Papers by Antoinette Conca
Background: Delays in patient discharge can not only lead to deterioration, especially among geri... more Background: Delays in patient discharge can not only lead to deterioration, especially among geriatric patients, but also incorporate unnecessary resources at the hospital level. Many of these delays and their negative impact may be preventable by early focused screening to identify patients at risk for transfer to a post-acute care facility. Early interprofessional discharge planning is crucial in order to fit the appropriate individual discharge destination. While prediction of discharge to a post-acute care facility using post-acute care discharge score, the self-care index, and a combination of both has been shown in a single-center pilot study, an external validation is still missing. Objective: This paper outlines the study protocol and methodology currently being used to replicate the previous pilot findings and determine whether the post-acute care discharge score, the self-care index, or the combination of both can reliably identify patients requiring transfer to post-acute care facilities. Methods: This study will use prospective data involving all phases of the quasi-experimental study "In-HospiTOOL" conducted at 7 Swiss hospitals in urban and rural areas. During an 18-month period, consecutive adult medical patients admitted to the hospitals through the emergency department will be included. We aim to include 6000 patients based on sample size calculation. These data will enable a prospective external validation of the prediction instruments. Results: We expect to gain more insight into the predictive capability of the above-mentioned prediction instruments. This approach will allow us to get important information about the generalizability of the three different models. The study was approved by the institutional review board on November 21, 2016, and funded in May 2020. Expected results are planned to be published in spring 2021. Conclusions: This study will provide evidence on prognostic properties, comparative performance, reliability of scoring, and suitability of the instruments for the screening purpose in order to be able to recommend application in clinical practice.
The use of nurse‐led care intervention to improve self‐care abilities subsequently decreasing readmission in multimorbid hospitalized patients: A quasi‐experimental study in a real‐world setting
Nursing open, Feb 28, 2023
AimNurse‐led care aims to optimize the discharge preparation with a focus on increasing patients&... more AimNurse‐led care aims to optimize the discharge preparation with a focus on increasing patients' independency and self‐care abilities. This study compared patients' improvements of self‐care abilities and frequency of readmission rate between nurse‐led care and regular nursing care within the acute hospital setting.DesignA quasi‐experimental design within a real‐world setting was used for this work.MethodsWe included a pool of 2501 patients from a control group (medically stable in usual care) and 420 patients from an intervention group (nurse‐led care). After propensity score matching, the study cohort consisted of 612 patients.ResultsFrom admission to discharge, nurse‐led care patients showed superior improvements of total self‐care abilities compared to usual care patients. In particular, we found improvements in the following categories: mobility, grooming and excretion. Patients with nurse‐led care were furthermore less frequently readmitted to hospital compared with the control group patients.Patient or public contributionNo patient or public contribution.
Journal of Clinical Medicine Research, 2012
Background: Acute decompensated heart failure (ADHF) causes a substantial burden for health care ... more Background: Acute decompensated heart failure (ADHF) causes a substantial burden for health care systems. Data to rationally define the need for hospitalization or the appropriate length of stay (LOS) is limited. Our aim was to personalize length of stay in patients admitted to hospital for acute decompensated heart failure. Methods: Consecutive patients with ADHF presenting to our emergency department were prospectively followed. We daily conducted a multidisciplinary risk assessment and compared proposed with actually observed triage decisions. Results: At presentation, all patients required hospitalization. Median LOS was 11 days including 1 day after reaching medical stability. In 42.7% of patients, hospitalization was prolonged after medical stability mainly for nursing and organizational reasons. Within 30 days of enrollment, 7 (9.3%) patients were rehospitalized, 3 of them for persisting or relapsing heart failure. Conclusions: There appears to be potential to shorten inhospital stay in patients with ADHF mainly by providing post discharge ambulatory nursing care in order to improve resource utilization and to diminish "hospitalization-associated disability".
