Introduction Positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) in the VA Health Care System is challenging due to high demand/ limited resources and delay in timely ...communication of PAP problems. The 4 PAP respiratory therapists (RTs) at the Gainesville VAMC provide durable medical equipment (DME) services for over 5000 patients, making timely response to new PAP-user issues difficult. The Patient Adherence Management System utilizes protocol-driven centralized sleep coaches (CSC) who monitor adherence via a wireless PAP data program and provide live telephone contact on Days 3,7,14, and 30 after PAP setup to identify issues and encourage adherence. PAP issues not resolved by CSC are escalated to the DME/sleep provider. We hypothesized the CSC system improves PAP adherence in treatment-naïve patients. Methods A randomized prospective protocol comparing: Arm 1: standard PAP care (SPC) including PAP setup by PAP RT, wireless adherence monitoring, and a PAP help line. Arm 2: SPC + CSC. At PAP setup patients electing to participate signed an informed consent and were randomized to SPC or SPC+ CSC. The primary endpoint was 3-month adherence, and secondary endpoints were the change in Epworth sleepiness scale (ESS) and patient satisfaction. Results 117 patients were randomized (SPC+CSC n= 59, SPC n=58). The baseline characteristics SPC+CSC versus SPC (mean ± SD) for age (54.4 ± 10.7 versus 56.4 ± 13.6 yrs), diagnostic AHI (40.1 ± 23.4 versus 39.9 ± 24.7 #/hr), and ESS (11.4 ± 5.9 versus 10.6 ± 5.9) did not differ. At 3 months the % of participants with ≥ 70% of nights with ≥ 4 hrs of use (SPC+CSC 67.8 % versus SPC 46.6%, P=0.025) and average use among all nights (4.5 ± 2.4 versus 3.3 ± 2.6 hrs, P=0.022) were higher in the CSC arm. The residual AHI and improvement in ESS did not differ. The percentage of patients satisfied/very satisfied with their therapy was higher in the SPC+CSC group (88.5% versus 67.3%, P=0.01) Conclusion Addition of the CSC system to standard care significantly improves PAP adherence at 3 months. Support (If Any) Philips Respironics
This article reviews the studies examining patients' perspective toward telemedicine and their preference for virtual health care services.
An electronic literature search using PubMed was conducted ...to identify relevant research studies published between December 2019 and August 2020. Twenty-five studies were selected out of 1,041 studies based on inclusion and exclusion criteria, which highlight patients' satisfaction and experience with the use of telemedicine during the pandemic.
The findings based upon 48,144 surveyed patients and 146 providers in 12 different countries revealed high satisfaction with virtual encounters across a spectrum of diseases. Telemedicine was found satisfactory on various outcome measures, such as addressing patients' concerns, communication with health care providers, usefulness, and reliability. Most common advantages were time saved due to lesser traveling and waiting time, better accessibility, convenience, and cost efficiency. Age and sex did not significantly impact the satisfaction levels. Physicians and patients both showed a strong preference for continued usage and agreed upon telemedicine's potential to complement the regular health care services even after the pandemic. Technical challenges (reported in 10 studies) and lack of physical examination (reported in 13 studies) were the main limitations encountered in virtual visits.
Long-term sustainability of telemedicine for all socioeconomic classes requires closer scrutiny of issues such as technology, training, reimbursement, data privacy, legal guidelines, and framework. Telemedicine must be adopted as a proactive strategy and scaled-up even beyond emergency usage due to its immense potential in complementing conventional health care services, such as diagnosis, treatment, follow-up, surveillance, and infection control.
Patient privacy is top-of-mind for nurses, yet maintaining privacy is often focused on protected health information and upholding the standards of the Health Insurance Portability and Accountability ...Act of 1996. A 100-bed oncology specialty hospital consistently scored high in overall patient satisfaction, yet some areas warranted improvement. A "Wildly Important Goal" was created to attempt to move the needle in one of these areas. Three units focused on "staff concern for privacy" with a mean percentile ranking of 53%. Oncology patients are often faced with difficult conversations related to care decisions and deserve privacy during these conversations. This initiative was to ensure that patients' felt that staff cared about their privacy. The units created interactive boards to track progress. Teams met weekly to review interventions and progress. Teams were charged with meeting goals and held accountable by their peers and leaders. Staff intentionally used the word "privacy" when caring for patients or talking with visitors. Interventions evolved, including scripting with patients, visitors, physicians, and others. Also included were knocking and identifying one's self when entering patient rooms, asking permission to have conversations in the presence of others, and asking team members, including physicians, to delay sensitive conversations until privacy was ensured. Progress was measured via self-reporting, peer recognition, patients' verbal feedback during leader rounding, and Press-Ganey percentile rankings. Within the first month, scores rose dramatically to 81%. By the end of month four, most units had achieved percentile rankings close to 100% and to date have sustained these scores. Leader rounding and Press-Ganey surveys veys revealed that patients' expressed dissatisfaction with staff concern for their privacy. It was necessary to improve patients' perception, staff interventions, and percentile ranking. Improving patient privacy scores in a hospital with semi-private rooms seemed a daunting task to leaders. The original goal was a 10% increase, yet a 45% increase was seen in 7 months. Placement of tracking boards kept the initiative at top of mind and allowed patients to see that there was concern for their privacy. A QR code was created for staff check-in and accountability. When faced with what appeared insurmountable, leaders coached their staff into moving the needle and frontline nurses were empowered to advocate for their vulnerable patients faced with private, often difficult conversations.
