Dataset Information

Improving the provision of driving advice on discharge after abdominal surgery.

ABSTRACT: Ensuring the safety of patients is a vital duty of a doctor. It is their responsibility to advise patients about activity limitations on discharge from hospital. This study aims to assess the current provision of driving advice for patients after abdominal surgery and institute improvements to this provision of information in North Bristol NHS Trust. A preliminary questionnaire ascertained current doctor's knowledge regarding limitations of driving postoperatively and whether information was communicated to patients. Baseline retrospective data were collected from electronic discharge summaries to determine documentation of advice provision. Educational interventions were introduced, followed by data collection after each intervention. Initial questionnaires demonstrated poor knowledge amongst doctors and a lack of provision of driving advice postoperatively. After multiple educational interventions, the provision of driving advice on electronic discharge summaries increased from 0% (0) at baseline to 75% (9). Initially, the provision of driving advice postoperatively was poorly documented for inpatients undergoing abdominal surgery; following multiple educational interventions, the provision of written advice improved. Future plans include the introduction of prewritten sentences onto the electronic discharge summaries to facilitate ease of information provision and a reaudit in 12 months.

SUBMITTER: Buss I

PROVIDER: S-EPMC4693046 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Improving the provision of driving advice on discharge after abdominal surgery.

Buss Imogen I Gould Laura L

BMJ quality improvement reports 20151022 1

Ensuring the safety of patients is a vital duty of a doctor. It is their responsibility to advise patients about activity limitations on discharge from hospital. This study aims to assess the current provision of driving advice for patients after abdominal surgery and institute improvements to this provision of information in North Bristol NHS Trust. A preliminary questionnaire ascertained current doctor's knowledge regarding limitations of driving postoperatively and whether information was com ...[more]

PMID: 26734396

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Project description:BACKGROUND:Intra-abdominal emergency surgery is associated with high mortality risk and long length of hospital stay. The objective of this study was to explore variations in surgery rates, the relationship between admission source and discharge destination, and whether the postoperative length of stay was related to nursing home capacity in Irish counties. METHODS:Data on emergency hospital episodes for 2014-18 for patients aged over 65?years with a primary abdominal procedure code were obtained from the National Quality Assurance Improvement System. Data on population and nursing home capacity were obtained from the Central Statistics Office and the Health Information and Quality Authority. Episode rates per 100,000 were estimated for sex and age groups and compared between 26 Irish counties. The association between admission source and discharge destination was explored in terms episode numbers, length of stay and mortality. A negative binomial regression model estimated casemix adjusted excess post-operative length of stay. The correlation between excess post-operative length of stay and nursing home capacity was explored by linear regression. RESULTS:Overall, 4951 hospital episodes were included. The annual surgery rate ranged from 100 episodes per 100,000 65-69?years old to 250 per 100,000 85-89?year old men. 90% of the episodes were admitted from patients' home. Four in five of these patients returned to their home while 12.7% died at hospital. The proportion of episodes where patients returned to their home reduced to two in five for those aged 85-89?years. The post-operative length of stay was 13.6?days longer (p <?0.01) for episodes admitted from home and discharged to nursing home in comparison with episodes discharged home. A negative association (p =?0.08) was found between excess post-operative length of stay and county-level nursing home capacity. CONCLUSIONS:This study provides relevant information to support informed consent to surgery for patients and clinicians and to improve the provision of care to older patients presenting with intra-abdominal emergencies.

Project description:ImportanceAlthough discharges against medical advice (DAMA) are associated with greater morbidity and mortality, little is known about current racial and ethnic disparities in DAMA from the emergency department (ED) nationally.ObjectiveTo characterize current patterns of racial and ethnic disparities in rates of ED DAMA.Design, setting, and participantsThis cross-sectional study used data from the Nationwide Emergency Department Sample on all hospital ED visits made between January to December 2019 in the US.Main outcomes and measuresThe main outcome was odds of ED DAMA for Black and Hispanic patients compared with White patients nationally and in analysis adjusted for sociodemographic factors. Secondary analysis examined hospital-level variation in DAMA rates for Black, Hispanic, and White patients.ResultsThe study sample included 33 147 251 visits to 989 hospitals, representing the estimated 143 million ED visits in 2019. The median age of patients was 40 years (IQR, 22-61 years). Overall, 1.6% of ED visits resulted in DAMA. DAMA rates were higher for Black patients (2.1%) compared with Hispanic (1.6%) and White (1.4%) patients, males (1.7%) compared with females (1.5%), those with no insurance (2.8%), those with lower income (<$27 999; 1.9%), and those aged 35 to 49 years (2.2%). DAMA visits were highest at metropolitan teaching hospitals (1.8%) and hospitals that served greater proportions of racial and ethnic minoritized patients (serving ≥57.9%; 2.1%). Odds of DAMA were greater for Black patients (odds ratio [OR], 1.45; 95% CI, 1.31-1.57) and Hispanic patients (OR, 1.16; 95% CI, 1.04-1.29) compared with White patients. After adjusting for sociodemographic characteristics (age, sex, income, and insurance status), the adjusted OR (AOR) for DAMA was lower for Black patients compared with the unadjusted OR (AOR, 1.18; 95% CI, 1.09-1.28) and there was no difference in odds for Hispanic patients (AOR, 1.03; 95% CI, 0.92-1.15) compared with White patients. After additional adjustment for hospital random intercepts, DAMA disparities reversed, with Black and Hispanic patients having lower odds of DAMA compared with White patients (Black patients: AOR, 0.94 [95% CI, 0.90-0.98]; Hispanic patients: AOR, 0.68 [95% CI, 0.63-0.72]). The intraclass correlation in this secondary analysis model was 0.118 (95% CI, 0.104-0.133).Conclusions and relevanceThis national cross-sectional study found that Black and Hispanic patients had greater odds of ED DAMA than White patients in unadjusted analysis. Disparities were reversed after patient-level and hospital-level risk adjustment, and greater between-hospital than within-hospital variation in DAMA was observed, suggesting that Black and Hispanic patients are more likely to receive care in hospitals with higher DAMA rates. Structural racism may contribute to ED DAMA disparities via unequal allocation of health care resources in hospitals that disproportionately treat racial and ethnic minoritized groups. Monitoring variation in DAMA by race and ethnicity and hospital suggests an opportunity to improve equitable access to health care.

