INTRODUCTIONThe aim of the present study was to investigate the challenges faced by physicians during shift handovers in a university hospital that has a high handover sender/recipient ratio.

METHODSA multifaceted approach was adopted, comprising recording and analysis of handover information, rating of handover quality, and shadowing of handover recipients. Data was collected at the general medical ward of a university hospital in Singapore for a period of three months. Handover information transfer (i.e. senders' and recipients' verbal communication, and recipients' handwritten notes) and handover environmental factors were analysed. The relationship between 'to-do' tasks, and information transfer, handover quality and handover duration, were examined using analysis of variance.

RESULTSVerbal handovers for 152 patients were observed; handwritten notes on 102 (67.1%) patients and handover quality ratings for the handovers of 98 (64.5%) patients were collected. Although there was good task prioritisation (information transfer: p < 0.005, handover duration: p < 0.01), incomplete information transfer and poor implementation of nonmodifiable identifiers were observed. The high sender/recipient ratio of the hospital made face-to-face and/or bedside handover difficult to implement. Although the current handover method (i.e. use of telephone communication), allowed interactive communication, it resulted in systemic information loss due to the lack of written information. The handover environment was chaotic in the high sender/recipient ratio setting, and the physicians had no designated handover time or location.

CONCLUSIONHandovers in high sender/recipient ratio settings are challenging. Efforts should be made to improve the handover processes in such situations, so that patient care is not compromised.

Adult ; Communication ; Continuity of Patient Care ; Data Collection ; Female ; Hospitals, University ; Humans ; Male ; Patient Handoff ; Patient Safety ; Physicians ; Singapore ; Young Adult

PURPOSE: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. METHODS: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. RESULTS: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. CONCLUSION: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.
Bias (Epidemiology) ; Continuity of Patient Care ; Education ; Emergency Service, Hospital ; Humans ; Outcome Assessment (Health Care) ; Patient Discharge ; Quality of Life ; Sample Size ; Transitional Care

No abstract available.
Continuity of Patient Care*

Objective: Our goal is to identify an operational roadmap of core elements in the set-up of the Philippines General Hospital Child Protection Unit (PGH-CPU) established in 1997, and Child Protection Network (CPN) established in 2002. This roadmap will guide future improvement needs for PGH-CPU and CPN and could help accelerate the set-up of future child protection units or networks. Methods: Using the 5 pillars of the Care Continuum for Child Maltreatment for categorization of deliverables — multidisciplinary intervention, training, governance, research/publication, and prevention — we identified operational deliverables (excluding patient numbers and outcomes) of the PGH-CPU and CPN. These were qualitatively analyzed to identify trends across the past 20-years and along 5 pillars of the Care Continuum. Results: Identification and qualitative analyses of documented deliverables reveal pillar-specific and time-dependent trends across 5-year periods. This trend analysis identified the core elements central to the set-up of a CPU and reveal an operational roadmap in the set-up of CPUs in resource-constrained settings. Conclusions Case study review and qualitative analyses identify core elements that comprise a roadmap for need based prioritization in the set-up of CPUs/CPNs towards a comprehensive care continuum for child maltreatment. The 20-year experience in a developing nation context validates the roadmap
Continuity of Patient Care

PURPOSE: This study aimed to construct a management model for patient transfer in a multilevel healthcare system and to predict the effect of counseling with nurses on the patient transfer process. METHODS: Data were collected from the electronic medical records of 20,400 patients using the referral system in a tertiary hospital in Seoul from May 2015 to April 2017. The data were analyzed using system dynamics methodology. RESULTS: The rates of patients who were referred to a tertiary hospital, continued treatment, and were terminated treatment at a tertiary hospital were affected by the management fee and nursing staffing in a referral center that provided patient transfer counseling. Nursing staffing in a referral center had direct influence on the range of increase or decrease in the rates, whereas the management fee had direct influence on time. They were nonlinear relations that converged the value within a certain period. CONCLUSION: The management fee and nursing staffing in a referral center affect patient transfer counseling, and can improve the patient transfer process. Our findings suggest that nurses play an important role in ensuring smooth transitions between clinics and hospitals.
Continuity of Patient Care ; Counseling* ; Delivery of Health Care ; Electronic Health Records ; Fees and Charges ; Humans ; Nursing ; Patient Transfer* ; Referral and Consultation ; Seoul ; Tertiary Care Centers

