1
|
Iennaco JD, Molle E, Allegra M, Depukat D, Parkosewich J. The Aggressive Incidents in Medical Settings (AIMS) Study: Advancing Measurement to Promote Prevention of Workplace Violence. Jt Comm J Qual Patient Saf 2024; 50:166-176. [PMID: 38158280 DOI: 10.1016/j.jcjq.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Rates of aggressive events and workplace violence (WPV) exposure are often represented by proxy measures (restraint, incident, injury reports) in health care settings. Precise measurement of nurse and patient care assistant exposure rates to patient aggression on inpatient medical units in acute care hospitals advances knowledge, promoting WPV prevention and intervention. METHODS This prospective, multisite cohort study examined the incidence of patient and visitor aggressive events toward patient care staff on five inpatient medical units in a community hospital and an academic hospital setting in the northeastern United States. Data were collected with event counters, Aggressive Incident and Management Logs (AIM-Logs), and demographic forms over a 14-day period in early 2017. RESULTS Participants recorded a total of 179 aggressive events using event counters, resulting in a rate of 2.54 aggressive events per 20 patient-days. Patient verbal aggression rates (2.00 events per 20 patient-days) were higher compared to physical aggression rates (0.85 events per 20 patient-days). The staff aggression exposure rate was 1.17 events per 40 hours worked (verbal aggression exposure rate: 0.92 events per 40 hours; physical aggression exposure rate: 0.39 events per 40 hours). The most common precipitants included medication administration (18.6%), waiting for care (17.2%), and delivering food/drinks (15.9%). Most events were managed with verbal de-escalation (75.2%). The number of patients assigned to patient care staff was significantly greater during a shift when an aggressive event occurred compared to when no event occurred (6.3 vs. 5.7, t = -2.12, df = 201.6, p = 0.0348). CONCLUSION Event counters and AIM-Logs offer greater information about patterns of aggression and preventive interventions used and provide information on the need for debriefing and worker support after aggressive events. Additional studies of this methodology in other settings are needed to evaluate the value of this technology for improving worker and patient safety.
Collapse
|
2
|
Slusser K, Knobf MT, Linsky S, Kaisen A, Parkosewich J, Sterne P, Johnson C, Carley J, Beckman B. A Focus Group Study of Retirement-Age Nurses: Balancing Tension and a Love of Nursing in a Changing Healthcare Environment. J Nurs Adm 2022; 52:646-652. [PMID: 36409257 DOI: 10.1097/nna.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aims of this study were to explore the experience of retirement-age nurses and identify decision-making factors and innovations to enhance retention. BACKGROUND A national shortage of nurses has created challenges to preserving quality patient care and level of nursing competency and managing turnover costs. METHODS A qualitative study using focus groups was conducted of nurses 55 years or older who were working or recently retired. Data were audiotaped and transcribed verbatim, with content analysis used to code in an iterative process until consensus was reached. RESULTS The tension of balancing the love of patient care within a changing healthcare system was described. Patient acuity, competing roles, and the centrality of computers were stressors and integrally related. Flexibility in work schedules and new practice models were important to retirement decision making for work-life balance and retention. CONCLUSION Passion for patient care dominated decisions to continue working. Innovations in practice models and scheduling offer opportunities to enhance the retention of experienced nurses.
Collapse
Affiliation(s)
- Kim Slusser
- Author Affiliations: Vice President, Patient Care Services (Ms Slusser) and Senior Administrative Assistant (Ms Carley), Smilow Cancer, Yale New Haven Hospital; Professor (Dr Knobf) and Research Associate II (Ms Linsky), Yale University School of Nursing, New Haven; Senior Manager, Corporate Supply Chain (Ms Kaisen), Nurse Researcher (Dr Parkosewich), and Patient Services Manager (Ms Johnson), Yale New Haven Hospital; Director, Nursing Operations and Magnet (Dr Sterne), Greenwich Hospital; and Chief Nurse Executive (Dr Beckman), Yale New Haven Health System, New Haven, Connecticut
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Pierson M, Cretella B, Roussel M, Byrne P, Parkosewich J. A Nurse-Led Voiding Algorithm for Managing Urinary Retention After General Thoracic Surgery. Crit Care Nurse 2022; 42:23-31. [PMID: 35100628 DOI: 10.4037/ccn2022727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Untreated postoperative urinary retention (POUR) leads to bladder overdistension. Treatment of POUR involves urinary catheterization, which predisposes patients to catheter-associated urinary tract infections. The hospital's rate of POUR after lobectomy was 21%, exceeding the Society of Thoracic Surgeons' benchmark of 6.4%. Nurses observed that more patients were being catheterized after implementation of a newly revised urinary catheter protocol. OBJECTIVE To reduce the incidence of POUR by implementing a thoracic surgery-specific nurse-led voiding algorithm. METHODS Experts validated the voiding algorithm that standardized postoperative assessment. It was initiated after general thoracic surgery among 179 patients in a thoracic surgery stepdown unit of a large Magnet hospital. After obtaining verbal consent from patients, nurses collected demographic and clinical data and followed the algorithm, documenting voided amounts and bladder scan results. Descriptive statistics characterized the sample and the incidence of POUR. Associations were determined between demographic and clinical factors and POUR status by using the t test and χ2 test. RESULTS The POUR-positive group and the POUR-negative group were equivalent with regard to demographic and clinical factors, except more patients in the POUR-positive cohort had had a lobectomy (P = .05). The rate of POUR was 8%. Society of Thoracic Surgeons reports revealed a rapid and sustained reduction in the hospital's rates of POUR after lobectomy: from 21% to 3%. CONCLUSION The use of this nurse-led voiding algorithm effectively reduced and sustained rates of POUR.
