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Herrmann EJ, Raghavan B, Tekeste M, Mantzsch K, Meybohm P, Assmus B. Randomized Pilot Trial of Pre- and Postoperative Heart Failure Nurse-Supported Care in Heart Failure Patients Requiring Noncardiac Surgery-Feasibility and Results. Clin Cardiol 2024; 47:e24304. [PMID: 38924180 PMCID: PMC11194970 DOI: 10.1002/clc.24304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION The perioperative cardiovascular management of patients undergoing noncardiac surgery is particularly challenging in those with pre-existing heart failure (HF). This study was designed to evaluate the effectiveness of nurse-based pre- and postoperative specialized HF management in reducing postoperative HF-associated complications in patients with known HF undergoing noncardiac surgery. METHODS This prospective, randomized pilot study included patients with established HF requiring intermediate- to high-risk noncardiac surgery. Patients received postoperatively either standard care (control group, CG) or nurse-supported HF management (intervention group, IG). The primary endpoint was a composite of HF-related postoperative complications at 30 days. Secondary endpoints included length on intensive care unit, length of hospital stay, death, hospitalization for HF, and quality of life assessment using the SF-12 questionnaire. RESULTS The trial was halted prematurely for futility. A total of 34 patients (median age 70.5 [IQR 67-75] years; with 15 HfpEF, 9 HfmrEF,10 HfrEF), with an average NT-proBNP of 1.413 [463-2.832] pg/mL were included. The IG had a lower rate of postoperative primary events (25%; n = 4) compared with the CG (33%; n = 6). There were no differences in secondary endpoints between the groups. Quality-of-life scores improved slightly in both groups (δ 5.6 ± 0.9 [CG] and 3.1 ± 1.2 [IG]). CONCLUSION Nurse-based pre- and postoperative HF care appears to be feasible and may reduce HF-associated complications in patients undergoing noncardiac surgery. Larger clinical trials are needed to further evaluate the effectiveness of this approach in reducing postoperative complications in this high-risk patient population.
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Affiliation(s)
- Ester J. Herrmann
- Department of Cardiology and AngiologyUniversity Hospital Giessen and MarburgGiessenGermany
| | | | - Meaza Tekeste
- Department of CardiologyUniversity Hospital Frankfurt/MainGiessenGermany
| | - Kathleen Mantzsch
- Department of CardiologyUniversity Hospital Frankfurt/MainGiessenGermany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care and Emergency and Pain MedicineUniversity Hospital WürzburgWürzburgGermany
| | - Birgit Assmus
- Department of Cardiology and AngiologyUniversity Hospital Giessen and MarburgGiessenGermany
- Department of CardiologyUniversity Hospital Frankfurt/MainGiessenGermany
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2
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Salley KE, Crawford AS, Robichaud DI, DeVivo G, Steppacher RC, Schanzer A, Simons JP. Targeted use of postoperative discharge phone calls to reduce early readmission rates. J Vasc Surg 2024; 79:1206-1216.e4. [PMID: 38244644 DOI: 10.1016/j.jvs.2024.01.009] [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: 09/20/2023] [Revised: 12/29/2023] [Accepted: 01/06/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES Postoperative readmissions are common and costly. Office-initiated phone calls to patients shortly after discharge may identify concerns and allow for early intervention to prevent readmission. We sought to evaluate our 30-day readmission rate after the implementation of a standardized postoperative discharge phone call (PODPC) intervention, compared with a historical aggregated cohort. METHODS From July 2020 to 21, postoperative patients were prospectively identified at 48 hour after discharge. Medical assistants performed PODPCs, administering a survey designed to identify medical/surgical issues that could signify a complication and warrant escalation to a nurse practitioner (NP) for further management. Demographics, comorbidities, and procedure type were obtained retrospectively. Descriptive statistics were used to evaluate PODPC responses, frequency of escalation, readmission, and reasons. The electronic medical record identified a historical aggregated cohort (July 2018 to 2019) and the 30-day readmission rate. A χ2 analysis was used to compare readmission rates between the preintervention historical and PODPC intervention groups. Predictors of 30-day readmission were modeled with multivariable logistic regression. RESULTS Of 411 PODPCs conducted, 106 patients (26%) reported not feeling well; having concerns. Eighty-four PODPCs (20%) triggered escalation to a NP; of these, 60 patients (71%) were counseled over the phone by an NP, 16 (19%) were brought into clinic, 6 (7%) were sent to the emergency department, and 2 (2%) did not answer the NP call. Of 411 patients, 17% (n = 68) were readmitted within 30 days. Comparatively, the historical aggregated cohort readmission rate was significantly higher at 28% (n = 346; P < .001). On multivariable analysis, chronic obstructive pulmonary disease (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.01-3.65; P = .046), and feeling run down; having difficulty with movement; needing assistance for most activities (OR, 3.94; 95% CI, 2.09-7.43; P < .0001) were predictive of 30-day readmission when controlling for procedure type. CONCLUSIONS Although readmissions remained common (>15%), being in the intervention cohort was associated with a significantly lower readmission rate compared with the historical aggregated cohort. One-fifth of PODPCs identified a concern; however, >90% of these could be managed by an NP by phone or in clinic. This PODPC intervention holds promise as a viable mechanism for decreasing readmissions.