Der Alltag pflegender Angehöriger – Was sie während des Spitalaufenthalts ihres Familienmitglieds beschäftigt im Hinblick auf den Austritt und was sie diesbezüglich für sich benötigen: eine qualitative Studie
Pflege, Apr 1, 2015
Background: The care of an elderly frail and ill family member places a great responsibility on i... more Background: The care of an elderly frail and ill family member places a great responsibility on informal caregivers. Following discharge of the older person from the hospital setting it can be observed that caregivers are often inadequately informed about aspects such as health status, prognosis, complications, and care interventions. Concerns and needs of caregivers regarding their daily living and routine following hospital discharge has not been investigated and is considered important for an optimized discharge management. Aim: To explore personal needs and concerns of informal caregivers with regard to daily living prior to discharge of their family member. Method: Eight narrative interviews were conducted with caregivers and were analysed using Mayring's content analysing method. Results: All caregivers had concerns regarding the maintenance of a functional daily routine. As well as caring and household duties, this functional daily routine included negotiating one's own personal time off duties, the reality of the deteriorating health status of the family member and the associated sense of hope. The intensity of family ties affected the functional daily routine. Caregivers had different expectations with regard to their integration during the hospital period. Conclusions: To support caregivers in their situation it is advisable to assess the functional daily routine of caregivers. Their need for time off their household and caring duties and their informational and educational needs to pertaining to disease progression, possible sources of support and symptom management should be recognised. Further inquiries into caregiver's involvement and responsibilities in the discharge process are needed.
In Krankenhäusern werden immer häufiger betagte Menschen mit mehreren Erkrankungen und hohen Bedü... more In Krankenhäusern werden immer häufiger betagte Menschen mit mehreren Erkrankungen und hohen Bedürfnissen an die Versorgung gepflegt. Seit Ende 2010 bietet das Kantonsspital Aarau (KSA) mit der pflegegeleiteten Versorgung (NLC-KSA) eine für den schweizerischen Kontext neue und innovative Versorgungsform an. Mit dieser neuen Versorgungsform und den dazugehörigen spezifischen Pflegeschwerpunkten erhalten medizinisch stabile, jedoch in ihren Alltags-und Selbstpflegefähigkeiten eingeschränkte Patienten eine individuelle Pflege, um ihre Selbstständigkeit, ihre Alltags-und Selbstpflegekompetenzen zu erhöhen. Diese Studie beschreibt die demographischen und pflegerischen Merkmale von NLC-KSA Patienten sowie die Unterschiede in den Alltags-und Selbstpflegekompetenzen zwischen NLC-KSA Versorgung und der üblichen Versorgung im Akutkrankenhaus. Aus allen zwischen Dezember 2012 und Januar 2014 in der medizinischen Universitätsklinik betreuten Patienten wurden jene Patienten ausgewählt, die mit der Versuchsgruppe (45 NLC-KSA Patienten) vergleichbar waren. Es zeigte sich, dass die NLC-KSA Patienten älter waren, als die in der medizinischen Gesamtgruppe. Außerdem hatten sie mehr Einschränkungen hinsichtlich ihrer Alltags-und Selbstpflegekompetenzen. Bereits bei Eintritt wurde bei dieser Patientengruppe ein erhöhtes Risiko für einen Bedarf an Unterstützung nach dem stationären Aufenthalt festgestellt. Im Vergleich zur Kontrollgruppe gewannen NLC-KSA Patienten, die bis zur Hälfte ihres Aufenthalts in NLC-KSA Versorgung waren, mehr Alltags-und Selbstpflegefähigkeiten zurück. Ebenso wurden sie selbstständiger im Bereich Bewegung. Schlussfolgernd lässt sich festhalten, da es sich bei den NLC-KSA betreuten Patienten um ältere und mehrfacherkrankte Patienten handelte, profitierten diese insbesondere von einem intensiveren Aufbautraining, der Unterstützung ihres Selbstmanagements und der gezielten Austrittsvorbereitung der pflegegeleiteten Versorgung. EINLEITUNG "Nurse-led care" oder pflegegeleitete Versorgung gilt als ein für die Schweiz neues Modell zur Optimierung der Patientenversorgung, besonders bei älteren, multimorbiden Patienten. Diese leiden nicht nur an einer, sondern an mehreren Krankheiten (Multimorbidität) und haben dadurch komplexere Pflege-und Betreuungsbedürfnisse auch während eines Krankenhausaufenthaltes (Moreau-Gruet, 2013). Die Zunahme von betagten und multimorbiden Patienten erhöht die Anforderungen an Behandlungsund Prozessabläufe in Akutkrankenhäusern. Da funktionale Verschlechterungen negative Folgen für die Betroffenen haben sowie hohe Kosten verursachen, wird empfohlen, diese