Collapse
Affiliation(s)
- Mary Pierson
- Mary Pierson is the assistant nurse manager of the medical intensive care stepdown unit, Yale New Haven Hospital. At the time this article was written, she was the assistant nurse manager of the 5-4 thoracic stepdown unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Brittany Cretella
- Brittany Cretella is a casual status clinical nurse on the 5-4 thoracic stepdown unit, Heart and Vascular Center, Yale New Haven Hospital
| | - Maureen Roussel
- Maureen Roussel is the clinical nurse specialist for cardiothoracic surgery, Heart and Vascular Center, Yale New Haven Hospital
| | - Patricia Byrne
- Patricia Byrne is the patient services manager of the 5-4 thoracic stepdown unit, Heart and Vascular Center, Yale New Haven Hospital
| | | |
Collapse
|
4
|
Tyler SP, Dixon J, Parkosewich J, Mullan PC, Aghera A. Development, Validation, and Implementation of a Guideline to Improve Clinical Event Debriefing at a Level-I Adult and Level-II Pediatric Trauma Center. J Emerg Nurs 2021; 47:707-720. [PMID: 34217519 DOI: 10.1016/j.jen.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Clinical event debriefing is recommended by the American Heart Association and the European Resuscitation Council, because debriefings improve team performance. The purpose here was to develop and validate tools needed to overcome barriers to debriefing in the emergency department. METHOD This quality improvement project was conducted in 4 phases. Phase 1: Current evidence related to debriefing in the emergency department was reviewed and synthesized to inform an iterative process for drafting the debriefing guideline and instrument for documentation. Phase 2: Content Validity Index of the tools was evaluated by obtaining ratings of items' clarity and relevance from 5 national experts in 2 rounds of review. On the basis of experts' feedback, tools were revised, and a Facilitators' Guide was created. Phase 3: The validated debriefing tools were implemented. Phase 4: Debriefing facilitators completed a survey about their experience with using the new tools. RESULTS The Content Validity Index of 71 debriefing tool items (guideline, instrument, Facilitators' Guide) was 0.93 and 0.96 for clarity and relevance, respectively. Of the 32 debriefings conducted during the first 8 weeks of implementation, 53% described patient safety concerns, and 97% described recommendations to improve performance. Most (94%) facilitators agreed that the guideline clarified debriefing requirements. CONCLUSION The use of debriefing tools validated by computation of the Content Validity Index led to the identification of safety threats and recommendations to improve care processes. These tools can be used in ED settings to promote team learning and aid in identifying and resolving safety concerns.
Collapse
|
5
|
Ford C, McCormick D, Parkosewich J, Derycke-Chapman K, Marshall J, Mancarella J, Chepulis A. Safety and Effectiveness of Early Oral Hydration in Patients After Cardiothoracic Surgery. Am J Crit Care 2020; 29:292-300. [PMID: 32607569 DOI: 10.4037/ajcc2020841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients fast after cardiothoracic surgery because of concerns for nausea, vomiting, dysphagia, and aspiration pneumonia; fasting, however, causes thirst, a distressing symptom. To our knowledge, no studies exist to guide hydration practices in this population. OBJECTIVE To determine the effect of early oral hydration on adverse events and thirst in patients after cardiothoracic surgery. METHODS This study applied a prospective 2-group design in which 149 patients from an 18-bed cardiothoracic intensive care unit were randomized to either usual care (a 6-hour fast) or early oral hydration after extubation. The research protocol involved nurses evaluating patients' readiness for oral hydration and then offering them ice chips. If patients tolerated the ice chips, they were allowed to drink water 1 hour later. RESULTS Most patients (91.3%) had undergone coronary artery or valve surgery, or both. Demographic and clinical variables were similar in both groups. No significant between-group differences were found for the incidence of nausea, vomiting, or dysphagia, and no aspiration pneumonia occurred. Significantly more patients with a high thirst level were in the usual care group (81.2%) than in the early oral hydration group (56.5%; P = .002, r2 test). After adjustment for demographic and clinical variables by using logistic regression, early oral hydration was independently and negatively associated with a high thirst level (odds ratio, 0.30 [95% CI, 0.13-0.69]; P = .004). CONCLUSION This research provides new evidence that oral hydration (ice chips and water) soon after extubation is safe and significantly reduces thirst in particular patients.
