/sufficient, 1 = good). RESULTS Analyses showed that several culture dimensions were negatively or positively associated with the implementation of the patient safety defenses. A culture in which hospital handoffs and transitions were perceived adequate was related to less frequent implementation of four of seven organizational patient safety defenses, whereas a culture with well-perceived hospital management support for patient safety predicted more frequent implementation of four of seven organizational patient safety defences. CONCLUSIONS Results suggest that well-perceived culture dimensions might inhibit improvements by lack of a sense of urgency as well as facilitate improvements by inducing feelings of support for organizational changes and improvements. The influence of patient safety culture appeared to be not always as straightforward as it seems to be in advance.
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http://intqhc.oxfordjournals.org/content/22/3/162.short

August 7, 2019

Health care providers’ opinions on communication between nursing homes and emergency departments

OBJECTIVES To characterize the beliefs and opinions of nursing home (NH) and emergency medicine providers about communication between NH and emergency departments (ED) during transitions of care of NH residents. DESIGN: A cross-sectional study using a mailed and Internet survey. PARTICIPANTS AND SETTING Physicians, nurse practitioners, physicians assistants, and nurses […]
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OBJECTIVES To characterize the beliefs and opinions of nursing home (NH) and emergency medicine providers about communication between NH and emergency departments (ED) during transitions of care of NH residents. DESIGN: A cross-sectional study using a mailed and Internet survey. PARTICIPANTS AND SETTING Physicians, nurse practitioners, physicians assistants, and nurses who practice in ED settings and NH settings, affiliated with hospitals of an academic medical center in Rochester, New York. MEASUREMENTS Opinions on communication; beliefs about frequency of information transmission; opinions on how often verbal communication should occur. RESULTS A total of 155 nurses and medical providers participated in the survey for a response rate of 32.2% (155/481). Of the survey participants, 63.0% and 56.8% had been more than 5 years in their position and facility, respectively. Most respondents felt that important information was lost during patient transfers between NH and ED settings. Providers from ED and NH settings had different opinions on the likelihood that key information would be readily identifiable at patient transfer and that care would include requested tests and follow-up. Providers from both sites of care supported verbal communication at their position when NH residents are transferred to the other setting. CONCLUSION Nurses and medical providers from both emergency and NH settings agree that transitional communication is poor between NHs and EDs and support a role for verbal communication during the ED transitions of care of NH residents.
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http://www.sciencedirect.com/science/article/pii/S1525861009003016

August 7, 2019

Chronic Care Coordination

Chronic Care Coordination is a nurse-based model with consultation from licensed clinical social workers, for providing clinical and educational support to complex patients
Chronic Care Coordination is a nurse-based model with consultation from licensed clinical social workers, for providing clinical and educational support to complex patients
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http://www.innovativecaremodels.com/care_models/13

August 7, 2019

Reducing Emergency Visits in Older Adults With Chronic Illness

Coleman E, Eilertsen T, Kramer A. Reducing Emergency Visits in Older Adults With Chronic Illness. Eff Clin Pract. 2001;(4) 49-57. http://www.caretransitions.org/documents/Reducing%20ER%20-%20ECP.pdf Accessed August 1, 2014. On average, patients in the intervention group attended 10.6 group visits during the 2-year study period. These patients averaged fewer emergency department visits (0.65 vs. […]
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Coleman E, Eilertsen T, Kramer A. Reducing Emergency Visits in Older Adults With Chronic Illness. Eff Clin Pract. 2001;(4) 49-57. http://www.caretransitions.org/documents/Reducing%20ER%20-%20ECP.pdf Accessed August 1, 2014. On average, patients in the intervention group attended 10.6 group visits during the 2-year study period. These patients averaged fewer emergency department visits (0.65 vs. 1.08 visits; P=0.005) and were less likely to have any emergency department visits (34.9% vs. 52.4%; P =0.003) than controls. These differences remained statistically significant after controlling for demographic factors, comorbid conditions, functional status, and prior utilization. Adjusted mean difference in visits was –0.42 visits (95% CI, –0.13 to –0.72), and adjusted RR for any emergency department visit was 0.64 (CI, 0.44 to 0.86).
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http://www.caretransitions.org/documents/Reducing%20ER%20-%20ECP.pdf

August 7, 2019

The Association Between Care Coordination and Emergency Department Use in Older Managed Care Enrollees.

Coleman E, Eilertsen T, Magid D, et.al. The Association Between Care Coordination and Emergency Department Use in Older Managed Care Enrollees. International Journal of Care Integration. 2002;2. http://www.caretransitions.org/documents/The%20assoc%20between%20care%20coord%20-%20IJIC.pdf Results: Self-reported care co-ordination was not significantly different between cases and controls for any of the four classifications of inappropriate ED use. […]
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Coleman E, Eilertsen T, Magid D, et.al. The Association Between Care Coordination and Emergency Department Use in Older Managed Care Enrollees. International Journal of Care Integration. 2002;2. http://www.caretransitions.org/documents/The%20assoc%20between%20care%20coord%20-%20IJIC.pdf Results: Self-reported care co-ordination was not significantly different between cases and controls for any of the four classifications of inappropriate ED use. Similarly, no differences were found in the number of different physicians or medication prescribers involved in the patients’ care. Four-week follow-up after potentially high-risk events for subsequent ED use, including changes in chronic disease medications, missed encounters, and same day encounters, did not differ between subjects with inappropriate ED use and controls. Conclusion: Existing measures of care co-ordination were not associated with inappropriate ED use in this study of older adults with complex care needs. The absence of an association may, in part, be attributable to the paucity of validated measures to assess care co-ordination, as well as the methodological complexity inherent in studying this topic. Future research should focus on the development of new measures and on approaches that better isolate the role of care co-ordination from other potential variables that influence utilization.
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http://www.caretransitions.org/documents/The%20assoc%20between%20care%20coord%20-%20IJIC.pdf

August 7, 2019

Improving the Quality of Transitional Care for Persons with Complex Care Needs. American Geriatrics Society (AGS) Position Statement.

