scholarly journals Referrals to a Pediatric Emergency Department of a Tertiary Care Teaching Hospital Before and After Introduction of a Referral Education Module - a Quality Improvement Study

2020 ◽  
Author(s):  
Gopalakrishnan Ezhumalai ◽  
Muralidharan Jayashree ◽  
Karthi Nallasamy ◽  
Arun Bansal ◽  
Bhavneet Bharti
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Critically Ill Children ◽  
Referral Letter ◽  
Care Providers ◽  
Post Intervention ◽  
Intervention Phase ◽  
Before And After ◽  
Referral Letters

Abstract Background: Provision of timely care to critically ill children is essential for good outcome. Referral from smaller peripheral hospitals to higher centers for intensive care is common. However, lack of an organized referral and feedback system compromises optimal care. We studied the quality of referral letters coming to our Emergency Department (ED) with respect to their demography, association with severity of illness and mortality before and after referral education. Methods: Our study was completed in three phases in the Pediatric ED; Pre-intervention, Intervention and Post intervention phases. Quality of referral letter was matched with a quality checklist proforma and graded as ‘good’, ‘fair’ and ‘poor’ if it scored >7, 5 –7 and < 5 points respectively. A peer reviewed referral education module was prepared using case studies, expert opinions, and lacunae observed in the first phase and administered to health care providers (HCP’s) of referring hospitals. Quality of referral letter was compared between pre and post intervention phases. Results: Most referrals belonged to the neighboring states of Punjab (48.2%) and Haryana (22.4%). Major referring hospitals were from public sector (80.9%), of which the teaching hospitals topped the list (53.6%). Government run ambulance services (85.5%) was commonest mode of transport used and need for a PICU bed and/or mechanical ventilation (50.4%) was the commonest reason for referral. The post intervention phase saw a significant decline in the proportion of poor (93.2 vs.78.2%; p=0.001) and a significant increase in the proportion of fair (6.1 vs 18%; p=0.001) and good referral letters (0.7 vs 18%; p=0.001). The proportion of children with physiological decompensation at triage had reduced significantly in the post intervention phase [513 out of 1403 (36.5%) vs. 310 out of 957 (32.3%); p= 0.001]. Conclusion: Referral education had significantly improved the quality of referral letters. Proportion of children with physiological decompensation at triage had decreased significantly after referral module. This change suggests sensitization of the peripheral hospitals towards a better referral process. Continued multifaceted approach will be required for sustained and increased benefits

scholarly journals Referrals to a Pediatric Emergency Department of a Tertiary Care Teaching Hospital Before and After Introduction of a Referral Education Module - A Quality Improvement Study

2020 ◽  
Author(s):  
Gopalakrishnan Ezhumalai ◽  
Muralidharan Jayashree ◽  
Karthi Nallasamy ◽  
Arun Bansal ◽  
Bhavneet Bharti
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Critically Ill Children ◽  
Referral Letter ◽  
Care Providers ◽  
Post Intervention ◽  
Intervention Phase ◽  
Before And After ◽  
Referral Letters

Abstract Background: Provision of timely care to critically ill children is essential for good outcome. Referral from smaller peripheral hospitals to higher centers for intensive care is common. However, lack of an organized referral and feedback system compromises optimal care. We studied the quality of referral letters coming to our Emergency Department (ED) with respect to their demography, association with severity of illness and mortality before and after referral education. Methods: Our study was completed in three phases in the Pediatric ED; Pre-intervention, Intervention and Post intervention phases. Quality of referral letter was matched with a quality checklist proforma and graded as ‘good’, ‘fair’ and ‘poor’ if it scored >7, 5 –7 and < 5 points respectively. A peer reviewed referral education module was prepared using case studies, expert opinions, and lacunae observed in the first phase and administered to health care providers (HCP’s) of referring hospitals. Quality of referral letter was compared between pre and post intervention phases.Results: Most referrals belonged to the neighboring states of Punjab (48.2%) and Haryana (22.4%). Major referring hospitals were from public sector (80.9%), of which the teaching hospitals topped the list (53.6%). Government run ambulance services (85.5%) was commonest mode of transport used and need for a PICU bed and/or mechanical ventilation (50.4%) was the commonest reason for referral. The post intervention phase saw a significant decline in the proportion of poor (93.2 vs.78.2%; p=0.001) and a significant increase in the proportion of fair (6.1 vs 18%; p=0.001) and good referral letters (0.7 vs 18%; p=0.001). The proportion of children with physiological decompensation at triage had reduced significantly in the post intervention phase [513 out of 1403 (36.5%) vs. 310 out of 957 (32.3%); p= 0.001]. Conclusion: Referral education had significantly improved the quality of referral letters. Proportion of children with physiological decompensation at triage had decreased significantly after referral module. This change suggests sensitization of the peripheral hospitals towards a better referral process. Continued multifaceted approach will be required for sustained and increased benefits.

