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McCullough K, Baker M, Bloxsome D, Crevacore C, Davies H, Doleman G, Gray M, McKay N, Palamara P, Richards G, Saunders R, Towell-Barnard A, Coventry LL. Clinical deterioration as a nurse sensitive indicator in the out-of-hospital context: A scoping review. J Clin Nurs 2024; 33:874-889. [PMID: 37953491 DOI: 10.1111/jocn.16925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
AIMS To explore and summarise the literature on the concept of 'clinical deterioration' as a nurse-sensitive indicator of quality of care in the out-of-hospital context. DESIGN The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review and the JBI best practice guidelines for scoping reviews. METHODS Studies focusing on clinical deterioration, errors of omission, nurse sensitive indicators and the quality of nursing and midwifery care for all categories of registered, enrolled, or licensed practice nurses and midwives in the out-of-hospital context were included regardless of methodology. Text and opinion papers were also considered. Study protocols were excluded. DATA SOURCES Data bases were searched from inception to June 2022 and included CINAHL, PsychINFO, MEDLINE, The Allied and Complementary Medicine Database, EmCare, Maternity and Infant Care Database, Australian Indigenous HealthInfoNet, Informit Health and Society Database, JSTOR, Nursing and Allied Health Database, RURAL, Cochrane Library and Joanna Briggs Institute. RESULTS Thirty-four studies were included. Workloads, education and training opportunities, access to technology, home visits, clinical assessments and use of screening tools or guidelines impacted the ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting. CONCLUSIONS Little is known about the work of nurses or midwives in out-of-hospital settings and their recognition, reaction to and relay of information about patient deterioration. The complex and subtle nature of non-acute deterioration creates challenges in defining and subsequently evaluating the role and impact of nurses in these settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Further research is needed to clarify outcome measures and nurse contribution to the care of the deteriorating patient in the out-of-hospital setting to reduce the rate of avoidable hospitalisation and articulate the contribution of nurses and midwives to patient care. IMPACT What Problem Did the Study Address? Factors that impact a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting are not examined to date. What Were the Main Findings? A range of factors were identified that impacted a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting including workloads, education and training opportunities, access to technology, home visits, clinical assessments, use of screening tools or guidelines, and avoidable hospitalisation. Where and on whom will the research have an impact? Nurses and nursing management will benefit from understanding the factors that act as barriers and facilitators for effective recognition of, and responding to, a deteriorating patient in the out-of-hospital setting. This in turn will impact patient survival and satisfaction. REPORTING METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines guided this review. The PRISMA-Scr Checklist (Tricco et al., 2018) is included as (supplementary file 1).Data sharing is not applicable to this article as no new data were created or analysed in this study." NO PATIENT OR PUBLIC CONTRIBUTION Not required as the Scoping Review used publicly available information.
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Affiliation(s)
- Kylie McCullough
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Melanie Baker
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Dianne Bloxsome
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Carol Crevacore
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Hugh Davies
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Gemma Doleman
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
| | - Michelle Gray
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Nilufeur McKay
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Peter Palamara
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Gina Richards
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
| | - Linda L Coventry
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
- Centre for Research in Aged Care Edith Cowan University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, Western Australia, Australia
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Bui LN, Yoon J, Harvey SM, Luck J. Coordinated Care Organizations and mortality among low-income infants in Oregon. Health Serv Res 2019; 54:1193-1202. [PMID: 31657003 DOI: 10.1111/1475-6773.13228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine the impact of Oregon's Coordinated Care Organizations (CCOs), an accountable care model for Oregon Medicaid enrollees implemented in 2012, on neonatal and infant mortality. DATA SOURCES Oregon birth certificates linked with death certificates, and Medicaid/CCO enrollment files for years 2008-2016. STUDY DESIGN The sample consisted of the pre-CCO birth cohort of 135 753 infants (August 2008-July 2011) and the post-CCO birth cohort of 148 650 infants (August 2012-December 2015). We used a difference-in-differences probit model to estimate the difference in mortality between infants enrolled in Medicaid and infants who were not enrolled. We examined heterogeneous effects of CCOs for preterm and full-term infants and the impact of CCOs over the implementation timeline. All models were adjusted for maternal and infant characteristics and secular time trends. PRINCIPAL FINDINGS The CCO model was associated with a 56 percent reduction in infant mortality compared to the pre-CCO level (-0.20 percentage points [95% CI: -0.35; -0.05]), and also with a greater reduction in infant mortality among preterm infants compared to full-term infants. The impact on mortality grew in magnitude over the postimplementation timeline. CONCLUSIONS The CCO model contributed to a reduction in mortality within the first year of birth among infants enrolled in Medicaid.
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Affiliation(s)
- Linh N Bui
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.,Health Management and Policy Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Jangho Yoon
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.,Health Management and Policy Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.,Health Management and Policy Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Jeff Luck
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.,Health Management and Policy Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
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Abstract
Developments in perinatal and neonatal care have increased the survival rate of high-risk newborns but led to a rise in chronic diseases seen in these infants. A significant number of them attend primary and secondary health care centers after discharge; however, there are very few standard protocols for the long-term follow-up of these babies. Therefore, we aimed to establish a follow-up guideline that emphasizes on universal screening schemes and takes into consideration national data. The guide presented here provides brief recommendations for physicians in light of evidence-based data for the follow-up of high-risk newborn infants. The steps taken to monitor and solve the problems of all high-risk infants may vary. We hope the use of such a standard approach in evaluating each infant in daily routine will improve the life quality of these high-risk infants.
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Affiliation(s)
- Betul Acunaş
- Division of Neonatology, Department of Pediatrics, Trakya University, Faculty of Medicine, Edirne, Turkey
| | - Sinan Uslu
- Neonatology Clinic, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Yağmur Baş
- Division of Neonatology, Department of Pediatrics, Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
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