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Affiliation(s)
- Katherine E Salley
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Allison S Crawford
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Devon I Robichaud
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Gabrielle DeVivo
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | | | - Andres Schanzer
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Jessica P Simons
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA.
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Perez R, Yarrington ME, Deri CR, Smith MJ, Hayes J, Wrenn RH, Moehring RW. Teams in Transition: Increasing Role of Advanced Practice Providers in Antimicrobial Use and Infectious Diseases Consultation. Open Forum Infect Dis 2024; 11:ofae141. [PMID: 38577030 PMCID: PMC10993059 DOI: 10.1093/ofid/ofae141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Background Advanced practice providers (APPs) have taken on increasing responsibilities as primary team members in acute care hospitals, but the impact of this practice shift on antimicrobial prescribing and infectious diseases (ID) consultation requests is unknown. Here we describe longitudinal trends in antimicrobial days of therapy (DOT) and ID consultation by attributed provider type in 3 hospitals. Methods We performed a retrospective time series analysis of antimicrobial use and ID consultation from July 2015 to June 2022 at a major university hospital and 2 community hospitals. We evaluated antimicrobial DOT and ID consultation over time and assessed attribution to 3 groups of providers: attending physicians, trainees, and APPs. We used multinomial logistic regression to measure changes in percentage of DOT and ID consultation across the clinician groups over time using physicians as the referent. Results Baseline distribution of antimicrobial DOT and ID consultation varied by practice setting, but all subgroups showed increases in the proportion attributable to APPs. Large increases were seen in the rate of ID consultation, increasing by >30% during the study period. At our university hospital, by study end >40% of new ID consults and restricted antimicrobial days were attributed to APPs. Conclusions Hospitals had differing baseline patterns of DOT attributed to provider groups, but all experienced increases in DOT attributed to APPs. Similar increases were seen in changes to ID consultation. APPs have increasing involvement in antimicrobial use decisions in the inpatient setting and should be engaged in future antimicrobial stewardship initiatives.
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Affiliation(s)
- Reinaldo Perez
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Durham, North Carolina, USA
| | - Michael E Yarrington
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Durham, North Carolina, USA
| | - Connor R Deri
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael J Smith
- Department of Medicine, Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Durham, North Carolina, USA
- Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Jillian Hayes
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Rebekah H Wrenn
- Department of Pharmacy, Duke University Medical Center, Durham, North Carolina, USA
| | - Rebekah W Moehring
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke Center for Antimicrobial Stewardship and Infection Prevention, Department of Medicine, Durham, North Carolina, USA
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4
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Poghosyan L, Liu J, Spatz E, Flandrick K, Osakwe Z, Martsolf GR. Nurse Practitioner Care Environments and Racial and Ethnic Disparities in Hospitalization Among Medicare Beneficiaries with Coronary Heart Disease. J Gen Intern Med 2024; 39:61-68. [PMID: 37620724 PMCID: PMC10817858 DOI: 10.1007/s11606-023-08367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Nurse practitioners care for patients with cardiovascular disease, particularly those from racial and ethnic minority groups, and can help assure equitable health outcomes. Yet, nurse practitioners practice in challenging care environments, which limits their ability to care for patients. OBJECTIVE To determine whether primary care nurse practitioner care environments are associated with racial and ethnic disparities in hospitalizations among older adults with coronary heart disease. DESIGN In this observational study, a cross-sectional survey was conducted among primary care nurse practitioners in 2018-2019 who completed a valid measure of care environment. The data was merged with 2018 Medicare claims data for patients with coronary heart disease. PARTICIPANTS A total of 1244 primary care nurse practitioners and 180,216 Medicare beneficiaries 65 and older with coronary heart disease were included. MAIN MEASURES All-cause and ambulatory care sensitive condition hospitalizations in 2018. KEY RESULTS There were 50,233 hospitalizations, 9068 for ambulatory care sensitive conditions. About 28% of patients had at least one hospitalization. Hospitalizations varied by race, being highest among Black patients (33.5%). Care environment moderated the relationship between race (Black versus White) and hospitalization (OR 0.93; 95% CI, 0.88-0.98). The lowest care environment was associated with greater hospitalization among Black (odds ratio=1.34; 95% CI, 1.20-1.49) compared to White beneficiaries. Practices with the highest care environment had no racial differences in hospitalizations. There was no interaction effect between care environment and race for ambulatory care sensitive condition hospitalizations. Nurse practitioner care environment had a protective effect on these hospitalizations (OR, 0.96; 95% CI, 0.92-0.99) for all beneficiaries. CONCLUSIONS Unfavorable care environments were associated with higher hospitalization rates among Black than among White beneficiaries with coronary heart disease. Racial disparities in hospitalization rates were not detected in practices with high-quality care environments, suggesting that improving nurse practitioner care environments could reduce racial disparities in hospitalizations.
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Affiliation(s)
- Lusine Poghosyan
- School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA.