scholarly journals Referrals to a pediatric emergency room of a tertiary care teaching hospital before and after introduction of a referral education module- a qualitative study 

2020 ◽  
Author(s):  
Gopalakrishnan Ezhumalai ◽  
Jayashree Muralidharan ◽  
Arun Bansal ◽  
Karthi Nallasamy ◽  
Bhavneet Bharti
Keyword(s):  
Emergency Room ◽  
Tertiary Care ◽  
Geographical Area ◽  
Pediatric Emergency ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Care Providers ◽  
Post Intervention ◽  
Intervention Phase

Abstract Background: Provision of timely care to critically ill children is essential for good outcome. With development of specialized pediatric critical care units, referral from community and smaller peripheral hospitals has received greater impetus. Our tertiary care hospital caters to referrals from a wide geographical area. Since there is no standard referral and feedback system in India, we decided to evaluate the quality of referrals coming to our Emergency Room (ER) with respect to their demography, association with severity of illness and mortality. We plan to use this data to establish a standard referral and feedback process to streamline our ER referrals. Methods: Our study was completed in three phases in Pediatric ER;Pre-intervention, Intervention and Post intervention phases. Quality of referrals was graded by granting one score to presence of each item when matched with a quality checklist performa. A referral was graded ‘good’, ‘fair’ and ‘poor’ if it scored >7, 5 –7 and < 5 points respectively. Case studies, expert opinions, and lacunae observed in first phase were taken into consideration while preparing the referral education module, that was administered to health care providers of referring hospitals. Quality of referrals was compared between pre and post intervention phases. Results: Majority of inpatient admissions were ‘referred’ patients (99.3%). Most referrals belonged to the neighboring states of Punjab (48.2%) and Haryana (22.4%). Major referrals were from public sector hospitals (80.9%) of which the teaching hospitals topped the list (53.6%). Most common mode of transport was government run ambulance services(85.5%) and the common reason for referral was need for PICU bed and/or mechanical ventilation (50.4%). The post intervention phase saw a significant decline in the proportion of poor referrals (93.2 vs.78.2%;p=0.001) and a significant increase in the proportion of fair(6.1 vs 18%; p=0.001)and good referrals (0.7 vs 18%;p=0.001) Proportion of children presenting to triage with physiological decompensation with respect to poor referrals had significantly decreased in post intervention phase [580(79.8%) vs 1025(93.7%); p=0.0001]. Conclusion:Referral education had significantly improved the quality of referrals coming to our ER. Continuing education will be required for sustained and increased benefits. Key words: Quality of referral, Pediatric emergency, Triage

scholarly journals Evaluation of Human Papillomavirus Vaccination After Pharmacist-Led Intervention: A Pilot Project in an Ambulatory Clinic at a Large Academic Urban Medical Center

2020 ◽  
Vol 135 (3) ◽  
pp. 313-321
Author(s):  
Julianna Cebollero ◽  
Suzanne M. Walton ◽  
Laurie Cavendish ◽  
Kristi Quairoli ◽  
Carrie Cwiak ◽  
...  
Keyword(s):  
Health Care ◽  
Human Papillomavirus ◽  
Health Care Providers ◽  
Medical Center ◽  
Vaccine Dose ◽  
Pilot Project ◽  
Care Providers ◽  
Post Intervention ◽  
Intervention Phase ◽  
Active Intervention

