Post-Hospitalization Home Monitoring Programs During the COVID-19 Pandemic: Survey Results from the Hospital Medicine Re-engineering Network (HOMERuN).

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, hospitals and healthcare systems launched innovative responses to emerging needs. The creation and use of programs to remotely follow patient clinical status and recovery after COVID-19 hospitalization has not been thoroughly described. OBJECTIVE: To characterize deployment of remote post-hospital discharge monitoring programs during the COVID-19 pandemic METHODS: Electronic surveys were administered to leaders of 83 US academic hospitals in the Hospital Medicine Re-engineering Network (HOMERuN). An initial survey was completed in March 2021 with follow-up survey completed in July 2022. RESULTS: There were 35 responses to the initial survey (42%) and 15 responses to the follow-up survey (43%). Twenty-two (63%) sites reported a post-discharge monitoring program, 16 of which were newly developed for COVID-19. Physiologic monitoring devices such as pulse oximeters were often provided. Communication with medical teams was often via telephone, with moderate use of apps or electronic medical record integration. Programs launched most commonly between January and June 2020. Only three programs were still active at the time of follow-up survey. CONCLUSIONS: Our findings demonstrate rapid, ad hoc development of post-hospital discharge monitoring programs during the COVID-19 pandemic but with little standardization or evaluation. Additional study could identify the benefits of these programs, instruct their potential application to other disease processes, and inform further development as part of emergency preparedness for upcoming crises.

Workplace Violence in Healthcare Settings: A Scoping Review of Guidelines and Systematic Reviews.

Workplace violence in healthcare settings is alarmingly common and represents significant financial and human cost. The aim of this scoping review was to identify and summarize evidence on strategies to prevent and/or manage workplace violence in healthcare settings. Searches were limited to evidence-based clinical practice guidelines and systematic reviews published between 2015 and 2021. Multiple databases were searched and screened. Quality of the included guidelines and reviews was also assessed. Three guidelines and 33 systematic reviews were included. Both the Occupational Safety and Health Administration 2015 and Registered Nurses' Association of Ontario 2019 guidelines provided useful recommendations for building a comprehensive prevention program. Evidence-based risk assessment, prevention and management, and education and training are all central components. Regular reassessment and adjustment is required. Included reviews (n = 33) were grouped into five main categories: violence toward nurses (n = 10); violence toward healthcare workers in general (n = 8); violence in the emergency department (n = 5); violence related to mental health (n = 5); and measurement related to workplace violence (n = 5). Multicomponent interventions were often more effective than those applied in isolation. We found consistent support for certain strategies including education and training, post-incident debriefing, multidisciplinary rapid response teams, and environmental modifications; however, the strength of evidence and certainty of conclusions were limited across reviews. This scoping review found that strong leadership that cultivates and enforces a culture of inclusivity, support, and respect is a prerequisite for a successful workplace violence prevention program. Rigorous comparative effectiveness research testing interventions are needed.

Acute care patient portals: a qualitative study of stakeholder perspectives on current practices.

OBJECTIVE: To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. MATERIALS AND METHODS: Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. RESULTS: Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. DISCUSSION: Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. CONCLUSION: Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a "road map" for future work related to acute care patient portals.

Perceptions of people living with Parkinson's disease: a qualitative study in Iran.

AIM: This study explores the primary concerns and perceptions of patients living with Parkinson's disease (PD). METHOD: This was an exploratory qualitative study. A purposive sample of 17 patients with PD who were attending a hospital outpatients' neurology clinic in Iran were recruited. Study data were collected through semi-structured interviews and analysed using the conventional qualitative content analysis approach. FINDINGS: We identified the 'fear of becoming disabled' as a primary concern in these patients. This concern affected the physical, emotional, mental, and social aspects of their lives. The 'fear of becoming disabled' fell into four categories, including progressive physical disability, mental alteration, decreasing social connectedness, and self-change. CONCLUSION: The study results showed that older adults with PD face a number of challenges in self-care. In addition, the 'fear of becoming disabled' was the main concern of patients with PD, particularly in late stages of the disease.

Not ready, not set discharge: Patient-reported barriers to discharge readiness at an academic medical center.

BACKGROUND: Planning for discharge from the hospital should begin early in each patient's stay and focus on the patient's needs. OBJECTIVE: To determine how often patient-reported barriers to discharge on admission were resolved by discharge and to explore associations between barriers and readmission. DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study of patients admitted to an academic medical center. INTERVENTION AND MEASUREMENTS: Patients completed a barriers to discharge survey from the start of hospitalization to discharge. Primary outcomes were the prevalence of discharge barriers, rates of resolution of barriers during hospitalization, and comparisons between barriers identified in admission and discharge surveys. RESULTS: One hundred sixty-three patients were enrolled, and 68 patients (42%) completed an admission survey and discharge survey ≤48 hours before discharge. Patients completed on average 1.82 surveys (standard deviation, 1.10; range, 1-8). Total and mean numbers of barriers were highest on the admission survey and decreased until the fourth survey. On average, the total number of barriers to discharge decreased by 0.15 (95% confidence interval: 0.01-0.30) per day (P = 0.047). Ninety percent of patients were discharged with at least 1 issue. The 3 most common barriers on the admission and discharge survey remained the same: pain, lack of understanding of recovery plan, and daily-living activities. CONCLUSIONS: Patient-reported barriers to discharge are prevalent and incompletely addressed. This suggests an opportunity for improved discharge planning and a framework for communication between providers and patients. Journal of Hospital Medicine 2016;11:610-614. © 2016 Society of Hospital Medicine.

Disrupted social connectedness in people with Parkinson's disease.

A study was conducted to explore the effects of Parkinson's disease on people's social interactions. An exploratory qualitative design was used. Participants were a purposive sample of 10 people with Parkinson's disease who were attending a hospital outpatients' neurology clinic. Data were collected by semi-structured in-depth interviews. All interviews were transcribed and analysed by using conventional content analysis to explore the participants' experiences and perceptions on social interactions, using the central question 'what effect does Parkinson's disease have on people's social interactions?' Analysis revealed that Parkinson's disease affected social interactions by disrupting social connectedness. Social connectedness was disrupted by a number of factors, including 'progressive physical disability, mood disturbances, shrinking of social activities and secluding oneself. Older adults with Parkinson's disease therefore face a number of challenges to remaining socially connected. It appears that disrupted social connectedness is one of the negative consequences of living with Parkinson's.