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Transitional care post TAVI: A pilot initiative focused on bridging gaps and improving outcomes

机译:过渡性护理岗位Tavi:一项专注于桥接差距和改善结果的试点倡议

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摘要

Interventions focused on ensuring safe transitions for patients from hospital to home can assist in providing continuity of care, preventing readmissions, and reducing duplication of services. Patients undergoing a Transcatheter Aortic Valve Implantation (TAVI) procedure are often frail, elderly, and have multiple co-morbidities. A pilot initiative evaluating transitional care strategies through telephone follow up was implemented in a tertiary centre with the aim to identify gaps and intervene, preventing re-admission and improving patient outcomes. TAVI patients or caregivers were contacted at 3 days and 30 days post discharge by an Advanced Practice Nurse (APN). Telephone follow up centered on best practices for transitional care. Outcomes revealed fluid balance monitoring, medication management, and feelings of anxiety and depression post TAVI were the most frequent areas requiring intervention. Findings from this initiative reinforce the need to establish consistent processes that support elderly patient populations during potentially vulnerable points in the care trajectory.
机译:干预措施专注于确保医院患者的安全过渡,可以帮助提供护理,预防入伍和减少服务重复的连续性。经过转膜管主动脉瓣植入(TAVI)程序的患者往往是虚弱的,老年人,并具有多种共同的生命性。通过电话进行过渡性护理策略评估过渡性护理策略的试点倡议在三级中心实施,目的是识别间隙和干预,预防重新入场和改善患者结果。 Tavi患者或护理人员在3天和30天后接触,通过先进的实践护士(APN)。电话跟进以过渡性护理的最佳实践为中心。结果显示出液体平衡监测,药物管理和焦虑和抑郁症的感觉是Tavi的最常见的区域需要干预。此次举措的调查结果强化了建立一致的过程,这些过程在护理轨迹的潜在脆弱点期间支持老年患者群体。

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