Objectives Despite the safety and efficacy of the human papillomavirus (HPV) vaccine, many persons are still not receiving it. The purpose of this pilot project was to evaluate the number of first doses of the 9-valent HPV (9vHPV) vaccination administered after a pharmacist-led intervention in the Adult Family Planning Clinic at Grady Health System (GHS), a large academic urban medical center in Atlanta, Georgia. Methods The pilot project had 3 phases: pre-intervention (November 15, 2016, through March 31, 2017), active intervention (November 15, 2017, through December 29, 2017), and post-intervention (December 30, 2017, through March 31, 2018). The pre-intervention phase was used as a historical control. The active intervention phase consisted of pharmacist interventions in the clinic and patient and health care provider education. The post-intervention phase evaluated the durability of pharmacist-led interventions performed and education provided during the active phase. Results Eighty-nine first-dose 9vHPV vaccines (of the 3-dose series) were administered to young adults aged 18-26 during the project period (November 15, 2017, through March 31, 2018); none were administered during the pre-intervention phase. Of 89 patients who received a first 9vHPV vaccine dose, 20 patients also received a second 9vHPV vaccine dose. During the project period, 166 doses of 9vHPV vaccine (first, second, or third doses) were administered. Conclusion This pharmacist-led intervention led to an increase in the number of young adult patients receiving their first dose of the 9vHPV vaccination series. With the support of other health care providers, pharmacist-led initiatives can expand vaccine-related health literacy and facilitate access to immunization services.

Exploring the Effect of Mindfulness on Burnout in a Pediatric Emergency Department

2021 ◽  
pp. 216507992110044
Author(s):  
Kei U. Wong ◽  
Lauren Palladino ◽  
Melissa L. Langhan
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Large Scale ◽  
Maslach Burnout Inventory ◽  
Pediatric Emergency ◽  
Personal Accomplishment ◽  
Pediatric Emergency Department ◽  
Care Providers ◽  
Before And After

Background: Burnout is a common phenomenon among health care providers known to adversely affect their mental health and clinical acumen. As mindfulness has been shown to diminish burnout with large-scale interventions, our aim was to assess whether smaller, on-shift activities aimed at increasing mindfulness could decrease burnout among staff in a pediatric emergency department (PED). Methods: Prior to the implementation of a series of mindfulness-based activities, a diverse cohort of PED staff including nurses, physicians, nurse practitioners, technicians, and administrative personnel completed electronic preintervention surveys about their demographics, personal mindfulness engagement, and individual baseline burnout level using the Maslach Burnout Inventory (MBI). Trained nurses and physicians served as champions who coordinated on-shift mindfulness activities, and burnout levels were subsequently reassessed using a postintervention survey. Findings: Among 83 eligible staff, 75 completed the preintervention and 69 completed the postintervention survey. For the MBI, the majority of staff had moderate to high burnout levels at baseline. Few staff engaged in personal mindfulness activities outside of work. Although 82% of staff participated in the on-shift interventions, no significant differences were found in scores before and after the intervention for emotional exhaustion (20.1 vs. 20, p = .93), depersonalization (7.6 vs. 7.3, p = .97), and personal accomplishment (36.1 vs. 34.8, p = .11). Conclusion/Application to Practice: While mindfulness effectively combats burnout, few PED providers regularly practice mindfulness activities. Brief, on-shift mindfulness activities were insufficient to significantly reduce burnout levels. Hospital leadership should consider dedicating resources to more intensive mindfulness activities to combat amplified burnout levels among emergency department staff.

scholarly journals Fenomenologi : Caring Perawat Terhadap Klien Dengan Kondisi Kritis Di Instalasi Gawat Darurat – Rumah Sakit Dr. Saiful Anwar Malang

2017 ◽  
Vol 2 (1) ◽  
pp. 17
Author(s):  
Janes Jainurakhma ◽  
Indah Winarni ◽  
Setyoadi Setyoadi
Keyword(s):  
Emergency Department ◽  
Health Care Providers ◽  
Critical Condition ◽  
Care Providers ◽  
Emergency Nurses ◽  
Nursing Experience ◽  
Nursing Services ◽  
Nurse Caring ◽  
Critical Patients

Caring is an important part of nursing process that difficult to be apart. Emergency nursing is a profession that required health care providers with fast performance, accurate, and quality of complicated and holistic problems. A lot of patients with critical condition at emergency department, they ask a quality of nursing services and it is affected by the quality of a nurse caring. Without caring passion, a nurse vulnerable to act that violate ethical of nursing, no exception nursing profession at emergency installations of RSSA Malang. The purpose of this study is to explore the experience of nurse caring for clients with critical condition at emergency installations of RSSA Malang. This study used a qualitative approach, with interpretive phenomenological method. Purposive sampling is a method used in this study, the criteria of experience as nurse in the emergency installations of RSSA Malang at least 5 years, still working in the emergency installations of RSSA Malang, and willing as participant. Using semi-structure interviews technique, and analyzed by Miles and Huberman model approach. The results led to three themes, namely: the resque of critically ill patients, improve patient and family confidence,  desire to do the best for crical patients. Based on the results of the study are expected to follow up with the theme of the next study of emergency nurses caring of the perpective of patient and families, and needs to be improved further for the training of emergency skill of nurses in the emergency department, so thet skills and knowledge of nurses in handling critical patients better.; Key words: caring, nursing experience, critical patient.

