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Background: Unit-to-unit transfer of critically ill patients infers hazards that may cause adverse events. Circumstantial factors associated with mortality after intensive care include days in the ICU, night-time or weekend discharge and capacity transfer as compared to other reasons for transfer. Distance travelled may also constitute an indirect risk. The aim of this study was to assess potential associations between these circumstantial factors and the risk of death 30 days after transfer. Methods: Data from 2015 to 2019 was retrieved from the Swedish Intensive Care Registry. Logistic regression was used for risk analysis. Results: Among 4,327 patients, 965 (22%) were deceased 30 days after transfer. 1351 patients undergoing capacity transfer had a higher morbidity than patients transferred for other reasons. Using univariable logistic regression, days spent in the referring ICU before transfer, capacity transfer as compared to clinical transfer and repatriation as well as SAPS3 in the receiving ICU were associated with a higher risk of death at 30 days. However, after multivariable regression with adjustment for ICD-10 diagnosis and Standardised Mortality Rate in the receiving ICU, these associations were lost. Conclusion: Our results suggest that inter-hospital transfer is safe to carry out at any time of day and over shorter as well as longer distances. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONPurpose: Work-related musculoskeletal disorders (WMSDs) during bed-to-wheelchair and wheelchair-to-commode transfers are a significant concern, yet prior assessments often focused on specific subtasks, overlooking potential cumulative risks.Methods: This study employed Xsens Inertial Measurement Units (IMUs) and force plates integrated with an automated Rapid Entire Body Assessment (REBA) system to provide a continuous and comprehensive evaluation of WMSDs risks associated with the use of a walking belt and a floor lift.Results: The continuous assessment revealed peak REBA scores ranging from 8.81 to 9.19, categorizing tasks such as applying the sling, repositioning the patient from supine to sitting, and adjusting the wheelchair footrest as high-risk. During bed-to-wheelchair transfers, the floor lift significantly reduced the mean peak REBA score by 1.73 points (95% CI [1.23, 2.24], p < 0.001) and the mean vertical force by 14.68 N (95% CI [10.15, 19.22], p < 0.001) compared to the walking belt.Conclusion: These findings highlight the value of a continuous risk assessment approach in identifying high-risk tasks and informing targeted ergonomic interventions. The results underscore the need for optimizing patient handling practices and developing advanced assistive devices to enhance caregiver safety and efficiency.The use of continuous and comprehensive evaluation tools like Xsens IMUs and the automated REBA system helps identify high-risk tasks more accurately, enabling targeted interventions in rehabilitation practices.The findings highlight the benefits of using floor lifts over walking belts, suggesting that integrating such equipment into rehabilitation protocols can significantly reduce the risk of WMSDs during patient transfers.Rehabilitation programs can incorporate specific training for caregivers on high-risk tasks such as applying slings, repositioning patients, and adjusting footrests to minimize WMSD risks.The use of continuous and comprehensive evaluation tools like Xsens IMUs and the automated REBA system helps identify high-risk tasks more accurately, enabling targeted interventions in rehabilitation practices.The findings highlight the benefits of using floor lifts over walking belts, suggesting that integrating such equipment into rehabilitation protocols can significantly reduce the risk of WMSDs during patient transfers.Rehabilitation programs can incorporate specific training for caregivers on high-risk tasks such as applying slings, repositioning patients, and adjusting footrests to minimize WMSD risks. [ABSTRACT FROM AUTHOR]

Background and Objectives: The COVID-19 pandemic caused a significant strain on world health care systems. The lack of trained and experienced staff was a complicated issue during the pandemic. To overcome insufficient staffing problems, the intrahospital transfer (IHT) strategy was implemented at Milad Hospital in Tehran during COVID-19. We evaluated the effectiveness of the IHT strategy in order to determine whether the strategy should be continued post-COVID. Methods: Six supervisors with experience in COVID-19 wards and the IHT strategy were consulted to identify the advantages of continuing the IHT strategy and to evaluate the success and continuation of IHT factors. Then, the decision-making trial and evaluation laboratory (DEMATEL) method was used to establish a network of influence relationships among IHT strategy factors' success. Results: The result showed that all criteria except increasing patient satisfaction (C1) and reducing waste of time (C8) are cause-and-effect criteria that affected other criteria. Conclusion: The research findings have implications for improving the day-to-day experience of staff navigating transfers of patients between wards and paraclinic units. This study also highlights the theoretical value of the cross-disciplinary integration of medical decision issues and multiple-attribute decision-making methodologies. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the prognosis of the not evaluated (NE) group by comparing it with the lost to follow-up (LTFU) group among patients with multidrug/rifampin-resistant tuberculosis (MDR/RR-TB). Materials and Methods: This was a retrospective longitudinal follow-up study using an integrated database constructed by data linkage of the three national databases. This database included 7226 cases of MDR/RR-TB notified between 2011 and 2017 in South Korea. Results: Among the 7226 MDR/RR-TB cases, 730 (10.1%) were classified as LTFU group, and 353 (4.9%) as NE group. When comparing NE group with LTFU group, there were no significant differences in the all-cause mortality rate (18.1% vs. 13.8%, p=0.065), median time to death [404 days (interquartile range, IQR 46-850) vs. 443 days (IQR 185-1157), p=0.140], and retreatment rate (26.9% vs. 22.2%, p=0.090). After adjusting for potential confounders, the adjusted hazard ratio (aHR) for all-cause mortality (aHR 1.11; 95% confidence interval 0.80-1.53; p=0.531) in NE group was not significantly different than that in LTFU group. Among retreated cases, NE group had a higher treatment success rate (57.9% vs 43.8%, p=0.029) and a lower LTFU rate (11.6% vs 38.3%, p<0.001) compared to LTFU group. Conclusion: NE group had an unfavorable outcome comparable to LTFU group, suggesting undetected cases of LTFU or deaths during the referral process. Establishing an efficient patient referral system would contribute to reducing the incidence of NE cases. [ABSTRACT FROM AUTHOR]

Background: Norwegian Municipal Inpatient Acute Care (MIPAC) services were established as part of the 2012 Coordination Reform. The intention was to prevent unnecessary hospital admissions by redirecting and maintaining less urgent patients at the primary care level, which provides inpatient acute healthcare services closer to patients' home. However, the role MIPAC plays in the patient trajectory and how trajectories vary across different units and settings is less clear. Objective: Therefore, this study aimed to (1) describe the general patient transfer trajectories for MIPAC patients and (2) examine facility and regional variations in MIPAC patients' sources of admission and discharge destinations. Design: A cross-sectional study using aggregated register data. Methods: The study involved 36 662 admissions across 185 MIPAC units in 2019. Descriptive statistics were used to describe patient transfer trajectories, and a random-effects multinomial logistic model was applied to assess the association between facility and regional factors and patients' admission sources and discharge destinations. Results: The findings revealed distinct admission and discharge patterns based on facility and regional factors. Notably, intermunicipal units with 5 and more municipalities collaborating had higher relative risk ratios (RRR) for discharging to hospital (RRR = 1.50, 95%CI: 1.30-1.72) compared with independent MIPAC units. Large MIPAC units with more than 5 beds had increased relative risk ratios of patients admitted from the hospital than from home (RRR = 4.29, 95%CI: 1.56-11.78). Additionally, regional disparities existed, with units in the Central (RRR = 2.29, 95%CI: 1.56-3.38) and Western Norway health authorities (RRR:1.58, 95%CI: 1.22-2.06) displaying higher nursing home discharge rates than units in the South-Eastern Norway health authority. Conclusions and implications: This study confirms the Norwegian MIPAC services' adherence to admission avoidance policies and identifies significant variations in service delivery across regions and facilities. The Norwegian MIPAC model also has potential to inspire other countries in developing admission avoidance services in the primary care setting. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to identify variables associated with clinical outcomes after urologic transfers before and during the COVID pandemic. Methods: After IRB approval, a retrospective chart review was performed on adult patients transferred to our institution from 01/01/2018 to 12/31/2019 ("pre‐COVID") and from 01/02/2020 to 12/31/2022 ("COVID"). We identified demographics, origin hospitals, ICD‐10 pre‐ and post‐transfer diagnoses, distance of transfer, and post‐transfer CPT codes. Results: During the study period, our adult urology service accepted 160 transfers with a mean patient age of 71 years. A total of 49/160 (30%) of subjects made up the "pre‐COVID" cohort and 111/160 (70%) made up the "COVID" cohort. There were 11/111 (10%) transfers of >100 miles in the COVID period but 0/49 in the pre‐COVID period (p = 0.02). Patients from the COVID period waited on average 1.2 days longer for a procedure after transfer compared to pre‐COVID period (p = 0.03). The time until a patient's surgical procedure after transfer was a significant predictor of length of stay > 5 days (OR 1.91, CI 1.43 – 2.58, p < 0.01). Different diagnosis upon re‐evaluation after transfer was associated with a decreased rate of subsequent readmission (OR 0.30, CI 0.09–0.97, p = 0.05). Conclusions: Long‐distance transfer, even >100 miles (which we termed "mega‐transfers"), was a new pandemic‐related phenomenon at our institution. Delays in definitive care and changes in diagnoses after transfer were associated with readmission and length of stay. Our findings illustrate the importance of inter‐institutional communication, diagnostic accuracy, and post discharge planning when managing transfer patients. [ABSTRACT FROM AUTHOR]