In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.
Telerehabilitation ; COVID-19 ; Continuity of Patient Care

The incidence of pediatric-onset inflammatory bowel disease (IBD) is on the rise, accounting for up to 25% of IBD cases. Pediatric IBD often has extensive bowel involvement with aggressive and rapidly progressing behavior compared to adult IBD. Because IBD has a high morbidity rate and can have a lifelong impact, successful transition from pediatric to adult care is important to maintain the continuity of care. Furthermore, successful transition facilitates appropriate development and psychosocial well-being among patients, as well as comprehensive and harmonious healthcare delivery amongst stakeholders. However, there are various obstacles related to patients, family, providers, and organizations that interfere with successful transition. Successful transition requires a flexible and tailored plan that is made according to the patient's developmental abilities and situation. This plan should be established through periodic interviews with the patient and family and through close collaboration with other care providers. Through a stepwise approach to the transition process, patients' knowledge and self-management skills can be improved. After preparation for the transition is completed and the obstacles are overcome, patients can be gradually moved to adult care. Finally, successful transition can increase patients' adherence to therapy, maintain the appropriate health status, improve patients' self-management, and promote self-reliance among patients.
Adult ; Colitis, Ulcerative ; Continuity of Patient Care ; Cooperative Behavior ; Crohn Disease ; Delivery of Health Care ; Humans ; Incidence ; Inflammatory Bowel Diseases* ; Self Care ; Transition to Adult Care*

Cancer patients suffer very diverse physical, psychological symptoms and functional impairments throughout cancer care continuum. These problems often go undetected and untreated, and may result in reduced health-related quality of life and disability. Cancer rehabilitation is a varied and challenging field of increasing public health importance. A growing evidence base suggests that impairment-driven rehabilitative interventions succeed in preserving and restoring the functional status of patients with cancer. There are many clinical and political barriers existed to limit expanding of this field. This article is intended to provide all cancer care physician with an overview of the issues relevant to the medical rehabilitation of patients with cancer.
Continuity of Patient Care ; Humans ; Public Health ; Quality of Life ; Rehabilitation*

Continuity of Patient Care ; Humans ; Models, Nursing ; Practice Patterns, Nurses' ; Singapore

PURPOSE: The purpose of this study was to identify level of recognition of the importance, satisfaction and contribution of APNs' role by physicians, nurses, and advanced practice nurses. METHOD: Perceived importance and satisfaction were measured with a 23-item questionnaire on APN role with 5 subcategories. APNs' contribution was investigated using a 13-item outcome questionnaire developed by the researchers. Between August 15 and October 31, 2009, the researchers collected data from 68 physicians, 265 nurses, and 23 APNs all working in a single tertiary hospital. Data were analyzed using descriptive statistics, Kruskal-Wallis Test with Bonferroni's Correction and scatter plot. RESULT: The importance (3.24~3.39, 4 point scale), satisfaction (3.02~3.13, 4 point scale), and contribution of APNs' role (3.39~4.12, 5 point scale) were well recognized by the health care professionals. All the three health care professional groups rated APNs' contribution high in medical service management, continuity of care, patient accessibility, improvement in patient satisfaction, and patient and family education. 'Importance-Satisfaction Analysis' showed that patient data management by APNs needed greater effort. CONCLUSIONS: The findings show that the importance, satisfaction, contribution of APNs' role are recognized, and indicate a need for further development of APNs' role through efforts to overcome the gaps identified through this research.
Continuity of Patient Care ; Delivery of Health Care ; Humans ; Patient Satisfaction ; Surveys and Questionnaires ; Tertiary Care Centers