- Mailman School of Public Health, Columbia University, New York, USA.
| | - Jianfang Liu
- School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA
| | - Erica Spatz
- School of Medicine, Yale University, New Haven, CT, USA
| | - Kathleen Flandrick
- School of Nursing, Columbia University, 560 West 168th Street, Office 624, New York, NY, 10032, USA
| | - Zainab Osakwe
- College of Nursing and Public Health, Adelphi University, Garden City, NY, USA
| | - Grant R Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Ilkjær C, Hoffmann T, Heiberg J, Hansen LS, Hjortdal VE. The effect of early follow-up after open cardiac surgery in a student clinic. SCAND CARDIOVASC J 2023; 57:2184861. [PMID: 36883910 DOI: 10.1080/14017431.2023.2184861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Objectives. Readmission rates following open cardiac surgery are high, affecting patients and the cost of care. This study aimed to investigate the effect of early additional follow-up after open cardiac surgery when 5th-year medical students conducted follow-ups under the supervision of physicians. The primary endpoint was unplanned cardiac-related readmissions within one year. The secondary outcomes were the detection of impending complications and health-related quality of life (HRQOL). Methods. Patients undergoing open cardiac surgery were prospectively included. For intervention, additional follow-up visits, including point-of-care ultrasound, were conducted by supervised 5th-year medical students on postoperative days 3, 14 and 25. Unplanned cardiac-related readmissions, including emergency department visits, were registered within the first year of surgery. Danish National Health Survey 2010 questionnaire was used for HRQOL. In standard follow-up, all patients were seen 4-6 weeks postoperative. Results. For data analysis, 100 of 124 patients in the intervention group and 319 of 335 patients in the control group were included. The 1-year unplanned readmission rates did not differ; 32% and 30% in the intervention and control groups, respectively (p = 0.71). After discharge, 1% of patients underwent pericardiocentesis. The additional follow-up initiated scheduled drainage, contrary to more unscheduled/acute drainages in the control group. Pleurocentesis was more common in the intervention group (17% (n = 17) vs 8% (n = 25), p = 0.01) and performed earlier. There was no difference between groups on HRQOL. Conclusion. Supervised student-led follow-up of newly cardiac-operated patients did not alter readmission rates or HRQOL but may detect complications earlier and initiate non-emergent treatment of complications.
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Affiliation(s)
- Christine Ilkjær
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Departmet of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Torben Hoffmann
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Departmet of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Johan Heiberg
- Departmet of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Laura Sommer Hansen
- Departmet of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Surgery, Aarhus University Hospital, Aarhus
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Driscoll A, Meagher S, Kennedy R, Hare DL, Johnson DF, Asker K, Farouque O, Romaniuk H, Orellana L. Impact of a heart failure nurse practitioner service on rehospitalizations, emergency presentations, and survival in patients hospitalized with acute heart failure. Eur J Cardiovasc Nurs 2023; 22:701-708. [PMID: 36413653 DOI: 10.1093/eurjcn/zvac108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 10/12/2023]
Abstract
AIMS Heart failure nurse practitioners (HF NPs) are an emerging component of the heart failure (HF) specialist workforce but their impact in an inpatient setting is untested. The aim of this paper is to explore the impact of an inpatient HF NP service on 12-month all-cause rehospitalizations, emergency department (ED) presentations, and mortality in patients hospitalized with HF compared with usual hospital care. METHODS AND RESULTS Retrospective, two-group comparative design involving patients (n = 408) admitted via ED with acute HF to a metropolitan quaternary hospital between January 2013 and August 2017. Doubly robust estimation with augmented inverse probability weighting (DR-AIPW) was used to account for the non-random allocation of patients to usual hospital care or the HF NP service in addition to usual in-hospital care. Among 408 patients (186 usual care and 222 HF NP service) admitted with acute HF, the mean age was 76.5 [standard deviation (SD) 12.0] years and 56.4% (n = 230) were male. After IPW adjustment, patients seen by the HF NP service had a lower risk of 12-month rehospitalization (61.3 vs. 78.3% usual care; difference -16.9%, 95% CI: -26.4%, -6.6%) and ED presentations (12.6 vs. 22.0%; difference -9.4%, 95% CI: -17.3%, -1.4%) with no difference in 6- or 12-month mortality. The HF NP service improved referrals to a home visiting programme that was available to HF patients (64.4 vs. 45.4%; difference 19%, 95% CI: 8.8%, 28.8%). CONCLUSION Additional support by an inpatient HF NP service has the potential to significantly reduce rehospitalizations and ED presentations over 12 months. Further evidence from a multicentre randomized control trial is warranted.
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Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Sharon Meagher
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Rhoda Kennedy
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - David L Hare
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Douglas F Johnson
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- The Royal Melbourne Hospital, Department of General Medicine, Grattan St, Parkville, VIC 3050, Australia
| | - Kristina Asker
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Omar Farouque
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Helena Romaniuk
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
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Oksholm T, Gissum KR, Hunskår I, Augestad MT, Kyte K, Stensletten K, Drageset S, Aarstad AKH, Ellingsen S. The effect of transitions intervention to ensure patient safety and satisfaction when transferred from hospital to home health care-A systematic review. J Adv Nurs 2023; 79:2098-2118. [PMID: 36762670 DOI: 10.1111/jan.15579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/08/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
AIM The aim of this systematic review is to describe and evaluate the effectiveness of transition interventions to safeguard patient safety and satisfaction during patients' transition from hospital to home health care. DESIGN Systematic review. DATA SOURCES MEDLINE, Ovid Nursing Database, PsycINFO, EMBASE, CINAHL, Clinical Trials and SveMed+ was systematic searched in January 2019 and September 2020 to identify peer-reviewed papers. No language, geographical or publication date restrictions. REVIEW METHODS Cochrane Handbook for Systematic Reviews of Interventions was used. Data analysis focused on aggregated data and a descriptive synthesis. Risk of bias was rated using Cochrane risk-of-bias tool. RESULTS In total, 10,524 references were identified in the literature search, twenty-six articles were included. The interventions were divided into three main groups: (i). systematic patient education pre-discharge; (ii). establishment of contact with the local healthcare services pre-discharge and (iii). follow-up initiated by nurses from the hospital at home post-discharge. The studies either used one intervention or combined two or three interventions. We considered the intervention to improve patient safety or satisfaction when they reported statistically significant results. Only four interventions increased both patient safety and satisfaction, seven interventions increased patient safety and thirteen increased patient satisfaction. Interventions that appear to be quite similar, with the same duration, measured different effects on patients' satisfaction and safety. Interventions that ensured patient safety did not necessarily facilitate patient satisfaction and vice versa. CONCLUSION Interventions can improve patient safety and satisfaction during transfer. However, interventions that improve patient safety or satisfaction do not always match. IMPACT This review suggests that transition interventions can improve patients' safety and satisfaction. However, to compare the impact of future interventions is it important to use standardized measurement tools of satisfaction. There is a need to try out tailored interventions, where interventions are customized to the needs of each patient.