Many patients require inter-hospital transfer (IHT) to tertiary Emergency Departments (EDs) to access specialty services. The purpose of this study is to determine operational outcomes for patients undergoing IHT to a tertiary academic ED, with an emphasis on timing and specialty consult utilization. This study was a retrospective observational cohort study at a tertiary academic hospital from 10/1/21–9/30/22. Key operational metrics, including specialty consultations, were queried from the ED Information System (EDIS). Data were analyzed for temporal variation in operational metrics and consulting patterns between transferred and non-transferred patients, stratified by time of day and week. During the study period there were 50,589 ED patient encounters, of which 3196 (6.3 %) were identified as IHTs. Transferred patients made up a larger proportion of patient arrivals in off-hours compared to daytime hours (p < 0.001). Transferred patients were more likely to be admitted to the hospital (76 % vs 35 %, p < 0.001), go directly to a procedure (6 % vs 2 %, p < 0.001), or receive a specialty consult (90 % vs 42 %, p < 0.001), regardless of the day of week or time of day. Relative risk of consults amongst transferred patients varied by service, though was particularly increased amongst surgical sub-specialties. Transferred patients represented a larger proportion of ED volume during evening and overnight hours, received more consults, and had higher likelihood of admission. Consults for transfers were disproportionately surgical subspecialties, though few patients went directly to a procedure. These findings may have operational implications in optimizing availability of specialty services across regionalized health systems. [ABSTRACT FROM AUTHOR]

Purpose: Measures of disease burden using hospital administrative data are susceptible to over-inflation if the patient is transferred during their episode of care. We aimed to identify and compare measures of coronary heart disease (CHD) and myocardial infarction (MI) episodes using six algorithms that account for transfers. Patient and Methods: We used person-linked hospitalisations for CHD and MI for 2000– 2016 in Western Australia based on the interval between discharge and subsequent admission (date, datetime algorithms), pathway (admission source, discharge destination) and any combination to generate machine learning models (random forest [RF], gradient boosting machine [GBM]). The date and datetime algorithms used deidentified patient identifiers to identify records belonging to the same individual. We calculated counts, age-standardised rates (ASR) and age-adjusted trends for CHD and MI for each algorithm. Results: Counts of CHD increased from 11,733 in 2000 to 13,274 in 2016, while MI increased from 2605 to 4480 using the date algorithm. Correspondingly ASR for CHD decreased from 2086.2 to 1463.1 while MI increased from 468.2 to 498.1 per 100,000 person-years. ASR for CHD and MI for datetime algorithm were consistently 1– 2% higher than the date algorithm. Differences in ASR of CHD and MI counts increased over time with the admission source, RF and GBM algorithms relative to the date algorithm. Age-adjusted trends in CHD and MI episode rates using RF and GBM differed significantly from all other algorithms. Only 86.7% and 87.6% of MI episodes identified by the date algorithm were identified by the admission source and discharge destination algorithms, respectively. Conclusion: The date and datetime algorithms produced the most valid measures of CHD and MI episodes. Findings underscore the importance of identifying admission and discharge dates/times belonging to the same individual in enumerating these episodes. [ABSTRACT FROM AUTHOR]

Standardized transfer is an evidence-based framework designed to improve communication between healthcare professionals, reducing risks and ensuring safe, high-quality care. Despite its benefits, implementing this framework in clinical practice poses challenges. Nurses often do not use a systematic guide as a theoretical framework for handovers in daily practice. Objective: To explore nurses' perceptions regarding the use of standardized transfers. Methodology: This exploratory qualitative cross-sectional study aimed to gain insight into nurses' experiences and perspectives on pediatric patient transfers. Using purposive sampling, nurses from the pediatric intensive care unit and hospital wards at the hospital institution hosting the study were interviewed. Data were collected through 21 in-depth individual interviews conducted between April and May 2023. The semi-structured interviews, lasting 16 to 28 min, focused on nurses' views on communication between units during patient transfers. The qualitative approach allowed for a comprehensive understanding of nurses' perceptions, particularly the barriers they face in practice. The study included 21 nurses: 9 from the pediatric intensive care unit and 12 from pediatric wards. To ensure diverse representation, nurses with varying levels of work experience were included, and at least one nurse from each hospital ward participated. Results: The data were classified into the following main categories: the current state of pediatric patient transfers, attitudes of healthcare professionals, barriers and challenges to implementation, nursing documentation, motivational aspects, and the child-family relationship. The findings revealed significant issues in the communication process during patient transfers, with no systematic guidelines in place. While nurses demonstrated a positive attitude toward the standardization of transfers, they identified numerous practical challenges, particularly those related to the hospital's nursing documentation system. Conclusions: Nurses view standardized transfers favorably, but they face substantial barriers that limit their practical implementation. [ABSTRACT FROM AUTHOR]

Standardized transfer is an evidence-based framework designed to improve communication between healthcare professionals, reducing risks and ensuring safe, high-quality care. Despite its benefits, implementing this framework in clinical practice poses challenges. Nurses often do not use a systematic guide as a theoretical framework for handovers in daily practice. Objective: To explore nurses’ perceptions regarding the use of standardized transfers. Methodology: This exploratory qualitative cross-sectional study aimed to gain insight into nurses’ experiences and perspectives on pediatric patient transfers. Using purposive sampling, nurses from the pediatric intensive care unit and hospital wards at the hospital institution hosting the study were interviewed. Data were collected through 21 in-depth individual interviews conducted between April and May 2023. The semi-structured interviews, lasting 16 to 28 min, focused on nurses’ views on communication between units during patient transfers. The qualitative approach allowed for a comprehensive understanding of nurses’ perceptions, particularly the barriers they face in practice. The study included 21 nurses: 9 from the pediatric intensive care unit and 12 from pediatric wards. To ensure diverse representation, nurses with varying levels of work experience were included, and at least one nurse from each hospital ward participated. Results: The data were classified into the following main categories: the current state of pediatric patient transfers, attitudes of healthcare professionals, barriers and challenges to implementation, nursing documentation, motivational aspects, and the child-family relationship. The findings revealed significant issues in the communication process during patient transfers, with no systematic guidelines in place. While nurses demonstrated a positive attitude toward the standardization of transfers, they identified numerous practical challenges, particularly those related to the hospital’s nursing documentation system. Conclusions: Nurses view standardized transfers favorably, but they face substantial barriers that limit their practical implementation.

