The Variables of the Readiness for Discharge from Hospital in Patients after Myocardial Infarction.

Discharge after myocardial infarction (MI) reduces the risk of repeated myocardial infarction and stroke and has a positive effect on the patient's prognosis. An important element of preparation is the assessment of the patient's readiness for discharge from hospital. This study aimed to evaluate the associations between a patient's readiness for hospital discharge after MI, their functioning in the chronic illness, and socio-demographic and clinical variables. Methods: This was a cross-sectional, single-center study. The study was conducted among 242 patients who were hospitalized for myocardial infarction after percutaneous coronary intervention (PCI). The Readiness for Hospital Discharge After Myocardial Infarction Scale (RHD-MIS) and the Functioning in Chronic Illness Scale (FCIS) were used. Results: No statistically significant differences were found between socio-demographic and clinical factors and the overall result of the RHD-MIS (p >0.05).There is a positive correlation between hospital discharge readiness and functioning in chronic disease in patients after MI (r = 0.20; p < 0.001). The higher the level of subjective knowledge, the better the functioning in chronic disease (rho = 0.16; p < 0.05), the greater the increase in the sense of influence on the course of the disease (rho = 0.17; p < 0.05) and the greater the decrease in the impact of the disease on the patient's attitude (rho = 0.23, p < 0.05). Conclusions: The higher the readiness for discharge from hospital, the better the patient's functioning in the disease and the lower the impact of the disease on the patient.

Social care causes of delayed transfer of care (DTOC) from hospital for older people: Unpicking the nuances of 'provider capacity' and 'patient choice'.

Unnecessarily prolonged stays in hospitals can have negative impacts on patients and present avoidable costs to health and social care systems. This paper presents the qualitative findings of a multi-methods study of the social care causes of delayed transfers of care (DTOC) for older people in England. The quantitative strand of this study found that DTOC are significantly affected by homecare supply. In this paper, we explore in depth how and why social care capacity factors lead to delays, from the perspectives of those working within the system. We examined the local transfer arrangements in six English local authority (LA) sites that were purposively sampled to include a range of DTOC performance and LA characteristics. Between March and December 2018, 52 professionals involved in arranging or facilitating discharge from hospitals in these sites provided qualitative data, primarily through semi-structured interviews. Topics included discharge teams and processes, strategic issues and perceived causes of delays. The thematic analysis uncovered the nuances behind the causes of DTOC previously categorised broadly as 'provider capacity' and 'patient choice'. In particular, our analysis highlights the lack of fit between available provision and the needs of people leaving hospital (theme 1); workforce inconsistencies (theme 2) and a myth of patient choice (theme 3). We are now at a turning point in the development of policy to reduce DTOC in the English system, with the full implications of a new national discharge to assess programme yet to be seen. Our research shows the significance of the alignment of service capacity, including the type and location of provision, with the needs and preferences of those leaving hospital. As the new system becomes established, attendance to such nuances behind blockages in the system will be more important than ever.

Telerehabilitation Intervention in Patients with COVID-19 after Hospital Discharge to Improve Functional Capacity and Quality of Life. Study Protocol for a Multicenter Randomized Clinical Trial.

COVID-19 can cause important sequels in the respiratory system and frequently presents loss of strength, dyspnea, polyneuropathies and multi-organic affectation. Physiotherapy interventions acquire a fundamental role in the recovery of the functions and the quality of life. Regarding the recovery phases after hospital discharge, the current evidence available is very preliminary. Telerehabilitation is presented as a promising complementary treatment method to standard physiotherapy. The main objective of this research is to evaluate the effectiveness of a personalized telerehabilitation intervention after discharge from hospital for the improvement of functional capacity and quality of life compared to a program of health education and/or care in a rehabilitation center. As secondary objectives, to identify the satisfaction and perception of patients with the telerehabilitation intervention and the presence of barriers to its implementation, as well as to evaluate the cost-effectiveness from the perspective of the health system. This study protocol will be carried out through a single blind multicenter randomized clinical trial in the south of Spain. We hypothesize that the implementation of a telerehabilitation program presents results not inferior to those obtained with the current standard intervention. If the hypothesis is confirmed, it would be an opportunity to define new policies and interventions to address this disease and its consequences. Trial registration NCT04742946.

"Longing to be independent again" - A qualitative study on older adults' experiences of life after hospitalization.

