Vårdtiderna för äldre patienter på sjukhus har förkortats och detta har fått till följd att allt fler äldre med stora omvårdnadsbehov skrivs ut till det egna hemmet. Flera brister har uppmärksammats när det gäller samordnad vårdplanering för den äldre patienten vid utskrivning från sjukhus till hemmet. En av utmaningarna för den samordnade vårdplaneringen är att ge den äldre patienten en individuellt anpassad hjälp där patientens behov av trygghet och självbestämmande tillgodoses. Syftet med litteraturstudien var att beskriva äldre patienters upplevelser av samordnad vårdplanering. Den litteratur som studerades bestod av nio kvalitativa och en kvantitativ artikel. Resultatet sammanfattades till två centrala teman vilka beskrev äldre patienters upplevelse av Otrygghet och hinder för Självbestämmande. Underteman som påverkade de äldre patienternas upplevelse av otrygghet och självbestämmande identifierades och beskrev strukturen på den samordnade vårdplaneringen, de äldre patienternas förberedelse inför samordnad vårdplanering, samt olika slag av kommunikation som användes under den samordnade vårdplaneringen. Dessa underteman kunde antingen främja eller hämma de äldre patienternas upplevelse av trygghet och möjlighet till självbestämmande. Risk finns för att den samordnade vårdplaneringen orsakar vårdlidande då äldre patienters livsvärld inte inkluderas och patientperspektivet inte beaktas. Ytterligare forskning om äldre patienters upplevelser i samband med samordnad vårdplanering är angelägen för att kunna säkerställa patientens behov av trygghet och självbestämmande. / The length of stay for the elderly patients in hospitals are becoming shorter, and this has led to an increasing number of elderly people with high care needs being discharged to their own home. Several deficiencies have been noted when it comes to discharge planning for the elderly patient when being discharged from hospital to home. One of the challenges for the discharge planning is to provide the elderly patient with an individually adapted plan that satisfies the patient's need for security and self-determination. The aim of the literature study was to describe older patients' experiences in the context of discharge planning. The literature study consisted of nine qualitative and one quantitative article. The result was summarized into two key themes describing older patients' experience of insecurity and self-determination. Sub themes that affected the elderly patients 'experience of insecurity and self-determination were identified and described the structure of discharge planning, the elderly patients' preparation for discharge planning, and different types of communication used during discharge planning. These subjects could either promote or inhibit the elderly patient's experience of security and self-determination. There is a risk that the discharge planning will cause care suffering when the elderly's lifeworld is not included and the patient perspective is not taken into account. Further research on older patients' experiences in the context of discharge planning is anxious to ensure the patient's need for security and self-determination.

In 2018, a new welfare law was implemented in Sweden aiming to increase the collaboration between hospital care, primary care and municipalities in cases where patients are in need of continued care and attention after they have been discharged from inpatient care (the Collaboration Act, my translation). The legislation contains instructions on the division of responsibilities between the different actors involved in the collaboration, but also provisions about municipal payment responsibility in cases where patients can´t be discharged from inpatient care at hospital within three days from the day he or she has been assessed as medically finished by the responsible doctor. This study aimed to describe and analyze the significance of the Collaboration Act for care managers in cases where elderly people have been discharged inpatient care. The empirical material was collected through qualitative interviews with six care managers. In order to analyze the empirical material a theoretical framework has been used consisting of Lundquists theory on officials as guardians of democracy and Lipskys theory on street-level bureaucrats. The result indicates that the care managers working methods are unchanged, but that the pace has increased in the care planning process. This means that the same amount of work must be performed as before, but with a more limited time before the municipal payment responsibility arises which has led to a consequence with inadequate investigations and needs assessments for the elderly client. To handle this dilemma, care managers overcompensate the elderly client with care interventions to create a feeling of security when they are dischared from inpatient care.

