Improving Patient Satisfaction with the Virtual Handoff Process through the Utilization of Educational Pamphlets in the Emergency Department

Boarding patients in the emergency room while waiting to transfer the patient to the proper unit can be harmful to clinical care and have significant financial opportunity costs. At one local hospital it was found that on average patients were being boarded in the emergency room (ED) for approximately 85 minutes waiting to be transferred. Several barriers that caused this delay were found including, delay in room cleaning, nurse staff shortage, and inability to give report to the nurse receiving the patient. In an attempt to combat this delay which may be caused by a difficulty in giving patient report, this organization is rolling out a virtual bedside handoff process. While virtual technology is not a new concept, there are many patients that may not be comfortable with the technology. The purpose of the evidence-based project was to provide a written educational pamphlet that details the how’s and why’s of the virtual handoff process to the patient to be given upon admission. The goal of the educational pamphlet was to increase the patients’ satisfaction with the process. A pre-survey was given to a group of patients after they experienced the virtual handoff process to assess their comfort level. These results were compared to the post-survey results of patients that received the educational pamphlet prior to experiencing the virtual handoff process. Ten pre-surveys and seven post-surveys were analyzed utilizing SPSS and descriptive statistics. The analysis concluded that the participants who received the educational pamphlet felt more prepared for the virtual handoff process

Acute care nurses' perceptions of barriers to using research information in clinical decision-making

Aim. To examine the barriers that nurses feel prevent them from using research in the decisions they make. Background. A sizeable research literature focusing on research utilization in nursing has developed over the past 20 years. However, this literature is characterized by a number of weaknesses: self-reported utilization behaviour; poor response rates and small, nonrandom sampling strategies. Design. Cross-case analysis involving anonymised qualitative interviews, observation, documentary audit and Q methodological modelling of shared subjectivities amongst nurses. The case sites were three large acute hospitals in the north of England. One hundred and eight nurses were interviewed, 61 of whom were also observed for a total of 180 h, and 122 nurses were involved in the Q modelling exercise (response rate of 64%). Results. Four perspectives were isolated that encompassed the characteristics associated with barriers to research use. These related to the individual, organization, nature of research information itself and environment. Nurses clustered around four main perspectives on the barriers to research use: (1) Problems in interpreting and using research products, which were seen as too complex, 'academic' and overly statistical; (2) Nurses who felt confident with research-based information perceived a lack of organizational support as a significant block; (3) Many nurses felt that researchers and research products lack clinical credibility and that they fail to offer the desired level of clinical direction; (4) Some nurses lacked the skills and, to a lesser degree, the motivation to use research themselves. These individuals liked research messages passed on to them by a third party and sought to foster others' involvement in research-based practice, rather than becoming directly involved themselves. Conclusions. Rejection of research knowledge is not a barrier to its application. Rather, the presentation and management of research knowledge in the workplace represent significant challenges for clinicians, policy-makers and the research community

Measuring Nurses’ Impact on Health Care Quality: Progress, Challenges, and Future Directions

Background: Quality measurement is central in efforts to improve health care delivery and financing. The Interdisciplinary Nursing Quality Research Initiative supported interdisciplinary research teams to address gaps in measuring the contributions of nursing to quality care. Objective: To summarize the research of 4 interdisciplinary teams funded by The Interdisciplinary Nursing Quality Research Initiative and reflect on challenges and future directions to improving quality measurement. Methods: Each team summarized their work including the targeted gap in measurement, the methods used, key results, and next steps. The authors discussed key challenges and recommended future directions. Results: These exemplar projects addressed cross-cutting issues related to quality; developed measures of patient experience; tested new ways to model the important relationships between structure, process, and outcome; measured care across the continuum; focused on positive aspects of care; examined the relationship of nursing care with outcomes; and measured both nursing and interdisciplinary care. Discussion: Challenges include: measuring care delivery from multiple perspectives; determining the dose of care delivered; and measuring the entire care process. Meaningful measures that are simple, feasible, affordable, and integrated into the care delivery system and electronic health record are needed. Advances in health information systems create opportunities to advance quality measurement in innovative ways. Conclusions: These findings and products add to the robust set of measures needed to measure nurses’ contributions to the care of hospitalized patients. The implementation of these projects has been rich with lessons about the ongoing challenges related to quality measurement

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A Novel Method for Assessing Medication-Related Adverse Outcomes in a Community Hospital