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Affiliation(s)
- Trine Oksholm
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Karen Rosnes Gissum
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Irene Hunskår
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | | | - Kristin Kyte
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Kari Stensletten
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Sigrunn Drageset
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Sidsel Ellingsen
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Hladkowicz E, Dumitrascu F, Auais M, Beck A, Davis S, McIsaac DI, Miller J. Evaluations of postoperative transitions in care for older adults: a scoping review. BMC Geriatr 2022; 22:329. [PMID: 35428193 PMCID: PMC9013054 DOI: 10.1186/s12877-022-02989-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background Most people having major surgery are over the age of 65. The transition out of hospital is a vulnerable time for older adults, particularly after major surgery. Research on postoperative transitions in care is growing, but it is not clear how postoperative transitions are being evaluated. The objective of this scoping review was to synthesize processes and outcomes used to evaluate postoperative transitions in care for older adults. Methods We conducted a scoping review that included articles evaluating a postoperative transition in care among adults aged > 65 having major elective surgery. We searched Medline (Ovid), EMBASE (Ovid), CINHAL, and Cochrane Central Register of Controlled Trials (CENTRAL) from their respective inception dates to April 6, 2021. We also searched The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov from their respective inception dates to April 6, 2021. Screening and data extraction was completed by reviewers in duplicate. Data relevant to study design and objective, intervention description, and process or outcome evaluations were extracted. Process evaluations were categorized using the Ideal Transitions in Care Framework, and outcome evaluations were categorized using the Institute for Healthcare Improvement Triple Aim Framework. Results After screening titles and abstracts and full-text article review, we included 20 articles in our final synthesis. There was variability in the processes and outcomes used to evaluate postoperative transitions in care. The most common outcomes evaluated were health service utilization (n = 9), including readmission and Emergency Department visits, experiential outcomes (n = 9) and quality of life (n = 7). Process evaluations included evaluating the education provided to patients to promote self-management (n = 6), coordination of care among team members (n = 3) and outpatient follow-up (n = 3). Only two articles measured frailty, one article used theory to guide their evaluations and no articles engaged knowledge users. Conclusions There is inconsistency in how postoperative transitions in care were evaluated. There is a need to use theories and to engage key stakeholders involved in postoperative transitions in care, including older adults and their caregivers, to identify the most appropriate approaches for developing and evaluating interventions to meaningfully improve care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02989-6.
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Wynne R, Nolte J, Matthews S, Angel J, Le A, Moore A, Campbell T, Ferguson C. Effect of an mHealth self-help intervention on readmission after adult cardiac surgery: Protocol for a pilot randomized controlled trial. J Adv Nurs 2021; 78:577-586. [PMID: 34841554 PMCID: PMC9299838 DOI: 10.1111/jan.15104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
Aim To describe a protocol for the pilot phase of a trial designed to test the effect of an mHealth intervention on representation and readmission after adult cardiac surgery. Design A multisite, parallel group, pilot randomized controlled trial (ethics approval: HREC2020.331‐RMH69278). Methods Adult patients scheduled to undergo elective cardiac surgery (coronary artery bypass grafting, valve surgery, or a combination of bypass grafting and valve surgery or aortic surgery) will be recruited from three metropolitan tertiary teaching hospitals. Patients allocated to the control group with receive usual care that is comprised of in‐patient discharge education and local paper‐based written discharge materials. Patients in the intervention group will be provided access to tailored ‘GoShare’ mHealth bundles preoperatively, in a week of hospital discharge and 30 days after surgery. The mHealth bundles are comprised of patient narrative videos, animations and links to reputable resources. Bundles can be accessed via a smartphone, tablet or computer. Bundles are evidence‐based and designed to improve patient self‐efficacy and self‐management behaviours, and to empower people to have a more active role in their healthcare. Computer‐generated permuted block randomization with an allocation ratio of 1:1 will be generated for each site. At the time of consent, and 30, 60 and 90 days after surgery quality of life and level of patient activation will be measured. In addition, rates of representation and readmission to hospital will be tracked and verified via data linkage 1 year after the date of surgery. Discussion Interventions using mHealth technologies have proven effectiveness for a range of cardiovascular conditions with limited testing in cardiac surgical populations. Impact This study provides an opportunity to improve patient outcome and experience for adults undergoing cardiac surgery by empowering patients as end‐users with strategies for self‐help. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000082808.