Contexte. Bien que les conséquences de la malnutrition après la sortie de l'hôpital soient bien documentées chez l’adulte, il est nécessaire d'évaluer les résultats des enfants hospitalisés dénutris lors de leur retour en communauté. Objectif. Cette étude prospective multicentrique vise à évaluer si le risque et le statut nutritionnel des enfants hospitalisés sont associés aux complications post-congé et aux réadmissions à l'hôpital. Méthodologie. Les données ont été recueillies dans 5 centres pédiatriques tertiaires canadiens entre 2012 et 2016. Le risque et le statut nutritionnel ont été mesurés à l'admission à l'hôpital par des outils validés et des mesures anthropométriques. Trente jours après la sortie, la survenue de complications après la sortie et les réadmissions à l'hôpital ont été documentées. Des tests du chi carré de Pearson et des régressions logistiques ont été réalisés pour explorer les relations entre les variables. Résultats. Un total de 360 participants a été inclus dans l'étude (âge médian, 6,07 ans ; durée médiane du séjour, 5 jours). Après la sortie de l'hôpital, 24,1 % ont connu des complications et 19,5 % ont été réadmis à l'hôpital. Les complications après la sortie étaient associées à un risque nutritionnel élevé (26,4 % ; χ2=4,663 ; p<0,05), à un état de malnutrition (32,2 % ; χ2=5,834 ; p<0,05) et à un faible niveau d'appétit (47,5 % ; χ2=12,669 ; p<0,001). Un risque nutritionnel élevé triplait presque les chances de complications (OR, 2,85 ; IC 95 %, 1,08-7,54 ; p=0,035) tandis qu'être mal nourri doublait la probabilité de développer des complications (OR, 1,92 ; IC 95 %, 1,15-3,20 ; p=0,013) et de réadmission à l'hôpital (OR, 1,95 ; IC 95 %, 1,12-3,39 ; p=0,017). Les raisons documentées de la réadmission comprenaient des infections aiguës (32,8 %) et des complications variées (31,4 %), telles que des symptômes gastro-intestinaux et/ou une aggravation de l'état de santé. Conclusion. Les enfants dénutris qui sortent d'un centre pédiatrique connaissent plus de complications que leurs homologues bien nourris, principalement des infections aiguës. Ces complications sont associées à une réadmission à l'hôpital. L'amélioration des soins et des services nutritionnels à la sortie de l'hôpital et dans la communauté est essentielle pour maintenir l'optimisation de l'état nutritionnel. / Context. While the consequences of malnutrition post-discharge are well-documented in adults, there is a need to assess the faith of malnourished inpatient children when returning in the community. Objective. This prospective multi-centered study aims to evaluate whether nutritional risk and status measured at admission are associated with post-discharge complications and hospital readmissions in children. Study design. Data was collected from 5 Canadian tertiary pediatric centers between 2012 and 2016. Nutritional risk and status were evaluated at hospital admission with validated tools and anthropometric measurements. Thirty days after discharge, occurrence of post-discharge complications and hospital readmission were documented. Pearson’s chi-squared tests and logistic regressions were used to explore the relationships between variables. Results. A total of 360 participants were included in the study (median age, 6.07 years; median length of stay, 5 days). Following discharge, 24.1% experienced complications and 19.5% were readmitted to the hospital. Post-discharge complications were associated with a high nutritional risk (26.4%; χ2=4.663; p<0.05), a malnourished status (32.2%; χ2=5.834; p<0.05) and a poor appetite level (47.5%; χ2=12.669; p<0.001). A high nutritional risk nearly tripled the odds of complications (OR, 2.85; 95% CI, 1.08-7.54; p=0.035) while being malnourished doubled the likelihood of developing complications (OR, 1.92; 95% CI, 1.15-3.20; p=0.013) and of hospital readmission (OR, 1.95; 95% CI, 1.12-3.39; p=0.017). The reasons documented for readmission included acute infections (32.8%) and varied complications (31.4%), such as gastrointestinal symptoms and/or worsening of medical condition. Conclusion. Complications post-discharge are common as are readmissions, however malnourished children are more likely to experience worst outcomes than their well-nourished counterparts. Enhancing nutritional care during admission, at discharge and in the community may be an area of outcome optimization.

Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture.

No description available.

No description available.

There are numerous threats to medication safety at care transitions, which are heightened for older people, because they live with multiple long-term conditions as well as polypharmacy, and have frequent hospital admissions. Whilst evidence of the severity and scale of these medicines-related problems exists, there is insufficient detail about the lived experience of post-discharge medicines management, in particular what helps or what hinders, and how better support could be enabled. This thesis, underpinned by the Medicines Research Council framework for complex intervention design, aimed to find acceptable intervention components, which would enhance patient experience. This research followed a sequential, mixed method design to: establish the evidence base through critical literature review, develop theory using an interview study grounded in behaviour change theory, and finally to model potential intervention components by expert consensus. Interviews revealed that there were gaps in current service provision, which impacted on participants’ knowledge of and capabilities with their medicines. Despite these challenges, some participants took actions to safeguard from problems after discharge. The literature review found that effective components of trialled interventions were self-management advice, post-discharge telephone follow up and medicines reconciliation. Further behaviour change techniques from the literature, alongside expert consensus and theory-driven analysis of interview findings resulted in final selection of eight potential components. Real-world implementation of these must be coupled with key changes to current healthcare practices and policy, including better engagement with patients and carers, as well as pro-active post-discharge follow-up. Future work must carefully explore how these components can be tested pragmatically.