It is important to support older adults' independence after hospitalization and, thus, to increase their perceived quality of life. The present descriptive study took a qualitative approach and aimed to describe older adults' experiences of their life situation after hospital discharge. Fifteen individuals (≥65 years) from two regional hospitals in central Sweden were interviewed between October 2015 and January 2016 in their own home following hospital discharge. The interview data were analyzed using manifest and latent qualitative content analysis. The analysis revealed one theme: "Longing to be independent again" based on four categories: `Dependent on other people and aids´, `Obstacles, impediments and limitations in daily life´, Adapt to the situation´ and `Psychological and physical values´. Understanding older adults' experiences of life after hospitalization is also a prerequisite for being able to provide person-centered care.

[Cause analysis and treatment strategies of "recurrence" with novel coronavirus pneumonia (COVID-19) patients after discharge from hospital].

With a large number of COVID-19 patients discharging from hospital, some had showed re-fever and positive nucleic acid test after discharge from hospital. This might be due to the biological characteristics of 2019-nCoV, and might also be related to the basic disease, clinical status, glucocorticoid using, sample sampling, processing and detecting of patients, and some even related to the re-infection or secondary bacterial virus infection. Therefore, we suggest that in view of this phenomenon, further stratified management of discharge from hospital should be carried out on the basis of guidelines, especially for patients with advanced age, underlying diseases or severe or critical pneumonia. For those patients who can't completely deoxygenate for a long time after hospitalization, individualized treatment methods and different discharge evaluation criteria should be adopted to ensure the complete cure of patients and prevent recurrencing after discharge from hospital.

Preparação da família e pessoa em situação crítica para um regresso a casa: uma intervenção especializada de enfermagem / Preparing the family and the person in critical situation for a return home: a specialized nursing intervention

A preparação da alta hospitalar deverá iniciar-se na admissão ou tão precocemente quanto possível. A alta hospitalar é um momento potenciador de ansiedade na pessoa e família após um evento crítico, sobretudo se advir alterações ao status prévio da pessoa quer sejam temporárias ou permanentes com necessidade de reorganização dos papéis sociais, e com a família a assumir o papel de cuidador. O processo de transição saúde-doença da pessoa em situação crítica é assim acompanhado da alteração da dinâmica familiar com repercussão na representação social de cada um dos seus elementos. Reconhecer estas transições permite intervir junto da pessoa e do familiar, com o intuito de promover uma transição saudável e com menor impacto possível. O enfermeiro desempenha o papel de facilitador da transição com intervenções especializadas no cuidado à pessoa em situação crítica e família. Cabe-lhe, dessa forma, antecipar o momento da alta através de uma preparação estruturada da pessoa e família para o momento do seu regresso a casa. A preparação para um regresso a casa foi a temática escolhida para nortear o percurso de aquisição e desenvolvimento de competências sustentado na Teoria das Transições de Afaf Meleis e com o objetivo de atingir o estadio de perito definido por Patrícia Benner no Modelo de Dreyfus adaptado à Enfermagem. Este percurso foi constituído pela realização de estágio em contexto de serviço de urgência e unidade de cuidados intensivos, com a construção de objetivos específicos para cada um dos contextos e a realização de atividades direcionadas ao seu cumprimento.

The preparation for hospital discharge should start on admission or as early as possible. Hospital discharge is a moment that increases anxiety in the person and family after a critical event, especially if changes occur to the person's previous status, whether temporary or permanent, in need of reorganizing social roles, and with the family taking on the role of caregiver. The health-disease transition process of the person in critical condition is thus accompanied by changes in family dynamics with repercussions on the social representation of each of its members. Recognizing these transitions makes it possible to intervene with the person and the family, to promote a healthy transition with the least possible impact. The nurse plays the role of facilitating the transition with specialized interventions in the care of the person in critical situation and family. Thus, it is up to him to anticipate the moment of discharge through the structured preparation of the person and family for the moment of their return home. Preparing homecoming was the theme chosen to guide the path of acquisition and development of skills based on the Theory of Transitions by Afaf Meleis and with the objective of reaching the stage of expert defined by Patrícia Benner in the Dreyfus Model adapted to Nursing. This path was constituted by the doing an internship in the context of an emergency service and an intensive care unit, with the definition of specific objectives for each of the contexts and the performance of activities aimed at fulfilling them.