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Affiliation(s)
- Rochelle Wynne
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia.,School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia.,The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Joanne Nolte
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Stacey Matthews
- The Royal Melbourne Hospital, Parkville, Victoria, Australia.,National Heart Foundation, Docklands, Victoria, Australia
| | - Jennifer Angel
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ann Le
- Liverpool Hospital, South West Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Andrew Moore
- Healthily Pty Ltd, Melbourne, Victoria, Australia
| | | | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia
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10
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Eustache J, El-Kefraoui C, Ekmekjian T, Latimer E, Lee L. Do postoperative telemedicine interventions with a communication feature reduce emergency department visits and readmissions?-a systematic review and meta-analysis. Surg Endosc 2021; 35:5889-5904. [PMID: 34231068 DOI: 10.1007/s00464-021-08607-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/14/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Emergency department (ED) visits and readmissions after surgery are common and represent a significant cost-burden on the healthcare system. A notable portion of these unplanned visits are the result of expected complications or normal recovery after surgery, suggesting that improved coordination and communication in the outpatient setting could potentially prevent these. Telemedicine can improve patient-physician communication and as such may have a role in limiting unplanned emergency department visits and readmissions in postoperative patients. METHODS Major electronic databases were searched for randomized controlled trials and cohort studies in surgical patients examining the effect of postoperative telemedicine interventions with a communication feature on 30-day readmissions and emergency department visits as compared to current standard postoperative follow-up. All surgical subspecialties were included. Two independent reviewers assessed eligibility, extracted data, and evaluated risk of bias using standardized tools. Our primary outcomes of interest were 30-day ED visits and readmissions. Our secondary outcomes were patient satisfaction with the intervention. RESULTS 29 studies were included in the final analysis. Fourteen studies were RCTs, and the remaining fifteen were cohort studies. Eighteen studies reported 30-day ED visit as an outcome. There was no overall reduction in 30-day ED visit in the telemedicine group (RR: 0.89, 95%CI: 0.70-1.12). Twenty-two studies reported 30-day readmission as an outcome. The overall pooled estimate did not show a difference in this outcome (RR: 0.90, 95%CI: 0.74-1.09). Fifteen studies reported a metric of patient satisfaction regarding utilization of the telemedicine intervention. All studies demonstrated high levels of satisfaction (> 80%) with the telemedicine intervention. DISCUSSION This review fails to demonstrate a clear reduction ED visits and readmissions to support use of a telemedicine intervention across the board. This may be in part explained by significant heterogeneity in the proportions of potentially preventable visits in each surgical specialty. As such, targeting interventions to specific surgical settings may prove most useful.
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Affiliation(s)
- Jules Eustache
- Department of Surgery, McGill University Health Centre, Glen Campus-DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada.,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Charbel El-Kefraoui
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Taline Ekmekjian
- Medical Libraries, McGill University Health Centre, Montreal, QC, Canada
| | - Eric Latimer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Research Centre, Montreal, QC, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Glen Campus-DS1.3310, 1001 Decarie Boulevard, Montreal, QC, H3G 1A4, Canada. .,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
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The association between advanced practice nursing roles and outcomes in adults following cardiac surgery: A systematic review of randomized controlled trials. Int J Nurs Stud 2021; 122:104028. [PMID: 34325359 DOI: 10.1016/j.ijnurstu.2021.104028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Empirical findings have shown significant and non-significant effects of advanced practice nursing roles within postoperative cardiac settings. The inconsistencies of the current literature preclude the identification of a significant effect of advanced practice nursing roles on patient and organizational outcomes. OBJECTIVE 1) identify patient and organizational outcomes of advanced practice nursing roles in postoperative cardiac surgery and 2) synthesize the evidence of current roles of advanced practice nurses in postoperative cardiac surgery to provide the best quality of care for patients. METHOD A systematic review of randomized controlled trials was conducted in six electronic databases, including Medline, CINHAL, Embase, Cochrane Database, Joanna Briggs Database and Web of Science, and the grey literature. Randomized controlled trials published after 1999 were included if they examined advanced practice nursing roles and recruited patients who underwent cardiac surgery. The study selection was performed by two independent reviewers, and consensus was achieved with a third reviewer. Data extraction was conducted by one reviewer and revised by a second reviewer. The methodological quality of the included studies was assessed with the Evidence Project risk of bias tool by two independent reviewers and revised by a third reviewer. A narrative synthesis of the available evidence was completed. No meta-analysis technique was attempted because of the high heterogeneity of the included studies. RESULTS Among 4,448 retrieved papers, ten randomized controlled trials and three secondary analyses were included in this review. The methodological quality of the included studies was moderate. All studies included a comparison group and the majority of the studies collected data using a blinded researcher. However, all studies were based on small sample sizes and failed to randomly recruit participants. Five studies implemented nurse practitioner roles and five studies implemented clinical nurse specialist roles. The advanced practice nursing care included health condition management, lifestyle promotion and coping strategies with patients. A total of 22 outcomes were identified, including 13 patient outcomes (e.g., depressive symptoms) and nine organizational outcomes (e.g., rehospitalization after discharge). Each outcome was examined in one to five studies. All of the included outcomes were associated with inconsistent findings. CONCLUSION The findings from existing literature remain inconsistent. The high risk of bias and the small sample sizes could potentially explain the non-significant findings. Avenues for future research should focus on the development of methodologically high-quality studies with larger sample sizes to enhance our understanding of the effectiveness of advanced practice nursing roles.