scholarly journals LO23: Reducing time to disposition for treat & release patients in the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S14-S14
Author(s):  
V. Woolner ◽  
S. Ensafi ◽  
J. De Leon ◽  
L. George ◽  
L. Chartier
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Providers ◽  
Initial Assessment ◽  
Teaching Hospitals ◽  
Care Providers ◽  
Patient Disposition ◽  
Forcing Function

Introduction: Treat and Release (T&R) patients are seen and discharged home from the emergency department (ED), and asked to return within 12-72 hours for follow-up care (e.g., ultrasound, repeat blood work). Our two academic teaching hospitals see approximately 2,000 T&R patients per year. Handover of care for T&R patientsdone through charting only and therefore dependent on the charts adequacy and completenessis crucial to the safety and quality of care they receive. An 18-month retrospective chart audit at our sites identified quality gaps, including suboptimal documentation that ultimately impedes patient disposition. Our projects aim was to reduce the time-to-disposition (TTD; time spent by patients between provider initial assessment and discharge from the ED) by a third (from 70min) in 6-months time (March 2017), a target felt to be both meaningful and realistic by our stakeholder team. Methods: Our primary outcome measure was the TTD (in minutes). Our process measure was the quality of documentation, using a modified version of QNOTE, a validated tool used to assess the quality of health-care documentation. PDSA cycles included: 1) Involvement of stakeholders for the creation and refinement of an improved T&R handover tool to cue more specific documentation; 2) Education of health-care providers (HCPs) about T&R patients; 3) Replacement of the previous T&R handover tool with a newly designed and mandatory tool (i.e. a forcing function); 4) Refinement of the process for T&R patients and chart hold-over. Results: Run charts for both the median TTD and median modified QNOTE scores over time demonstrate a shift (i.e., run chart rule) associated with the second and third clustered PDSA cycles. After the first three clusters of PDSA cycles (i.e., before-and-after), mean TTD was reduced by 40% (70min to 42min, p=0.005). The quality of documentation (mean modified QNOTE scores) was also significantly improved (all results p<0.0001): patient assessment from 81% to 92%, plan of care from 58% to 85% and follow-up plan from 67% to 90%. Conclusion: We reduced the time-to-disposition for T&R patients by identifying gaps in the quality of documentation of their chart. Using iterative PDSA cycles, we improved their time-to-disposition through improved communication between health-care providers and a new T&R handover tool working as a forcing function. Other centers could use similar assessment methods and interventions to improve the care of T&R patients.

scholarly journals Assessing the quality of referral letters written by general practitioners: a cross-sectional study in rural Iran

2017 ◽  
Vol 33 (2) ◽  
Author(s):  
Ali Janati ◽  
Abolgasem Amini ◽  
Davoud Adham ◽  
Mansour Naseriasl
Keyword(s):  
General Practitioners ◽  
Health Care Providers ◽  
Cross Sectional Study ◽  
Cluster Sampling ◽  
Care Providers ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical Specialists ◽  
Referral Letters

Abstract: Establishing effective communication between general practitioners (GPs) and medical specialists is a key component of the referral system. Written communication between GPs and medical specialists is the most common communication tool. This study was conducted to evaluate quality (information content) of the referral letters written by GPs and addressed to gynecologists and cardiologists. We evaluated quality of the referral letters through a cross-sectional study in the villages of Sarab city, located in East Azerbaijan Province, Northwest Iran. The study was conducted during August and September 2015 in which a total of 400 referral letters were evaluated according to specific quality criteria. Cluster sampling was implemented and data were collected using an instrument designed by the Department of Family Medicine at the University of Manitoba, Canada. A specifically designed referral form was used to refer pregnant women to gynecologists. Referrals addressed to gynecologists showed better quality in comparison to cases referred to cardiologists. Legibility of referral letters was 73%. It is recommended that agreed-upon referral letters be designed cooperatively for different groups of diseases. Furthermore, primary health care providers should be trained to write proper referral letters.