prioritär zu behandeln (Lafont, Gérard, Voisin, Pahor, & Vellas, 2011). Die Schweizerische Akademie der Medizinischen Wissenschaften betont, dass Multimorbidität und die damit einhergehenden spezifischen Bedürfnisse an die Betreuung hohe Anforderungen an das Gesundheitswesen stellen. Um diesen Anforderungen gerecht zu werden, ist die Entwicklung sowie die Umsetzung einer patientenzentrierten und zielorientierten Versorgung unabdingbar (Battegay, 2014). Ebenfalls ist die Krankenhausorganisation rund um die älteren Patienten zu überdenken (Lafont et al., 2011). Die pflegegeleitete Versorgung ("Nurse-led care") hat das Ziel, die funktionalen Verschlechterungen zu verhindern, das Selbstmanagement und das Empowerment von Patienten zu fördern und dadurch die Gesundheitsergebnisse nachhaltig zu verbessern (Harris, Wilson-Barnett, & Griffiths, 2007). Pflegegeleitete Versorgung Die stationäre "Nurse-led" Versorgung im Krankenhaus Setting, welche von qualifizierten Pflegefachpersonen gemanagt wird, hat häufig das prioritäre Ziel, die postakute Phase des Therapieverlaufs zu unterstützen (Wong & Chung, 2006). Befinden sich Patienten in der stationären Postakutphase, sind sie nicht mehr auf intensive, ärztliche Behandlung angewiesen und werden zielgerichtet sowie individuell von qualifizierten Pflegenden auf den Austritt nach Hause oder in eine andere Institution vorbereitet. "Nurseled" Dienstleistungen werden interprofessionell erbracht
Disease Markers, 2015
The Glasgow Prognostic Score (GPS) is useful for predicting long-term mortality in cancer patient... more The Glasgow Prognostic Score (GPS) is useful for predicting long-term mortality in cancer patients. Our aim was to validate the GPS in ED patients with different cancer-related urgency and investigate whether biomarkers would improve its accuracy. We followed consecutive medical patients presenting with a cancer-related medical urgency to a tertiary care hospital in Switzerland. Upon admission, we measured procalcitonin (PCT), white blood cell count, urea, 25-hydroxyvitamin D, corrected calcium, Creactive protein, and albumin and calculated the GPS. Of 341 included patients (median age 68 years, 61% males), 81 (23.8%) died within 30 days after admission. The GPS showed moderate prognostic accuracy (AUC 0.67) for mortality. Among the different biomarkers, PCT provided the highest prognostic accuracy (odds ratio 1.6 (95% confidence interval 1.3 to 1.9), < 0.001, AUC 0.69) and significantly improved the GPS to a combined AUC of 0.74 (= 0.007). Considering all investigated biomarkers, the AUC increased to 0.76 (< 0.001). The GPS performance was significantly improved by the addition of PCT and other biomarkers for risk stratification in ED cancer patients. The benefit of early risk stratification by the GPS in combination with biomarkers from different pathways should be investigated in further interventional trials.
Inter- und intraprofessionelle Zusammenarbeit in Krisensituationen auf der Intensivstation am Beispiel von COVID-19
Pflege, Jun 10, 2021
Zusammenfassung. Hintergrund: Interprofessionelle Zusammenarbeit ist ein elementarer Bestandteil ... more Zusammenfassung. Hintergrund: Interprofessionelle Zusammenarbeit ist ein elementarer Bestandteil auf der Intensivstation, ein Erfolgsfaktor in schwierigen Patientensituationen und bei der Umsetzung von komplexen Therapien. Die COVID-19-Pandemie stellte neu zusammengesetzte Behandlungsteams vor Herausforderungen, Erfahrungen fehlten. Fragestellung und Ziel: Wir analysierten persönliche Erfahrungen und Sichtweisen zur inter- / intraprofessionellen Zusammenarbeit auf der Intensivstation während der COVID-19-Pandemie und identifizierten beeinflussende Faktoren. Methode: Wir nutzten ein qualitatives, retrospektives Studiendesign, erhoben Daten bei Ärzt_innen, Intensiv-, Anästhesie- und OP-Pflegefachpersonen und Physiotherapeut_innen in Gruppendiskussionen mittels Story- / Dialogue-Methode und analysierten die Daten mit Mayrings Qualitativer Inhaltsanalyse. Ergebnisse: Wir identifizierten zwei Hauptkategorien mit je drei Subkategorien: 1. Eine Ausnahmesituation aktiv meistern (Ein gemeinsames Ziel erkennen; Solidarisch handeln; Sich in der inter- / intraprofessionellen Zusammenarbeit kennenlernen), 2. Die Ausnahmesituation rückblickend überstanden haben (Persönliche Kontakte erhalten; Neues Wissen und neue Perspektiven gewonnen haben; Gelerntes mit in die Zukunft nehmen). Die Teilnehmenden bewerteten die inter- / intraprofessionelle Zusammenarbeit gut bis sehr gut. Schlussfolgerungen: Die Zusammenarbeit fördernde Faktoren und positive Erfahrungen sollen in den Arbeitsalltag übernommen werden. Das intraprofessionelle Kaderteam definiert dabei gemeinsame Ziele und Werte für eine bestmögliche Patientenversorgung.