Purpose : The authors aimed to identify the factors affecting interhospital transfer (“transfer”) of severe pediatric patients who visited to an emergency department (ED). Methods : Using the Korean National ED Information System, we analyzed high-acuity patients aged 18 years or younger who visited EDs of local or regional emergency centers nationwide. The high acuity was defined as a Korean Triage and Acuity Scale 1-2. To investigate the factors associated with transfer, a multilevel modeling was selected, examining independent variables at both individual- and hospital-levels with transfer as a dependent variable. Results : A model consisting of variables at individual- and hospital-levels showed the factors as follows: mode of arrival(self-transport: odds ratio, 0.48 [95% confidence interval, 0.38-0.61]; other ambulances: 0.41 [0.24-0.71]; compared with firehouse ambulance), visit at 18:00-07:59 (0.75 [0.64-0.88]), intentional injury (1.59 [1.03-2.47]; compared with non-injury), decreased level of consciousness (drowsy: 1.94 [1.33-2.84]; stupor: 4.08 [2.99-5.57]; coma: 1.81 [1.26-2.60]; compared with alert), severe illness diagnosis (1.49 [1.12-1.98]), the number of all beds in EDs (1.02 [1.01-1.04]), and acceptance for treatment (0.92 [0.87-0.98]; with increment of 1%). Conclusion : This study confirms that both individual-level and hospital-level factors affect the transfer risk of severe pediatric patients in EDs. The study suggests the needs for direct transportation to specialized pediatric treatment facilities, and concentrated support for the pediatric emergency medical centers and pediatric trauma centers.

Adequate coordination between healthcare levels has been proven to improve clinical indicators, care costs, and user satisfaction. This is more relevant to complex or vulnerable patients, who often require increased care. This study aims to evaluate the differences between hospital discharge follow-up indicators, including number of general practitioners’ (GPs) and community nurses’ (CNs) consultations, presentiality of consultations, type of first post-discharge consultation, and time between hospital discharge and first consultation. Vulnerable and non-vulnerable patients were compared. A longitudinal retrospective study was carried out in the north of Tenerife on the post-discharge care of patients discharged from the Canary Islands University Hospital (Spanish acronym HUC) between 1 January 2018 and 31 December 2022. The results obtained show deficiencies in the care provided to patients by primary care (PC) after being discharged from the hospital, including delayed first visits, low presentiality of those visits that were less frequent even with increased patient complexity, scarce first home visits to functionally impaired patients and delays in such visits, and a lack of priority visits to patients with increased follow-up needs. Addressing these deficiencies could help those most in need of care to receive PC, thus reducing inequalities and granting equal access to healthcare services in Spain.

People who experience out-of-hospital cardiac arrest often require care at a regional center for continued treatment after resuscitation, but many do not initially present to the hospital where they will be admitted. For patients who require interfacility transport after cardiac arrest, the decision to transfer between centers is complex and often based on individual clinical characteristics, resources at the presenting hospital, and available transport resources. Once the decision has been made to transfer a patient after cardiac arrest, there is little direct guidance on how best to provide interfacility transport. Accepting centers depend on transferring emergency departments and emergency medical services professionals to make important and nuanced decisions about postresuscitation care that may determine the efficacy of future treatments. The consequences of early care are greater when transport delays occur, which is common in rural areas or due to inclement weather. Challenges of providing interfacility transfer services for patients who have experienced cardiac arrest include varying expertise of clinicians, differing resources available to them, and nonstandardized communication between transferring and receiving centers. Although many aspects of care are insufficiently studied to determine implications for specific out-of-hospital treatment on outcomes, a general approach of maintaining otherwise recommended postresuscitation care during interfacility transfer is reasonable. This includes close attention to airway, vascular access, ventilator management, sedation, cardiopulmonary monitoring, antiarrhythmic treatments, blood pressure control, temperature control, and metabolic management. Patient stability for transfer, equity and inclusion, and communication also must be considered. Many of these aspects can be delivered by protocol-driven care. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO) can be a life‐saving treatment for patients requiring advanced cardiopulmonary support. Several ECMO centres offer interhospital transport (ECMO IHT) services that involve establishing ECMO teams to initiate ECMO at referring hospitals and then transfer patients to ECMO centres. ECMO IHT is often high risk and complex. Understanding the experience of transport team members is crucial to ensure patient safety and promote quality improvement. Aim: To explore the experiences of transport teams performing ECMO IHT. Study Design: A descriptive qualitative methodology was adopted. Results: Thirteen health care professionals who have performed ECMO IHT at a general hospital in China agreed to be interviewed and enrolled in this study. Two investigators conducted face‐to‐face individual interviews in September–November 2022. All interviews were audio‐recorded, transcribed verbatim and analysed using inductive thematic analysis. Three main themes and nine sub‐themes were developed: (1) practicing with good organizational management (conducting training programs, cultivating the spirit of good teamwork and developing a standardized transport procedure), (2) dedicated to ensuring patient safety (adequate preparation and regular checking to reduce risk, accurate evaluation to avoid futility and maintaining communication to increase safety) and (3) having confidence despite being uneasy (feeling stressed is common, facing insecurity in transport settings and gaining confidence through practice). Conclusions: Health care professionals must adequately prepare and assess ECMO IHT to ensure patient safety. Supportive measures should be taken to ensure team members' health and improve patient safety. Good communication and teamwork could improve this challenging task. Further research is required for training programs and establishing standardized transport procedures. Relevance to Clinical Practice: This study presents multi‐professional perspectives on the experience of performing ECMO IHT to help management identify what needs to be further developed. With the increasing number of ECMO IHT, promoting its standardization is warranted. [ABSTRACT FROM AUTHOR]

Adequate coordination between healthcare levels has been proven to improve clinical indicators, care costs, and user satisfaction. This is more relevant to complex or vulnerable patients, who often require increased care. This study aims to evaluate the differences between hospital discharge follow-up indicators, including number of general practitioners' (GPs) and community nurses' (CNs) consultations, presentiality of consultations, type of first post-discharge consultation, and time between hospital discharge and first consultation. Vulnerable and non-vulnerable patients were compared. A longitudinal retrospective study was carried out in the north of Tenerife on the post-discharge care of patients discharged from the Canary Islands University Hospital (Spanish acronym HUC) between 1 January 2018 and 31 December 2022. The results obtained show deficiencies in the care provided to patients by primary care (PC) after being discharged from the hospital, including delayed first visits, low presentiality of those visits that were less frequent even with increased patient complexity, scarce first home visits to functionally impaired patients and delays in such visits, and a lack of priority visits to patients with increased follow-up needs. Addressing these deficiencies could help those most in need of care to receive PC, thus reducing inequalities and granting equal access to healthcare services in Spain. [ABSTRACT FROM AUTHOR]

Transfers between health facilities for postpartum women living with HIV are associated with disengagement from care. In South Africa, women must transfer from integrated antenatal/HIV care to general HIV services post-delivery. Thereafter, women transfer frequently e.g. due to geographic mobility. To explore barriers to transfer, we conducted in-depth interviews >2 years post-delivery in 28 participants in a trial comparing postpartum HIV care at primary health care (PHC) antiretroviral therapy (ART) facilities versus a differentiated service delivery model, the adherence clubs, which are the predominant model implemented in South Africa. Data were thematically analysed using inductive and deductive approaches. Women lacked information including where they could transfer to and transfer processes. Continuity mechanisms were affected when women transferred silently i.e. without informing facilities or obtaining referral letters. Silent transfers often occurred due to poor relationships with healthcare workers and were managed inconsistently. Fear of disclosure to family and community stigma led to transfers from local PHC ART facilities to facilities further away affecting accessibility. Mobility and the postpartum period presented unique challenges requiring specific attention. Information regarding long-term care options and transfer processes, ongoing counselling regarding disclosure and social support, and increased health system flexibility are required.

