Jed Duff

What really matters? A multi-view perspective of one patient’s hospital experience

Abstract Background: ‘Patient experience’ is both recognised and solicited as a means of assessing healthcare delivery and a method for gauging patient centredness. Research comparing healthcare recipient and provider perceptions regarding the same episode of care is lacking. Aim: To identify what mattered to a patient and family member (healthcare recipients) during the patient’s hospital experience and to examine the healthcare provider’s awareness of what mattered. Methods: A qualitative descriptive investigation was undertaken using semi-structured interviews designed to compare multiple perceptions of one patient’s hospital experience. Interviews were undertaken with the patient, family member, and healthcare providers. A definition of hospital experience was sought from each participant. Additional phrases as presented by the patient and family member were coded and grouped into categories and then salient themes. Phrases as presented by the healthcare providers were coded, and then allocated to the previously identified themes. Findings: One patient, his wife and seven healthcare providers (doctors (2), registered nurses (4) and a patient care orderly (1)) were interviewed. Definitions of ‘hospital experience’ differ between participants. Recipients include pre and post hospital admission periods, whereas providers limit hospital experience to admission. Three salient themes emerged from recipient data suggesting; medication management, physical comfort and emotional security are what mattered to the recipients. Awareness was dependent upon theme and differed between the providers. Conclusion: Hospital experience as a term is poorly defined, and definitions differ between recipients and providers of care. Healthcare providers are not always aware of what matters to the patient and family during their hospital admission.

Nurses report a healthy culture: Results of the Practice Environment Scale (Australia) in an Australian hospital seeking Magnet recognition

Walker K, Middleton S, Rolley J, Duff J. International Journal of Nursing Practice 2010; 16: 616–623 Nurses report a healthy culture: Results of the Practice Environment Scale (Australia) in an Australian hospital seeking Magnet recognition The Magnet Recognition Program requires evidence that the nursing practice environment supports staff to provide optimal care, access professional development opportunities and participate in hospital affairs. This research aimed to assess clinical nurses’ work environment at a leading private hospital in Sydney, Australia using a version of the Practice Environment Scale of the Nursing Work Index modified for the Australian context. Our results were comparable to Magnet hospitals for two subscales and significantly higher than Magnet results for the remaining three subscales and the composite scale. This was especially pleasing in relation to the hospitals preparation for Magnet recognition. Hospitals across Australasia might find administration of the Practice Environment Scale (modified for use in the Australian context) a useful exercise both as a stimulus to preparation and an indicator of readiness for Magnet recognition.

Preventing hypothermia in elective arthroscopic shoulder surgery patients: a protocol for a randomised controlled trial

BackgroundPatients having arthroscopic shoulder surgery frequently experience periods of inadvertent hypothermia. This common perioperative problem has been linked to adverse patient outcomes such as myocardial ischaemia, surgical site infection and coagulopathy. International perioperative guidelines recommend patient warming, using a forced air warming device, and the use of warmed intraoperative irrigation solutions for the prevention of hypothermia in at-risk patient groups. This trial will investigate the effect of these interventions on patients’ temperature, thermal comfort, and total recovery time.Method/DesignThe trial will employ a randomised 2 x 2 factorial design. Eligible patients will be stratified by anaesthetist and block randomised into one of four groups: Group one will receive preoperative warming with a forced air warming device; group two will receive warmed intraoperative irrigation solutions; group three will receive both preoperative warming and warmed intraoperative irrigation solutions; and group four will receive neither intervention. Participants in all four groups will receive active intraoperative warming with a forced air warming device. The primary outcome measures are postoperative temperature, thermal comfort, and total recovery time. Primary outcomes will undergo a two-way analysis of variance controlling for covariants such as operating room ambient temperature and volume of intraoperative irrigation solution.DiscussionThis trial is designed to confirm the effectiveness of these interventions at maintaining perioperative normothermia and to evaluate if this translates into improved patient outcomes.Australian New Zealand Clinical Trials Registry numberACTRN12610000591055