Collapse
Affiliation(s)
- Catherine Ford
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Donna McCormick
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Janet Parkosewich
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Katrien Derycke-Chapman
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Judith Marshall
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Jessica Mancarella
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| | - Anne Chepulis
- About the Authors: Catherine Ford and Donna McCormick are clinical nurses; Katrien Derycke-Chapman, Judith Marshall, Jessica Mancarella, and Anne Chepulis are former clinical nurses in the cardiothoracic intensive care unit, Heart and Vascular Center, Yale New Haven Hospital, New Haven, Connecticut
| |
Collapse
|
6
|
Grimshaw KS, Fan K, Mullins A, Parkosewich J. Using Quality Improvement Methods to Understand Incidence, Timing, and Factors Associated With Unplanned Intensive Care Unit Transfers of Patients With End-Stage Liver Disease. Prog Transplant 2019; 29:361-363. [DOI: 10.1177/1526924819888132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Patients with end-stage liver disease are at risk for clinical deterioration, often requiring hospital admissions while awaiting transplantation. Nurses observed that many patients were or became unstable soon after arrival, requiring transfers to the medical intensive care unit. Objective: To explore the incidence, timing, and factors associated with unplanned intensive care transfers. Design: We conducted a quality improvement project using plan-do-study-act methods to explore administrative data from adult patients admitted to the hepatology service’s medical–surgical unit. Chi-square and t-tests were used to examine associations between demographic, clinical, and temporal factors and unplanned transfers. Data were analyzed at the hospital encounter level. Results: Unplanned transfers occurred in 8.6% of 1418 encounters. The number of transfers during these encounters ranged from 1 to 6. Most unplanned transfers (65.9%) occurred during the evening shift. On average, there was a 4.2-hour delay to the transfer. Fifty-one percent of these encounters required support from clinicians outside the unit while waiting for a bed. Factors associated with unplanned intensive care unit transfer were male sex ( P = .02), self-referral to the emergency department ( P < .001), and lower initial mean Rothman Index ( P < .001). Discussion: Results validated nurses’ concerns about the patients’ severity of illnesses at the time of admission and frequent need for transfer to intensive care soon after admission. We now have actionable data that are being used by leaders to assess unit admission criteria and develop operating budgets for human and material resources needed to care for this challenging population.
Collapse
Affiliation(s)
| | - Kitty Fan
- Yale New Haven Hospital, New Haven, CT, USA
| | | | | |
Collapse
|
7
|
Mattioli E, Tabuzo B, Sangkachand P, Parkosewich J, Reyes L, Funk M. Safety and Patients' Response to Ambulation With a Pulmonary Artery Catheter in the Cardiac Intensive Care Unit. Am J Crit Care 2019; 28:101-108. [PMID: 30824513 DOI: 10.4037/ajcc2019339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early mobilization of patients in the intensive care unit can be beneficial, but evidence is insufficient to indicate whether allowing patients with an indwelling pulmonary artery catheter to walk is safe. OBJECTIVE To describe the physiological and emotional responses to ambulation in patients with heart failure and a pulmonary artery catheter. METHODS This prospective, descriptive study included 19 patients with heart failure monitored with a pulmonary artery catheter in a cardiac intensive care unit. Each patient, accompanied by a nurse, walked with continuous observation of heart rate and rhythm and pulmonary artery tracing on a transport monitor. Pulmonary artery catheter position and waveform, arrhythmias, and perceived levels of exertion and fatigue were recorded before and after each walk. The distance ambulated was documented. One to 3 times per week, nurses administered a questionnaire addressing patients' sense of well-being. RESULTS The 19 patients had 303 walks (range, 1-68; median, 7). During 7 patient walks (2.4%), catheter migration of 1 to 5 cm occurred, but no arrhythmias or waveform changes were observed. Changes in exertion and fatigue were significant (P < .001, paired t test), but levels of both were minimal after walking. Patients expressed physical and emotional benefits of walking. CONCLUSIONS This study provides preliminary evidence that for hemodynamically stable patients with heart failure, ambulating with a pulmonary artery catheter is safe and enhances their sense of well-being. The presence of an indwelling pulmonary artery catheter should not preclude walking.
