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Phone checklist can detect clinical changes in patients receiving home care

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A simple phone checklist completed by carers can help detect important real-time changes in the health status of people receiving care at home, according to the findings of a pilot study in the US.

The idea, said researchers from Harvard Medical School, was to prevent complications before they became serious enough to require hospital admission.

The study, published in the Journal of the American Geriatrics Society, involved carers recording changes in the status of home care recipients during a telephone call at the end of each shift.

Care givers answered simple questions about the care recipient’s condition during a telephone-based “clock-out” at the end of each shift, prompted by an automated message.

The message included a list of questions pertaining to changes in mental, neurologic, gastrointestinal, urinary and other indicators.

The responses were electronically captured in software that the caregivers also used to “clock-in,” manage care, and “clock-out” on every shift.

Any changes reported via the automated system were immediately dispatched to a manager at the home-care agency office for further assessment and triage.

Analysis of the data collected over a six-month period across 22 home care offices revealed that changes in clinical status were relatively common – occurring in 2% of all shifts and affecting.

The majority of changes were in behaviour and skin condition, followed by changes in eating or drinking behaviour and ability to stand or walk.

The researchers said the results underlined the potential of real-time monitoring systems to spot problems and avert complications before they escalated enough to require hospital admission.

Patients who may benefit the most include those with long-term conditions, in whom even seemingly innocuous changes could indicate serious problems, highlighted the researchers.

They cited one particular example that emerged during follow-up interviews with staff, which involved a diabetes patient whose caregiver reported a foot ulcer via the phone-based checklist.

Treatment started immediately after the patient’s nurse was contacted, resulting in the wound healing one week later. Normally, the ulcer would not have been reported until the end of the week, said the study authors.

Over the course of the six-month trial, 14% of the home care recipients were admitted, they noted.

The researchers cautioned that it remained unknown whether their system could prevent admission, but noted that the fact a basic phone questionnaire could capture important clinical indicators suggested its value for monitoring those receiving care at home.

They highlighted that the idea was also the subject of an ongoing randomised trial across 400 home care locations in the US.

Frontline cares play a critical role in monitoring, reporting and preventing serious complications among patients with chronic conditions, added the researchers.

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Readers' comments (1)

  • I think this new venture shows great promise. All sorts of conditions could be caught early and treated before the onset of further complications. This will mean less admissions or shorter stays in hospital. I think it's a great idea. An individuals regular carer often sees changes that others might miss. I rely heavily on my team to notice any changes and this has resulted in residents being diagnosed much sooner than they might have been.

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