Project description:Background: Factors surrounding pediatricians' parenting advice and training on parenting during residency have not been well studied. The Resident Parenting Questionnaire (RPQ) was developed to assess (a) the relationship between pediatric residents' upbringing and their parenting advice style and (b) factors associated with confidence and resource use when delivering parenting advice. Methods: Three hundred and one pediatric residents from 15 United States residency programs completed the RPQ with upbringing and advice responses categorized using Baumrind's parenting model (authoritative, authoritarian, permissive). Chi-square/Fisher's exact tests, Bowker's test of symmetry, and regression analyses assessed associations between residents' upbringing, parenting advice style/content, and confidence in providing parenting advice. Results: Most participants indicated being raised authoritatively (68%) and giving authoritative parenting advice (83%), but advice differed based on how they perceived their upbringing (p < 0.001). Residents noting authoritative upbringing were more likely to give authoritative advice (85%) while others tended to give advice differing from upbringing (e.g., those perceiving authoritarian upbringing were more likely to give authoritative/permissive). Analyses suggest resident race, acculturation, future plans, and resident level are associated with parenting advice type. Confidence in giving parenting advice decreased significantly as patient age increased and increased with resident level advancement. Residents reported consulting attending physicians for parenting advice guidance more than any other evidence-based resources. Conclusion: Most pediatric residents appear to be aware of appropriate authoritative parenting advice regardless of upbringing, especially as they advance through residency. Residents may benefit from opportunities to reflect upon their upbringing, particularly if raised in authoritarian or permissive styles. Targeted training of residents on evidence-based parenting strategies, particularly for older pediatric patients, appears warranted.

Project description:ImportanceHospital readmissions contribute to higher expenditures and may sometimes reflect suboptimal patient care. Individuals discharged against medical advice (AMA) are a vulnerable patient population and may have higher risk for readmission.ObjectivesTo determine odds of readmission and mortality for patients discharged AMA vs all others, to characterize patient and hospital-level factors associated with readmissions, and to quantify their overall cost burden.Design, setting, and participantsNationally representative, all-payer cohort study using the 2014 National Readmissions Database. Eligible index admissions were nonobstetrical/newborn hospitalizations for patients 18 years and older discharged between January 2014 and November 2014. Admissions were excluded if there was a missing primary diagnosis, discharge disposition, length of stay, or if the patient died during that hospitalization. Data were analyzed between January 2018 and June 2018.ExposuresDischarge AMA and non-AMA discharge.Main outcomes and measuresThirty-day all-cause readmission and in-hospital mortality rate.ResultsThere were 19.9 million weighted index admissions, of which 1.5% resulted in an AMA discharge. Within the AMA cohort, 85% were younger than 65 years, 63% were male, 55% had Medicaid or other (including uninsured) coverage, and 39% were in the lowest income quartile. Thirty-day all-cause readmission was 21.0% vs 11.9% for AMA vs non-AMA discharge (P < .001), and 30-day in-hospital mortality was 2.5% vs 5.6% (P < .001), respectively. Individuals discharged AMA were more likely to be readmitted to a different hospital compared with non-AMA patients (43.0% vs 23.9%; P < .001). Of all 30-day readmissions, 19.0% occurred within the first day after AMA discharge vs 6.1% for non-AMA patients (P < .001). On multivariable regression, AMA discharge was associated with a 2.01 (95% CI, 1.97-2.05) increased adjusted odds of readmission and a 0.80 (95% CI, 0.74-0.87) decreased adjusted odds of in-hospital mortality compared with non-AMA discharge. Nationwide readmissions after AMA discharge accounted for more than 400 000 inpatient hospitalization days at a total cost of $822 million in 2014.Conclusions and relevanceIndividuals discharged AMA have higher odds of 30-day readmission at significant cost to the health care system and lower in-hospital mortality rates compared with non-AMA patients. Patients discharged AMA are also more likely to be readmitted to different hospitals and to have earlier bounce-back readmissions, which may reflect dissatisfaction with their initial episode of care.

Dataset Information

Improving the provision of driving advice on discharge after abdominal surgery.

Publications

Improving the provision of driving advice on discharge after abdominal surgery.

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