Hospital Readmission and Costs of Total Knee Replacement Surgery in 2009 and 2014: Potential Implications for Health Care Managers.

The purpose of this article is to describe changes in hospital readmissions and costs for US hospital patients who underwent total knee replacement (TKR) in 2009 and 2014. Data came from the Healthcare Cost and Utilization Project net-Nationwide Readmissions Database. Compared with 2009, overall 30-day rates of readmissions after TKR decreased by 15% in 2014.

Reducing RN Vacancy Rate: A Nursing Recruitment Office Process Improvement Project.

Objective: The aim of this study was to reduce the RN vacancy rate at an academic medical center by improving the hiring process in the Nursing Recruitment Office.

Background: Inability to fill RN positions can lead to higher vacancy rates and negatively impact staff and patient satisfaction, quality outcomes, and the organization's bottom line.

Methods: The Model for Improvement was used to design and implement a process improvement project to improve the hiring process from time of interview through the position being filled.

Hospital Readmission in Total Hip Replacement Patients in 2009 and 2014.

Objective: To document changes in 30-day hospital readmission rates and causes for returning to the hospital for care in THR patients.

Design: Retrospective cross-sectional descriptive design.

Setting: Community-based acute care hospitals.

Improving Quality and Safety Through Use of Secondary Data: Methods Case Study.

Researchers need to evaluate the strengths and weaknesses of data sets to choose a secondary data set to use for a health care study. This research method review informs the reader of the major issues necessary for investigators to consider while incorporating secondary data into their repertoire of potential research designs and shows the range of approaches the investigators may take to answer nursing research questions in a variety of context areas. The researcher requires expertise in locating and judging data sets and in the development of complex data management skills for managing large numbers of records.

Intrahospital Transport of the Critically Ill Adult: A Standardized Evaluation Plan.

Background: Intrahospital transport of the critically ill adult carries inherent risks that can be manifested as unexpected events.

Objective: The aim of this study is to evaluate the implementation of a standardized evaluation plan for intrahospital transports to/from adult intensive care units.

Methods: Nurses at a level I trauma/academic center captured clinical data throughout transport.

Cascade iatrogenesis: a case-control study to detect postoperative respiratory failure in hospitalized older adults.

During hospitalization, older adults are at high risk for cascade iatrogenesis, the serial development of complications. In this retrospective, descriptive, case-control pilot study, 28 patients (cases) who developed respiratory failure after an elective surgical procedure were compared to 28 matched controls who did not develop postoperative respiratory failure. The type, frequency, and timing of events that preceded the development of postoperative respiratory failure in hospitalized older adults (age 65 and older) and the presence and timing of similar events for matched controls during a postoperative period of the same length were recorded.

Design and evaluation of a prelicensure interprofessional course on improving care transitions.

Effective management of care transitions for older adults require the coordinated expertise of an interprofessional team. Unfortunately, different health care professions are rarely educated together or trained in teamwork skills. To address this issue, a team of professionally diverse faculty from the Duke University Geriatric Education Center designed an interprofessional course focused on improving transitions of care for older adults.

Implementation of the Josie King Care Journal in a pediatric intensive care unit: a quality improvement project.

The Care Journal is a tool developed by the Josie King Foundation to promote interactive exchange among providers and patients/families. The Care Journal was implemented in a pediatric intensive care unit, and surveys were administered to assess perceptions about use. Parents who used the Care Journal and nursing staff found it to be a useful tool that improved communication, made parents feel more knowledgeable and empowered, and improved parents' overall perception of the hospital stay.

Can we make postoperative patient handovers safer? A systematic review of the literature.

Postoperative patient handovers are fraught with technical and communication errors and may negatively impact patient safety. We systematically reviewed the literature on handover of care from the operating room to postanesthesia or intensive care units and summarized process and communication recommendations based on these findings. From >500 papers, we identified 31 dealing with postoperative handovers.

Design, implementation, and evaluation of population-specific telehealth nursing services.

An implementation project was conducted to introduce a structure for telehealth nursing practice (TNP) which would address the specific needs of complex endocrinology patients in a hospital-based clinic. Outcomes of the pilot study include analysis of 727 advice calls, survey responses from a sample of 101 patients, and feedback from 9 providers. Results support current evidence that disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education.

Use of a Clinical Decision Support Tool to improve guideline adherence for the treatment of methicillin-resistant Staphylococcus aureus: Skin and Soft Tissue Infections.

