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Implementing a discharge process for patients undergoing elective surgery: Rapid review 实施出院程序的病人接受择期手术:快速回顾
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2023-02-01 DOI: 10.1016/j.ijotn.2023.101001
Maria J.C. Teixeira , Ma'ali Khouri , Evangeline Martinez , Suzanne Bench

Background

Hospital discharge is a ‘vulnerable stage’ in care. A delayed, inappropriate or poorly planned discharge increases hazards and costs, inhibiting recovery, and often leading to unplanned readmission. New discharge processes could boost practice, reduce the length of stay, and, consequently, reduce costs and improve patients' quality of life.

Aim

To identify technology based interventions that have been implemented to facilitate a safe and timely discharge procedure after elective surgery, and to describe implementation barriers and facilitators and patient satisfaction.

Method

This rapid review followed a restricted systematic review framework, searching Medline, EMBASE, CINAHL, PsychINFO, and ClinicalTrials.gov. for relevant studies published from 2015 to 2021 in English.

Results

Eleven studies were included. Most interventions were machine-learning-based, and only one study reported patient involvement. Effective leadership, team work and communication were stated as implementation facilitators. The main barriers to implementation were: lack of support from leaders, poor clinical documentation, resistance to change, and financial and logistical concerns. None of the studies evaluated patient satisfaction.

Conclusions

Findings highlight factors that support the implementation of technology based interventions aimed at a safe and timely discharge process following elective surgery. Nurses play an important role in the provision of information, and in the development and implementation of discharge processes.

出院是护理中的“脆弱阶段”。延迟、不适当或计划不周的出院会增加危险和成本，抑制康复，并经常导致意外再入院。新的出院流程可以促进实践，缩短住院时间，从而降低成本，提高患者的生活质量。目的确定已实施的基于技术的干预措施，以促进择期手术后安全及时的出院程序，并描述实施障碍、促进因素和患者满意度。方法采用有限的系统评价框架，检索Medline、EMBASE、CINAHL、PsychINFO和ClinicalTrials.gov。查阅2015年至2021年发表的相关英文研究。结果共纳入6项研究。大多数干预都是基于机器学习的，只有一项研究报告了患者的参与。有效的领导、团队合作和沟通被认为是促进实施的因素。实施的主要障碍是:缺乏领导的支持、临床文件不完善、对变革的抵制以及财政和后勤问题。没有一项研究评估患者满意度。结论:研究结果强调了支持实施基于技术的干预措施的因素，旨在实现择期手术后安全和及时的出院过程。护士在提供信息、制定和实施出院流程方面发挥着重要作用。
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引用次数: 0
A tribute to Dr Julie Santy-Tomlinson (Editor in Chief) 向朱莉·圣蒂-汤姆林森博士(主编)致敬
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2023-02-01 DOI: 10.1016/j.ijotn.2022.100996
Rebecca Jester Professor PhD (Editor in Chief)
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引用次数: 0
Literature reviews 文学评论
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2023-02-01 DOI: 10.1016/j.ijotn.2023.101000
Carole Jackson, Carmen Queiros, Shareena Bibi Mohd Arif
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引用次数: 0
Information needs, expectations, and treatment preference of patients considering spinal surgery: A case-control survey 考虑脊柱手术的患者的信息需求、期望和治疗偏好:一项病例对照调查
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2022-11-01 DOI: 10.1016/j.ijotn.2022.100979
William Wing-Kuen Lam , Alice Yuen Loke , Chun-Kwan Wong , Bronya Hi-Kwan Luk

Study design

Case-control survey.

Objectives

To explore intrapersonal factors associated with decision of patients with degenerative back pain for surgery.

Methods

From September 2018 to May 2019 patients were invited to complete a questionnaire. Patients who decided on (case) and declined surgery (control) were later confirmed from medical records.

Results

Seventy-five patients were recruited. Male patients (75.0%, p = 0.019), those who were married (78.7%, p = 0.0045), and had spousal care-givers (89.2%, p < 0.0001) were more likely to decide for surgery. All patients who decided on surgery expressed need for information on “the severity of their spine conditions” (p = 0.039). Those who decided on surgery did not have as the high expectation on “to sleep more comfortably” as those who declined (4.71 vs. 4.91, p = 0.022). The predictive factors for surgery decision by logistic regression analysis were: male gender (OR = 3.23, 95% CI: 1.19–8.77, p = 0.021); married (OR = 5.231, 95% CI: 1.87–14.61, p = 0.002); with available spousal care-giver (OR = 1.85, 95% CI: 0.198–3.89, p = 0.031); and those who preferred to treat/cure the spine disorder by pharmacological treatment (OR = 2.77, 95% CI: 1.02–7.50, p = 0.045).

Conclusion

Patients who decided on surgery were likely to indicate need of medical information related to their condition. Patients were in hope of better relief of physical symptoms, especially related to sleep comfort. Patients would escalate their treatment from conservative to surgery when conservative treatments were no longer effective.

