The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Impact of a Nurse-Driven Breastfeeding Educational Intervention on Maternal-Child Nurse Knowledge Gain and Patient Satisfaction in a Community Hospital

Session presented on Thursday, July 24, 2014: Purpose: The purpose of this project is to describe the implementation and evaluation of a maternal-child nurse breastfeeding educational training at South Miami Hospital. Methods: A hospital-based inter-professional team was developed to conduct an educational needs assessment, identify a breastfeeding curriculum, execute the mandatory breastfeeding training, and track nurse and patient outcomes pre- and post- the educational intervention. From that team, 10 lactation specialists were trained to be breastfeeding instructors and taught twenty 4-hour sessions between January 2013 and August 2013. Nurse Knowledge gain was evaluated by conducting a paired t-test of a random sample of pre- and post- test scores. Patient Satisfaction with nurse support of breastfeeding was tracked for the first quarter of the year in 2013 and compared to five years prior. Results: Approximately 287 maternal-child nurses attended the training. There was a statistically significant increase in knowledge scores from pre to post testing (t (20) = 8.04, p \u3c 0.0001). Patient satisfaction for the first quarter of 2013 was the highest (92%) that it had been in the previous five years. Conclusion: A nurse-driven breastfeeding educational intervention has the potential to impact nurse knowledge gain, patient satisfaction, and the overall reputation of a hospital

Evaluation of the Impact of Instructional Methodology of the WHO/UNICEF Breastfeeding Training on Maternal–child Nurse Knowledge Gain and Perception of Breastfeeding Support

Nurses are the largest group of healthcare professionals who support breastfeeding and lactating mothers in maternity facilities. Yet, the most effective instructional methodology to deliver the 20-hour WHO/UNICEF breastfeeding training for maternal-child nurses is still not determined. Breastfeeding knowledge gain and perception of breastfeeding support are two key modifiable outcomes of breastfeeding training that are commonly identified in the nursing literature. The purpose of this study was to evaluate the impact of instructional methodology (classroom versus computer-based) on the maternal–child nurse’s breastfeeding knowledge gain and perception of breastfeeding support for nurses that participated in the 20-hour WHO/UNICEF breastfeeding training. A secondary analysis was conducted on a sample of 521 cases of attendance by three types of maternal–child nurses- labor and delivery, postpartum, and neonatal- at a metropolitan hospital. Commercial breastfeeding knowledge tests had been administered pre- and post each session. A perception of breastfeeding support questionnaire, the Iowa Infant Feeding Attitude Scale, and demographic information had been collected at the end of each session. Instructional methodology significantly impacted breastfeeding knowledge gain for one content-specific breastfeeding session. The best predictor of perception of breastfeeding support was not instructional methodology, but infant feeding attitude. Type of maternal-child nurse significantly impacted breastfeeding knowledge gain and perception of breastfeeding support. These findings will have significant applications in choice of instructional methodology for breastfeeding education in the acute care setting, as well as continuing breastfeeding education post the 20-hour training.</p