JMIR Research Protocols, Jan 14, 2021
Background: Delays in patient discharge can not only lead to deterioration, especially among geri... more Background: Delays in patient discharge can not only lead to deterioration, especially among geriatric patients, but also incorporate unnecessary resources at the hospital level. Many of these delays and their negative impact may be preventable by early focused screening to identify patients at risk for transfer to a post-acute care facility. Early interprofessional discharge planning is crucial in order to fit the appropriate individual discharge destination. While prediction of discharge to a post-acute care facility using post-acute care discharge score, the self-care index, and a combination of both has been shown in a single-center pilot study, an external validation is still missing. Objective: This paper outlines the study protocol and methodology currently being used to replicate the previous pilot findings and determine whether the post-acute care discharge score, the self-care index, or the combination of both can reliably identify patients requiring transfer to post-acute care facilities. Methods: This study will use prospective data involving all phases of the quasi-experimental study "In-HospiTOOL" conducted at 7 Swiss hospitals in urban and rural areas. During an 18-month period, consecutive adult medical patients admitted to the hospitals through the emergency department will be included. We aim to include 6000 patients based on sample size calculation. These data will enable a prospective external validation of the prediction instruments. Results: We expect to gain more insight into the predictive capability of the above-mentioned prediction instruments. This approach will allow us to get important information about the generalizability of the three different models. The study was approved by the institutional review board on November 21, 2016, and funded in May 2020. Expected results are planned to be published in spring 2021. Conclusions: This study will provide evidence on prognostic properties, comparative performance, reliability of scoring, and suitability of the instruments for the screening purpose in order to be able to recommend application in clinical practice.
Zeitschrift Fur Gerontologie Und Geriatrie, Jun 13, 2019
Acknowledgements. We would like to thank the people who were involved in 4 data collection: the n... more Acknowledgements. We would like to thank the people who were involved in 4 data collection: the nursing team of the Acute Geriatric Unit, Pascale Haus, as well as Katharina
[Patient care expertise and daily presence]
PubMed, 2015
Lebens- und Pflegequalität aus der Sicht von Bewohnerinnen und Bewohnern in Pflegeheimen der Schweiz
Bis heute wird Pflegequalitat in Pflegeheimen meist aus der Sicht von Gesundheitsfachpersonen mit... more Bis heute wird Pflegequalitat in Pflegeheimen meist aus der Sicht von Gesundheitsfachpersonen mit objektiven Ergebniskriterien erfasst. Um ein umfassenderes Bild der Pflegequalitat zu erhalten, ist es wichtig, zusatzlich die subjektive Einschatzung der Betroffenen einzubeziehen. Anhand strukturierter Interviews wurden 1035 Bewohnerinnen und Bewohner aus 51 Pflegeheimen der deutsch- und der franzosischsprachigen Schweiz zu ihrer Lebensqualitat befragt.
Wirkt interkulturelle Mediation integrierend
... Sandro Cattacin für Initiative zu Beginn des Projektes, ▪ Frau Dr. Stephanie Schönholzer von ... more ... Sandro Cattacin für Initiative zu Beginn des Projektes, ▪ Frau Dr. Stephanie Schönholzer von der ... Dr. phil. Alexander Bischoff Dr. phil. Janine Dahinden Projektverantwortlicher INS Projektverantwortliche SFM Antoinette Conca-Zeller, MNS Igor Rothenbühler, lic. ethn. ...
