Use of Six Sigma for Eliminating Missed Opportunities for Prevention Services

Interventions to prevent or reduce rationing or missed nursing care: A scoping review

AIMS

To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions.

BACKGROUND

Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes.

DESIGN

Scoping review.

DATA SOURCES

We searched for eligible studies, published between 1980-2019, in six electronic databases.

REVIEW METHODS

Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based.

RESULTS

The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care.

CONCLUSIONS

The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions.

IMPACT

Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.

Using Lean to Enhance Heart Failure Patient Identification Processes and Increase Core Measure Scores

BACKGROUND

Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. Health systems target readmission rates for quality improvement and cost reduction.

LOCAL PROBLEM

Heart failure core measure (CM) scores at our medical center were lower than the national average, and methods for capturing the appropriate documentation on HF patients to ensure CM compliance were not clear.

METHODS

An interdisciplinary team determined barriers to increasing CM scores, gathered baseline data, and identified gaps in the existing process.

INTERVENTIONS

The team implemented an accurate reporting system and error-proofing process, redesigned the process for identifying patients admitted with a HF diagnosis, and developed a patient appointment section before discharge in the electronic medical record.

RESULTS

There was a decrease in readmissions within 30 days of implementation from 12% to 8%, and HF CM compliance score increased from 88% to 100%. The percentage of HF patients not identified during hospitalization decreased from 17% to 0%. Heart failure patients discharged with a 7-day follow-up appointment increased from 88% to 98%.

CONCLUSION

Through implementation of an interdisciplinary-led process improvement and lean methodologies, metrics and CMs were achieved.