The use of medications for hospitalized patients is universal, and unfortunately medication-related adverse outcomes are common. The accurate assessment of medication-related harm in hospitalized patients is foundational to the development of an effective hospital medication safety program. Every hospital has its own unique fingerprint of harm, accurate determination of the nature of medication-related harm specific to each hospital is necessary to facilitate prevention of that harm with specific and effective interventions. This project has provided a community hospital with its first systematic methodology for assessing medication-related harm. The methodology is adapted from that used in a recent national-level study. Several commonly accepted methods of assessment of medication-related adverse events are in use, but no single method is capable of giving a complete picture of harm at the hospital level. Using a method nearly identical to one employed in large national studies the author examined rates and types of medication-related adverse outcomes in a California community hospital. The hospital had about one-third the national rate of adverse events. An incidental finding was a 4-year pattern of increasing incidence of adverse outcomes followed by 2 years of declining incidence of adverse outcomes. The information gained from the novel assessment method provided a clearer picture of patient harm, a basis for a more effective medication safety plan, and promoted interprofessional collaboration

The impact of perioperative data science in hospital knowledge management

Conservative practices, such as manual registry have limited scope regarding preoperative, intraoperative and post operative decision making, knowledge discovery, analytical techniques and knowledge integration into patient care. To maximize quality and value, perioperative care is changing through new technological developments. In this context, knowledge management practices will enable future transformation and enhancements in healthcare services. By performing a data science and knowledge management research in the perioperative department at Hospital Dr. Nélio Mendonça between 2013 and 2015, this paper describes its principal results. This study showed perioperative decision-making improvement by integrating data science tools on the perioperative electronic system (PES). Before the PES implementation only 1,2% of the nurses registered the preoperative visit and after 87,6% registered it. Regarding the patient features it was possible to assess anxiety and pain levels. A future conceptual model for perioperative decision support systems grounded on data science should be considered as a knowledge management tool.info:eu-repo/semantics/publishedVersio

Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting

Impact of an APRN Directed Workflow Change on Outpatient Palliative Care Referral Acceptance Rates

Abstract Patients diagnosed with an advanced disease or serious illness often experience a variety of distressing symptoms that can negatively impact their functional status and quality of life. Outpatient palliative care is a medical specialty that often requires a referral from a primary care or specialty care provider who has identified a need for specialized pain and symptom management, psychosocial or caregiver distress, end-of-life care management, or goals of care discussions. Despite notable effectiveness in the provision of palliative care for patients with advanced disease and serious illness, barriers exist that prevent patients from accepting palliative care referrals even after a need has been identified by their referring provider. This DNP project aimed to increase the rate of palliative care referral acceptance rates in adult patients referred to the outpatient palliative care team within Sansum Clinic, by incorporating an APRN-led workflow change into the initial outreach process for patients referred to the team. Referral and demographic data were analyzed for this DNP project. Considerations for future educational, clinical and research opportunities are discussed

Use of Secure Messaging By United States Veterans and Significant Others

ABSTRACT USE OF SECURE MESSAGING BY UNITED STATES VETERANS AND SIGNIFICANT OTHERS By Claudia S. Derman The University of Wisconsin-Milwaukee, 2014 Under the Supervision of Professor Karen H. Morin, PhD, RN, ANEF, FAAN The purpose of this study was to describe the topics discussed using secure messaging (SM), the pattern of use of SM, and whether the themes discussed and/or the pattern of use varied based on gender and age of the SM user. Secure messaging is an example of a technology that focuses on patient-centered communication. Secure messaging allows patients to communicate with their clinicians using the Internet and at their convenience, while maintaining the privacy of the information exchanged. Secure messages, if approved by the patient, may also be written by family members or significant others for the patient. By its nature, the use of SM is indicative of an individual\u27s involvement in their healthcare, utilizing self-management skills. Few studies were found that reported on the content of messages written by patients or their families. No studies were found that reviewed the topics patients write about in these secure messages nor were studies found that tracked the number of messages written by patients and relating to the days and time that were most utilized. A review of 1200 secure messages written by veterans and their caregivers was undertaken to determine what information was contained within the secure messages. The 1200 messages contained 1720 themes that were grouped using content analysis to yield a total of ten topics. The day of week and the time of day of messages were additionally reviewed by gender and age of the individual. Messages written by friends of family members were reviewed and compared to those written by patients. The topic most addressed as that of medications, with more than one-third of the 1720 themes within messages relating to medications. Veterans aged 55 to 64 years were the greatest users of the SM system followed closely by those between the ages of 65 to 74. Men wrote most frequently about medications while women wrote more themes related to the topics of complaints and concerns and consultations with specialists. Pattern of use of relative to time of day and day of the week was also reviewed in subset of the sample (n= 600). The most common time frame during which messages were sent was between 9:00 a.m. and 6 p.m., accounting for more than 70% of all messages. Tuesdays and Thursdays were the most often utilized days of week for SM. The implications of this study include revisiting how MyHealtheVet is configured to enhance the veteran\u27s ability to communicate effectively and appropriately with healthcare providers. It is possible that participants employed SM rather than other identified means to contact providers as they were assured of a response within a defined period of time. Findings have implications for users, clinicians, hospital administrators, and technical staff. The purposes of SM can be revisited with users, clinicians may wish to consider alternative strategies, and administrators may wish to revisit the current structure in terms of identifying a method to sort the information contained in SM