Skin and Soft Tissue Infections (SSTI's) with abscess are commonly seen in the Emergency Department (ED) setting. Given the increasing prevalence of methicillin-resistant Staphylococcus-aureus (MRSA)-related abscesses, appropriate evidence-based decisions are essential in assuring successful treatment. Provider adherence to clinical guidelines for the treatment of SSTI's with presumed MRSA remains inconsistent in terms of prescriptive practice related to antibiotic selection, culturing wounds, and patient discharge recommendations regarding the use of infection control techniques.

Evaluation of an evidence-based, nurse-driven checklist to prevent hospital-acquired catheter-associated urinary tract infections in intensive care units.

Catheter-associated urinary tract infections account for 40% of all health care-associated infections. An evidence-based, nurse-driven daily checklist for initiation and continuance of urinary catheters was implemented in 5 adult intensive care units. Measures of compliance, provider satisfaction, and clinical outcomes were recorded.

What does quality care mean to nurses in rural hospitals?

Aim: This paper is a report of a study conducted to answer the question: 'How do rural nurses and their chief nursing officers define quality care?'

Background: Established indicators of quality care were developed primarily in urban hospitals. Rural hospitals and their environments differ from urban settings, suggesting that there might be differences in how quality care is defined. This has measurement implications.

A necessary sea change for nurse faculty development: spotlight on quality and safety.

More than 10 years have passed since the publication of the Institute of Medicine's report, To Err is Human: Building a Safer Health Care System, yet recent reports indicate that significant strides toward transformational improvement in quality and patient safety are still necessary. Real progress toward superior health care quality requires foundational enhancements in health care education. An urgent need exists for undergraduate nursing programs to strengthen quality and safety knowledge in their curricula.

Increased risk for patient safety incidents in hospitalized older adults.

2004 HCUPnet data indicated that hospitalized patients age 65 and older experience higher rates of patient safety incidents than younger adults for 11 of 13 indicators analyzed; patients over age 85 in particular were susceptible to certain adverse events. In this article, rates of patient safety incidents for hospitalized older adults are described and adverse events for which older adults might be at particular risk are identified.

Cascade iatrogenesis: factors leading to the development of adverse events in hospitalized older adults.

Older adults are at particular risk for injuries associated with hospitalization and the rate of adverse events increases significantly with age. The purpose of this paper is to review factors associated with the development of adverse events in hospitalized older adults, especially those factors that contribute to cascade iatrogenesis. Cascade iatrogenesis is the serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event [Rothschild, J.

Managing to improve quality: the relationship between accreditation standards, safety practices, and patient outcomes.

Background: Given the trend toward eliminating reimbursement for "never events," hospital administrators are challenged to implement practices designed to prevent their occurrence. Little evidence exists, however, that patient safety practices, as evaluated using accreditation criteria, are related to the achievement of patient safety outcomes.

Purpose: The aim of this study was to examine the relationship between patient safety practices, as measured by accreditation standards, and patient safety outcomes as measured by hospital rates of infections, decubitus ulcers, postoperative respiratory failure, and failure to rescue.

Clinical perspectives on portable do-not-resuscitate orders.

A do-not-resuscitate (DNR) order is a written medical order that documents a patient's wishes regarding resuscitation and, more specifically, the patient's desire to avoid cardiopulmonary resuscitation (CPR). A DNR order is one of the most important patient care directives that can be issued because it has dramatic and irreversible consequences. A portable DNR order is a do-not-resuscitate directive that travels with the patient.

Nursing patient safety research in rural health care settings.

Adverse events occur in virtually all health care arenas, and while rural health care settings are no exception, these facilities often face unique financial burdens and personnel shortages. That may hamper patient safety efforts. Many of the interventions recommended to improve patient safety have largely been based on research conducted in urban hospitals.

Methodologies used in nursing research designed to improve patient safety.

Nursing research studies of patient safety for 2002-2005 were reviewed to determine methods used and methodological challenges within this field of research. Methods used in traditional clinical research and in health services research were often combined or adapted in innovative research designs to advance knowledge regarding nursing care and patient safety outcomes. This relatively new focus of complex research posed methodological challenges in areas such as measurement and the availability and analysis of data.

A necessity not a luxury: preparing advanced practice nurses to care for older adults.

Of today's 2.7 million registered nurses, less than 1% are certified in gerontological nursing and only 3% of advanced practice nurses (APNs) have specialized training in this area. These statistics indicate that there are not enough gerontological nurse practitioners or geriatric clinical nurse specialists to care for the burgeoning older adult population.

Incorporating geriatrics into baccalaureate nursing curricula: laying the groundwork with faculty development.

In June 2001, the John A. Hartford Foundation of New York awarded the American Association of Colleges of Nursing (AACN) a 3.99 million dollar grant to enhance gerontology curriculum development and new clinical experiences in 20 baccalaureate and 10 graduate schools of nursing.