Background: Optimizing transitional care by practicing family-centered care might reduce unplanned events for patients who undergo major abdominal cancer surgery. However, it remains unknown whether involving family caregivers in patients’ healthcare also has negative consequences for patient safety. This study assessed the safety of family involvement in patients’ healthcare by examining the cause of unplanned events in patients who participated in a family involvement program (FIP) after major abdominal cancer surgery. Methods: This is a secondary analysis focusing on the intervention group of a prospective cohort study conducted in the Netherlands. Data were collected from April 2019 to May 2022. Participants in the intervention group were patients who engaged in a FIP. Unplanned events were analyzed, and root causes were identified using the medical version of a prevention- and recovery-information system for monitoring and analysis (PRISMA) that analyses unintended events in healthcare. Unplanned events were compared between patients who received care from family caregivers and patients who received professional at-home care after discharge. A Mann-Whitney U test was used to analyze data. Results: Of the 152 FIP participants, 68 experienced an unplanned event and were included. 112 unplanned events occurred with 145 root causes since some unplanned events had several root causes. Most root causes of unplanned events were patient-related factors (n = 109, 75%), such as patient characteristics and disease-related factors. No root causes due to inadequate healthcare from the family caregiver were identified. Unplanned events did not differ statistically (interquartile range 1–2) (p = 0.35) between patients who received care from trained family caregivers and those who received professional at-home care after discharge. Conclusion: Based on the insights from the root-cause analysis in this prospective multicenter study, it appears that unplanned emergency room visits and hospital readmissions are not related to the active involvement of family caregivers in surgical follow-up care. Moreover, surgical follow-up care by trained family caregivers during hospitalization was not associated with increased rates of unplanned adverse events. Hence, the concept of active family involvement by proficiently trained family caregivers in postoperative care appears safe and feasible for patients undergoing major abdominal surgery.
In de huidige gezondheidszorg ontvangen patiënten vaak zorg van verschillende zorgverleners, bijvoorbeeld de huisarts (eerstelijns zorg) en de specialist in het ziekenhuis (tweedelijns zorg). Wanneer een patiënt die geneesmiddelen gebruikt in het ziekenhuis opgenomen wordt, brengt dit vaak de betrokkenheid van verschillende voorschrijvers met zich mee. Na ontslag uit het ziekenhuis ontstaan hierdoor vaak zogenoemde geneesmiddelgerelateerde problemen. Informatie over het geneesmiddelengebruik van de patiënt wordt bij het ontslag uit het ziekenhuis namelijk vaak onvolledig overgedragen naar de eerstelijnszorgverleners. Daarnaast wordt de patiënt niet altijd goed geïnformeerd over de veranderingen van zijn geneesmiddelen, zoals bijvoorbeeld over aanpassingen in de dosering of nieuwe geneesmiddelen. De ontstane geneesmiddelgerelateerde problemen kunnen de patiëntveiligheid in gevaar brengen. Ze kunnen bijvoorbeeld resulteren in een ongeplande heropname in het ziekenhuis of andere gezondheidsschade voor de patiënt. Zo ervaart een op de vijf patiënten binnen drie weken na ontslag een bijwerking van een geneesmiddel. De focus van de studies beschreven in dit proefschrift ligt op de periode direct na het ontslag uit het ziekenhuis. We noemen dit de heropname in de eerste lijn. Patiënten, maar ook hun mantelzorgers, voelen zich vaak onvoorbereid voor de thuiskomst. Tijdens de ziekenhuisopname nemen de zorgverleners in het ziekenhuis de zorg voor de patiënt op zich. Het moment van ontslag betekent dat zij zelf de regie over hun gezondheid en geneesmiddelen weer moeten overnemen. Het is daarom van belang om kort na het ontslag uit het ziekenhuis het geneesmiddelengebruik met de patiënt te evalueren om onduidelijkheden over bijvoorbeeld hun nieuwe geneesmiddelenschema weg te nemen. Van oudsher hadden openbaar apothekers als hoofdtaak het bereiden en verstrekken van geneesmiddelen. Tegenwoordig zijn zij echter meer en meer betrokken bij het begeleiden van patiënten met betrekking tot hun geneesmiddelengebruik. Deze andere rol kan cruciaal zijn bij het garanderen van de medicatieveiligheid gedurende en na de overgang van het ziekenhuis naar huis. Daarom is het doel van dit proefschrift om de problemen die optreden bij de heropname in de eerste lijn te ontrafelen en om de rol van de openbaar apotheker hierin te onderzoeken.
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BACKGROUND: Acute hospitalization may lead to posthospital syndrome, but no studies have investigated how this syndrome manifests and geriatric syndromes are often used as synonym. However, studies on longitudinal associations between syndromes and adverse outcomes are scarce. We aimed to analyze longitudinal associations between geriatric syndromes and functional decline (FD), readmission, and mortality.METHODS: Prospective cohort study, including 401 acutely hospitalized patients (aged ≥ 70). We performed: (i) logistic regression analyses to assess associations between patterns of geriatric syndromes as they develop over time (between admission and 1 month postdischarge), and FD and readmission; (ii) generalized estimating equations to assess longitudinal associations between geriatric syndromes over five time points (admission, discharge, 1, 2, and 3 months postdischarge) and FD, mortality, and readmission at 3 months postdischarge.RESULTS: After syndrome absent, syndrome present at both admission and 1 month postdischarge was most prevalent. Persistent patterns of apathy (odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.54-12.30), pain (OR = 3.26, 95% CI = 1.21-8.8), malnutrition (OR = 3.4, 95% CI = 1.35-8.56), mobility impairment (OR = 6.65, 95% CI = 1.98-22.38), and fear of falling (OR = 3.17, 95% CI = 1.25-8.02) were associated with FD. Developing cognitive impairment (OR = 6.40, 95% CI = 1.52-26.84), fatigue (OR = 4.71, 95% CI = 1.03-21.60), and fall risk (OR = 4.30, 95% CI = 1.21-16.57) postdischarge, was associated with readmission; however, only 4%-6% developed these syndromes. Over the course of five time points, mobility impairment, apathy, and incontinence were longitudinally associated with FD; apathy, malnutrition, fatigue, and fall risk with mortality; malnutrition with readmission.CONCLUSION: Most geriatric syndromes are present at admission and patients are likely to retain them postdischarge. Several geriatric syndromes are longitudinally associated with mortality and, particularly, persistently present syndromes place persons are at risk of FD. Although few persons develop syndromes postdischarge, those developing cognitive impairment, fatigue, and fall risk were at increased readmission risk.