研究设计:病例对照调查。目的探讨影响退行性腰痛患者手术决定的个人因素。方法于2018年9月至2019年5月对患者进行问卷调查。决定(病例)而拒绝手术(对照组)的患者后来从医疗记录中得到证实。结果共纳入75例患者。男性患者(75.0%，p = 0.019)、已婚患者(78.7%，p = 0.0045)、有配偶照顾者(89.2%，p <0.0001)更有可能决定手术。所有决定手术的患者都表示需要了解“脊柱状况的严重程度”(p = 0.039)。选择手术的患者对“睡得更舒服”的期望值没有选择手术的患者高(4.71比4.91,p = 0.022)。经logistic回归分析，影响手术决定的预测因素为:男性(OR = 3.23, 95% CI: 1.19 ~ 8.77, p = 0.021);已婚(或= 5.231,95%置信区间CI: 1.87 - -14.61, p = 0.002);有配偶照顾者(OR = 1.85, 95% CI: 0.198-3.89, p = 0.031);以及倾向于通过药物治疗/治愈脊柱疾病的患者(OR = 2.77, 95% CI: 1.02-7.50, p = 0.045)。结论选择手术的患者有可能表示需要与其病情相关的医学信息。患者希望能更好地缓解身体症状，特别是与睡眠舒适有关的症状。当保守治疗不再有效时，患者会从保守治疗升级到手术治疗。
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引用次数: 1
A quality improvement project addressing the underreporting of delirium in hip fracture patients 解决髋部骨折患者谵妄漏报的质量改进项目
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2022-11-01 DOI: 10.1016/j.ijotn.2022.100974
Naoko Onizuka , Fernando A. Huyke-Hernández , Myriam A. Roby , Tom F. Martell , Rachael M. Scislow , Sarah C. Jones , Andrew Olson , Nicole James , Julie A. Switzer

Introduction

After discovering a low incidence of delirium for hip fracture patients at our institution, we evaluated if this was due to underreporting and, if so, where process errors occurred.

Methods

Hip fracture patients aged ≥60 with a diagnosis of delirium were identified. Chart-Based Delirium Identification Instrument (CHART-DEL) identified missed diagnoses of delirium. Process maps were created based off staff interviews and observations.

Results

The incidence of delirium was 15.3% (N = 176). Within a random sample (n = 98), 15 patients (15.5%) were diagnosed, while 20 (24.7%) went undiagnosed despite evidence of delirium. Including missed diagnoses, delirium prevalence was higher in the sample compared to all patients (35.7% vs 15.3%, p < 0.001). Most missed diagnoses were due to failure in identifying delirium (60%) or failure in documenting/coding diagnosis (20%). The prevalence of baseline cognitive impairment was higher in undiagnosed delirium patients versus correctly diagnosed patients (80% vs 20%, p = 0.001).

Conclusions

Our institution significantly underreports delirium among hip fracture patients mainly due to; (1) failure to identify delirium by the clinical staff, and (2) failure to document/code diagnosis despite correct identification. Baseline cognitive impairment can render delirium diagnosis challenging. These serve as targets for quality improvement and hip fracture care enhancement.

在发现我院髋部骨折患者谵妄发生率较低后，我们评估了这是否是由于漏报所致，如果是，则发生了处理错误。方法选择年龄≥60岁伴有谵妄的骨折患者。基于图表的谵妄鉴别仪(CHART-DEL)识别谵妄的漏诊。流程图是根据员工访谈和观察创建的。结果谵妄发生率为15.3%(176例)。在随机抽样(n = 98)中，15名患者(15.5%)被诊断，而20名患者(24.7%)尽管有谵妄的证据但未被诊断。包括漏诊在内，样本中谵妄患病率高于所有患者(35.7% vs 15.3%， p <0.001)。大多数漏诊是由于未能识别谵妄(60%)或未能记录/编码诊断(20%)。未确诊谵妄患者的基线认知障碍患病率高于正确诊断的患者(80% vs 20%， p = 0.001)。结论我院对髋部骨折患者谵妄的低报主要是由于;(1)临床工作人员未能识别谵妄，(2)尽管有正确的识别，但未能记录/编码诊断。基线认知障碍可使谵妄诊断具有挑战性。这些可作为质量改善和髋部骨折护理加强的目标。
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引用次数: 2
Soft collar for acute cervical spine injury immobilisation -patient experiences and outcomes: A single centre mixed methods study 软领用于急性颈椎损伤固定-患者经验和结果:单中心混合方法研究
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2022-11-01 DOI: 10.1016/j.ijotn.2022.100965
Fiona L. Jennings , Marion L. Mitchell , James Walsham , David SR. Lockwood , Robert M. Eley

Background

Cervical collars are used as standard care for neck immobilisation after cervical spine injury. Although evidence for the most effective type of collar is lacking, there is evidence regarding adverse patient outcomes when managed in a semi or rigid collar. In response to the evidence of complications and adverse effects when using a hard collar, a large Australian adult trauma hospital that specializes in spinal care, changed its policy from hard to soft collars when managing acute cervical spine injury.

Objective

The aim of this study was to investigate patients’ experiences and outcomes when wearing a soft collar for acute cervical spine injury management in hospital.

Method

A single centre mixed method sequential study design was used.