Collapse
Affiliation(s)
- Elisa Mattioli
- Elisa Mattioli and Bienvenido Tabuzo Jr are both a clinical nurse III and Liberty Reyes is a clinical nurse II in the cardiac intensive care unit, Yale New Haven Hospital, New Haven, Connecticut. Prasama Sangkachand is a service line educator, Heart and Vascular Center, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor Emerita of Nursing, Yale School of Nursing, West Haven, Connecticut
| | - Bienvenido Tabuzo
- Elisa Mattioli and Bienvenido Tabuzo Jr are both a clinical nurse III and Liberty Reyes is a clinical nurse II in the cardiac intensive care unit, Yale New Haven Hospital, New Haven, Connecticut. Prasama Sangkachand is a service line educator, Heart and Vascular Center, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor Emerita of Nursing, Yale School of Nursing, West Haven, Connecticut
| | - Prasama Sangkachand
- Elisa Mattioli and Bienvenido Tabuzo Jr are both a clinical nurse III and Liberty Reyes is a clinical nurse II in the cardiac intensive care unit, Yale New Haven Hospital, New Haven, Connecticut. Prasama Sangkachand is a service line educator, Heart and Vascular Center, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor Emerita of Nursing, Yale School of Nursing, West Haven, Connecticut
| | - Janet Parkosewich
- Elisa Mattioli and Bienvenido Tabuzo Jr are both a clinical nurse III and Liberty Reyes is a clinical nurse II in the cardiac intensive care unit, Yale New Haven Hospital, New Haven, Connecticut. Prasama Sangkachand is a service line educator, Heart and Vascular Center, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor Emerita of Nursing, Yale School of Nursing, West Haven, Connecticut
| | - Liberty Reyes
- Elisa Mattioli and Bienvenido Tabuzo Jr are both a clinical nurse III and Liberty Reyes is a clinical nurse II in the cardiac intensive care unit, Yale New Haven Hospital, New Haven, Connecticut. Prasama Sangkachand is a service line educator, Heart and Vascular Center, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor Emerita of Nursing, Yale School of Nursing, West Haven, Connecticut
| | - Marjorie Funk
- Elisa Mattioli and Bienvenido Tabuzo Jr are both a clinical nurse III and Liberty Reyes is a clinical nurse II in the cardiac intensive care unit, Yale New Haven Hospital, New Haven, Connecticut. Prasama Sangkachand is a service line educator, Heart and Vascular Center, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital. Marjorie Funk is the Helen Porter Jayne and Martha Prosser Jayne Professor Emerita of Nursing, Yale School of Nursing, West Haven, Connecticut
| |
Collapse
|
8
|
Bradley C, Keithline M, Petrocelli M, Scanlon M, Parkosewich J. Perceptions of Adult Hospitalized Patients on Family Presence During Cardiopulmonary Resuscitation. Am J Crit Care 2017; 26:103-110. [PMID: 28249861 DOI: 10.4037/ajcc2017550] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Family presence during cardiopulmonary resuscitation in acute care is not widespread. Patients are not likely to be asked about their wishes for family presence or if they wish to be the decision makers about who should be present. OBJECTIVE To explore the perceptions of patients on general medical units and to find factors independently associated with family presence during cardiopulmonary resuscitation. METHODS A cross-sectional study of 117 randomly selected adult patients was conducted at an academic medical center. Participants were interviewed via a survey to obtain information on demographics, knowledge of cardiopulmonary resuscitation, sources of information on resuscitation, and preferences for family presence. RESULTS About half of the participants agreed or strongly agreed that family presence during cardiopulmonary resuscitation was important (52.1%), that the participant should be the decision maker about who should be present (50.4%), and that the patient should give consent ahead of time (47.0%). Participants indicated that they would want an adult sibling, parents, or others (20.5%); spouse (14.5%); adult child (8.5%); close friend (5.1%); or companion (4.3%) present during cardiopulmonary resuscitation. Younger participants (20-45 years old) were 6.28 times more likely than those ≥ 66 years old (P = .01) and nonwhite participants were 2.7 times more likely than white participants (P = .049) to want family presence. CONCLUSION Patients have strong preferences about family presence during cardiopulmonary resuscitation, and they should have the opportunity to make the decision about having family present.