Background: Access to healthcare services is a prerequisite for societal justice. Unfair distribution of these services can lead to patient migration to cities with higher quality medical centers for better medical services. This study aimed to determine the direct and indirect non-medical costs of patients referred from Sistan and Balouchestan to hospitals in Mashhad.Methods: A descriptive-analytic study was conducted in Eastern Iran in 2020. The research sample included all patients who migrated from Sistan and Balouchestan to Mashhad for medical purposes and were hospitalized in government hospitals affiliated with Mashhad University of Medical Sciences. The total number of these patients was 2062, and they were identified using a census method in 2020. Given the large population size (2060 individuals), 350 patients were selected as a sample based on the Cochrane method. A validated checklist was used for data collection, and SPSS-23 software was used for data analysis.Results: The average direct non-medical cost for medical services in Mashhad was 61,686,857 Rials (270 USD). The highest and lowest costs were related to travel costs (26,545,714 Rials or 116 USD), and care received for children (37,142 Rials or 0.16 USD), respectively.Conclusion: According to the results of this research, an increase in direct non-medical and indirect costs due to patient migration for treatment imposes significant costs on patients and their families. It is crucial to have an equitable distribution of health and treatment resources and facilities across a country’s geographical regions to ensure access to health services.

Ruptured abdominal aortic aneurysms (rAAAs) are highly morbid emergencies. Not all hospitals are equipped to repair them, and an air ambulance network may aid in regionalising specialty care to quaternary referral centres. The association between travel distance by air ambulance and rAAA mortality in patients transferred as an emergency for repair was examined. A retrospective review of institutional data. Adults with rAAA (2002 – 2019) transferred from an outside hospital (OSH) to a single quaternary referral centre for repair via air ambulance were identified. Patients who arrived via ground transport or post-repair at an OSH for continued critical care were excluded. Patients were divided into near and far groups based on the 75th percentile of the straight line travel distance (> 72 miles) between hospitals. The primary outcome was 30 day mortality. Multivariable logistic regression was used to assess the association between distance and mortality after adjusting for age, sex, ethnicity, cardiovascular comorbidities, and repair type. A total of 290 patients with rAAA were transported a median distance of 40.4 miles (interquartile range 25.5, 72.7) with 215 (74.1%) near and 75 (25.9%) far patients. Both the near and far groups had similar ages, sex, and ethnicity. There was no difference in pre-operative loss of consciousness, intubation, or cardiac arrest between groups. Endovascular aneurysm repair utilisation and intra-operative aortic occlusion balloon use were also similar. Neither the observed (26.8% vs. 23.9%, p =.61) nor the adjusted odds ratio (0.70, 95% confidence interval 0.36 – 1.39, p =.32) 30 day mortality rate differed significantly between the near and far groups. Increasing distance travelled during transfer by air ambulance was not associated with worse outcomes in patients with rAAA. The findings support the regionalisation of rAAA repair to large quaternary centres via an integrated and robust air ambulance network. [ABSTRACT FROM AUTHOR]

Background: The recommended treatment for cervical spinal cord injury (cSCI) is surgical decompression and stabilization within 24 h after injury. The aims of the study were to estimate our institutional compliance with this recommendation and identify potential factors associated with surgical delay. Methods: Population-based retrospective database study of patients operated for cSCI in 2015-2022 within the South-East Norway Health Region (3.1 million inhabitants). Data extracted were demographics, injury description, management timeline, place of primary triage [local hospital (LH) or neurotrauma center (NTC)]. Main outcome variables were: (1) time from injury to surgery at NTC, (2) time from injury to admission NTC, and (3) time from admission NTC to surgery. Results: We found 243 cSCI patients having acute neck surgery. Their median age was 63 years (IQR 47-74 years), 77% were male, 48% were =65 years old. Primary triage at an LH occurred in 150/243 (62%). The median time from injury to acute surgery was 27.8 h (IQR 15.4-61.9 h), and 47% had surgery within 24 h. The median time from injury to NTC admission was 5.6 h (IQR 1.9-19.4 h), and 67% of the patients were admitted to the NTC within 12 h. Significant factors associated with increased time from injury to NTC admission were transfer via LH, severe preinjury comorbidities, less severe cSCI, time of injury other than night, absence of multiple injuries. The median time from NTC admission to surgery was 16.7 h (IQR 9.5-31.0 h), and 70% had surgery within 24 h. Significant factors associated with increased time from NTC admission to surgery were increasing age and non-translational injury morphology. Conclusion: Less than half of the patients with cSCI were operated on within the recommended 24 h time frame after injury. To increase the fraction of early surgery, we suggest the following: (1) patients with clinical suspicion of cSCI should be transported directly to the NTC from the scene of the accident, (2) MRI should be performed only at the NTC, (3) at the NTC, surgery should commence on the same calendar day as arrival or as the first operation the following day. [ABSTRACT FROM AUTHOR]

Introduction: This descriptive study reviews clinical outcomes of individuals admitted to a northern Canadian, rural intensive care unit (ICU) with severe COVID-19. It reports our site-specific data that is part of an ongoing global effort to gather data and guide therapy; the aims of this study were to describe participants admitted to our ICU with COVID-19 and illuminate challenges faced by rural and remote centres. Methods: This retrospective study examined data from participants admitted to the ICU with COVID-19 pneumonia between 24th November 2020 and 28th February 2022. Using data from electronic and hardcopy health records, data were obtained according to standardised forms developed for the Short Period Incidence Study of Severe Acute Respiratory Infection. Results: Eighty-five adult participants were admitted to our ICU with COVID-19. The median age of participants was 57 years old (range: 23–83 years); 49.4% were males and 50.6% were females. Of our cohort, 58.9% required mechanical ventilation at some point during their stay and the median duration of stay in our ICU was 5 days (range: 1–36 days). Amongst individuals included, 25.9% were discharged alive from our hospital on their index admission, 57.6% were transferred to another facility and 16.5% died in our facility. Conclusion: COVID-19 significantly strained our local ICU resources, necessitating high numbers of patient transfers. However, despite limited resources, patients at our site received contemporary guideline-based care for COVID-19 pneumonia. Future pandemic and surge capacity planning must ensure that rural and remote communities receive adequate additional resources to meet the anticipated needs of their local populations. Introduction: Cette étude descriptive examine les résultats cliniques des personnes admises dans une unité de soins intensifs rurale du nord du Canada avec une COVID-19 sévère. Elle rapporte des données spécifiques à notre site qui font partie d'un effort global en cours pour rassembler des données et guider la thérapie. Les objectifs de cette étude étaient de décrire les participants admis dans notre unité de soins intensifs avec la COVID-19 et d'éclairer les défis auxquels sont confrontés les centres ruraux et éloignés. Méthodes: Cette étude rétrospective a examiné les données des participants admis à l'unité de soins intensifs pour une pneumonie due à la COIVD-19 entre le 24 novembre 2020 et le 28 février 2022. Les données ont été obtenues à partir de dossiers médicaux électroniques et papier, selon des formulaires standardisés développés pour l'étude d'incidence à court terme des infections respiratoires aiguës sévères (SPRINT-SARI). Résultats: 85 participants adultes ont été admis dans notre unité de soins intensifs avec la COVID-19. L'âge médian des participants était de 57 ans (intervalle: 23-83 ans); 49,4% étaient des hommes et 50,6% des femmes. Dans notre cohorte, 58,9% ont eu besoin d'une ventilation mécanique à un moment ou à un autre de leur séjour et la durée médiane du séjour dans notre unité de soins intensifs était de 5 jours (intervalle: 1-36 jours). Parmi les personnes incluses, 25,9% sont sorties vivantes de notre hôpital lors de leur admission initiale, 57,6% ont été transférées dans un autre établissement et 16,5% sont décédées dans notre établissement. Conclusion: La COVID-19 a mis à rude épreuve les ressources de notre unité locale de soins intensifs, nécessitant un grand nombre de transferts de patients. Cependant, malgré des ressources limitées, les patients de notre site ont reçu des soins fondés sur des lignes directrices contemporaines pour la pneumonie due à la COVID-19. À l'avenir, la planification de la pandémie et de la capacité de pointe doit garantir que les communautés rurales et éloignées reçoivent des ressources supplémentaires adéquates pour répondre aux besoins anticipés de leurs populations locales. [ABSTRACT FROM AUTHOR]