Results

Medical records from 136 patients were examined and no adverse events resulting from collar use were recorded. Interviews with 20 patients revealed that they understood the value of wearing a soft collar. The soft collars were considered supportive and well tolerated, with good adherence to recommendations for use.

Conclusions

Understanding the patients’ experiences informs better care management. This study suggests that soft collars are well tolerated, do not result in pressure injuries or other adverse events and are suitable for managing acute cervical spine injury.

颈圈是颈椎损伤后颈部固定的标准护理。虽然缺乏最有效的项圈类型的证据，但有证据表明在半或刚性项圈中管理患者的不良结果。由于有证据表明使用硬颈圈会产生并发症和不良反应，澳大利亚一家专门从事脊柱护理的大型成人创伤医院在处理急性颈椎损伤时，将硬颈圈改为软颈圈。目的探讨医院急性颈椎损伤患者佩戴软领治疗的体会和效果。方法采用单中心混合法序贯研究设计。结果共检查136例患者的病历，无因使用颈圈引起的不良事件记录。对20名患者的采访显示，他们明白戴软领的价值。软项圈被认为是支持性的，耐受性良好，并且很好地遵守了使用建议。结论了解患者的经历有助于更好地进行护理管理。本研究表明软颈圈耐受性良好，不会造成压力损伤或其他不良事件，适用于治疗急性颈椎损伤。
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引用次数: 2
Comparison of pain and discomfort in supine and lateral positions after surgery for lumbar degenerative disease: A prospective randomized controlled study 腰椎退行性疾病手术后仰卧位和侧卧位疼痛和不适的比较:一项前瞻性随机对照研究
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2022-11-01 DOI: 10.1016/j.ijotn.2022.100959
Yasuchika Aoki , Makoto Suzuki , Hiroshi Takahashi , Arata Nakajima , Masato Sonobe , Toshiaki Kotani , Takayuki Nakajima , Yusuke Sato , Masahiro Inoue , Junya Saito , Masaki Norimoto , Yawara Eguchi , Sumihisa Orita , Seiji Ohtori , Koichi Nakagawa

Introduction

To compare postoperative pain and discomfort between supine and lateral positions after lumbar surgery, a prospective randomized controlled study was performed.

Methods

Forty-three patients with lumbar degenerative disease, treated by decompression (n = 23) or fusion surgery (n = 20), were randomly assigned to be placed in either the supine (supine group: n = 21) or lateral (lateral group: n = 22) position postoperatively, and asked to maintain their position until a day after the surgery. Postoperative back pain and discomfort (visual analog scale [VAS], 0–100 mm) and the number of patients who could maintain their position were examined.

Results

The VAS scores for back pain (supine: 64.9 ± 22.0, lateral: 55.7 ± 21.4) showed no significant difference between the positions. However, the supine group showed significantly more severe discomfort (75.6 ± 15.7) than the lateral group (64.9 ± 15.7, p = 0.039). Significantly fewer patients maintained their position in the supine group (28.2%) than in the lateral group (68.2%; p = 0.022). Among patients who underwent fusion surgery, significantly fewer patients maintained their position in the supine group (10.0%) than those in the lateral group (60.0%, p = 0.029).

Conclusion

Postoperative discomfort was significantly reduced in the lateral position than in the supine position; thus, the lateral position is more suitable after lumbar surgery in terms of postoperative discomfort.

为了比较腰椎手术后仰卧位和侧卧位的术后疼痛和不适，进行了一项前瞻性随机对照研究。方法43例腰椎退行性疾病患者均行减压手术(n = 23)或融合手术(n = 20)，术后随机分为仰卧位(仰卧位组:n = 21)和侧卧位(侧卧位组:n = 22)两组，并保持该体位至术后1天。检查术后背部疼痛和不适(视觉模拟量表[VAS]， 0 ~ 100 mm)及能保持体位的患者人数。结果两组患者背部疼痛VAS评分(仰卧位:64.9±22.0，侧卧位:55.7±21.4)差异无统计学意义。仰卧位组(75.6±15.7)明显高于侧卧位组(64.9±15.7,p = 0.039)。仰卧位组(28.2%)明显少于侧卧位组(68.2%);p = 0.022)。在接受融合手术的患者中，仰卧位组保持体位的患者(10.0%)明显少于侧卧位组(60.0%，p = 0.029)。结论侧卧位术后不适感较仰卧位明显减轻;因此，就术后不适而言，侧卧位更适合腰椎手术后。
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引用次数: 1
Literature reviews 文学评论
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2022-11-01 DOI: 10.1016/j.ijotn.2022.100962
Carole Jackson, Carmen Queiros, Shareena Bibi Mohd Arif
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引用次数: 0
Editorial Board/Title Page 编委会/标题页
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2022-11-01 DOI: 10.1016/S1878-1241(22)00066-1
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引用次数: 0
Expert practice in orthopaedic nursing 骨科护理专家实习
IF 1.4 Q3 NURSING
International Journal of Orthopaedic and Trauma Nursing
Pub Date : 2022-11-01 DOI: 10.1016/j.ijotn.2022.100980
Paul McLiesh (Deputy Editor)
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引用次数: 0
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