Limited effect of structured medication report as the only intervention at discharge from hospital.

OBJECTIVE: To investigate whether a structured medication report at discharge from the hospital could reduce the number of medication discrepancies in primary care. METHOD: The study was performed as an open, randomised controlled study including patients transferred from one hospital in Norway to nursing home or home care. Both groups received epicrisis on discharge. In addition, the intervention group received a structured medication report. After discharge, the medication list in primary care service was compared with the list at discharge and medication discrepancies identified. In addition, these medication lists were retrospectively compared with the lists prior to admission to the hospital and at admission to hospital. A questionnaire on time spent and quality of the medication information was filled in by nurses in primary care. RESULTS: Medication discrepancies were found for 72% (26) of the patients in the intervention group and 76% (42) in the control group (P=0.918). Most common was drugs omitted or committed to the medication lists in primary care service. Typically, the committed drugs in primary care were omitted drugs after admission to the hospital. Nurses used significantly less time (66%) obtaining medication information in the intervention group (P=0.041). CONCLUSIONS: Structured medication report as the only intervention did not reduce the medication discrepancies after discharge from hospital. There is a need for reconciliation at admission to ensure the quality of the medication report. Structured medication report resulted in the nurses spending less time on collecting medication information in primary care service.

Adherence to Long-Acting Bronchodilators After Discharge for COPD: How Much of the Geographic Variation is Attributable to the Hospital of Discharge and How Much to the Primary Care Providers?

In moderate-severe chronic obstructive pulmonary disease (COPD), long-acting bronchodilators (LBs) are recommended to improve the quality of life. The aims of this study were to measure adherence to LBs after discharge for COPD, identify determinants of adherence, and compare amounts of variation attributable to hospitals of discharge and primary care providers, i.e. local health districts (LHDs) and general practitioners (GPs). This cohort study was based on the Lazio region population, Italy. Patients discharged in 2007-2011 for COPD were followed up for 2 years. Adherence was defined as a medication possession ratio >80%. Cross-classified models were performed to analyse variation. Variances were expressed as median odds ratios (MORs). An MOR of 1.00 stands for no variation, a large MOR indicates considerable variation. We enrolled 13,178 patients. About 29% of patients were adherent to LBs. Adherence was higher for patients discharged from pneumology wards and for patients with GPs working in group practice. A relevant variation between LHDs (MOR = 1.21, p = 0.001) and GPs (MOR = 1.28, p = 0.035) was detected. When introducing the hospital of discharge in the model, the MOR related to LHDs decreased to 1.05 (p = 0.345), MOR related to GPs dropped to 1.22 (p = 0.086), whereas MOR associated with hospitals of discharge was 1.38 (p < 0.001). Treatments with proven benefit for COPD were underused. Moreover, a relevant geographic variation was observed. This heterogeneity raises equity concerns in access to optimal care. The reduction of variability among LHDs and GPs after entering the hospital level proved that differences we observe in primary care partially 'reflect' the clinical approach of hospitals of discharge.

Nurse-initiated and criteria-led discharge from hospital for children and young people.

The readiness of a child or young person for discharge includes patient safety, the family's ability to care for the child at home and the ongoing treatment they will need, which has a direct influence on their health outcomes and future readmissions to hospital. There are no standard criteria for discharge practice and registered nurses have reported concerns about their ability to provide education and discharge planning to meet the needs of the patient and their family. A literature review was carried out to ascertain the current discharge principles adhered to in practice and the implemented tools used. The problems faced by registered nurses include ineffective communication, poorly defined role in discharge planning and lack of agreement with the multidisciplinary team. The standardisation of discharge procedures may reduce the risk of readmission and health deterioration of the patient and ensure positive health outcomes, improve family health literacy and continuity of care.