JAMA network open, Sep 28, 2022
IMPORTANCE Whether interprofessional collaboration is effective and safe in decreasing hospital l... more IMPORTANCE Whether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial. OBJECTIVE To evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in
Arbeitsbelastung von Pflegehelfenden in Schweizer Alters- und Pflegeheimen
Zeitschrift Fur Gerontologie Und Geriatrie, Jun 20, 2016
Due to demographic changes, the demand for care in nursing homes for the elderly and infirmed is ... more Due to demographic changes, the demand for care in nursing homes for the elderly and infirmed is growing. At the same time nursing staff shortages are also increasing. Nursing aides are the primary care providers and comprise the largest staff group in Swiss nursing homes. They are exposed to various forms of job stress, which threaten job retention. The aim of this study was to discover which features of the work situation and which personal characteristics of the nursing aides were related to the workload. Data from nursing aides in Swiss nursing homes were investigated through a secondary analysis of a national quantitative cross-sectional study, using descriptive statistics and a nonlinear canonical correlation analysis. A total of 1054 nursing aides were included in the secondary analysis, 94.6 % of whom were women between the ages of 42 and 61 years. The job stress most frequently mentioned in the descriptive analysis, almost 60 % of the participants referred to it, was staff shortage. The nonlinear canonical correlation analysis revealed that many job strains are caused by social and organizational issues. In particular, a lack of support from supervisors was associated with staff not feeling appreciated. These job strains correlated with a high level of responsibility, the feeling of being unable to work independently and a feeling of being exploited. These strains were predominant in the nursing aides between 32 and 51 years old who had part time jobs but workloads of 80-90 %. Middle-aged nursing aides who worked to 80-90 % are particularly at risk to resign from the position prematurely. Measures need to be mainly implemented in the social and organizational areas. It can be assumed that a targeted individual support, recognition and promotion of nursing aides may decrease the level of job strain.
Journal of Advanced Nursing, Oct 3, 2020
Aims: To identify indicators of nursing care performance by identifying structures, processes, an... more Aims: To identify indicators of nursing care performance by identifying structures, processes, and outcomes that are relevant, feasible and have the potential for benchmarking in Swiss acute hospitals. Design: A modified Delphi-Consensus Technique. Methods: We examined 19 indicators based on the current evidence and that were pre-selected by nursing scientists. Between August-October 2019, a consortium of experts (representatives of different cantons, hospitals, and healthcare roles in Switzerland) determined the relevance, feasibility, and suitability for benchmarking these indicators in two-round modus of digital survey. Consensus was defined a priori by at least 75% agreement on the highest level of a 3-point Likert-type scale. Results: The response rate was 70.4% in the first and 68.4% in the second round. In round one consensus was reached for three indicators on relevance but for none of the indicators regarding feasibility or potential for benchmarking. For round two, the experts suggested two additional indicators (new total of 21 indicators). Of 21 indicators, consensus was reached on twelve regarding relevance, seven regarding feasibility, and two regarding the potential for benchmarking. Conclusion: A national expert consortium defined 12 of 21 nursing care indicators as relevant. Feasibility, however, was estimated only among seven indicators and a consensus on suitability for benchmarking was reached for two nursing-sensitive indicators. Impact: The results show how the indicators to evaluate nursing care performance, which have been identified as priority by Canadian nursing scientists, are assessed in a different setting. There are many overlaps, but also some differences in the assessment of the indicators between the different settings. Different health systems prioritize the indicators to evaluate nursing care performance differently, which is why national surveys are important for the compilation of their own (priority) indicator sets.
