Journal of nursing care quality最新文献

Background: Quality improvement (QI) initiatives help ensure patients are receiving high-quality care. Iterative Plan-Do-Study-Act (PDSA) cycles are used to test change. Data are evaluated over time, and tests of change can be modified or discarded as needed.

Problem: Health care QI teams lack the flexibility to conduct PDSA cycles, often conducting pre/post quasi-experimental research studies instead.

Approach: This article reviews a case study of a "personal improvement" initiative as an example of QI methods and data evaluation for an individual trying to lose weight. The purpose of this article is to provide guidance on best practices for conducting QI initiatives; common pitfalls that clinicians may face when leading their own QI initiatives are identified and recommendations to overcome these challenges are discussed.

Conclusions: Concepts from this case study, along with supplemental resources provided, can help clinicians optimize QI methodologies in the health care setting.

Background: Human trafficking affects nearly 1.1 million persons in the United States. Over 50% of victims will receive care in an emergency department (ED) during their exploitation.

Purpose: The purpose of this study was to assess the effectiveness of a human trafficking protocol and electronic medical record screening and assessment tool in identifying victims of human trafficking in the ED.

Methods: A 5-year, retrospective chart audit was conducted.

Results: Over 2 million ED visits occurred during the 5-year study period. Less than 1% ( n = 525) of those patients screened positive as potential victims, while 45 (8.6%) were confirmed trafficking victims. The number of victims identified dropped following the pandemic.

Conclusions: Pandemic issues, staffing turnover, and lack of ongoing trafficking education impeded the identification of victims. Recommended changes to the protocol are presented.

Background: Bedside shift report improves patient satisfaction, peer accountability, communication, and decreases safety events.

Local problem: Clinical practice of bedside report varied prior to the pandemic. Due to limited personal protective equipment and exposure risk, bedside report was halted during the pandemic.

Approach: The Iowa Model of Evidence-Based Practice was used to guide this project. To standardize communication during bedside report, safety data and literature were reviewed and grouped by themes. The acronym COAST was developed, consisting of code status, oxygen, access, safety, and tubes/drains. These elements were to be discussed at the bedside during handoff.

Results: Compliance with completing elements of COAST increased during the pilot, 9- and 12-month sustainment periods. Additional safety-related outcomes of cardiopulmonary resuscitation wristband application, falls, and good catches improved. Notably, overtime declined.

Conclusions: A bedside report with standardized communication focusing on safety elements can improve compliance with adoption and patient safety outcomes.

Background: Care coordination is an important strategy for addressing patient needs and improving outcomes of care.

Purpose: The Minnesota Care Coordination Effectiveness Study sought to better understand the perspectives and experiences of clinicians/clinic leaders regarding the value, barriers, and facilitators for care coordination in primary care.

Methods: We conducted semi-structured interviews with 18 clinic managers, physicians, and advanced practice clinicians. Data were analyzed using a directed content analysis approach.

Results: Five themes arose in the interviews: financial issues were perceived as a primary barrier to care coordination; participants valued care coordination as an important asset; they employed significant variation in how care coordination was structured; they identified both medical and social needs of patients as important; and care coordinators' background, experience, and integration were viewed as critical to program success.

Conclusions: Care coordination received strong support from clinicians and clinic leaders who viewed it as a valuable component of successful care delivery.

Background: The Thrive program is an evidenced-based care model for Medicaid-insured adults in the hospital-to-home transition. A substantial portion of Thrive participants live with serious mental illness (SMI), yet Thrive's efficacy has not been tested among these patients.

Purpose: To compare 30-day postdischarge outcomes between Thrive participants with and without SMI and explore Thrive's appropriateness and acceptability among participants with SMI.

Methods: We conducted a sequential explanatory mixed-methods study of 252 (62 with SMI) Thrive participants discharged from an academic medical center from February 2021 to August 2023. Interviews of participants with SMI were analyzed using rapid qualitative analysis.

Results: Participants with and without SMI experienced similar rates of 30-day readmissions, emergency room visits, and postdischarge follow-up visits, with these differences being nonsignificant. Participants with SMI were highly satisfied with Thrive's care coordination and attention to social needs, yet participants suggested stronger connections to behavioral health care.

Conclusions: Participants with and without SMI benefit equitably from Thrive.