Nurse and Patient Perceptions of Discharge Readiness in Relation to Postdischarge Utilization

Background: Prevention of hospital readmission and emergency department (ED) utilization will be a crucial strategy in reducing health care costs. There has been limited research on nurse assessment and patient perceptions of discharge readiness in relation to postdischarge outcomes. Objectives: To investigate the association of nurse and patient assessments of discharge readiness with postdischarge readmissions and ED visits. Research Design: Hierarchical regression analysis of readmission or ED utilization using independent nurse and patient assessments of discharge readiness and patient characteristics as explanatory variables, with hospital and unit fixed effects. Subjects: A total of 162 adult medical-surgical patients and their discharging nurses from 13 medical-surgical units of 4 Midwestern hospitals. Measures: Readiness for Hospital Discharge Scale completed independently by patients and their discharging nurses within 4 hours before hospital discharge; Postdischarge utilization (unplanned readmission or ED visit within 30 days postdischarge). Results: Correlations between nurse assessment and patient perceptions of discharge readiness were low (r = 0.15- 0.32). Nurses rated patient readiness higher than patients themselves. Controlling for patient characteristics, nurse readiness for hospital discharge scale score (odds ratio = 0.57, P = 0.05) but not patient readiness for hospital discharge scale score was associated with postdischarge utilization. Conclusions: Nurse assessment was more strongly associated with postdischarge utilization than patient self-assessment. Formalizing nurse assessment of discharge readiness could facilitate identification of patients at risk for readmission or ED utilization before discharge when anticipatory interventions could prevent avoidable postdischarge utilization

Validation of the Registered Nurse Assessment of Readiness for Hospital Discharge Scale

Background Statistical models for predicting readmissions have been published for high-risk patient populations but typically focus on patient characteristics; nurse judgment is rarely considered in a formalized way to supplement prediction models. Objectives The purpose of this study was to determine psychometric properties of long and short forms of the Registered Nurse Readiness for Hospital Discharge Scale (RN-RHDS), including reliability, factor structure, and predictive validity. Methods Data were aggregated from two studies conducted at four hospitals in the Midwestern United States. The RN-RHDS was completed within 4 hours before hospital discharge by the discharging nurse. Data on readmissions and emergency department visits within 30 days were extracted from electronic medical records. Results The RN-RHDS, both long and short forms, demonstrate acceptable reliability (Cronbach’s alphas of .90 and .73, respectively). Confirmatory factor analysis demonstrated less than adequate fit with the same four-factor structure observed in the patient version. Exploratory factor analysis identified three factors, explaining 60.2% of the variance. When nurses rate patients as less ready to go home (\u3c7 out of 10), patients are 6.4–9.3 times more likely to return to the hospital within 30 days, in adjusted models. Discussion The RN-RHDS, long and short forms, can be used to identify medical-surgical patients at risk for potential unplanned return to hospital within 30 days, allowing nurses to use their clinical judgment to implement interventions prior to discharge. Use of the RN-RHDS could enhance current readmission risk prediction models

Rapidity gap survival in the black-disk regime

We summarize how the approach to the black-disk regime (BDR) of strong interactions at TeV energies influences rapidity gap survival in exclusive hard diffraction pp -> p + H + p (H = dijet, Qbar-Q, Higgs). Employing a recently developed partonic description of such processes, we discuss (a) the suppression of diffraction at small impact parameters by soft spectator interactions in the BDR; (b) further suppression by inelastic interactions of hard spectator partons in the BDR; (c) correlations between hard and soft interactions. Hard spectator interactions substantially reduce the rapidity gap survival probability at LHC energies compared to previously reported estimates.Comment: 4 pages, 3 figures. Proceedings of XV International Workshop on Deep-Inelastic Scattering and Related Subjects (DIS 2007), Munich, Germany, Apr. 16-20, 200

Validation of Patient and Nurse Short Forms of the Readiness for Hospital Discharge Scale and Their Relationship to Return to the Hospital

Objective: To validate patient and nurse short forms for discharge readiness assessment and their associations with 30-day readmissions and emergency department (ED) visits. Data Sources/Study Setting: A total of 254 adult medical-surgical patients and their discharging nurses from an Eastern US tertiary hospital between May and November, 2011. Study Design Prospective longitudinal design, multinomial logistic regression analysis. Data Collection/Extraction Methods: Nurses and patients independently completed an eight-item Readiness for Hospital Discharge Scale on the day of discharge. Patient characteristics, readmissions, and ED visits were electronically abstracted. Principal Findings: Nurse assessment of low discharge readiness was associated with a six- to nine-fold increase in readmission risk. Patient self-assessment was not associated with readmission; neither was associated with ED visits. Conclusions: Nurse discharge readiness assessment should be added to existing strategies for identifying readmission risk