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Coskun S, Duygulu S. The effects of Nurse Led Transitional Care Model on elderly patients undergoing open heart surgery: a randomized controlled trial. Eur J Cardiovasc Nurs 2021; 21:46-55. [PMID: 33821999 DOI: 10.1093/eurjcn/zvab005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/04/2020] [Accepted: 01/14/2021] [Indexed: 11/13/2022]
Abstract
AIMS Rate and number of successful cases in open heart surgery has been increasing due to the advances in medical technology and surgery. To improve patient convalescence results and reduce rate of post-discharge readmission to hospital and unplanned post-discharge rehospitalization, home-care and follow-up process of patients should be managed successfully. To evaluate the effectiveness of Nurse Led Transitional Care Model on the functional autonomy, quality of life, readmission, and rehospitalization rates of elderly patients undergoing open heart surgery. A randomized controlled trial was conducted from November 2017 to December 2018 and performed according to the CONSORT Guidelines. METHODS AND RESULTS Sixty-six elderly patients were randomly allocated to the intervention (n: 33) and control (n: 33) groups. Patients in intervention group were given care based on the Transitional Care Model until the post-discharge 9th week starting from date of hospitalization. Patients in control group were given standard care services. Functional autonomy, quality of life levels, and repeated admission/re-hospitalization rates to the clinic were evaluated. The Functional Autonomy Measurement System and SF-36 Quality of Life Scale scores of the intervention group were higher than that of the control group at the 9th week (P < 0.05). In addition, rate of readmission and rehospitalization during the follow-up period (6 months) of patients in the intervention group was found to be lower than the patients in the control group (P < 0.05). CONCLUSION Care services offered under the Transitional Care Model improved functional autonomy and quality of life and decreased post-discharge hospital readmission and rehospitalization rates of patients. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov (ID: NCT04384289).
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Affiliation(s)
- Simge Coskun
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Nursing Department, 14100 Gölköy Campus/ Bolu/ Turkey
| | - Sergul Duygulu
- Hacettepe University, Faculty of Nursing, 06100 S?hhiye/ Ankara / Turkey
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Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise Review of the Literature and Data 2008-2018. Crit Care Med 2020; 47:1442-1449. [PMID: 31414993 PMCID: PMC6750122 DOI: 10.1097/ccm.0000000000003925] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To provide a concise review of the literature and data pertaining to the use of nurse practitioners and physician assistants, collectively called advanced practice providers, in ICU and acute care settings. DATA SOURCES Detailed search strategy using the databases PubMed, Ovid MEDLINE, and the Cumulative Index of Nursing and Allied Health Literature for the time period from January 2008 to December 2018. STUDY SELECTION Studies addressing nurse practitioner, physician assistant, or advanced practice provider care in the ICU or acute care setting. DATA EXTRACTION Relevant studies were reviewed, and the following aspects of each study were identified, abstracted, and analyzed: study population, study design, study aims, methods, results, and relevant implications for critical care practice. DATA SYNTHESIS Five systematic reviews, four literature reviews, and 44 individual studies were identified, reviewed, and critiqued. Of the research studies, the majority were retrospective with others being observational, quasi-experimental, or quality improvement, along with two randomized control trials. Overall, the studies assessed a variety of effects of advanced practice provider care, including on length of stay, mortality, and quality-related metrics, with a majority demonstrating similar or improved patient care outcomes. CONCLUSIONS Over the past 10 years, the number of studies assessing the impact of advanced practice providers in acute and critical care settings continue to increase. Collectively, these studies identify the value of advanced practice providers in patient care management, continuity of care, improved quality and safety metrics, patient and staff satisfaction, and on new areas of focus including enhanced educational experience of residents and fellows.
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Smigorowsky MJ, Sebastianski M, Sean McMurtry M, Tsuyuki RT, Norris CM. Outcomes of nurse practitioner-led care in patients with cardiovascular disease: A systematic review and meta-analysis. J Adv Nurs 2019; 76:81-95. [PMID: 31588598 PMCID: PMC6973236 DOI: 10.1111/jan.14229] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 08/14/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
Aim To assess randomized controlled trials evaluating the impact of nurse practitioner‐led cardiovascular care. Background Systematic review of nurse practitioner–led care in patients with cardiovascular disease has not been completed. Design Systematic review and meta‐analysis. Data sources The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, Web of Science, Scopus and ProQuest were systematically searched for studies published between January 2007 ‐ June 2017. Review Methods Cochrane methodology was used for risk of bias, data extraction and meta‐analysis. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation approach. Results Out of 605 articles, five articles met the inclusion criteria. There was no statistical difference between nurse practitioner‐led care and usual care for 30‐day readmissions, health‐related quality of life and length of stay. A 12% reduction in Framingham risk score was identified. Conclusion There are a few randomized control trials assessing nurse practitioner‐led cardiovascular care. Impact Low to moderate quality evidence was identified with no statistically significant associated outcomes of care. Nurse practitioner roles need to be supported to conduct and publish high‐quality research.