Abstract The purpose of this work was to determine on the basis of the national hospital discharge register and cause-of-death statistics the extent of the hospital treatment required for chronic obstructive pulmonary disease (COPD) in Finland over the period 1972–2001, i.e. the use made of hospital services, factors affecting the length of stay in hospital and the correlation of length of stay with the prognosis. Different intervals within this period were taken for study according to the themes of the individual papers. The results suggest that the length of stay in hospital varies both geographically and seasonally in Finland, the shortest times being recorded in Northern Finland in summer. The main explanations for this would appear to lie in regional differences in health care resources and treatment practises and in climatic variations. The mean length of stay in hospital in the total material in 1987–1998 was nine days. The longest periods applied to cases with concurrent pneumonia or a cerebrovascular disorder. The duration of treatment for the exacerbation stage of COPD decreased by two days between 1993 and 2001, with the longest periods of treatment observed in the case of elderly women. One week of treatment with current modalities may be regarded as optimal, as this was associated with the longest interval before the next exacerbation, just over six months. About 3% of all emergency admissions ended in death, most commonly on a Friday in winter or spring. Patients admitted at a weekend died within the first 24 hours more frequently than did those admitted on a weekday. The mean duration of treatment and frequency of hospitalization increased towards the terminal stage. About one fourth of the patients had died within a year of the first admission for COPD and about a half within five years. Hospital treatment for COPD intensified in Finland during the 1990s as the numbers of hospital beds decreased. Treatment times became shorter and deaths in hospital during exacerbation became less frequent. It will be necessary from now onwards, however, to anticipate the ageing of the population and to develop treatment modalities to replace hospitalization, in order to reduce the costs accruing from this disease. Early diagnosis and outpatient rehabilitation should be developed, and special attention should be paid to appropriate treatment at the terminal stage. / Tiivistelmä Tutkimuksen tarkoituksena oli selvittää valtakunnallisen hoitoilmoitusrekisterin ja kuolemansyytilaston avulla keuhkoahtaumataudista (KAT) aiheutunutta sairaalahoitoa Suomessa 1972–2001: sairaalapalvelujen käyttöä, hoitojakson pituuteen vaikuttavia tekijöitä sekä hoitoajan yhteyttä ennusteeseen. Lähdeaineistosta valittiin erilaisia ajanjaksoja tutkimusasetelman mukaan. Tulokset viittaavat siihen, että hoitoajan pituus vaihtelee Suomessa maantieteellisesti ja vuodenaikojen mukaan: lyhyin hoitoaika on Pohjois-Suomessa kesällä. Ilmiötä selittänevät pääosin terveydenhuollon resurssien ja hoitokäytäntöjen alueelliset erot sekä ilmasto-olosuhteiden vaihtelu. Vuosina 1987–1998 keskimääräinen hoitoaika koko aineistossa oli yhdeksän vuorokautta. Jos potilaalla oli samanaikaisina sairauksina keuhkokuume tai aivoverenkiertohäiriö, nämä johtivat pisimpiin hoitoaikoihin. KAT:n pahenemisvaiheen hoitoaika lyheni kaksi vuorokautta vuodesta 1993 vuoteen 2001. Iäkkäitten naisten hoitoajat olivat pisimmät. Viikon pituinen hoitoaika nykyisillä hoitomuodoilla oli optimaalinen, sillä tällöin aika seuraavan pahenemisvaiheen hoitojakson alkuun oli pisin: vähän yli puoli vuotta. Kaikista päivystyshoitojaksoista potilaan kuolemaan päättyi kolmisen prosenttia. Yleisimmin tällainen hoitojakso päättyi potilaan kuolemaan perjantaisin ja todennäköisimmin talvella tai keväällä. Viikonloppuna sairaalaan tulleista potilaista kuoli ensimmäisen vuorokauden aikana enemmän kuin arkipäivinä tulleista. Keskimääräinen hoitoaika oli pisin ja sairaalahoito runsainta sairauden loppuvaiheessa kuoleman lähestyessä. Ensimmäisen KAT:n aiheuttaman hoitojakson jälkeen noin neljännes potilaista oli kuollut vuoden sisällä ja viiden vuoden kuluessa noin puolet. Keuhkoahtaumataudin sairaalahoito on tehostunut Suomessa 1990-luvulla sairaansijojen vähentyessä. Hoitoajat ovat lyhentyneet ja pahenemisvaiheiden sairaalakuolleisuus on vähäistä. Väestön ikääntyminen on kuitenkin ennakoitava ja sairaalaa korvaavia hoitomuotoja kehitettävä taudista aiheutuneiden kustannusten hillitsemiseksi. Varhaisdiagnostiikkaa ja avokuntoutusta on kehitettävä ja erityinen huomio kiinnitettävä sairauden loppuvaiheen asianmukaiseen hoitoon.