BACKGROUND: Current literature has not adequately addressed factors affecting wait times for hip fracture surgery in the rural setting. OBJECTIVE: This study aims to assess the factors affecting admission, transit, and preoperative wait times that impact the timeliness of hip fracture surgery within a rural health system. METHODS: A single-center retrospective cross-sectional study was conducted in a rural community comprising five community hospitals and two receiving hospitals. A trauma registry study included all hip fracture cases from 2019. Mean, standard deviation, median, and interquartile range were calculated for admission wait times, transit times to the receiving hospitals, and preoperative wait times in hours. Metrics based on means or medians were developed for these wait times. RESULTS: A total of 163 patients met the inclusion criteria. The emergency department wait times before and after admission to the community hospitals were 1 hour and 2.5 hours, respectively. The transit times from the community hospitals, ranging from shorter to farther distances, to receiving hospitals were 40 minutes and 1 hour, respectively. The preoperative wait time for admitted and transferred patients was 12 hours. CONCLUSION: Our study outlines a methodology for establishing wait time metrics that impact surgical timeliness for hip fracture patients within a rural healthcare system. We recommend conducting comparable studies with larger sample sizes across different healthcare systems. [ABSTRACT FROM AUTHOR]

Background/Objectives: Transitions to and from Emergency Departments (EDs) can be detrimental to long‐term care (LTC) residents and burden the healthcare system. While reducing avoidable transfers is imperative, various terms are used interchangeably including inappropriate, preventable, or unnecessary transitions. Our study objectives were to develop a conceptual definition of avoidable LTC‐ED transitions and to verify the level of stakeholder agreement with this definition. Methods: The EXamining Aged Care Transitions study adopted an exploratory sequential mixed‐method design. The study was conducted in 2015–2016 in 16 LTC facilities, 1 ED, and 1 Emergency Medical Service (EMS) in a major urban center in western Canada. Phase 1 included 80 participants, (healthcare aides, licensed practical nurses, registered nurses, LTC managers, family members of residents, and EMS staff). We conducted semistructured interviews (n = 25) and focus groups (n = 19). In Phase 2, 327 ED staff, EMS staff, LTC staff, and medical directors responded to a survey based on the qualitative findings. Results: Avoidable transitions were attributed to limited resources in LTC, insufficient preventive care, and resident or family wishes. The definition generated was: A transition of an LTC resident to the ED is considered avoidable if: (a) Diagnostic testing, medical assessment, and treatment can be accessed in a timely manner by other means; (b) the reasons for a transfer are unclear and the transition would increase the disorientation, pain, or discomfort of a resident, outweighing a clear benefit of a transfer; and (c) the transition is against the wishes expressed by the resident over time, including through informal and undocumented conversations. There was a high level of agreement with the definition across the four participant groups. Conclusions and Implications: To effectively reduce LTC resident avoidable transitions, stakeholders must share a common definition. Our conceptual definition may significantly contribute to improved care for LTC residents. Key points: Important dimensions in assessing transition avoidability include timely diagnostic testing availability, in‐facility assessment and treatment options, clear transfer purpose, risk/benefit analysis for resident well‐being, and recognition of advanced care goals and informal care preferences.Our findings highlighted essential differences between perceptions of unnecessary and avoidable transitions.Avoidable transitions were attributed to limited resources in long‐term care, insufficient preventive care, and resident or family wishes. [ABSTRACT FROM AUTHOR]

Background: Although telecritical care (TCC) implementation is associated with reduced mortality and interhospital transfer rates, its impact on goal-concordant care delivery in critical illness is unknown. We hypothesized that implementation of TCC across the Veterans' Health Administration system resulted in increased palliative care consultation and goals of care evaluation, yielding reduced transfer rates. Methods: We included veterans admitted to intensive care units between 2008 and 2022. We compared palliative care consultation and transfer rates before and after TCC implementation with rates in facilities that never implemented TCC. We used generalized linear mixed multivariable models to assess the associations between TCC initiation, palliative care consultation, and transfer and subsequently used mediation analysis to evaluate potential causality in this relationship. Results: Overall, 1,020,901 veterans met inclusion criteria. Demographic characteristics of patients were largely comparable across groups, although TCC facilities served more rural veterans. Palliative care consultation rates increased substantially in both ever-TCC and never-TCC hospitals during the study period (2.3%–4.3%, and 1.6%–4.7%, p < 0.01). Admissions post-TCC implementation were associated with an increased likelihood of palliative care consultation (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01–1.15). TCC implementation was also associated with a reduction in transfer rates (OR 0.90, 95% CI 0.84–0.95). Mediation analysis did not demonstrate a causal relationship between TCC implementation, palliative care consultation, and reductions in interhospital transfer rate. Conclusions: TCC is associated with increased palliative care engagement, while TCC and palliative care engagement are both independently related to reduced transfers. [ABSTRACT FROM AUTHOR]

Burns are serious injuries associated with significant morbidity and mortality. In Israel, burn patients are often transferred between facilities. However, unstructured and non-standardized transfer processes can compromise the quality of patient care and outcomes. In this retrospective study, we assessed the impact of implementing a transfer form for burn management, comparing two populations: those transferred before and after the transfer form implementation. This study included 47 adult patients; 21 were transferred before and 26 after implementing the transfer form. We observed a statistically significant improvement in reporting rates of crucial information obtained by Emergency Room clinicians and inpatient management indicators. Introducing a standardized transfer form for burn patients resulted in improved communication and enhanced primary management, transfer processes, and emergency room preparation. The burns transfer form facilitated accurate and comprehensive information exchange between clinicians, potentially improving patient outcomes. These findings highlight the importance of structured transfer processes in burn patient care and emphasize the benefits of implementing a transfer form to streamline communication and optimize burn management during transfers to specialized burn centers. • The importance of a national structured burns transfer process. • Israeli National Burn Center introduced the transfer form for burns in 2020. • The transfer form can potentially streamline communication and optimize burn management. [ABSTRACT FROM AUTHOR]

