Interventions to Prevent Readmissions in Hospitalized Peripheral Vascular Surgery Patients: A Systematic Review.

A large proportion of peripheral vascular patients worldwide experience unplanned hospital readmissions after inpatient vascular surgery. This review was conducted to identify acute care and post-discharge interventions that may help in reducing unplanned vascular surgery readmissions. A computer-based search of four databases was conducted July 2021 for original research reports published 2000 to 2021. Eight studies met inclusion criteria, with interventions including multidisciplinary care teams, advance practice provider discharge coordination, individualized case management, home care nursing, early primary care provider or telephone follow-up, and telehealth driven follow up evaluated. Some reductions in readmission rates were associated with most interventions but were inconsistent across studies. Further research is necessary to clarify and validate these findings, incorporate patient perspectives, and explore the role of technology-based interventions. This work is key to improving the patient's experience, reduce healthcare costs, and strengthen the quality of vascular surgery care.

Discharge process challenges of an academic vascular surgery service: A qualitative study.

Vascular surgery patients have a high incidence of unplanned hospital readmissions and complications. Previous research has not fully examined specific elements of the hospital discharge process for vascular surgery patients to identify issues that may contribute to readmissions. The objective of this qualitative descriptive study was to explore challenges identified by healthcare providers and patients regarding the discharge process from an academic vascular surgery service. Data were collected from eight focus group interviews and analyzed for relevant themes. Patients and healthcare providers identified several challenges within the standard discharge process, including ineffective communication, insufficient time for discharge education, and limitations accessing providers with post-discharge concerns. These obstacles may be ameliorated in part by specialized coordinators, caregiver support, and use of adaptive strategies outside of the current discharge process. The discharge challenges described by study participants likely contribute to adverse post-hospitalization outcomes, including unplanned hospital readmissions. A multifaceted approach that incorporates standardized discharge processes, as well as informal problem-solving strategies, is recommended to improve hospital discharge and outcomes for vascular surgery patients.

Informal Family Caregiving of Patients with Diabetic Extremity Wounds: An Integrative Review.

Annually, 26 million people worldwide develop diabetic extremity wounds, adversely impacting the lives of patients and their family caregivers, who provide vital health assistance to these patients. This integrative review synthesized scientific literature of informal caregiving experiences for patients with diabetic extremity wounds. Five databases were searched for relevant English-language quantitative or qualitative research; ten studies were included in the final analysis. The caregiving experience included disrupted routines, frustration, guilt, poor health care communication, helplessness, and anxiety. Increased caregiver burden and decreased quality of life were associated with higher patient amputation level, worsening wound appearance and patient pain, poor health care communication, lack of social support and/or caregiving help, and lack of caregiver employment outside the home. Future research opportunities include further exploration of caregiver tasks and priorities, caregiving experiences in settings lacking family support structures and equitable health system access, and relationships between the caregiver experience and patient health system utilization.