A Historical View of Nursing Research at HCA Healthcare.

Description HCA Healthcare has been a pioneer in evidence-based practice (EBP) in nursing for over 20 years. Nursing leaders overcame 2 major challenges, generating useful data to inform practice and disseminating EBP across their vast network. These challenges were overcome by using data outside the electronic health record (EHR) while advancing the standardization of data within the EHR.

Future advancement of health care through standardized nursing terminologies: reflections from a Friends of the National Library of Medicine workshop honoring Virginia K. Saba.

Objective: To honor the legacy of nursing informatics pioneer and visionary, Dr. Virginia Saba, the Friends of the National Library of Medicine convened a group of international experts to reflect on Dr. Saba's contributions to nursing standardized nursing terminologies.

Nursing process, derived from the clinical care classification system components, as an earlier indicator of nursing care during a pandemic.

Background: During COVID pandemic response, an early signal was desired beyond typical financial classifications or order sets. The foundational work of Virginia K Saba informed the essential, symbiotic relationship of nursing practice and resource utilization by means of the Clinical Care Classification System [CCC]. Scholars have confirmed the use of the CCC as the structure for data modeling, focusing on the concept of nursing cost [1].

A Framework for National Collaboration to Reduce Documentation Burden and Design for Usable and Reusable Data.

A focused effort is needed to capture the utility and usability of the electronic health record for providing usable and reusable data while reducing documentation burden. A collaborative effort of nurse leaders and experts was able to generate national consensus recommendations on documentation elements related to admission history. The process used in this effort is summarized in a framework that can be used by other groups to develop content that reduces documentation burden while maximizing the creation of usable and reusable data.

Universal Protection: Operationalizing Infection Prevention Guidance in the COVID-19 Era.

Introduction: The COVID-19 pandemic has required facilities to quickly respond to a myriad of infection prevention recommendations, as well as design their own protocols. The varied and changing guidance has been difficult for staff to absorb and has presented challenges for managing compliance.

Approach: HCA Healthcare recognized the need for a coordinated approach to managing infection prevention guidance during the COVID-19 pandemic and a mechanism for monitoring compliance and responding to implementation challenges remotely.

A Systems-Level Method for Developing Nursing Informatics Solutions: The Role of Executive Leadership.

Nursing leadership can play an essential role in the development of nursing informatics solutions by virtue of their broad understanding and oversight of nursing care. We describe a systems-level method for creating nursing informatics solutions with clearly defined structure and leadership from nursing executives. Based on the guiding principles of clear lines of responsibility, respect for expertise, and commitment to project aims, this allows nursing executive leadership to organize, set up, and own the development of nursing informatics solutions.

Phased implementation of an antimicrobial stewardship program for a large community hospital system.

Background: Antimicrobial stewardship is recommended as a crucial mechanism to reduce the emergence of antimicrobial resistance. The purpose of this article was to describe implementation of antimicrobial management programs (AMPs) across a large health system of community hospitals.

Methods: The initiative was structured in 4 phases.

Units of Distinction: Creating a Blueprint for Recognition of High-Performing Medical-Surgical Nursing Units.

Background: Hospital medical-surgical (M/S) nursing units are responsible for up to 28 million encounters annually, yet receive little attention from professional organizations and national initiatives targeted to improve quality and performance.

Objective: We sought to develop a framework recognizing high-performing units within our large hospital system.

Methods: This was a retrospective data analysis of M/S units throughout a 168-hospital system.

A Comprehensive Program to Reduce Rates of Hospital-Acquired Pressure Ulcers in a System of Community Hospitals.

Objectives: The prevention of hospital-acquired pressure ulcers (PrUs) has significant consequences for patient outcomes and the cost of care. Providers are challenged with evaluating available evidence and best practices, then implementing programs and motivating change in various facility environments.

Methods: In a large system of community hospitals, the Reducing Hospital Acquired-PrUs Program was developed to provide a toolkit of best practices, timely and appropriate data for focusing efforts, and continuous implementation support.

Validation of the NE1 wound assessment tool to improve staging of pressure ulcers on admission by registered nurses.

Background And Purpose: There is a need for a simple bedside tool to improve the ability of nurses to identify skin alterations, describe wounds, and stage pressure ulcers for proper care management and present on admission documentation. This study tests the test-retest reliability and criterion validity of the NE1 Wound Assessment Tool (NE1 WAT), a single-use tool featuring wound pictures and stage descriptions according to National Pressure Ulcer Advisor Panel criteria.

Methods: Registered nurses (N = 94) identified and staged 30 wound photographs under 3 test conditions: (a) without NE1 WAT, (b) with NE1 WAT after viewing a 10-min instructional presentation, (c) with NE1 WAT but no additional instruction after a 7-14-day delay.