Aims: To investigate the ways that nurses engage with referral letters and discharge summaries, and the qualities of these documents they find valuable for safe and effective practice. Design: This study comprised a qualitative, case‐study design within a constructivist paradigm using convenience sampling. Methods: Interviews were conducted with nurses to investigate their practices relating to referral letters and discharge summaries. Data collection also involved nurses' examination and evaluation of a diverse range of 10 referral letters and discharge summaries from medical records at two Australian hospitals through focus‐group sessions. The data were transcribed and analysed inductively. Results: In all, 67 nurses participated in interviews or focus groups. Nurses indicated they used referral letters and discharge summaries to inform their work when caring for patients at different times throughout their hospitalisation. These documents assisted them with verbal handovers, to enable them to educate patients about their condition and treatment and to provide a high standard of care. The qualities of referral letters and discharge summaries that they most valued were language and communication, an awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. Conclusion: Nurses relied on referral letters and discharge summaries to ensure safe and effective patient care. They used these documents to enhance their verbal handovers, contribute to patient care and to educate the patient about their condition and treatment. They identified several qualities of these documents that assisted them in maintaining patient safety including clarity and conciseness of information. Implications for the Profession and Patient Care: It is important that referral letters and discharge summaries are written clearly, concisely and comprehensively because nurses use them as key sources of evidence in planning and delivering care, and in communicating with other health professionals in relaying goals of care and implementing treatment plans. Impact: Nurses reported that they regularly used referral letters and discharge summaries as valuable sources of evidence throughout their patients' hospitalisation. The qualities of these documents which they most valued were language and communication styles, awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. This research has important impact on the patient experience in relation to encouraging effective referral letter and discharge summary writing. Reporting Method: We have adhered to the relevant EQUATOR guidelines through the SRQR reporting method. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Caregivers experience lower back pain due to patient transfer. Foot position is an important and adjustable posture for reducing lumbar loads during patient transfer. Specifically, a suitable foot position provides the use of the lower limbs instead of the lumbar region in patient handling. Thus, we have developed a monitoring and feedback system for foot positioning using wearable sensors to instruct suitable foot positions. However, existing measurement methods require multiple specific wearable sensors. In addition, the existing method has not been evaluated in patient transfer, including twisting and lowering. Thus, the objective of this study was to develop and evaluate a measurement method using only a smartphone-installed inertial sensor for foot position during patient transfer, including twisting and lowering. The smartphone attached to the trunk measures the acceleration, angular velocity, and geomagnetic field. The proposed method recognizes anteroposterior and mediolateral foot positions by machine learning using inertial data. The proposed method was tested using simulated patient transfer motions, including horizontal rotation. The results showed that the proposed method could recognize the two foot positions with more than 90% accuracy. These results indicate that the proposed method can be applied to wearable monitoring and feedback systems to prevent lower back pain caused by patient transfer. [ABSTRACT FROM AUTHOR]

Aims: The aims of the study were to gain insight in the transfer process from hospital to homecare or rehabilitation centre from a patient's perspectives and to describe the experienced involvement, information provision and information needs patients. Design: A multiple case study with a phenomenological approach. Methods: Observations and interviews were employed, between May 2019 and August 2019, to capture the patient's perspectives and experiences on involvement, information provision and needs. Observations were executed during the discharge process from hospital to homecare (n = 6) or revalidation centre (n = 1) and during admission interviews with community nurses (n = 6). Interviews were conducted at the patient's home and the revalidation centre. Results: Eight themes were identified within three phases of the transfer process. The Sign‐up phase contained two themes: 'organizing follow‐up care' and 'planning the moment of discharge from the hospital'. The two themes in the Transfer phase were, 'verbal information provision' and 'written information provision'. Four themes were identified in the End phase: 'nursing supplies', 'medication', 'the electronic patient portal' and 'continuation of (para)medical care'. Conclusions: Patient participation in the transition process from the hospital to follow‐up care can be improved. This study indicates that unsafe situations could be prevented by patient involvement and clear perceptions of the role and responsibilities of patients, family and healthcare professionals. Implications to Patient Care: Patient and family involvement has the potential to improve transition of care and techniques for shared decision‐making can be applied to a greater extent. Impact: This paper highlights that patients and families should be acknowledged as key figures in the transfer process and gives direction to healthcare professionals on how to increase involvement in the transfer process by actively inviting patients to participate in the transfer process. Reporting Method: COREQ guidelines for qualitative reporting. No patient or public contribution. Contribution to Global Clinical Community: This paper gives insights in patients' and families' perspectives on transition of nursing care and their involvement during the whole transfer process.This paper gives direction how to improve patient participation during the discharge process from hospital to follow‐up care. [ABSTRACT FROM AUTHOR]

Following a national multicentre study, two emergency department (ED) screening tools were developed to determine risk of medication-related problems; one for use at ED presentation and another at ED discharge to the community. This study aimed to determine the inter-rater reliability amongst ED health professionals when applying these screening tools to a series of case scenarios. A prospective, cross-sectional study was undertaken in the ED of a major metropolitan hospital. Twelve case scenarios were developed following ED observation of a range of patients, which were incorporated into a questionnaire and distributed to 50 health professionals. Inter-rater reliabilities of each explanatory variable of the screening tools and overall assessment were calculated using Fleiss' multi-rater kappa. The questionnaire was completed by 15 doctors, 19 nurses and 16 pharmacists. Fleiss' kappa showed an overall inter-rater reliability for the ED presentation tool of 0.83 (95% CI 0.83–0.84), indicating near perfect agreement. Fleiss' kappa for the ED discharge tool was 0.83 (95% CI 0.83–0.85), which also showed near perfect agreement. The screening tools produced favourable inter-rater reliability amongst ED health professionals. These results have important implications for ensuring consistency of ED decision-making in screening patients at risk of developing medication-related problems. [ABSTRACT FROM AUTHOR]

Background: Medication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient's medication use at home. Aim: In preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients, and data collection to reduce medication discrepancies at discharge and improve medication adherence, and (2) to explore the outcomes of the interventions. Method: Participants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed. Results: Of 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores. Conclusion: Based on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs. [ABSTRACT FROM AUTHOR]

Introduction: Due to the obviousness of musculoskeletal disorders in health workers, especially patient carriers, we felt it necessary to check the prevalence of musculoskeletal pain in these workers by correcting their posture. Mateials and Methods: The study is semi-experimental. First, a self-made demographic questionnaire was made on the level of awareness, and a Nordic questionnaire along with a numerical rating scale to measure the amount of pain related to musculoskeletal disorders was completed for all participants. Then, theoretical and practical interventions were carried out to correct posture using occupational medicine, ergonomics, and sports specialists, and again one month and six months later, questionnaires were completed and data were collected. In the end, data analysis was done with SPSS version 24 software. Results: Descriptive statistics show that interventions aimed at correcting postures, reduce the average pain scores for different body parts of patient carriers. The most prevalent musculoskeletal disorder was back pain. Statistical analysis showed that comparing the average score of back pain (p=0.000), neck (p=0.014), shoulder (p=0.006), knee (p=0.006), and leg (p=0.016) in patient carriers before There is a significant difference between postural correction and six months later. However, comparing the average pain score of the elbow (p=0.18), wrist (p=0.06), back (p=0.3), and thigh (p=0.08) at the end of six months after correcting the posture, no significant difference was observed. Conclusion: It seems that correcting the posture while carrying and moving the patient with the help of occupational medicine, ergonomics, and sports specialists can reduce musculoskeletal pain in medical workers, especially patient carriers. It was also seen that correcting posture has the fastest and highest effect on reducing back, neck, shoulder, knee, and leg pain.

Abstract Background Transferring residents from nursing homes (NHs) to emergency care facilities (ECFs) is often questioned as many are terminally ill and have access to onsite care. While some NH to ECF transfers have merit, avoiding other transfers may benefit residents and reduce healthcare system costs and provider burden. Despite many years of research in this area, differentiating warranted (i.e., appropriate) from unwarranted NH to ECF transfers remains challenging. In this article, we report consensus on warranted and unwarranted NH to ECF transfers scenarios. Methods A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics. Results Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions. Conclusions Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities.