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Affiliation(s)
| | - Meghan Sebastianski
- Department of Pediatrics, Alberta Strategy for Patient-Oriented Research SUPPORT Unit, Knowledge Translation Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Sean McMurtry
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ross T Tsuyuki
- Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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15
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Dale JG, Midthus E, Dale B. Using information and communication technology in the recovery after a coronary artery bypass graft surgery: patients' attitudes. J Multidiscip Healthc 2018; 11:417-423. [PMID: 30214223 PMCID: PMC6121744 DOI: 10.2147/jmdh.s175195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients who have undergone a coronary artery bypass graft (CABG) surgery are exposed to physical and mental problems after discharge from the specialist hospital and are often in need of post-discharge support and follow-up. AIM This study aimed to explore the attitudes of CABG patients toward using information and communication technology (ICT) during the first year of recovery after discharge from hospital. METHODS A cross-sectional design utilizing an electronic survey was employed. The sample consisted of 197 patients who had undergone a CABG surgery during 2015. The questionnaire included questions about follow-up needs, contacts with health professionals, use of the Internet, and attitudes toward using ICT in the recovery phase. RESULTS Mean age of the participants was 67.3 years; 18.3% were women. A total of 48.2% of the patient group was satisfied with the pre-discharge information. Only 27% had contacted the hospital after discharge. Whereas 58.4% of the participants had used the Internet to acquire information, only 30.4% found this information to be useful. Many patients (40%) reported that they could benefit from online health information and Skype meetings with professionals. More than 30% reported that nutritional guidance on the Internet could be motivating for choosing healthy diets, and 42.6% reported that Internet-based illustrative videotapes could be motivating for undertaking physical training. CONCLUSION ICT can be useful and resource-saving for patients who have undergone a CABG surgery, as well as for the health care services. The technology must be appropriately tailored, with regard to content and design, to be helpful for patients.
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Affiliation(s)
- Jan Gunnar Dale
- University of Agder, Institute of Health and Nursing Science, Grimstad, Norway,
| | | | - Bjørg Dale
- Centre for Care Research, Southern Norway, University of Agder, Grimstad, Norway
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Salamanca-Balen N, Seymour J, Caswell G, Whynes D, Tod A. The costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs: A systematic review of international evidence. Palliat Med 2018; 32:447-465. [PMID: 28655289 PMCID: PMC5788084 DOI: 10.1177/0269216317711570] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with palliative care needs do not access specialist palliative care services according to their needs. Clinical Nurse Specialists working across a variety of fields are playing an increasingly important role in the care of such patients, but there is limited knowledge of the extent to which their interventions are cost-effective. OBJECTIVES To present results from a systematic review of the international evidence on the costs, resource use and cost-effectiveness of Clinical Nurse Specialist-led interventions for patients with palliative care needs, defined as seriously ill patients and those with advanced disease or frailty who are unlikely to be cured, recover or stabilize. DESIGN Systematic review following PRISMA methodology. DATA SOURCES Medline, Embase, CINAHL and Cochrane Library up to 2015. Studies focusing on the outcomes of Clinical Nurse Specialist interventions for patients with palliative care needs, and including at least one economic outcome, were considered. The quality of studies was assessed using tools from the Joanna Briggs Institute. RESULTS A total of 79 papers were included: 37 randomized controlled trials, 22 quasi-experimental studies, 7 service evaluations and other studies, and 13 economic analyses. The studies included a wide variety of interventions including clinical, support and education, as well as care coordination activities. The quality of the studies varied greatly. CONCLUSION Clinical Nurse Specialist interventions may be effective in reducing specific resource use such as hospitalizations/re-hospitalizations/admissions, length of stay and health care costs. There is mixed evidence regarding their cost-effectiveness. Future studies should ensure that Clinical Nurse Specialists' roles and activities are clearly described and evaluated.
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Affiliation(s)
| | - Jane Seymour
- 2 School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Glenys Caswell
- 1 School of Health Sciences, The University of Nottingham, Nottingham, UK
| | - David Whynes
- 3 School of Economics, The University of Nottingham, Nottingham, UK
| | - Angela Tod
- 2 School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
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17
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How do nurse practitioners work in primary health care settings? A scoping review. Int J Nurs Stud 2017; 75:51-57. [DOI: 10.1016/j.ijnurstu.2017.06.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022]
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Johal J, Dodd A. Physician extenders on surgical services: a systematic review. Can J Surg 2017; 60:172-178. [PMID: 28327274 DOI: 10.1503/cjs.001516] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND With the introduction of resident duty hour restrictions and the resulting in-house trainee shortages, a long-term solution to ensure safe and efficient patient care is needed. One solution is the integration of nurse practitioners (NPs) and physician assistants (PAs) in a variety of health care settings. We sought to examine the use of NPs and PAs on surgical/trauma services and their effect on patient outcomes and resident workload. METHODS We performed a systematic review of EMBASE, Medline, CINAHL, and the Cochrane Central Register of Controlled Trials. We included studies (all designs) examining the use of NPs and PAs on adult surgical and trauma services that reported the following outcomes: complications, length of stay, readmission rates, patient satisfaction and perceived quality of care, resident workload, resident work hours, resident sleep hours, resident satisfaction, resident perceived quality of care, other health care worker satisfaction and perceived quality of care, and economic impact assessments. We excluded studies assessing nonsurgical/trauma services or pediatrics and review articles. RESULTS Twenty-nine articles met the inclusion criteria. With the addition of NPs and PAs, patient length of stay decreased, and morbidity and mortality were unchanged. In addition, resident workload decreased, sleep time increased, and operating time improved. Patient and health care worker satisfaction rates were high. Several studies reported cost savings after the addition of NPs/PAs. CONCLUSION The addition of NPs and PAs to surgical/trauma services appears to be a safe, cost-effective method to manage some of the challenges arising because of resident duty hour restrictions. More high-quality research is needed to confirm these findings and to further assess the economic impact of adding NPs and PAs to the surgical team.
