Multifocal Clinical Performance Improvement Across 21 Hospitals

Quality and Safety in Nursing: Recommendations From a Systematic Review

ABSTRACT

As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care. However, a comprehensive review of evidence-based recommendations to guide nursing interventions that enhance the Q&S of patient care is lacking. Therefore, the purpose of our systematic review was to create evidence-based recommendations for the Q&S component of a nursing professional practice model for military hospitals. To accomplish this, a triservice military nursing team used Covidence software to conduct a systematic review of the literature across five databases. Two hundred forty-nine articles met inclusion criteria. From these articles, we created 94 recommendations for practice and identified eight focus areas from the literature: (1) communication; (2) adverse events; (3) leadership; (4) patient experience; (5) quality improvement; (6) safety culture/committees; (7) staffing/workload/work environment; and (8) technology/electronic health record. These findings provide suggestions for implementing Q&S practices that could be adapted to many healthcare delivery systems.

Hospital costs and factors associated with days alive and at home after surgery (DAH30 )

OBJECTIVE

To assess the relationships of patient and surgical factors and hospital costs with the number of days alive and at home during the 30 days following surgery (DAH₃₀ ).

DESIGN

Retrospective cohort study; analysis of Medibank Private health insurance hospital claims data, Australia, 1 January 2016 - 31 December 2017.

SETTING, PARTICIPANTS

Admissions of adults (18 years or older) to hospitals for elective or emergency inpatient surgery with anaesthesia covered by private health insurance, Australia, 1 January 2016 - 31 December 2017.

MAIN OUTCOME MEASURES

Associations between DAH₃₀ and total hospital costs, and between DAH₃₀ and surgery risk factors.

RESULTS

Complete data were available for 126 788 of 181 281 eligible patients (69.9%); their median age was 62 years (IQR, 47-73 years), 72 872 were women (57%), and 115 117 had undergone elective surgery (91%). The median DAH₃₀ was 27.1 days (IQR, 24.2-28.8 days), the median hospital cost per patient was $10 358 (IQR, $6624-20 174). The association between DAH₃₀ and total hospital costs was moderate (Spearman ρ = -0.60; P < 0.001). Median DAH₃₀ declined with age, comorbidity score, ASA physical status score, and surgical severity and duration, and was also lower for women.

CONCLUSIONS

DAH₃₀ is a validated, patient-centred outcome measure of post-surgical outcomes; higher values reflect shorter hospital stays and fewer serious complications, re-admissions, and deaths. DAH₃₀ can be used to benchmark quality of surgical care and to monitor quality improvement programs for reducing the costs of surgical and other peri-operative care.

Patient-specific factors associated with pressure injuries revealed by electronic health record analyses

Hospital-acquired pressure injuries (HAPIs) are a major source of unintended patient harm and unnecessary costs. The Braden Scale is widely used for risk assessment, yet it lacks specificity and clinical applications. This study used the electronic health record to examine associations between patient-specific factors and pressure injury. Adult patients (age >18) with 3-day length of stay from April 2011 to December 2016 were included. Pressure injuries were identified by ICD-9/ICD-10 codes. Longitudinal multivariate logistic regression was used to evaluate the association between patient-specific factors and HAPIs. This included 57,227 hospital encounters and 241 HAPIs. We observed 2-3 times increased likelihood of acquiring a pressure injury among patients who were malnourished or who had increased intraoperative time. The Braden subscales of nutrition, mobility, and friction showed significant predictive value. Future work is needed to assess the clinical applicability of this work.