Syftet med denna studie har varit att undersöka om biståndshandläggares arbete inom äldreomsorgen har förändrats i samband med utskrivningsprocessen från sjukhus mot bakgrund av den nya lag som tillkom januari 2018, lag (2017:612) om samverkan vid utskrivning från sluten hälso- och sjukvård. Vi har velat synliggöra vilka förändringar av arbetet som skett i och med att lagändringen trädde i kraft, vad dessa i praktiken inneburit för biståndshandläggarna i arbete med äldre samt undersöka vad de upplever sig behöva för hanteringen av detta. Studien har en kvalitativ ansats och det empiriska materialet består av totalt åtta intervjuer med yrkesverksamma socionomer inom biståndshandläggning äldreomsorgen vid en stadsdelsförvaltning belägen i Stockholms kommun. Det insamlade materialet har analyserats genom användningen av en perspektivanalys och analysschema av Håkan Jönson. Vidare har vi analyserat våra resultat utifrån Michael Lipskys teori om gräsrotsbyråkrater och även använt oss av teoretiska begrepp som handlingsutrymme och makt. Resultatet av studien visar att det finns flera bakomliggande faktorer som påverkar biståndshandläggarnas upplevelser av sin yrkesroll utifrån den nya lagändringen, en har medfört ett förändrat arbetssätt och bland annat ställt krav på en högre grad av effektivisering i deras arbete. Respondenterna uttrycker att arbetssättet blivit mer akutstyrt, kravfyllt och de har svårigheter att förfoga över sin egen arbetstid vilket leder till att utskrivningar prioriteras framför hembesök och uppföljningar som därmed skjuts upp. Vidare framgår att det har blivit en sämre kvalité i arbetet då biståndshandläggarna pressas till att arbeta bakvänt i handläggningen till följd av bristande och uteblivna ADL-bedömningar (aktiviteter i det dagliga livet) från vårdens sida och de förkortade handläggningsdagarna i samband med utskrivningsprocessen. Biståndshandläggarna påverkas av stress i arbetet då tempot avsevärt har ökat vilket kan leda till felaktigheter i handläggningen och i förlängningen en känsla av otrygghet och rättsosäkerhet för den äldre. / The purpose of this study has been to investigate how the work of care managers has changed in connection with the discharge process from hospital against the background of the new law that was added in January 2018, Law (2017:612) on collaboration during discharge from inpatient health care. We wanted to make visible the changes to the work that took place as a result of the change in law coming into force, what these meant in practice for the care managers, and to examine what they feel they need to handle this. The study has a qualitative approach and the empirical material consists of a total of eight interviews with professional care manager in the field of elderly care assistance at a district administration located in Stockholm municipality. The collected material has been analyzed through the use of a perspective analysis and analysis scheme by Håkan Jönson. Furthermore, we have analyzed our results based on Michael Lipsky's theory of the street-level bureaucrats and also used theoretical concepts such as discretion and power. The results of the study show that there are several underlying factors that affect the care managers experiences of their professional role based on the new law change, one has brought about a changed way of working and, among other things, set demands for a higher degree of efficiency in their work. The respondents express that the way of working has become more urgent, full of demands and they have difficulties managing their own working hours, which leads to discharges being prioritized over home visits and follow-ups, which are therefore postponed. Furthermore, it appears that there has been a lower quality in the work as the care managers are pressured to work backwards in the processing as a result of insufficient and absent ADL assessments (activities in daily life) from the care side and the shortened processing days in connection with the discharge process. The care managers are affected by stress at work as the pace has increased significantly, which can lead to errors in the processing and, by extension, a feeling of insecurity and legal uncertainty for the elderly.

Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323