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Affiliation(s)
- Jagdeep Johal
- From the Department of Orthopedic Surgery, University of Calgary, Calgary, Alta
| | - Andrew Dodd
- From the Department of Orthopedic Surgery, University of Calgary, Calgary, Alta
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Fredericks S, Martorella G, Catallo C. Using knowledge translation as a framework for the design of a research protocol. Int J Nurs Pract 2016; 21 Suppl 2:157-63. [PMID: 26125581 DOI: 10.1111/ijn.12338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Knowledge translation has been defined as the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, resulting in a stronger health-care system. Using KT activities to aid in the adoption of evidence into practice can address current health-care challenges such as increasing organizational practice standards, alleviating the risk for adverse events and meeting practitioner needs for evidence at the bedside. Two general forms of KT have been identified. These being integrated KT and end-of-grant KT. Integrated KT involves the knowledge users in the research team and in the majority of stages of the research process. End-of-grant KT relates to the translation of findings through a well-developed dissemination plan. This paper describes the process of using an integrated knowledge translation approach to design a research protocol that will examine the effectiveness of a web-based patient educational intervention. It begins with a description of integrated knowledge translation, followed by the presentation of a specific case example in which integrated knowledge translation is used to develop a nursing intervention. The major elements of integrated knowledge translation pertain to need for a knowledge user who represents the broad target user group, and who is knowledgeable in the area under investigation and who as authority to enact changes to practice. Use of knowledge users as equal partners within the research team; exploring all feasible opportunities for knowledge exchange; and working with knowledge users to identify all outcomes related to knowledge translation are the other major elements of integrated knowledge translation that are addressed throughout this paper. Furthermore, the relevance of psychosocial or educational interventions to knowledge translation is also discussed as a source of knowledge. In summary, integrated knowledge translation is an important tool for the development of new interventions, as it helps to apply science to practice accurately. It supports the elaboration of the design while enhancing the relevance of the intervention through the validation of feasibility and acceptability with clinicians and patients.
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Affiliation(s)
- Suzanne Fredericks
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | | | - Cristina Catallo
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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Reuter-Rice K, Madden MA, Gutknecht S, Foerster A. Acute Care Pediatric Nurse Practitioner: The 2014 Practice Analysis. J Pediatr Health Care 2016; 30:241-51. [PMID: 26878813 DOI: 10.1016/j.pedhc.2016.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/16/2016] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study describes the current practice of the acute care pediatric nurse practitioner (AC PNP) to inform an update of the Certified Pediatric Nurse Practitioner-Acute Care (CPNP-AC) examination content outline. METHOD A descriptive analysis was performed of the responses of 319 pediatric nurse practitioners, practicing in an acute care role, who completed a practice survey in 2014. RESULTS Respondents were primarily White women with a mean age of 40 years; 75% had been formally educated as AC PNPs, compared with 48% in 2009. Regional practice was most heavily concentrated in the Southeast (28%) and Midwest (27%). Most respondents (81%) practiced in urban areas. Respondents reported spending 75% of practice time in inpatient settings. The most frequently cited areas of practice were critical care (36%), followed by emergency department (9%) and subspecialty practices. DISCUSSION This third analysis of AC PNP practice 10 years after initiation of the CPNP-AC certification examination demonstrates changes in clinical practice and educational preparation.
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Symptoms Experienced by Jordanian Men and Women After Coronary Artery Bypass Graft Surgery. Dimens Crit Care Nurs 2016; 35:125-32. [DOI: 10.1097/dcc.0000000000000175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Streiner DL, Kottner J. Recommendations for reporting the results of studies of instrument and scale development and testing. J Adv Nurs 2014; 70:1970-1979. [PMID: 24684713 DOI: 10.1111/jan.12402] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 01/28/2023]
Abstract
Scales and instruments play an important role in health research and practice. It is important that studies that report on their psychometric properties do so in a way such that readers can understand what was done and what was found. This paper is a guide to writing articles about the development and assessment of these tools. It covers what should be in the abstract and how key words should be chosen. The article then discusses what should be in the main parts of the paper: the introduction, methods, results and discussion. In each of these parts, it suggests the statistical tests that should be used and how to report them. The emphasis throughout the paper is that reliability and validity are not fixed properties of a scale, but depend on an interaction among it, the population being evaluated and the circumstances under which the instrument is administered.
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Affiliation(s)
- David L Streiner
- University of Toronto - Psychiatry, Toronto, Ontario, Canada.,McMaster University - Psychiatry & Behavioural Neurosciences, Hamilton, Ontario, Canada
| | - Jan Kottner
- Charité-Universitätsmedizin Berlin - Clinical Research Center for Hair and Skin Science, Germany
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