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Achieving excellent patient satisfaction is important because it is associated with positive patient outcomes. In addition, it can have a direct impact on hospital revenue. Despite different ...strategies implemented by healthcare facilities, improving patient satisfaction remains a huge challenge. Recently, there are studies showing the positive impact of nurse leader rounding (NLR) on patient satisfaction (Ayaad et al., 2019; Littleton et al., 2019). NLR allows nurse leaders to connect with patients, gain real-time feedback, achieve quick recovery, recognize staff, and follow up to ensure patients' needs are met (Morton et al., 2014; Tan & Lang, 2015). The purpose of this initiative was to improve patient satisfaction in the ambulatory oncology infusion clinics of a medical center by implementing nurse leader rounding of patients. The Plan-do-study-act model was used in this process improvement project. In January 2022, the ambulatory nursing supervisor, director of oncology operations, vice president of oncology services, and the director of patient experience met to plan, develop and implement nurse leader rounding of patients. A rounding script was created. Nurse leaders conducting rounds included the oncology nursing supervisor and the director of nursing. This initiative was implemented in March 2022. Patients were randomly selected and rounding lasted for an average of 5 minutes per patient. From March to August 2022, a total of 200 patients were rounded on between the two ambulatory oncology clinics. Post-implementation, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient satisfaction top box scores increased from 75% to 83% for both units. Nurse leader rounding of patients may improve patient satisfaction. Despite the small sample of patients rounded by the nurse leaders in this initiative, it still made a positive impact. One drawback of NLR is the amount of time needed to round patients especially with nurse leaders' competing priorities. Hospital leadership may consider having a designated time for nurse leaders to conduct NLR with no competing system wide meetings or other responsibilities to promote this practice. This initiative provides a different strategy that may be used in addition to existing strategies to improve patient satisfaction.
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Coordination of Care Medical oncology patients have complicated home and outpatient needs after hospitalization. They often require extensive post-discharge arrangements and enhanced discharge ...education. This contributes to delayed discharges with only 30% of patients leaving the hospital before 2 pm. Afternoon discharges delay new admissions because of bed availability and can set back the initiation of inpatient chemotherapy and treatment. This can ultimately extend the length of admission and create a costly cycle for the unit and frustration for patients, providers, and nursing staff. The goal of this project was multifactorial: to prepare hospitalized patients for discharge earlier in their hospital stay and improve their confidence in leaving the hospital; to educate patients about the discharge process so they could arrange transport and avoid frustration with additional delays; to facilitate discharges before 2pm allowing time sensitive chemotherapy admissions to start treatment sooner; and to include bedside nurses in the discharge process and discharge teaching throughout the patient's admission. Between January-March 2022, bedside nurses were educated on a new unit standard for preparing patients for discharge. Nursing staff were instructed to ask each of their patients on each shift what discharge concerns they had and document these concerns as well as any education provided and how the concern was being addressed in a newly created portion of the patient care plan in the electronic medical record. Daily audits were done to ensure nurses were implementing this practice and tracking how often the discharge question got asked. A laminated Discharge Checklist was also posted in each patient room listing the essential discharge steps that needed to be completed prior to discharge that the bedside or discharge nurses could check off with a dry erase marker. Staff and patient surveys were distributed after the implementation of this project that showed improved satisfaction in discharge process for both groups. A comparison analysis of reported delays in discharge revealed that 46% of discharges occurred before 2 pm in March 2022 compared to 36% in March 2021, an improvement of 10%. This discharge improvement project was successful and beneficial to the unit as evidenced by improved staff and patient satisfaction and earlier discharge times. This project will have long term positive effects on the discharge process if nurses continue to use the discharge tools that were developed.
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