scholarly journals Literature Review Tentang Pendidikan Kesehatan Untuk Meningkatkan Pengetahuan Personal Hygiene Menstruasi Pada Remaja

2021 ◽  
Vol 1 ◽  
pp. 590-596
Author(s):  
Lilis Purwaningsih ◽  
I Isytiaroh ◽  
Windha Widyastuti
Keyword(s):  
Health Education ◽  
Literature Review ◽  
Health Care Providers ◽  
Young Women ◽  
Personal Hygiene ◽  
Care Providers ◽  
Menstrual Hygiene ◽  
Before And After ◽  
Tract Infections

AbstractGood understanding of menstrual hygiene management (MHM) is essential for women since uterus is susceptible to infection. Insufficient understanding of MHM may lead yound women to various problems such as unpleasant vaginal odour, Leukorrhea, and Urinary Tract Infections (UTI). Health education is an effort to provide information about health in order to change people behavior to achieve better quality of life. The purpose of this study was to determine the improvement of young women understanding of MHM before and after being given health education. This study was a literature review of three articles taken from the Google Scholar with “young women”, “personal hygiene”, and “menstruation” as the keywords, in the form of fulltext articles, and published during 2012-2020. The total number of the respondents from the three articles was 170. The results showed that after being given health education, the respondents’ understanding level of MHM increased from 7%-55%. In conclusion, health education could improve young women’s understanding level of MHM. Therefore, health care providers are suggested to conduct health education to improve the understanding of MHM to young women.Keywords: menstruation, knowledge, young women AbstrakPersonal hygiene yang baik pada saat menstruasi sangat diperlukan karena rahim mudah terkena infeksi. Dampak yang ditimbulkan apabila remaja putri tidak memperhatikan hygiene pada daerah kewanitaannya, antara lain muncul bau yang tidak sedap, keputihan dan berkembangnya bakteri yang dapat menimbulkan infeksi saluran kemih. Literature review ini bertujuan untuk mengetahui perbedaan pengetahuan remaja tentang personal hygiene sebelum dan sesudah diberikan pendidikan kesehatan.Desain karya tulis ilmiah berupa literature review. Hasil penelitian terdapat perbedaannilai pengetahuan baik sebelum dilakukan pendidikan kesehatan adalah 7% dan sesudah pendidikan kesehatan nilai pengetahuan baik menjadi 55%. Simpulannya pendidikan kesehatan dapat meningkatkan pengetahuan remaja mengenai personal hygiene ketika menstruasi.Saran bagi tenaga kesehatan agar melakukan pendidikan kesehatan untuk meningkatkan pengetahuan remaja mengenai personal hygiene ketika menstruasi. Kata kunci: Menstruasi; pengetahuan; remaja

Client characteristics and satisfaction with the quality of primary health-care services in Calabar, Nigeria

2020 ◽  
Vol 3 ◽  
pp. 1-8
Author(s):  
H. C. Okeke ◽  
P. Bassey ◽  
O. A. Oduwole ◽  
A. Adindu
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Client Satisfaction ◽  
Demographic Characteristics ◽  
Care Providers ◽  
Client Characteristics ◽  
Study Objective ◽  
Primary Health

Different mix of clients visit primary health care (PHC) facilities, and the quality of services is critical even in rural communities. The study objective was to determine the relationship between socio-demographic characteristics and client satisfaction with the quality of PHC services in Calabar Municipality, Cross River State, Nigeria. Specifically to describe aspects of the health facilities that affect client satisfaction; determine the health-care providers’ attitude that influences client satisfaction; and determine the socio-demographic characteristics that influence client satisfaction with PHC services. A cross-sectional survey was adopted. Ten PHCs and 500 clients utilizing services in PHC centers in Calabar Municipality were randomly selected. Clients overall satisfaction with PHC services was high (80.8%). Divorced clients were less (75.0%) satisfied than the singles and the married counterparts (81%), respectively. Clients that were more literate as well as those with higher income were less satisfied, 68.0% and 50.0%, respectively, compared to the less educated and lower-income clients, 92.0% and 85.0% respectively. These differences in satisfaction were statistically significant (P = 0.001). Hence, it was shown that client characteristics such as income and literacy level show a significant negative relationship with the clients satisfaction with the quality of PHC services in Calabar Municipality.

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