Ambulatory Care Nurse-Sensitive Indicators Series: Reaching for the Tipping Point in Measuring Nurse-Sensitive Quality in the Ambulatory Surgical and Procedure Environments.

The value of the ambulatory care nurse remains undocumented from a quality and patient safety measurement perspective and the practice is at risk of being highly variable and of unknown quality. The American Academy of Ambulatory Care Nursing and the Collaborative Alliance for Nursing Outcomes propose nurse leaders create a tipping point to measure the value of nursing across the continuum of nursing care, moving from inpatient to ambulatory care. As care continues to shift into the ambulatory care environment, the quality imperative must also shift to assure highly reliable, safe, and effective health care.

Improving hospital patient falls: leveraging staffing characteristics and processes of care.

Objective: Predictive models for falls, injury falls, and restraint prevalence were explored within nursing unit structures and processes of care.

Background: The patient care team is responsible for patient safety, and improving practice models may prevent injuries and improve patient safety.

Methods: Using unit-level self-reported data from 215 hospitals, falls, injury falls, and restraint prevalence were modeled with significant covariates as predictors.

Modeling hospital-acquired pressure ulcer prevalence on medical-surgical units: nurse workload, expertise, and clinical processes of care.

Objective: This study modeled the predictive power of unit/patient characteristics, nurse workload, nurse expertise, and hospital-acquired pressure ulcer (HAPU) preventive clinical processes of care on unit-level prevalence of HAPUs.

Data Sources: Seven hundred and eighty-nine medical-surgical units (215 hospitals) in 2009.

Study Design: Using unit-level data, HAPUs were modeled with Poisson regression with zero-inflation (due to low prevalence of HAPUs) with significant covariates as predictors.

Excellence and evidence in staffing: a data-driven model for excellence in staffing (2nd edition).

The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system.

Safety culture relationships with hospital nursing sensitive metrics.

Public demand for safer care has catapulted the healthcare industry's efforts to understand relationships between patient safety and hospital performance. This study explored linkages between staff perceptions of safety culture (SC) and ongoing measures of hospital nursing unit-based structures, care processes, and adverse patient outcomes. Relationships between nursing-sensitive measures of hospital performance and SC were explored at the unit-level from 9 California hospitals and 37 nursing units.

Eliminating hospital-acquired pressure ulcers: within our reach.

Hospital-acquired pressure ulcers (HAPUs) are a serious nosocomial problem that has been viewed as a ubiquitous consequence of immobility. This article provides data from the Collaborative Alliance for Nursing Outcomes (CALNOC) that shows a significant reduction in HAPUs in adults from 78 acute care hospitals over 8 years (2003-2010).

Nursing-sensitive benchmarks for hospitals to gauge high-reliability performance.

Benchmarking expedites the quest for best practices and is crucial to hospitals' effective, reliable, and superior performance. Comparative performance data are used by accrediting and regulatory bodies to evaluate performance and by consumers in making decisions on where to seek healthcare. Nursing-sensitive quality measures affirmed by the National Quality Forum are now used in public reporting and pay-for-performance in addition to traditional medical outcome metrics.

Benchmarking for small hospitals: size didn't matter!

Benchmarking is an indispensable tool as hospital leaders face challenges to balance efficiency with safe and effective care. Selection of appropriate "like" hospitals is critical to the benchmarking aim of understanding comparative performance. Based on 10 years of observed outcome differences between small and large hospitals, the Collaborative Alliance for Nursing Outcomes (CALNOC) sought to empirically define small hospitals, and to determine if there were statistical differences between small and large hospitals for selected nursing sensitive outcome indicators.

Quartile dashboards: translating large data sets into performance improvement priorities.

Quality professionals are the first to understand challenges of transforming data into meaningful information for frontline staff, operational managers, and governing bodies. To understand an individual facility, service, or patient care unit's comparative performance from within large data sets, prioritization and focused data presentation are needed. This article presents a methodology for translating data from large data sets into dashboards for setting performance improvement priorities, in a simple way that takes advantage of tools readily available and easily used by support staff.

Mandated nurse staffing ratios in California: a comparison of staffing and nursing-sensitive outcomes pre- and postregulation.

This article examines the impact of mandated nursing ratios in California on key measures of nursing quality among adults in acute care hospitals. This study is a follow-up and extension of our first analysis exploring nurse staffing and nursing-sensitive outcomes comparing 2002 pre-ratios regulation data to 2004 postratios regulation data. For the current study we used postregulation ratios data from 2004 and 2006 to assess trends in staffing and outcomes.

Leveraging nurse-related dashboard benchmarks to expedite performance improvement and document excellence.

Using nursing quality benchmarks in operational dashboards and translating those data to drive performance excellence is a strategic imperative. Since access to unit-level, hospital-generated nurse-related benchmarks is an emerging arena, the authors provide an overview of aggregated trends and benchmarks gleaned from the California Nursing Outcome Coalition acute care database for 2 established nurse-related quality indicators-patient falls incidence and hospital-acquired pressure ulcer prevalence. Integrating these acute care benchmarks into clinical dashboards can be invaluable to clinicians, administrators, and policy makers who share a common commitment to expediting evidence-based improvement in patient care safety, outcomes, and excellence.

Creating and analyzing a statewide nursing quality measurement database.

Purpose: To explicate a replicable methodology for designing and analyzing a large ongoing reliable and valid quality database to examine nurse staffing and patient care outcomes in acute care hospitals.

Design: Prospective nurse staffing, process of care, and patient outcomes data based on the American Nurses Association's (ANA) nursing quality indicators collected from a voluntary convenience sample at acute care hospitals in California with rolling-site accrual.

Methods: The ongoing CalNOC database development and repository project, the largest statewide effort of its kind in the United States (US), currently includes data on hospital nurse staffing, patient days, patient falls, pressure ulcer and restraint prevalence, registered nurse (RN) education, and patients' perceptions of satisfaction with care.

Tips for teaching quality concepts to international audiences.

Healthcare quality professionals in the United States have opportunities to teach healthcare providers in other countries how to measure and monitor quality. Special preparation is required to effectively teach an international audience. This article offers tips for teaching basic quality concepts based upon the authors' experiences in the People's Republic of China.

Nurse staffing and patient perceptions of nursing care.

Unlabelled: OBJECTIVE To examine the relationship between nurse staffing and patient perceptions of nursing care in a convenience sample of 40 California hospitals.

Background: Growing concern about the adequacy of nurse staffing has led to an increased emphasis on research exploring the relationships between nurse staffing and patient outcomes. Patient satisfaction with nursing care is one of the 21 indicators identified by the American Nurses Association as having a strong "theoretical link to the availability and quality of professional nursing services in hospital settings.

Lessons in redesigning a quality program across the continuum.

The Kaiser Permanente North East Bay service area redesigned its quality program beginning in 1995, to better mirror how care was provided across the continuum. The old model had evolved over time, was based on departmental structure, and did not focus on all patient populations. The purpose of this article is to describe the redesign process, the quality model implemented, and future directions, with the hope that the lessons learned will provide other healthcare quality professionals some of the knowledge needed and, perhaps, the courage to "design" their quality programs.