Corine Latour

Medical Inpatients at Risk of Extended Hospital Stay and Poor Discharge Health Status : Detection With COMPRI and INTERMED

Objective: To detect the patients in medical wards at risk of extended LOS and poor discharge health status with the use of complexity prediction instrument (COMPRI) and interdisciplinary medicine (INTERMED) instruments. Methods: Study 1: In a sample of 275 consecutively admitted medical inpatients, a hierarchical cluster analysis on INTERMED variables was performed. The clusters were compared on length of hospital stay (LOS) and Short Form 36 (SF‐36) at discharge. Study 2: Receiver operating characteristic (ROC) analysis was used to optimal cut‐off points for the COMPRI and INTERMED. Patients detected with COMPRI and INTERMED were then compared with undetected patients on LOS and SF‐36. Results: Study 1: In concordance with previous findings, a cluster of patients with high biopsychosocial vulnerability was identified with significantly higher scores on LOS (p < .05) and lower scores on SF‐36 (p < .001) than patients in other clusters. Study 2: A cut‐off point for the COMPRI of 5/6 was found to detect patients at risk of long LOS. A cut off score for the INTERMED of 20/21 was found to detect patients at risk of poor discharge health status. Patients detected with COMPRI and INTERMED had a significantly longer LOS (p < .001) and a poorer discharge health status (SF‐36 MCS: p < .001; SF‐36 PCS: p = .05) than nondetected patients. Of the detected patients, 37% had an extended hospital stay and poor discharge health status; of the nondetected patients, this was only 7%. Conclusions: The COMPRI‐INTERMED can help to detect complex patients admitted to medical wards within the first days of admission, and rule out those with a small chance of poor outcomes.

Implementing psychiatric interventions on a medical ward: effects on patients' quality of life and length of hospital stay.

Objective The authors investigated the effects of implementing psychiatric interventions on a general medical ward by means of a stepped detection and treatment strategy conducted by a consultation–liaison (CL) nurse in terms of reducing length of hospital stay (LOS) and improving quality of life (QOL) at discharge. Materials and Methods One hundred ninety-three patients participated in a controlled trial, in which patients were screened with COMPRI and INTERMED. A nurse under supervision of a CL psychiatrist conducted interventions, consisting of simple psychiatric interventions by herself, referral to auxiliary services, or initiation of postdischarge care. Intervention patients were compared with historic controls on LOS and QOL (SF36) at discharge. Results In multivariate analysis of variance, a significant effect of the intervention on QOL (p = 0.037) was found, which diminished after controlling for confounders (p = 0.28). No significant effect on LOS was found for the whole sample (p = 0.72), but in patients age 65 years or older, a reduction in LOS (p = 0.05) was found. This effect remained after controlling for confounders (p = 0.06). Conclusions These data suggest that screening for risk of increased health care might improve outcomes in general medical inpatients. Because of the design of the study, however, these findings should be considered preliminary and confirmed in a larger, multicenter, randomized controlled trial.

Interrater reliability of the INTERMED in a heterogeneous somatic population.

The INTERMED has been developed to score biopsychosocial case complexity and care needs. In this study, the interrater reliability of the INTERMED was assessed by calculating the agreement of two independent raters, based on the same information. Forty-three in- and outpatients with varying somatic complaints were double scored by a psychologist and a psychiatric C-L nurse. Correlations between total scores of the two raters were ranging from 0.91-0.96. On item level, in 83% there were no differences between the raters, in 16% there was a 1-point difference and in 1% a 2-point difference. Based on a cut-off score of 20/21, a constant k of 0.85 was found. We concluded that the two experienced raters had a high agreement, and that after sufficient training the INTERMED can be reliably scored. Its utility in improving health care delivery for patients with complex biopsychosocial care needs still has to be demonstrated.

Assessment of Biopsychosocial Complexity and Health Care Needs: Measurement Properties of the INTERMED Self-Assessment Version

Objective The INTERMED Self-Assessment questionnaire (IMSA) was developed as an alternative to the observer-rated INTERMED (IM) to assess biopsychosocial complexity and health care needs. We studied feasibility, reliability, and validity of the IMSA within a large and heterogeneous international sample of adult hospital inpatients and outpatients as well as its predictive value for health care use (HCU) and quality of life (QoL). Methods A total of 850 participants aged 17 to 90 years from five countries completed the IMSA and were evaluated with the IM. The following measurement properties were determined: feasibility by percentages of missing values; reliability by Cronbach &agr;; interrater agreement by intraclass correlation coefficients; convergent validity of IMSA scores with mental health (Short Form 36 emotional well-being subscale and Hospital Anxiety and Depression Scale), medical health (Cumulative Illness Rating Scale) and QoL (Euroqol-5D) by Spearman rank correlations; and predictive validity of IMSA scores with HCU and QoL by (generalized) linear mixed models. Results Feasibility, face validity, and reliability (Cronbach &agr; = 0.80) were satisfactory. Intraclass correlation coefficient between IMSA and IM total scores was .78 (95% CI = .75–.81). Correlations of the IMSA with the Short Form 36, Hospital Anxiety and Depression Scale, Cumulative Illness Rating Scale, and Euroqol-5D (convergent validity) were −.65, .15, .28, and −.59, respectively. The IMSA significantly predicted QoL and also HCU (emergency department visits, hospitalization, outpatient visits, and diagnostic examinations) after 3- and 6-month follow-up. Results were comparable between hospital sites, inpatients and outpatients, as well as age groups. Conclusions The IMSA is a generic and time-efficient method to assess biopsychosocial complexity and to provide guidance for multidisciplinary care trajectories in adult patients, with good reliability and validity across different cultures.

Erratum to “The Scale on COmmunity care PErceptions (SCOPE) for nursing students: A development and psychometric validation study” [Nurse Educ. Pract. 31 July 2018 61–67]

The publisher regrets that the Appendix 1. SCOPE: Scale on COmmunity care Perceptions was not completely included in the published article. [Figure presented] The publisher would like to apologise for any inconvenience caused.

Vaardig worden in de omgang met suïcidale patiënten in een algemeen ziekenhuis

SamenvattingDeze Toolkit levert een bijdrage aan het leren omgaan met suïcidale patiënten in een algemeen ziekenhuis. Het gaat daarbij om herkenning, eerste opvang en begeleiding van patiënten waarbij (mogelijk) sprake is van suïcidaliteit.