3 results on '"Kruse, Robin L."'
Search Results
2. A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement.
- Author
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Vogel, Todd R, Kruse, Robin L, Schlesselman, Chase, Doss, Elizabeth, Camazine, Maraya, and Popejoy, Lori L
- Abstract
Objective: Transition from the hospital to an outpatient setting is a multifaceted process requiring coordination among a variety of services and providers to ensure a high-quality discharge. Vascular surgery patients comprise a complex population that experiences high unplanned readmission rates. We performed a qualitative study to identify themes for process improvement for vascular surgery patients. A validated discharge process, RED (Re-Engineered Discharge), was used to identify additional actionable themes to create a more efficient discharge process tailored specifically to the vascular surgery population. Methods: A prospective, qualitative analysis at a tertiary center using a semi-structured focus group interview guide was performed to evaluate the current discharge process and identify opportunities for improvement. Focus groups were Zoom recorded, transcribed into electronic text files, and were loaded into Dedoose qualitative software for analysis using a directed content analysis approach. Two researchers independently thematically coded each transcript, starting with accepted discharge components to identify new thematic categories. Prior to analysis, all redundancy of codes was resolved, and all team members agreed on text categorization and coding. Results: Eight focus groups with a total of 38 participants were conducted. Participants included physicians (n = 13), nursing/ancillary staff (n = 14), advanced nurse practitioners (n = 2), social worker/dietitian/pharmacist (n = 3), and patients (n = 6). Transcript analyses revealed facilitators and barriers to the discharge process. In addition to traditional RED components, unique concepts pertinent to vascular surgery patients included patient complexity, social determinants of health, technology literacy, complexity of ancillary services, discharge appropriateness, and use of advanced nurse practitioners for continuity. Conclusions: Specific themes were identified to target and enhance the future vRED (vascular Re-Engineered Discharge) bundle. Thematic targets for improvement include increased planning, organization, and communication prior to discharge to address vascular surgery patients' multiple comorbidities, extensive medication lists, and need for complex ancillary services at the time of discharge. Other thematic barriers discovered to improve include provider awareness of patient health literacy, patient understanding of complex discharge instructions, patient technology barriers, and intrinsic social determinants of health in this population. To address these discovered barriers, organizational targets to improve include enhanced social support, the use of advanced nurse practitioners for education reinforcement, and increased coordination. These results provide a framework for future quality improvement targeting the vascular surgery discharge process. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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3. Cohort study of risk factors for 30-day readmission after abdominal aortic aneurysm repair
- Author
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Bath, Jonathan, Smith, Jamie B., Kruse, Robin L., and Vogel, Todd R.
- Abstract
Abstract.Background:We conducted a retrospective cohort study of thirty-day readmission after abdominal aortic aneurysm (AAA) repair. Patients and methods:Inpatients (2009–2016) undergoing elective AAA repair were selected from the multicenter Cerner Health Facts® database using ICD-9 procedure codes. We identified characteristics associated with 30-day readmission with chi-square analysis and logistic regression. Results:4,723 patients undergoing elective AAA procedures were identified; 3,101 endovascular aneurysm repairs (EVAR) and 1,622 open procedures. Readmission differed by procedure type (6.5 % EVAR vs. 9.3 % open, p =.0005). Multivariable logistic regression found that patients undergoing EVAR were less likely to be readmitted (OR 0.71, 95 % CI 0.54–0.92) than patients undergoing open repair. The following risk factors were associated with 30-day readmission following any AAA repair: surgical site infection during the index admission (OR 2.79, 95 % CI 1.25–6.22), age (OR 1.03, 95 % CI 1.01–1.05), receipt of bronchodilators (OR 1.34, 95 % CI 1.06–1.70) or steroids (OR 1.45, 95 % CI 1.04–2.02), serum potassium > 5.2 mEq/L (OR 1.89, 95 % CI 1.16–3.06), and higher Charlson co-morbidity scores (OR 1.12, 95 % CI 1.04–1.21). Subgroup analysis revealed that age (OR 1.02, 95 % CI 1.01–1.04), higher Charlson comorbidity scores (OR 1.20, 95 % CI 1.09–1.33), and receipt of post-operative bronchodilators (OR 1.39, 95 % CI 1.03–1.88) were risk factors for 30-day readmission following EVAR. After open procedures, readmission was associated with surgical site infection during the index admission (OR 2.91, 95 % CI 1.17–7.28), chronic heart failure (OR 2.18, 95 % CI 1.22–3.89), and receipt of post-operative steroids (OR 1.92, 95 % CI 1.24–2.96). The most common infections were pneumonia after open procedures and urinary tract infection after EVAR. Conclusions:The risk factor most associated with 30-day readmission after elective AAA repair was surgical site infection. Awareness of these risk factors and vulnerable groups may help identify high-risk patients who could benefit from increased surveillance programs to reduce readmission.
- Published
- 2024
- Full Text
- View/download PDF
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