PLOS ONE, Mar 28, 2019
Background Reducing delays in hospital discharge is important to improve transition processes and... more Background Reducing delays in hospital discharge is important to improve transition processes and reduce health care costs. The recently proposed post-acute care discharge score focusing on the self-care abilities before hospital admission allows early identification of patients with a need for post-acute care. New limitations in self-care abilities identified during hospitalization may also indicate a risk. Our aim was to investigate whether the addition of the postacute care discharge score and a validated self-care instrument would improve the prognostic accuracy to predict post-acute discharge needs in unselected medical inpatients. Methods We included consecutive adult medical and neurological inpatients. Logistic regression models with area under the receiver operating characteristic curve were calculated to study associations of post-acute discharge score and self-care index with post-acute discharge risk. We calculated joint regression models and reclassification statistics including the net reclassification index and integrated discrimination improvement to investigate whether merging the self-care index and the post-acute discharge score leads to better diagnostic accuracy. Results Out of 1342 medical and 402 neurological patients, 150 (11.18%) and 94 (23.38%) have reached the primary endpoint of being discharged to a post-acute care facility. Multivariate analysis showed that the self-care index is an outcome predictor (OR 0.897, 95%CI 0.864-0.930). By combining the self-care index and the post-acute care discharge score discrimination for medical (from area under the curve 0.77 to 0.83) and neurological patients (from area under the curve 0.68 to 0.78) could be significantly improved. Reclassification statistics
Journal of nursing & care, 2016
Introduction: OPTIMA is a multi-professional quality management and research project, conducted a... more Introduction: OPTIMA is a multi-professional quality management and research project, conducted at the Cantonal Hospital of Aarau (KSA), Switzerland in cooperation with post-acute care institutions from November 2009 until December 2012. Objective: The goal of this study was to optimize patient care pathways and to provide patient-centered, costeffective care that is conform with the introduction of the Diagnosis Related Groups (DRG) in 2012. Methods: The "Post-Acute Care Discharge Scores" (PACD) was applied to assess the risk for transfer to postacute care facilities in 240 patients suffering from lower respiratory tract infections during the first phase of the study (OPTIMA I) from October 2009 until April 2010. In order to assess the patients' self-care ability, the "Self-Care Index" (SPI) tool was applied on admission and during the course of inpatient treatment. Results: The PACD predicted that 55% of patients (N=202) were at medium to high risk of requiring post-acute care. According to the SPI, 38% of patients (N=217) showed reduced ability to care for themselves. The discharge of 69% of medically stable patients (N=43) was postponed due to shortage of beds in post-acute care facilities. Correspondingly, 62% of the medically stable patients (N=141) could imagine receiving post-acute care in a "Nurseled Unit" (NLU). Despite being medically stable, one third of the patients (N=124) was not ready to return to their homes because they felt too weak or insecure to cope with everyday life. Conclusion: Using standardized tools to predict patients at risk for transfer to post-acute care facilities and reduced self-care abilities and the continuous evaluation of medical stability are all methods that could be applied to enhance interdisciplinary care and optimize discharge management. Furthermore, setting up NLU is expected to unburden the occupancy of acute care beds by a considerable amount of patients who are in need of post-acute care.
Open Access Emergency Medicine, Oct 1, 2017
Background: Benchmarking of real-life quality of care may improve evaluation and comparability of... more Background: Benchmarking of real-life quality of care may improve evaluation and comparability of emergency department (ED) care. We investigated process management variables for important medical diagnoses in a large, well-defined cohort of ED patients and studied predictors for low quality of care. Methods: We prospectively included consecutive medical patients with main diagnoses of community-acquired pneumonia, urinary tract infection (UTI), myocardial infarction (MI), acute heart failure, deep vein thrombosis, and COPD exacerbation and followed them for 30 days. We studied predictors for alteration in ED care (treatment times, satisfaction with care, readmission rates, and mortality) by using multivariate regression analyses. Results: Overall, 2986 patients (median age 72 years, 57% males) were included. The median time to start treatment was 72 minutes (95% CI: 23 to 150), with a median length of ED stay (ED LOS) of 256 minutes (95% CI: 166 to 351). We found delayed treatment times and longer ED LOS to be independently associated with main medical admission diagnosis and time of day on admission (shortest times for MI and longest times for UTI). Time to first physician contact (-0.01 hours, 95% CI:-0.03 to-0.02) and ED LOS (-0.01 hours, 95% CI:-0.02 to-0.04) were main predictors for patient satisfaction. Conclusion: Within this large cohort of consecutive patients seeking ED care, we found time of day on admission to be an important predictor for ED timeliness, which again predicted satisfaction with hospital care. Older patients were waiting longer for specific treatment, whereas polymorbidity predicted an increased ED LOS.