Background: Transferring residents from nursing homes (NHs) to emergency care facilities (ECFs) is often questioned as many are terminally ill and have access to onsite care. While some NH to ECF transfers have merit, avoiding other transfers may benefit residents and reduce healthcare system costs and provider burden. Despite many years of research in this area, differentiating warranted (i.e., appropriate) from unwarranted NH to ECF transfers remains challenging. In this article, we report consensus on warranted and unwarranted NH to ECF transfers scenarios. Methods: A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics. Results: Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions. Conclusions: Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities. [ABSTRACT FROM AUTHOR]

Context: Hospitalized patients who experience unplanned intensive care unit (ICU) admissions face significant challenges, and their family members have unique palliative care needs. Objectives: To identify predictors of palliative care consultation among hospitalized patients with unplanned ICU admissions and to examine the association between palliative care consultation and family outcomes. Methods: We conducted a prospective cohort study of patients with unplanned ICU admissions at two medical centers in Seattle, WA. This study was approved by the institutional review board at the University of Washington (STUDY00008182). Using multivariable logistic regression, we examined associations between patient characteristics and palliative care consultation. Family members completed surveys assessing psychological distress within 90 days of patient discharge. Adjusted ordinal probit or binary logistic regression models were used to identify associations between palliative care consultation and family symptoms of psychological distress. Results: In our cohort (n = 413 patients and 272 family members), palliative care was consulted for 24% of patients during hospitalization (n = 100), with the majority (93%) of these consultations occurring after ICU admission. Factors associated with palliative care consultation after ICU transfer included enrollment site (OR, 2.29; 95% CI: 1.17–4.50), Sequential Organ Failure Assessment score at ICU admission (OR, 1.12; 95% CI: 1.05–1.19), and reason for hospital admission (kidney dysfunction [OR, 7.02; 95% CI: 1.08–45.69]). There was no significant difference in family symptoms of depression or posttraumatic stress based on palliative care consultation status. Conclusions: For patients experiencing unplanned ICU admission, palliative care consultation often happened after transfer and was associated with illness severity, comorbid illness, and hospital site. Patient death was associated with family symptoms of psychological distress. [ABSTRACT FROM AUTHOR]

Despite the proven benefits of motorized lifting devices in reducing the physical stresses experienced by nurses during patient transfers, the low adoption of these devices remains limited. The study aimed to assess the perceptions of nurses regarding the new motorized lifting device (NEAR-1) in terms of their perceived workload and usability during patient transfers. A cross-sectional study was conducted to evaluate the perceptions of nurses (n = 45) and students (n = 6) when performing patient transfers from bed to wheelchair and vice versa using the NEAR-1 compared to an existing floor lift, walking belt, and manual transfer. Participants filled out surveys evaluating the perceived task demands and usability of the NEAR-1, as well as open-ended interviews. The use of the NEAR-1 significantly reduced the mean of all NASA-TLX constructs (p < 0.001) when compared to manual transfer. When comparing with other existing lifting devices, the NEAR-1 (24.4 ± 3.0) recorded the lowest overall score of NASA-TLX perceived workload, followed by the existing floor lift (26.1 ± 11.6), a robotic-assisted transfer device (28.3 ± 6.8) and mechanical floor lift (31.5 ± 9.3). The participants recorded a usability score of 76.86, indicating positive perceptions of the nurses towards the technology. Overall, the NEAR-1 has the potential to reduce the physical stresses on nurses and decrease the likelihood of work-related musculoskeletal disorders (WMSDs). The NEAR-1 may represent a promising new intervention for transferring patients that is capable of minimizing the nurses' perceived workload in clinical and non-clinical settings. The NEAR-1 motorized lifting device reduced perceived workload for nurses while handling and transferring patients between a bed and wheelchair. The nurses recorded a usability score of 76.86 for the NEAR-1, reflecting their positive perceptions towards the technology. The new device has the potential to reduce the physical stress on nurses and decrease the incidence of work-related musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

Older patients often have complex medication regimens, which change as they move across transitions of care. Engagement of older patients and families in making medication decisions across transitions of care is important for safe and high-quality medication management. To explore decision-making between health professionals, older patients and families about medication changes across transitions of care, and to examine how patient and family engagement is enacted in the process of decision-making in relation to these medication changes. A focused ethnographic design was undertaken with semi-structured interviews, observations, and reflective focus groups or interviews. Reflexive thematic analysis was conducted on transcribed data. The study was undertaken at a public teaching acute care hospital and a public teaching community hospital in Australia. In all, 182 older patients, 44 family members and 94 health professionals participated. Four themes were conceptualised from the data: different customs and routines, medication challenges, health professional interactions, and patient and family involvement. Environments had differences in their customs and routines, which increased the potential for medication delays or the substitution of unintended medications. Medication challenges included health professionals assuming that patients and families did not need information about regularly prescribed medications. Patients and families were informed about new medications after health professionals had already made decisions to prescribe these medications. Health professionals tended to work in disciplinary silos, and they had views about their role in interacting with patients and families. Patients and families were expected to take the initiative to participate in decision-making about medication changes. Patient movements across transitions of care can create complex and chaotic medication management situations, which lacks transparency, especially for older patients and their families. A greater focus on pre-emptive and planned discussions about medication changes will contribute to improving patient and family involvement in medication decision-making. • Varied medication policies across settings were associated with adverse effects. • Older patients were not often given information about changes to their regular medications. • Older patients were informed about new medications after decisions were made. • Health professionals had rigid views about their own roles in medication decisions. • Shared decision-making was rarely observed during medication changes. [ABSTRACT FROM AUTHOR]

Background: Cranio-maxillofacial (CMF) injuries represent a significant challenge in low- and middle-income countries (LMICs), exacerbated by inadequate infrastructure, resources, and training. This systematic review aims to evaluate the current strategies and solutions proposed in the literature to improve CMF fracture care in LMICs, focusing on education, patient transfer, and off-label solutions. Methods: A comprehensive literature search was conducted using PubMed/Medline from January 2000 to June 2023. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Solutions were categorized into three main areas: education (digital and on-site teaching, fellowships abroad), patient transfer to specialized clinics, and off-label/non-operative solutions. Results: Twenty-three articles were included in the review, revealing a consensus on the necessity for enhanced education and training for local surgeons as the cornerstone for sustainable improvements in CMF care in LMICs. Digital platforms and on-site teaching were identified as key methods for delivering educational content. Furthermore, patient transfer to specialized national clinics and innovative off-label techniques were discussed as immediate solutions to provide quality care despite resource constraints. Conclusions: Effective CMF fracture care in LMICs requires a multifaceted approach, prioritizing the education and training of local healthcare professionals, facilitated patient transfer to specialized centers, and the adoption of off-label solutions to leverage available resources. Collaborative efforts between international organizations, local healthcare providers, and educational institutions are essential to implement these solutions effectively and improve patient outcomes in LMICs. [ABSTRACT FROM AUTHOR]

Background: Achieving efficient throughput of patients is a challenge faced by many hospital systems. Factors that can impede efficient throughput include increased ED use, high surgical volumes, lack of available beds, and the complexities of coordinating multiple patient transfers in response to changing care needs. Traditionally, many hospital inpatient units operate via a fixed acuity model, relying on multiple intrahospital transfers to move patients along the care continuum. In contrast, the acuity-adaptable model allows care to occur in the same room despite fluctuations in clinical condition, removing the need for transfer. This model has been shown to be a safe and cost-effective approach to improving throughput in populations with predictable courses of hospitalization, but has been minimally evaluated in other populations, such as patients hospitalized for traumatic injury. Purpose: This quality improvement project aimed to evaluate implementation of an acuity-adaptable model on a 20-bed noncritical trauma unit. Specifically, we sought to examine and compare the pre- and postimplementation metrics for throughput efficiency, resource utilization, and nursing quality indicators; and to determine the model's impact on patient transfers for changes in level of care. Methods: This was a retrospective, comparative analysis of 1,371 noncritical trauma patients admitted to a level 1 trauma center before and after the implementation of an acuity-adaptable model. Outcomes of interest included throughput efficiency, resource utilization, and quality of nursing care. Inferential statistics were used to compare patients pre- and postimplementation, and logistic regression analyses were performed to determine the impact of the acuity-adaptable model on patient transfers. Results: Postimplementation, the median ED boarding time was reduced by 6.2 hours, patients more often remained in their assigned room following a change in level of care, more progressive care patient days occurred, fall and hospital-acquired pressure injury index rates decreased respectively by 0.9 and 0.3 occurrences per 1,000 patient days, and patients were more often discharged to home. Logistic regression analyses revealed that under the new model, patients were more than nine times more likely to remain in the same room for care after a change in acuity and 81.6% less likely to change rooms after a change in acuity. An increase of over $11,000 in average daily bed charges occurred postimplementation as a result of increased progressive care–level bed capacity. Conclusions: The implementation of an acuity-adaptable model on a dedicated noncritical trauma unit improved throughput efficiency and resource utilization without sacrificing quality of care. As hospitals continue to face increasing demand for services as well as numerous barriers to meeting such demand, leaders remain challenged to find innovative ways to optimize operational efficiency and resource utilization while ensuring delivery of high-quality care. The findings of this study demonstrate the value of the acuity-adaptable model in achieving these goals in a noncritical trauma care population. This quality improvement project evaluated implementation of an acuity-adaptable model on a 20-bed noncritical trauma unit, examining the pre- and postimplementation metrics for throughput efficiency, resource utilization, and nursing quality indicators, as well as the model's impact on patient transfers for changes in level of care. [ABSTRACT FROM AUTHOR]

