Improving Patient-Centered Care for End-Stage Renal Disease Patients at a Community Palliative Setting.

End-stage renal disease (ESRD) is a complex medical condition growing fastest in Americans 65 years and older. Despite its chronic nature, fewer than 10% of these patients have had advanced care planning. A chart audit (n = 20) of the palliative patients at a community palliative program revealed that no patient had a conversation about prognostication, 10% (n = 2) about the burden of kidney disease, 30% (n = 6) had coordination of care with the nephrologist, and 35% (n = 7) had engaged in end-of-life planning.

Trauma-Informed Psychosocial Screening and Care Planning: A Patient-Centered Improvement Project in a Midwife Clinic.

Introduction: Traumatic stress is associated with increases in preterm birth, low birth weight, and other perinatal complications. Yet the identification of patients with traumatic stress and intervention for traumatic stress prevention or treatment remain low. Locally in this university hospital-based midwife clinic, a health records review found that trauma exposure was documented in 5% of patient records, and no records had a diagnosis of posttraumatic stress disorder (PTSD).

Improving Timeliness of Obstetrical Triage Throughput in an Urban Tertiary Care Hospital.

Background: Obstetrical triage units function like emergency departments with unpredictable volumes that affect the timely evaluation and treatment of patients and lead to longer wait times, delays in care, and longer length of stay (LOS).

Objective: The aim of this quality improvement initiative was to decrease the length of stay (LOS) of obstetrical triage patients by 20% through the utilization of nurse-driven orders, improved communication, and patient engagement.

Methods: Rapid cycle quality improvement using four plan-do-study-act cycles was utilized.

The American College of Nurse-Midwives' Benchmarking Project: A Demonstration of Professional Preservation and Improvement.

Maternal and newborn outcomes in the United States are suboptimal. Care provided by certified nurse-midwives and certified midwives is associated with improved health outcomes for mothers and newborns. Benchmarking is a process of continuous quality assurance providing opportunities for internal and external improvement.

Prevalence of low vitamin D levels in an urban midwestern obstetric practice.

Introduction: This study describes the prevalence of low vitamin D levels in pregnancy in a diverse urban population.

Methods: This was a retrospective chart review of 2839 women who gave birth at a Michigan hospital between January 1, 2008 and December 31, 2009 and had at least 1 vitamin D (25-hydroxyvitamin D [25(OH)D]) measurement during their pregnancies. Race/ethnic group, wearing the hijab, and season of 25(OH)D sample collection were used in the descriptive analysis.