Implementation of standardized pediatric i.v. medication concentrations.

Purpose: The development and implementation of a comprehensive and standardized list of pediatric i.v. medication concentrations across a large healthcare system are described.

Defining and incorporating basic nursing care actions into the electronic health record.

Purpose: To develop a definition of basic nursing care for the hospitalized adult patient and drive uptake of that definition through the implementation of an electronic health record.

Design And Methods: A team of direct care nurses, assisted by subject matter experts, analyzed nursing theory and regulatory requirements related to basic nursing care. The resulting list of activities was coded using the Clinical Care Classification (CCC) system and incorporated into the electronic health record system of a 170-bed community hospital.

A bundled approach to reduce methicillin-resistant Staphylococcus aureus infections in a system of community hospitals.

Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant challenge to U.S. healthcare facilities, but there has been limited study of initiatives to reduce infection and increase patient safety in community hospitals.

Rapid core measure improvement through a "business case for quality".

Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement.

Data-driven process and operational improvement in the emergency department: the ED Dashboard and Reporting Application.

Emergency departments (EDs) in the United States are expected to provide consistent, high-quality care to patients. Unfortunately, EDs are encumbered by problems associated with the demand for services and the limitations of current resources, such as overcrowding, long wait times, and operational inefficiencies. While increasing the effectiveness and efficiency of emergency care would improve both access and quality of patient care, coordinated improvement efforts have been hindered by a lack of timely access to data.

Quality improvement projects targeting health care-associated infections: comparing Virtual Collaborative and Toolkit approaches.

Background: Collaborative and toolkit approaches have gained traction for improving quality in health care.

Objective: To determine if a quality improvement virtual collaborative intervention would perform better than a toolkit-only approach at preventing central line-associated bloodstream infections (CLABSIs) and ventilator-associated pneumonias (VAPs).

Design And Setting: Cluster randomized trial with the Intensive Care Units (ICUs) of 60 hospitals assigned to the Toolkit (n=29) or Virtual Collaborative (n=31) group from January 2006 through September 2007.

Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth.

Objective: No studies exist that have examined the effectiveness of different approaches to a reduction in elective early term deliveries or the effect of such policies on newborn intensive care admissions and stillbirth rates.

Study Design: We conducted a retrospective cohort study of prospectively collected data and examined outcomes in 27 hospitals before and after implementation of 1 of 3 strategies for the reduction of elective early term deliveries.

Results: Elective early term delivery was reduced from 9.

Emergency department use during the postpartum period: implications for current management of the puerperium.

Objective: The purpose of this study was to define patterns of morbidity that are experienced by women in the postpartum period who seek care in the emergency department within 42 and 100 days of discharge.

Study Design: We conducted a retrospective examination of discharge diagnosis codes and descriptions for emergency department visits and analyzed temporal patterns of both emergency department visits and hospital readmissions.

Results: During 2007, 222,084 patients delivered in Hospital Corporation of America facilities in the United States.

Reduction of severe hyperbilirubinemia after institution of predischarge bilirubin screening.

Objective: The objective of this study was to demonstrate efficacy of universal predischarge neonatal bilirubin screening in reducing potentially dangerous hyperbilirubinemia in a large, diverse national population.

Methods: This was a 5-year prospective study directed at neonates who were aged < or =28 days and evaluated at facilities of the Hospital Corporation of America with a serum bilirubin level of > or =20.0 mg/dL.

Evidence-based algorithms for diagnosing and treating ventilator-associated pneumonia.

Background: Ventilator-associated pneumonia (VAP) is widely recognized as a serious and common complication associated with high morbidity and high costs. Given the complexity of caring for heterogeneous populations in the intensive care unit (ICU), however, there is still uncertainty regarding how to diagnose and manage VAP.

Objective: We recently conducted a national collaborative aimed at reducing health care-associated infections in ICUs of hospitals operated by the Hospital Corporation of America (HCA).

The chief nurse executive role in large healthcare systems.

Community hospitals are most frequently led by nonclinicians. Although some may have employed physician leaders, most often clinical leadership is provided by a chief nurse executive (CNE) or chief nursing officer. Clinical leadership of community hospital and health systems may similarly be provided by a system-level nursing executive or, often, by a council of facility CNEs.

Survey of infection control programs in a large national healthcare system.

In light of consumers' and regulators' increasing focus on infection prevention, infection control practices and resources were surveyed at 134 hospitals owned by the Hospital Corporation of America. Infection control practices and resources varied substantially among hospitals, and many facilities reported difficulty acquiring the data they needed to report infection rates.