American Geriatrics Society. Improving the Quality of Transitional Care for Persons with Complex Care Needs. American Geriatrics Society (AGS) Position Statement. Journal of the American Geriatrics Society. 2007;51(4): 556-557. http://www.caretransitions.org/documents/Improving%20the%20quality%20-%20JAGS. Pdf. Published March 2007. Accessed August 7, 2014. The assisted living (AL) setting is subject to multiple transitional care points. […]
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American Geriatrics Society. Improving the Quality of Transitional Care for Persons with Complex Care Needs. American Geriatrics Society (AGS) Position Statement. Journal of the American Geriatrics Society. 2007;51(4): 556-557. http://www.caretransitions.org/documents/Improving%20the%20quality%20-%20JAGS. Pdf. Published March 2007. Accessed August 7, 2014. The assisted living (AL) setting is subject to multiple transitional care points. Each transition is an opportunity for a collaborative, multidisciplinary process. Of course, this can only occur with careful planning at both ends of the transition. For this process to be successful, a coordinated system involving several members of the multidisciplinary team is required. One important component of ensuring a successful process is open, regular communication with all the critical channels. By having a point person in the AL facility serve as the liaison and educator between each channel, a successful transitional care process can be achieved.
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http://www.caretransitions.org/documents/Improving%20the%20quality%20-%20JAGS.pdf

August 7, 2019

Transitions of Care in the Long-Term Care Continuum: Practice Guideline

This clinical practice guideline (CPG) has been developed under a project conducted by the American Medical Directors Association (AMDA), the national professional organization representing medical directors, attending physicians, and other practitioners who care for patients in the long-term care setting. This is one of a number of guidelines undertaken as […]
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This clinical practice guideline (CPG) has been developed under a project conducted by the American Medical Directors Association (AMDA), the national professional organization representing medical directors, attending physicians, and other practitioners who care for patients in the long-term care setting. This is one of a number of guidelines undertaken as part of the association’s mission to improve the quality of care delivered to patients in these settings. Original guidelines are developed by interdisciplinary workgroups, using a process that combines evidence and consensus-based approaches. Workgroups include practitioners and others involved in patient care in long-term care facilities. Beginning with a general guideline developed by an agency, association, or organization such as the Agency for Healthcare Research and Quality (AHRQ), pertinent articles and information, and a draft outline, each group works to make a concise, usable guideline that is tailored to the long-term care setting. Because scientific research in the long-term care population is limited, many recommendations are based on the expert opinion of practitioners in the field. A bibliography is provided for individuals who desire more detailed information. Guideline revisions are completed under the direction of the Clinical Practice Guideline Steering Committee. The committee incorporates information published in peer-reviewed journals after the original guidelines appeared as well as comments and recommendations not only from experts in the field addressed by the guideline but also from “hands-on” long-term care practitioners and staff.
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http://www.amda.com/tools/clinical/toccpg.pdf

August 7, 2019

Improving on Transitions of Care: Emergency Department to Home

NTOCC believes in the commitment of healthcare workers, practitioners, and leaders and in their ability to make a difference in improving transitions of care. To further NTOCC’s reach for improving the quality of care transitions, we have added to our Implementation and Evaluation Plan by offering this additional module: the […]
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NTOCC believes in the commitment of healthcare workers, practitioners, and leaders and in their ability to make a difference in improving transitions of care. To further NTOCC’s reach for improving the quality of care transitions, we have added to our Implementation and Evaluation Plan by offering this additional module: the emergency department to home transition. The methodology used here is the same for the introductory module released in 2008—implement a plan and evaluate it to see how it is working. This document is intended to be used in conjunction with the original document, “Improving on Transitions of Care: How to Implement and Evaluate a Plan.” This plan includes evaluation questions, acceptable metrics or measures, tools, and tips applicable to emergency departments, home caregivers, and primary care offices. As with other NTOCC strategies, communication is the most important component of any plan, tool, or quality improvement effort.
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http://www.ntocc.org/Portals/0/ImplementationPlan_EDToHome.pdf

August 7, 2019

Emergency Department Case Management: The Dyad Team of Nurse Case Manager and Social Worker Improve Discharge Planning and Patient and Staff Satisfaction While Decreasing Inappropriate Admissions and Costs: A Literature Review

A model of emergency department (ED) case management consisting of a social worker and a nurse case manager can prevent inappropriate admissions, improve discharge planning, decrease cost, and enhance patient satisfaction. 3 The individual and combined roles of the dyad team of social worker and nurse case manager are discussed. […]
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A model of emergency department (ED) case management consisting of a social worker and a nurse case manager can prevent inappropriate admissions, improve discharge planning, decrease cost, and enhance patient satisfaction. 3 The individual and combined roles of the dyad team of social worker and nurse case manager are discussed. A literature review includes how a case management dyad team of social worker and nurse case manager in the ED can decrease utilization of the ED for nonemergent visits, promote the use of community resources, and improve discharge planning to avoid excessive costs. The importance of the dyad team working with the interdisciplinary team in the ED, the primary care physician (PCP), and other community health care providers in order to provide a holistic approach to care is addressed. A discussion about the improvement of both patient and staff satisfaction demonstrates the results of case management strategies that support and advocate for patients to receive quality, cost-effective care across the health care continuum, while decreasing the use of the ED for nonemergent care.
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http://journals.lww.com/professionalcasemanagementjournal/Abstract/2002/05000/Emergency_Department_Case_Management__The_Dyad.6.aspx