Aligning Evidence-Based Practice With Translational Research: Opportunities for Clinical Practice Research

Magnet(R) and other organizations investing resources in evidence-based practice (EBP) are ideal laboratories for translational nursing research. Translational research, the study of implementation of evidence into practice, provides a unique opportunity to leverage local EBP work for maximum impact. Aligning EBP projects with rigorous translational research can efficiently meet both EBP and research requirements for Magnet designation or redesignation, inform clinical practice, and place organizations at the leading edge of practice-based knowledge development for the nursing discipline

Transverse imaging of the proton in exclusive diffractive pp scattering

In a recent paper (hep-ph/0608271) we describe a new approach to rapidity gap survival (RGS) in the production of high-mass systems (H = dijet, Higgs, etc.) in exclusive double-gap diffractive pp scattering, pp -> p + H + p. It is based on the idea that hard and soft interactions are approximately independent (QCD factorization), and allows us to calculate the RGS probability in a model-independent way in terms of the gluon generalized parton distributions (GPDs) in the colliding protons and the pp elastic scattering amplitude. Here we focus on the transverse momentum dependence of the cross section. By measuring the "diffraction pattern," one can perform detailed tests of the interplay of hard and soft interactions, and even extract information about the gluon GPD in the proton from the data.Comment: 4 pages, 2 figures, uses ws-procs9x6.cls. Proceedings of XIV International Workshop on Deep Inelastic Scattering (DIS2006), Tsukuba City, Japan, Apr 20 - 24, 200

Teaching students to teach patients: A theory-guided approach

Nurses in every setting provide patient teaching on a routine basis, often several times a day. Patient teaching skills are essential competencies to be developed during pre-licensure nursing education. While students learn what to teach for specific conditions, they often lack competence in how to teach in ways that individualize and optimize patient learning. The ultimate goal of patient teaching is to arm patients with the knowledge and skills, and the desire and confidence in their ability to reach their targeted health outcomes. We describe the creation of a theoretical framework to guide development of patient teaching skills. The framework, rooted in the contemporary health care values of patient-centered care, is a synthesis of four evidence-based approaches to patient teaching: patient engagement, motivational interviewing, adult learning theory, and teach-back method. Specific patient teaching skills, derived from each of the approaches, are applied within the context of discharge teaching, an important nursing practice linked to patient outcomes. This exemplar emphasizes the use of critical teaching process skills and targeted informational content. An online student learning module based on the theoretical framework and combined with simulation experiences provides the nurse educator with one strategy for use with nursing students. The theoretical framework has applicability for skill development during pre-licensure education and skill refinement for nurses in clinical practice

Modeling quasar accretion disc temperature profiles

Microlensing observations indicate that quasar accretion discs have half-light radii larger than expected from standard theoretical predictions based on quasar fluxes or black hole masses. Blackburne and colleagues have also found a very weak wavelength dependence of these half-light radii. We consider disc temperature profile models that might match these observations. Nixon and colleagues have suggested that misaligned accretion discs around spinning black holes will be disrupted at radii small enough for the Lense-Thirring torque to overcome the disc's viscous torque. Gas in precessing annuli torn off a disc will spread radially and intersect with the remaining disc, heating the disc at potentially large radii. However, if the intersection occurs at an angle of more than a degree or so, highly supersonic collisions will shock-heat the gas to a Compton temperature of T~10^7 K, and the spectral energy distributions (SEDs) of discs with such shock-heated regions are poor fits to observations of quasar SEDs. Torn discs where heating occurs in intermittent weak shocks that occur whenever the intersection angle reaches a tenth of a degree pose less of a conflict with observations, but do not have significantly larger half-light radii than standard discs. We also study two phenomenological disc temperature profile models. We find that discs with a temperature spike at relatively large radii and lowered temperatures at radii inside the spike yield improved and acceptable fits to microlensing sizes in most cases. Such temperature profiles could in principle occur in sub-Keplerian discs partially supported by magnetic pressure. However, such discs overpredict the fluxes from quasars studied with microlensing except in the limit of negligible continuum emission from radii inside the temperature spike.Comment: Submitted to MNRAS. Comments welcome. 20 pages, 5 figure

Ground state energy of a homogeneous Bose-Einstein condensate beyond Bogoliubov

The standard calculations of the ground-state energy of a homogeneous Bose gas rely on approximations which are physically reasonable but difficult to control. Lieb and Yngvason [Phys. Rev. Lett. 80, 2504 (1998)] have proved rigorously that the commonly accepted leading order term of the ground state energy is correct in the zero-density-limit. Here, strong indications are given that also the next to leading term is correct. It is shown that the first terms obtained in a perturbative treatment provide contributions which are lost in the Bogoliubov approach.Comment: 6 pages, accepted for publication in Europhys. Lett. http://www.epletters.ch