Rationale: Lung-protective mechanical ventilation strategies have been proven beneficial in the operating room (OR) and the ICU. However, differential practices in ventilator management persist, often resulting in adjustments of ventilator parameters when transitioning patients from the OR to the ICU. Objectives: To characterize patterns of ventilator adjustments during the transition of mechanically ventilated surgical patients from the OR to the ICU and assess their impact on 28-day mortality. Methods: Hospital registry study including patients undergoing general anesthesia with continued, controlled mechanical ventilation in the ICU between 2008 and 2022. Ventilator parameters were assessed 1 hour before and 6 hours after the transition. Measurements and Main Results: Of 2,103 patients, 212 (10.1%) died within 28 days. Upon OR-to-ICU transition, VT and driving pressure decreased (−1.1 ml/kg predicted body weight [IQR, −2.0 to −0.2]; P < 0.001; and −4.3 cm H2O [−8.2 to −1.2]; P < 0.001). Concomitantly, respiratory rates increased (+5.0 breaths/min [2.0 to 7.5]; P < 0.001), resulting overall in slightly higher mechanical power (MP) in the ICU (+0.7 J/min [−1.9 to 3.0]; P < 0.001). In adjusted analysis, increases in MP were associated with a higher 28-day mortality rate (adjusted odds ratio, 1.10; 95% confidence interval, 1.06–1.14; P < 0.001; adjusted risk difference, 0.7%; 95% confidence interval, 0.4–1.0, both per 1 J/min). Conclusion: During transition of mechanically ventilated patients from the OR to the ICU, ventilator adjustments resulting in higher MP were associated with a greater risk of 28-day mortality. [ABSTRACT FROM AUTHOR]

Abstract Background/Objectives Transitions to and from Emergency Departments (EDs) can be detrimental to long‐term care (LTC) residents and burden the healthcare system. While reducing avoidable transfers is imperative, various terms are used interchangeably including inappropriate, preventable, or unnecessary transitions. Our study objectives were to develop a conceptual definition of avoidable LTC‐ED transitions and to verify the level of stakeholder agreement with this definition. Methods The EXamining Aged Care Transitions study adopted an exploratory sequential mixed‐method design. The study was conducted in 2015–2016 in 16 LTC facilities, 1 ED, and 1 Emergency Medical Service (EMS) in a major urban center in western Canada. Phase 1 included 80 participants, (healthcare aides, licensed practical nurses, registered nurses, LTC managers, family members of residents, and EMS staff). We conducted semistructured interviews (n = 25) and focus groups (n = 19). In Phase 2, 327 ED staff, EMS staff, LTC staff, and medical directors responded to a survey based on the qualitative findings. Results Avoidable transitions were attributed to limited resources in LTC, insufficient preventive care, and resident or family wishes. The definition generated was: A transition of an LTC resident to the ED is considered avoidable if: (a) Diagnostic testing, medical assessment, and treatment can be accessed in a timely manner by other means; (b) the reasons for a transfer are unclear and the transition would increase the disorientation, pain, or discomfort of a resident, outweighing a clear benefit of a transfer; and (c) the transition is against the wishes expressed by the resident over time, including through informal and undocumented conversations. There was a high level of agreement with the definition across the four participant groups. Conclusions and Implications To effectively reduce LTC resident avoidable transitions, stakeholders must share a common definition. Our conceptual definition may significantly contribute to improved care for LTC residents.

Background Physician transfer is an alternate option to patient transfer for expedient performance of mechanical thrombectomy in patients with acute ischemic stroke. Methods and Results We conducted a systematic review to identify studies that evaluate the effect of physician transfer in patients with acute ischemic stroke who undergo mechanical thrombectomy. A search of PubMed, Scopus, and Web of Science was undertaken, and data were extracted. A statistical pooling with random‐effects meta‐analysis was performed to examine the odds of reduced time interval between stroke onset and recanalization, functional independence, death, and angiographic recanalization. A total of 12 studies (11 nonrandomized observational studies and 1 nonrandomized controlled trial) were included, with a total of 1894 patients. Physician transfer was associated with a significantly shorter time interval between stroke onset and recanalization with a pooled mean difference estimate of −62.08 (95% CI, −112.56 to −11.61]; P=0.016; 8 studies involving 1419 patients) with high between‐study heterogeneity in the estimates (I2=90.6%). The odds for functional independence at 90 days were significantly higher (odds ratio, 1.29 [95% CI, 1.00–1.66]; P=0.046; 7 studies with 1222 patients) with physician transfer with low between‐study heterogeneity (I2=0%). Physician transfer was not associated with higher odds of near‐complete or complete angiographic recanalization (odds ratio, 1.18 [95% CI, 0.89–1.57; P=0.25; I2=2.8%; 11 studies with 1856 subjects). Conclusions Physician transfer was associated with a significant reduction in the mean of time interval between symptom onset and recanalization and increased odds for functional independence at 90 days with physician transfer compared with patient transfer among patients who undergo mechanical thrombectomy.

BackgroundThe recommended treatment for cervical spinal cord injury (cSCI) is surgical decompression and stabilization within 24 h after injury. The aims of the study were to estimate our institutional compliance with this recommendation and identify potential factors associated with surgical delay.MethodsPopulation-based retrospective database study of patients operated for cSCI in 2015–2022 within the South-East Norway Health Region (3.1 million inhabitants). Data extracted were demographics, injury description, management timeline, place of primary triage [local hospital (LH) or neurotrauma center (NTC)]. Main outcome variables were: (1) time from injury to surgery at NTC, (2) time from injury to admission NTC, and (3) time from admission NTC to surgery.ResultsWe found 243 cSCI patients having acute neck surgery. Their median age was 63 years (IQR 47–74 years), 77% were male, 48% were ≥65 years old. Primary triage at an LH occurred in 150/243 (62%). The median time from injury to acute surgery was 27.8 h (IQR 15.4–61.9 h), and 47% had surgery within 24 h. The median time from injury to NTC admission was 5.6 h (IQR 1.9–19.4 h), and 67% of the patients were admitted to the NTC within 12 h. Significant factors associated with increased time from injury to NTC admission were transfer via LH, severe preinjury comorbidities, less severe cSCI, time of injury other than night, absence of multiple injuries. The median time from NTC admission to surgery was 16.7 h (IQR 9.5–31.0 h), and 70% had surgery within 24 h. Significant factors associated with increased time from NTC admission to surgery were increasing age and non-translational injury morphology.ConclusionLess than half of the patients with cSCI were operated on within the recommended 24 h time frame after injury. To increase the fraction of early surgery, we suggest the following: (1) patients with clinical suspicion of cSCI should be transported directly to the NTC from the scene of the accident, (2) MRI should be performed only at the NTC, (3) at the NTC, surgery should commence on the same calendar day as arrival or as the first operation the following day.