Treatment Of A Hospitalized Patient

To effectively manage the discharge of individuals and transfer of care between settings, the social service team at UPMC-MDU start early to anticipate problems and discuss barriers and reoccurring traumatic events, but most importantly, patients and multidisciplinary team, via daily meeting, are involved at all stages of the discharge planning and medical treatment process. Considering this process and significance to employ a person-in-environment approach, I have become more aware of the need for skillful care coordination to achieve the most successful clinical and

Within this case study I am going to use two of the Chapelhow et al. (2005) enablers to discuss and reflect on the care of a patient I have been involved with on placement over a period of 5 weeks. ‘Enablers are the essential and underpinning skills that come together to provide expert professional practice’ (Chapelhow, C et al. 2005, p.2). These include; assessment, communication, documentation, risk, professional decision making and managing uncertainty. The enablers work together to provide a holistic approach to the care of patients in health care settings. I am going to focus on and discuss two of the enablers, linking them both together, which will be assessment and communication as I believe these two enablers can be related most to my patient.

Aiken, L.H., Clarke, S.P., Sloane, D.M., Lake, E.T. & Cheney, T. (2008). Effects of hospital care

In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals had to manage efficiently the treatment provided to a client and reduce the client’s length of stay (Jacob & Cherry, 2007). Case management, or internal case management “within the walls” of the health care facilities was created to streamline costs while maintaining quality care (Jacob & Cherry, 2007).

Due to variations in PACT patient plan of care and focus on high-risk patient needs, team huddles became a 2017 VISN 8 Leadership initiative to improve and sustain productive team huddles. I was instrumental in promoting THCC and Perry CBOC Team Huddles. At THCC I randomly attend PACT Huddles and evaluate productivity of multidisciplinary team participation. In the absence of the PC Nurse Manager, I provided NF/SG and VISN 8 leadership with weekly data reports on THCC PC and Perry CBOC team huddles and member attendance, as well as outcomes related to high-risk patients.

Healthcare in the United States is changing which has given rise to new hurdles that must be overcome. One of the issues that we are currently facing in many tertiary facilities is the need for set criteria involving intensive care unit admissions and discharges. Throughout the country the total number of intensive care unit (ICU) beds are on the rise, but the current supply still outnumbers the demand (Cognet & Coyer, 2014). The cost of staying in an ICU is continuing to increase with technology, and there are limitations that insurance companies and the government have set forth to the number of days a patient can reside there dependent upon his diagnosis and condition. Intensive care units will continue to undergo strain due to high census, and decisions to discharge patients will be effected (Wagner, Gabler, Ratcliffe, Brown, Strom, & Halpern, 2013). Typically, the decision to have a patient occupy an ICU bed is based upon whether or not they are sick enough to be there or if they are well enough to be discharged to a progressive care unit (PCU) or medical surgical unit (Meyer, 2003). A progressive care unit is a step down from an ICU, but has stricter criteria for admission than a medical surgical unit based upon the patients medical status. Not all facilities offer a PCU, but the need for this level of care is continuing to rise with the number of ICU admissions increasing. Standardized guidelines for patient placement in

The policy of interest that we have chosen to discuss is the two-midnight rule that is inclusive in the Independent Prospective Payers System of 2013. This rule states that only Medicare patients who are expected to require an admission for over two-midnights, or 48 hours, will have their stay covered (Wright, Junt, Feng, & Moore, 2014). The original intent of the observational status concept was to allow physicians a period of time to observe the patient to assess whether or not they required a more thorough medical workup and treatment (Doctorhoff et al., 2014). In 2013, this concept has spiraled into a situation where it is creating confusion to healthcare providers, as these patients are being admitted all over different hospital units, instead of a dedicated observation unit. It is also causing an increased cost to the patient for medical treatment because unless the admission is

In the United States, our health care system is often characterized by communication failures. According to the American Nurses Association (2012), “Care coordination has been proposed as a solution to many of the seemingly intractable problems of American health care: high costs, uneven quality, and too frequent disappointing patient outcomes” (para. 14). Care coordination is a very important aspect in nursing roles and is extremely valuable because it can improve outcomes for everyone: patients, payers, and providers. Although it is obvious that the changes will improve patient care and general efficiency, applying changes in the general approach and everyday routines may be overwhelming. Luckily, there are resources available for those interested in taking a more coordinated approach to primary care practice (“Social Media’s leading Physician Voice,” 2012).

One of the primary issues the Healthgrades report identified was the impact and direct costs involved with patient complications and mortality. Healthgrades focuses on making the hospitals accountable and transparent into their clinical performance thereby providing care that is of higher quality, save lives and decrease costs (Healthgrades, 2013). Everyone who works in an acute care setting hears the term “increased length of stay” and according to Healthgrades complications account for 31% to 68% of the total variation in direct hospital costs. In fact, increased length of stay has the biggest impact on direct cost to the hospital

Over the last several years there has been increased interest in the medical community on the initiative called rounding with a purpose. The point of this initiative is to make rounds more structured and routine that foster improved patient experiences (Borich, 2015). This has been widely proven to improve patient outcomes and satisfaction (Borich, 2015). In addition, research has also shown that regular rounding with the interdisciplinary team increases effective communication among caregivers (Flicek, 2012). At the end of the day, communication between nurses, physicians and patients affects care outcomes (Flicek,

After the enactment of the Affordable Care Act (ACA), patient length of stay (LOS) has become very important for the hospital administrators. One of the provisions in the ACA is bundled payment, also known as episode based payment which reimburses the healthcare providers on the basis of the expected costs for clinically defined episodes of care. For example, when two patients are admitted in the hospital with pneumonia, the reimbursement to the hospital will be same for both, even if one patient stay for 2 days and the other patient stays for 4 days. Hence, hospital tends to lose money (cost of patient room, nursing care, physician care, etc.) when patient have a longer length of stay. Further, when patient stays longer, hospital cannot admit new patient which results in further revenue loss. Thus, hospital administrators have set their sights on reducing the hospital length of stay.

The cost of the health care industry has always been rising since the early 1980s. It has been a growing concern in both the industry and society. Massachusetts General Hospital (MGH) is no exception. Even though the average length of stay (LOS) for the patients in MGH has been declining (Exhibit 10), it is still the highest compared to their competitors (Exhibit 6). Besides the cost, there is no uniformity of process and standardization across different facilities and departments of the hospital. MGH lacks communication and coordination between the facilities.

Furthermore, the conclusion identified that the classifications in the study that was based on patient care complexity, resulted with most patients being classified at minimal care (Andrade et al., 2017). In the conclusion, researchers identified limitations when conducting the study. Researchers indicated that, the study was lacking epidemiological information of the patients (Andrade et al., 2017). Along with the limitations of the study, researchers provided a recommendation of what could be done to fix this limitation in the study. It indicated that, studies should be conducted that would correlate the levels of patient care, hospitalization time, and epidemiological profile (Andrade et al., 2017). Providing this recommendation can improve further research on the use of a classification tool to improve how patient care is

Many standard procedures in surgeries nowadays that deal with biomaterial implants are loaded with antibiotics for local treatments and for the prevention of future implant infections. The goal of this approach is to rid the body of new infections or foreign bodies that may have entered during implantation of the biomaterial. The local release of antibiotics can be controlled and targeted based on the characteristics of the bacteria that are near the infection site. This route of treating infected tissues offers a never-before-seen possibility of an effective in situ treatment. Then again, some issues do raise concerning the effectiveness of this procedure with the fact that other experiments have been weakly proved to work.

Each hospital in the enterprise has accommodated a strategy to reduce the length of stay in the inpatient setting. The