Visão das mães em relação ao cuidado com o recém-nascido após a alta da UTI neonatal / Mothers´ perspective on the care of newlyborn children after discharge from neonatal ICU

Atualmente o número de internações de recém-nascidos em Unidade de Terapia Intensiva Neonatal (UTIN) tem sido relevante. Ao receberem alta para a Unidade Pediátrica as mães vivenciam sentimentos positivos e negativos relacionados à responsabilidade de cuidar do filho ainda em tratamento e preparar-se para a alta hospitalar. O estudo objetivou desvelar a visão das mães em relação ao cuidado com o recém-nascido durante o período de internação em Unidade Pediátrica, após alta da UTIN. Trata-se de uma pesquisa descritiva e exploratória com abordagem qualitativa. Foram entrevistadas cinco mães maiores de dezoito anos e com filhos menores de um ano, sendo que todas passaram pela experiência de terem seus filhos internados logo após o nascimento em uma UTIN e, após, receberam alta para uma Unidade Pediátrica. A partir da análise dos depoimentos, revelaram-se três categorias: a vivência dos primeiros momentos com o filho após a alta da UTIN; a percepção da mãe em relação aos cuidados prestados pela equipe de enfermagem na unidade pediátrica; e experienciando o momento de ir para casa. As mães desvelaram sentimentos de angústia, medo, impotência, alívio, alegria e satisfação frente ao cuidado. Assim observamos a importância do gerenciamento da assistência de enfermagem, realizada pelo enfermeiro com o intuito de orientar e capacitar as mães para o cuidado com o filho após a alta da Unidade Pediátrica. Sendo assim, buscamos instrumentalizar os profissionais enfermeiros com o intuito de contribuir para o processo de humanização da assistência de enfermagem.

The number of current hospitalizations of newly-born infants in Neonatal Intensive Therapy Units (NITU) is currently high. When the children are discharged from NITU, the mothers experience positive and negative feelings related to the responsibility of taking care of their children still under treatment and preparing themselves for total hospital discharge. Current analysis investigates the perspective of mothers with regard to the care of the newly-born during this period in the Pediatric Unit (PU) after discharge from NITU. The descriptive, quality and exploratory research comprised interviews with five over eighteen-year-old mothers with less than one-year-old children, who had their children hospitalized immediately after birth in NITU, coupled to a later stay at the Pediatric Unit. Interviews revealed three categories: experience of the first instances with the child after discharge from NITU; the mother´s perception with regard to care provided by the nursing team in the PU; experiencing the moment of returning home. Mothers revealed feelings of anxiety, fear, impotence, relief, happiness and satisfaction in the wake of care given. The administration in nursing to give guidance and capacity to mothers for child care after discharge from the PU is highly relevant. Nursing professionals should be capacitated to contribute towards the humanization of nursing assistance.

'Am I really ready to go home?': a qualitative study of patients' experience of early discharge following an enhanced recovery programme for liver resection surgery.

PURPOSE: Fast-track surgery or enhanced recovery programmes (ERP) have been shown to improve patient outcomes with shorter post-operative recovery times, fewer complications and more cost-effective care amongst the reported benefits. Traditionally, the effectiveness of ERPs have been assessed by measuring clinical outcomes, with the patient experience often being neglected. The aim of this qualitative study was to ascertain patients' expectations and experiences of fast-track surgery and recovery at home within the setting of an enhanced recovery programme (ERP). METHOD: Twenty patients enrolled in the treatment group of the randomised controlled trial 'Enhanced recovery in liver resection surgery' were interviewed pre-operatively and 6 weeks post-surgery. Transcripts were analysed using thematic analysis. RESULTS: Patients approached the surgery with a sense of renewed hope. Involvement with the ERP was viewed positively, and having milestones to aim for gave patients a sense of purpose. Many felt that real recovery from surgery began at home and so felt positive about having an early discharge. Patients did report some concerns about being discharged early and those who failed to meet milestones or were readmitted to hospital experienced this as failure. CONCLUSIONS: This qualitative data demonstrates some of the complexities of patients' expectations and experiences of the ERP. Whilst patients generally experience the ERP positively, they also have concerns about the process. The study highlights areas where additional support may be needed for patients enrolled in ERPs and discharged early.

Identification of drug-related problems of elderly patients discharged from hospital.