BMC Geriatrics, Sep 2, 2011
Background: Modern methods in intensive care medicine often enable the survival of older critical... more Background: Modern methods in intensive care medicine often enable the survival of older critically ill patients. The short-term outcomes for patients treated in intensive care units (ICUs), such as survival to hospital discharge, are well documented. However, relatively little is known about subsequent long-term outcomes. Pain, anxiety and agitation are important stress factors for many critically ill patients. There are very few studies concerned with pain, anxiety and agitation and the consequences in older critically ill patients. The overall aim of this study is to identify how an ICU stay influences an older person's experiences later in life. More specific, this study has the following objectives: (1) to explore the relationship between pain, anxiety and agitation during ICU stays and experiences of the same symptoms in later life; and (2) to explore the associations between pain, anxiety and agitation experienced during ICU stays and their effect on subsequent health-related quality of life, use of the health care system (readmissions, doctor visits, rehabilitation, medication use), living situation, and survival after discharge and at 6 and 12 months of follow-up. Methods/Design: A prospective, longitudinal study will be used for this study. A total of 150 older critically ill patients in the ICU will participate (ICU group). Pain, anxiety, agitation, morbidity, mortality, use of the health care system, and health-related quality of life will be measured at 3 intervals after a baseline assessment. Baseline measurements will be taken 48 hours after ICU admission and one week thereafter. Follow-up measurements will take place 6 months and 12 months after discharge from the ICU. To be able to interpret trends in scores on outcome variables in the ICU group, a comparison group of 150 participants, matched by age and gender, recruited from the Swiss population, will be interviewed at the same intervals as the ICU group. Discussion: Little research has focused on long term consequences after ICU admission in older critically ill patients. The present study is specifically focussing on long term consequences of stress factors experienced during ICU admission.
HeilberufeScience, Nov 30, 2022
Zusammenfassung Hintergrund Die Patientenzufriedenheit wird als ein Qualitätsindikator im Gesundh... more Zusammenfassung Hintergrund Die Patientenzufriedenheit wird als ein Qualitätsindikator im Gesundheitswesen angesehen. Bisherige Zufriedenheitsinstrumente in der Anästhesie bilden die Leistungen der Pflege nicht hinreichend ab, obwohl diese essenziell für die Teamleistung sind. Ziel Überarbeitung und Validierung eines Instruments zur Messung der Patientenzufriedenheit mit Anästhesieleistungen. Methode Zur Erfassung der Patientenzufriedenheit mit den Anästhesieleistungen in einer Querschnittstudie an 2 Kliniken wurde der "Heidelberg Peri-anaesthetic Questionnaire" überarbeitet und mittels einer explorativen Faktoranalyse auf Validität überprüft. Prädiktoren für die Patientenzufriedenheit wurden mittels Regressionsanalyse herausgearbeitet. Ergebnisse Die überarbeitete Version des Fragebogens mit 27 Fragen zur Messung der Patientenzufriedenheit mit den Anästhesieleistungen zeigte eine Einfaktorlösung der Dimension "Betreuung und Vertrauen" auf. Mit einem Cronbachs α von 0,955 weist dieser Fragebogen eine hohe interne Konsistenz auf. In der Regressionsanalyse zeigen sich, dass das Alter der Patientinnen und Patienten (OR 1,02, 95 %-KI 1,01-1,04), die mündliche Befragung (OR 2,49, 95 %-KI 1,28-4,87) und das weibliche Geschlecht (OR 0,58, 95 %-KI 0,39-0,87) einen signifikanten Einfluss auf die Patientenzufriedenheit mit den Anästhesieleistungen haben. Die Bildung, der Gesundheitszustand und das Spital zeigten sich nicht als Prädiktoren für die Patientenzufriedenheit mit den Anästhesieleistungen. Schlussfolgerungen Der Luzerner/Heidelberger Fragebogen ist zur Messung von Patientenzufriedenheit, einschließlich der Pflegeleistungen, geeignet und kann in der Praxis im deutschsprachigen Raum eingesetzt werden. Schlüsselwörter Zufriedenheit • Instrument • Faktoren • Prädiktoren Patient satisfaction with anesthesia services-Revision and validation of a questionnaire Abstract Background Patient satisfaction is considered a quality indicator in health care. General patient satisfaction does not provide information about patient satisfaction in the anesthesia setting. Previous satisfaction instruments do not adequately reflect the performance of nursing, although this is essential for team performance. Aim Revision and validation of an instrument to measure patient satisfaction with anesthesia services. Method To assess patient satisfaction with anesthesia services in a cross-sectional study at two hospitals, the "Heidelberg Peri-anaesthetic Questionnaire" was revised and tested for validity by means of an exploratory factor analysis. Predictors for patient satisfaction were worked out by means of regression analysis.
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Papers by Antoinette Conca