Lessons learned from study of depression in cardiovascular patients in an acute-care heart and vascular hospital.

Depression is highly prevalent in patients with cardiovascular disease, but questions about the effectiveness of screening and intervention remain unanswered. To evaluate the effects of proactive intervention at an acute-care heart and vascular hospital, patients who reported depressive symptoms on admission were randomized to an active, counseling-based depression intervention plus standard care (referral to a primary or psychiatric care physician) or to standard care alone. Despite early termination of patient enrollment because of lower-than-expected recruitment rates, the project had a positive impact.

The preadmission packet: a strategy that benefits patients and nurses during the admission process.

At Baylor Jack and Jane Hamilton Heart and Vascular Hospital, we developed a preadmission packet that is given to patients before their procedure date, enabling them to complete much of their paperwork in advance. The results of our subsequent study revealed that nurses save time during the assessment interview when patients arrive at the hospital with their admission database forms completed. In a busy facility with a large number of patients admitted daily, the nursing time saved can translate into a substantial economic benefit.

Implementation of an informational card to reduce family members' anxiety.

For surgical patients' family members, the wait during surgery can cause anxiety that can be exacerbated if staff members provide inadequate or inconsistent information about the patient's status. Educational interventions and other staff-intensive measures to help reduce family members' anxiety can be time consuming for staff members and impractical in a high-volume facility. To improve communication with patients' families, nurses at a heart and vascular hospital in Dallas, Texas, designed and distributed a card containing estimated procedure times, helpful telephone numbers, and other information.

Glucose control and opportunities for health care improvement in a hospital setting.

We initiated a study at Baylor Jack and Jane Hamilton Heart and Vascular Hospital to compare the sliding scale insulin (SSI) protocol used in 2006 with the SSI protocol currently used to treat diabetic patients admitted for procedures or surgery. An audit of patients' records revealed greater variation in staff compliance with the current protocol than with the previous one. In addition, it seemed that more patients were refusing insulin coverage under the current protocol than under the prior version.

Meta-analysis of fall-risk tools in hospitalized adults.

Objective: The aim of the study was to identify which fall-risk tool is most accurate for assessing adults in the hospital setting.

Background: Falls can have physical, emotional, social, and financial consequences. Risk assessment affords the first opportunity in prevention.

Appropriateness of sling immobilization to prevent lead displacement after pacemaker/implantable cardioverter-defibrillator implantation.

After pacemaker/implantable cardioverter-defibrillator (pacemaker/ICD) implantation, patients are often required to immobilize the affected arm with a sling to minimize the risk of lead displacement. We examined whether performing a resistive range-of-motion exercise protocol after pacemaker/ICD surgery would result in lead displacement and, therefore, whether sling immobilization and activity restrictions are justified. Ten subjects who had undergone pacemaker/ICD surgery performed four individual resistive range-of-motion exercises (three sets of 10 repetitions for each: one warm-up set without weight and two sets with a 1- or 2-pound hand weight) with the affected arm prior to hospital discharge.

Standardization of a surgical site precleansing technique for vascular patients.

Surgical site infection (SSI) is a serious complication that can increase hospital costs and length of stay and may be life threatening. The preoperative chlorhexidine shower is widely recommended to decrease SSI risk, although standardized guidelines for this practice and supporting clinical evidence are lacking. Because vascular patients often have comorbidities that hinder preoperative showering, OR nurses at a specialty hospital in Dallas, Texas, developed and implemented an intraoperative surgical site precleansing technique as standard practice for patients undergoing procedures involving the axilla or groin.