BACKGROUND: Drug-related problems (DRP) following hospital discharge are common among elderly patients using multiple drugs for the treatment of chronic diseases. The aim of this study was to investigate the occurrence of DRP in these patients using a specific tool for the identification of DRP by community pharmacists. METHODS: An observational study involving 340 patients aged over 60 years using at least five prescription drugs and discharged from hospital. The occurrence of DRP was assessed by means of an identification tool specifically developed for use by community pharmacists, including a semistructured patient interview and a checklist of common DRP. RESULTS: In total, 992 potential DRP were observed in the 340 patients (mean 2.9 ± 1.7). No drug prescribed but clear indication, an unnecessarily long duration of treatment, dose too low, and incorrect drug selection were the DRP most commonly observed. Ten percent of DRP occurring in 71 patients were drug-drug interactions. The number of DRP was related to the number of drugs prescribed. Frequently occurring DRP found using the patient interview were fear of side effects and no or insufficient knowledge of drug use. Medication of patients discharged from the pulmonary department and of those with type 2 diabetes was particularly associated with occurrence of DRP. CONCLUSION: Following hospital discharge, DRP occur frequently among elderly patients using five or more drugs for the treatment of chronic disease. The number of DRP increased with the number of drugs used. An important task for community pharmacists is to identify, resolve, and prevent the occurrence of DRP among this patient group. Since DRP are associated with an increased risk of hospital readmissions, morbidity, and mortality, it is very important to develop intervention strategies to resolve and prevent DRP.

The correlation factor analysis of the neonates abandoned in hospital less than 24 hours / 中国小儿急救医学

Objective To investigate the relative factors of the neonates that were abandoned in hospital less than 24 hours,then the level of the local neonates medical service and the neonatal remedy skills and the life quality could be improved.Methods The clinical data of 379 cases of hospitalized neonates less than 24 hours from 2007 to 2011 were analyzed retrospectively.The correlation factors of the neonates abandoned in hospital less than 24 hours(122 cases) and hospitalized more than 24 hours (244 cases) were analyzed by single and multiple factor regression analysis.Results (1) There were 379 neonates who were in hospital less than 24 hours,among them,122 neonates were gave up the treatments.The differences of the gestational age and weight among abandon group,hospital referral group,improve group and uncured group were significant(P ＜0.01).(2) The numbers of neonates abandoned in hospital less than 24 hours were different significantly from 2007 to 2011 (P ＜0.05) and tendency was decreased year by year(chi-square trend test x2 =6.115,P =0.013).The uncured group was increased year by year (P ＜ 0.05).The hospital referral group,improved group were fluctuation,but no descend or rise tendency(P ＞0.05).(3) The differences of the gestational age,birth weight,uterine-incision delivery,intrapartum asphyxia,intrauterine distress,birth hospital,family income less than twenty thousand yuan every year,father's culture level,diagnosed premature,very low birth weight infant,low birth weight infant,respiratory distress syndrome and brain injuries were significant between neonates in hospital less than 24 hours and more than 24 hours(P ＜ 0.05).The differences of the male,intrapartum high risk factors,mother's morbid state and miscarriage were not significant(P ＞0.05).(4) The uterine-incision delivery,intrapartum asphyxia,birth in the county and below county hospital,family income less than twenty thousand yuan every year and diagnosed respiratory distress syndrome were correlation to the abandon treatment in 24 hours.There were no correlation to the gave up treatment in 24 hours to the rest of the factors.Conclusion We should set up the systemic gravid detection system,avoid premature birth and respiratory distress syndrome,add the hardware configuration and medical personnel to the neonate department,improve the professional technology level,perfect social security system mechanism,decrease the hospital discharge rate of the hospitalization less than 24 hours,improve the level of the local neonatal treatment technology and the quality of population.

The Difference of Smoking Rates before and after Hospital Admission

BACKGROUND: The harmfulness of smoking is well known, but the smoking rate of adult males in Korea is still high. Therefore, we wanted to find out the factors related to smoking cessation among patients who had been admitted to hospital and to make an effective smoking cessation program. METHODS: We reviewed the medical records of patients who had been admitted to the department of internal medicine or orthopedic surgery of an hospital from January 25, 2005 to June 15, 2005. We enrolled 104 male patients who were smokers and gave them telephone interviews. Among them, 74 patients answered (71.2%). RESULTS: Among the subjects, 10 patients quit smoking and 64 smoked continuously. Age, duration and amount of smoking, past experiences of smoking cessation were not significantly different between the two groups. The patients who were admitted to the department of internal medicine (P=0.047) and advised from doctors to quit smoking (P=0.010) showed a high smoking cessation rate. The patients who were advised by doctors showed a higher rate of planning for smoking cessation, even though they were still smoking (P=0.001). CONCLUSION: For smoking cessation in admission patient's, doctor's advice to quit smoking was important.