Preventing inadvertent hypothermia: comparing two protocols for preoperative forced-air warming

Preoperative forced-air warming is one way of preventing inadvertent perioperative hypothermia. There is scant evidence, however, on the best warming method or the acceptability of these methods to patients. This pilot study compared two warming protocols: one that commenced at maximum temperature and was titrated down as requested (A) and one that commenced at near body temperature and was titrated up as tolerated (B). A crossover design was used in which each participant (n=10) received both protocols sequentially. The mean device temperature and length of time spent at maximum settings were greater for protocol A (43°C±0°C vs 41°C±1°C, P=.003; and 60±0 vs 41.5±2.8 minutes, P=.004). There was no difference in thermal comfort scores, participant temperature, or sweating between the two protocols. When asked, participants preferred protocol A to B (70% to 30%). Starting at higher device settings appears the more favorable of the two approaches.

Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician–patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients’ experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships.

Perioperative warming therapy for preventing surgical site infection in adults undergoing surgery

This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effects and safety of active and passive perioperative warming interventions for the prevention of SSI, when compared with standard care and other interventions.

Prevention of venous thromboembolism in hospitalized patients: Analysis of reduced cost and improved clinical outcomes

The impact of implementing a guideline on venous thromboembolism (VTE) prophylaxis was evaluated in a metropolitan private hospital with a before- and after-intervention study. This subsequent study aimed to identify if improved prophylaxis rates translated into cost savings and improved clinical outcomes. A conceptual decision-tree analytical model incorporating local treatment algorithms and clinical trial data was used to compare prophylaxis costs and clinical outcomes before and after the guideline implementation. The study analyzed data from 21,942 medical and surgical patients admitted to a 250-bed acute-care private hospital in Sydney, Australia. The modeled simulation estimated the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as adverse events such as heparin-induced thrombocytopenia (HIT), post-thrombotic syndrome (PTS), major bleeding, and mortality. The costs of prophylaxis therapy and treating adverse events were also calculated. The improvement in prophylaxis rates following the implementation of the guideline was estimated to result in 13 fewer deaths, 84 fewer symptomatic DVTs, 19 fewer symptomatic PEs, and 512 fewer hospital-bed days. Improved adherence to evidence-based prophylaxis regimens was associated with overall cost savings of

Improving the safety and efficacy of warfarin therapy in a metropolitan private hospital: A multidisciplinary practice improvement project

245,439 over 12 months. We conclude that improved adherence to evidence-based guidelines for VTE prophylaxis is achievable and is likely to result in fewer deaths, fewer VTE events, and a significant overall cost saving.

Supporting a healthy culture: results of the Practice Environment Scale, Australia in a Magnet® designated hospital.

Abstract Background: Warfarin is a very complex, high risk therapy and one that carries the potential for severe adverse events. The aim of this project was to improve warfarin management through the application of the best available evidence. The project was undertaken in a 250 bed acute care metropolitan private hospital. Interventions: A suite of evidence-based interventions were used including audit and feedback, patient and provider education, and decision support aides. Measures: This project used the ongoing collection of warfarin process and outcome clinical indicator data to measure improvement. Results: Compliance with loading protocol increased by 12% (42–54%); patient education prior to discharge increased by 54% (31–85%); INRs > 5 decreased by 2.6% (3.7–1.1%); and abnormal bleeds fell by 1.2% (1.2–0%). Conclusion: This multifaceted suite of interventions was successful in influencing clinician behaviour and improving compliance with evidence-based warfarin guidelines.

Forced air warming during sedation in the cardiac catheterisation laboratory: a randomised controlled trial

The Magnet Recognition Program® requires evidence that nursing practice environments support staff to provide optimal care, access professional development opportunities, and participate in hospital affairs. The research presented in this article aimed to assess clinical nurses’ work environment at a recently designated, private Magnet® hospital in Sydney, Australia. Authors compare results with baseline data collected for a gap analysis before application for recognition. The outcomes challenge previously reported data suggesting that hospitals on the journey to Magnet recognition outperform already designated hospitals in this respect.