HCA healthcare journal of medicine最新文献

Description I am a post-anesthesia care unit nurse who works in a busy ambulatory surgery center, and I consider myself a closet photographer. I love taking photographs of nature. It helps me relax and focus after a busy day. This photograph was taken on my way home on a very cold and snowy day. I found the trees stunning with their white snowy branches contrasting the black asphalt road. Such a peaceful view of nature.

Description Nursing represents the largest discipline in health care, with just over 5 million nurses in the United States, and the discipline is under increasing pressure to make evidence-based decisions in the delivery of patient care. This special issue of the HCA Healthcare Journal of Medicine can inspire and support nurses' scholarly work with an eye to dissemination in peer-reviewed medical journals. This issue highlights nursing's contributions to improving patient outcomes through nurse-sensitive indicators, with the hope of elevating the quality of tomorrow's health care.

Description Advanced practice registered nurses (APRNs) are key health care providers in a variety of settings. Often APRNs are grouped in a collective category, along with physician assistants, and referred to collectively as advanced practice providers. As APRNs assume an increasing role in patient care management in hospital, outpatient, and community settings, such as clinics and rural practices, measuring the impact of their care on patient outcomes and quality of care becomes a necessary component of performance evaluation. APRN-sensitive outcome indicators are an important way to identify the impact of the role. While a number of studies have been conducted that demonstrate APRN outcomes, identifying specific APRN-sensitive outcome indicators can be challenging. This article reviews the use of APRN-sensitive outcome indicators to identify the impact of the APRN role, highlighting exemplars from several clinical practice sites.

Description Throughout the United States, the post-COVID-19 pandemic period has been marked by profound disruption to health care operations, coordination, and care capacity. These disruptions have been especially serious in the emergency room (ER) setting. While intensely challenging, the post-pandemic period has also presented opportunities for health care systems to approach classic challenges facing the ER with fresh eyes. In this editorial, the authors discuss key strategies being used to help revitalize ERs nationally and reflect on future challenges and directions.

Background: This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis.

Methods: To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) impregnated caps and CHG pads. To reduce CLABSI in hemodialysis lines, a multidisciplinary team was formed comprising physicians, nurses, a dialysis technician, pharmacists, the dialysis director, the chief medical officer, the chief nursing officer, the assistant chief nursing officer, the infection preventionist, and the quality director. The team implemented a standardized approach to caring for hemodialysis lines, provided just-in-time education to staff, and standardized policies simultaneously at 8 hospitals. Initially, 1 facility served as the pilot facility for facility-owned dialysis services, totaling 9 facilities providing in-house standardized dialysis services. Data was reported back for monthly evaluation.

Results: Overall, there was an 88% reduction in CLABSI occurrences in hemodialysis lines from pre-intervention (n = 8) to post-intervention (n = 1), X² (1, N = 4112) = 4.181, P = .0408. Collaboration on these initiatives improved communication and enhanced quality care and patient safety across the entire spectrum of care.

Conclusions: Implementing innovative tracking of standardized approaches to patient care and infection prevention and evidence-based interventions resulted in decreased CLABSI rates, improving outcomes in vulnerable patients. An unintended benefit of this project was the increase in multidisciplinary collaboration.

Background: Blood cultures are vital to diagnostic workups among many hospitalized patients, providing valuable information about bloodstream infections (BSIs), which cause roughly 250 000 deaths annually between North America and Europe. Despite advances in health care, blood culture contamination remains a substantial problem, with deleterious effects on patient mortality, patient and hospital costs, and microbial resistance. This article reviews the repercussions of blood culture contamination on the health care system and delineates evidence-based strategies to decrease contamination rates.

Methods: To reduce blood culture contamination rates, our health care facility undertook a quality improvement initiative. A task force was created, consisting of leadership from the laboratory, phlebotomy, nursing, pathology, internal medicine teams, emergency medical services, and others. Measures included comprehensive staff training, standardization of protocols and supplies across facilities, and the introduction of waste tubes and smaller-volume chlorhexidine applicators for skin preparation. Data on blood culture contamination rates were collected before and after implementation.

Results: Prior to the intervention, the average monthly blood culture contamination rate across our facilities was 3.76%. Following the intervention, this rate decreased significantly to 2.07%, representing a reduction of 44.95%. Statistical analysis revealed a strong association between the implemented interventions and the decreased contamination rates, with a chi-square value of 62.3, 1 degree of freedom, and a P value of less than .001. These results indicate that the interventions were highly effective. Furthermore, the reduced contamination rates were sustained in the subsequent months, consistently remaining below 2%.

Conclusion: The study demonstrated a substantial reduction in blood culture contamination rates through targeted interventions, highlighting the efficacy of combining evidence-based strategies with interdisciplinary teamwork to improve patient care outcomes.

Background Patient falls are a common inpatient dilemma and comprise the largest category of preventable adverse events in hospitalized patients. These events place a clinical burden on the patient, such as increased morbidity and reduced quality of life, in addition to an economic burden on the hospital system. Fall prevention strategies have the opportunity to decrease inpatient health care costs and length of stay. Several risk factors have been identified that contribute to inpatient falls and several strategies have been identified to minimize this risk. These risk factors are typically characterized as intrinsic and extrinsic factors. Intrinsic factors include characteristics such as age, gender, impaired mobility, and physiological factors (eg, co-morbidities, low muscular strength, visual impairment, poor reaction time, and movement disorders). Extrinsic factors are related to characteristics in the environment, such as slippery surfaces, footwear, bad lighting, and the influence of medications. Risk assessment tools, such as the Hendrich II Fall Risk Model, Morse Fall Scale, and STRATIFY, were developed to help identify those at risk. In utilizing these models and our understanding of predisposing risk factors, prevention strategies may be utilized to mitigate these risks. These strategies are often generalized actions including patient education; however, targeted interventions (ie, patient education) also improve outcomes by interrogating specific risk factors.

Description In the world of trauma care, there is often darkness and despair. Sometimes we need to find the light around us to restore our positive balance. Photographs such as this capture the beauty of light and recharge my soul thus renewing my ability to provide compassion and empathy to our patients and families.

Description Infection prevention is a team within health care facilities and systems whose members are vital to reducing and mitigating patient harm secondary to infectious disease. Infection preventionists are subject matter experts who reside in the quality department and are responsible for multiple areas beyond infectious disease spread. They assist nursing teams, employee health programs, and epidemiologists in decreasing the spread of illness. They are widely under-recognized, though they have a significant impact on the overall stability of the health care system and the communities they serve.

Description Evidence-based practice holds the potential to streamline health care, reduce costs, and improve patient outcomes. A good share of the data collected to create the evidence comes from electronic health records and other digital sources. Nurse-sensitive indicators, such as patient falls, pressure injuries, and hospital-acquired infections, are examples of data used to reflect the quality of nursing care. Other data may come from routine assessments nurses perform. It is crucial that nurses use valid and reliable instruments to create this data and that the use of the instruments is consistent across nurses in units, different shifts, and even different facilities. Ensuring awareness and consistency as well as interrater reliability in using validated instruments may seem esoteric, but it is as practical as it gets. This article will educate and explore these concepts, as well as provide examples of unintended consequences from inconsistent use of an instrument, and strategies to implement, ensuring best practices for instrument usage.