Collapse
Affiliation(s)
- Carolyn Bradley
- Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut
| | - Michelle Keithline
- Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut
| | - Meghan Petrocelli
- Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut
| | - Mary Scanlon
- Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut
| | - Janet Parkosewich
- Carolyn Bradley is a service line educator, Michelle Keithline, Meghan Petrocelli, and Mary Scanlon are clinical nurses, and Janet Parkosewich is the nurse researcher, Yale New Haven Hospital, New Haven, Connecticut
| |
Collapse
|
9
|
O'Connor R, Parkosewich J, Curran J, Cartiera K, Knobf MT. Getting Used to Being a Patient: The Postoperative Experience of Living Liver Transplant Donors. Prog Transplant 2015; 25:153-9. [DOI: 10.7182/pit2015298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Context— Living donor liver transplant is a viable option for eligible persons in need of a liver transplant, but little is known about the hospitalization experience of patients undergoing hepatectomy for transplant donation. Objective— To explore the hospital experience of patients recovering from donor hepatectomy. Design— A qualitative interpretive descriptive design was used to understand the hospital experience of patients recovering from donor hepatectomy. Semistructured interviews, conducted before discharge, were audiotaped and transcribed verbatim. Coding was performed independently, then jointly by investigators to reach consensus on emerging themes. Setting— Major university hospital in the Northeastern United States. Sample— Adults (>18 years of age) whose primary language was English or Spanish and who could provide written informed consent. Results— The sample consisted of 15 participants who had a mean age of 34.6 years; half were women. Most were white and college educated. The relationship of the donors to recipients varied from immediate family to altruistic donors. “Getting used to being a patient” was the major theme that captured the patients' postoperative experience. Four subthemes explained the experience: regaining consciousness, all those tubes, expecting horrible pain, and feeling special and cared for. These were described in the context of an “amazing and impressive” transplant team. Conclusion— As healthy donors are getting used to being patients, these results provide clinicians with a deeper understanding of the transplant experience from the donor's perspective so that care can be tailored to meet their unique needs.
Collapse
Affiliation(s)
- Rick O'Connor
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| | - Janet Parkosewich
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| | - Jeffrey Curran
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| | - Katarzyna Cartiera
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| | - M. Tish Knobf
- Yale-New Haven Hospital (RO, JP, JC), Yale-New Haven Transplant Center (KC), Yale School of Nursing (TK), New Haven, Connecticut
| |
Collapse
|
10
|
Abstract
Several studies demonstrate that women have greater delays in primary percutaneous coronary intervention (PCI). To improve care for women, the Women's Heart Advantage at Yale-New Haven Hospital (YNHH) developed patient- and physician-level interventions to improve knowledge about chest pain syndromes to promote early presentation, diagnosis, and timely management of ST-elevation myocardial infarction (STEMI) in women presenting to the emergency department. Specifically, we analyzed chart-abstracted data from all patients undergoing PCI for STEMI at YNHH from January 2004 to July 2007 and assessed quality of care for STEMI and trends in time to reperfusion. Women's Heart Advantage and YNHH orchestrated several clinical initiatives and instituted hospital-wide systems to improve STEMI care over this period. Both men and women had declines in time to reperfusion (91-73 minutes for men and 120-74 minutes for women). Notably, improvements in time to reperfusion were more substantial in women; the greatest improvement was reduction in door-to-table time (50% decrease in women vs. 19% decrease in men [P < 0.05]). In this single-site study of men and women undergoing primary PCI at a large, urban teaching hospital, where ongoing interventions to increase both patient and physician awareness regarding heart disease in women were initiated, time to reperfusion for women improved to a greater degree than in men. These results are encouraging, showing that significant improvements can be made over a relatively short time frame. It is hoped these reductions in time to reperfusion are associated with improved outcomes; however, further studies are needed to verify this potential benefit.
Collapse
Affiliation(s)
- Veena Rao
- Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA.
| | | | | | | | | | | |
Collapse
|
11
|
Parkosewich J, Funk M, Bradley EH. Applying Five Key Success Factors to Optimize the Quality of Care for Patients Hospitalized With Coronary Artery Disease. ACTA ACUST UNITED AC 2007; 20:111-6. [PMID: 16030411 DOI: 10.1111/j.0889-7204.2005.04319.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Quality improvement (QI) efforts aimed at optimizing adherence to coronary artery disease quality indicators are helping to bridge the serious gaps in the quality of care for this population. Motivation for these initiatives is prompted by a number of sources, including the public reporting of hospitals' adherence to these indicators found on the Center for Medicare and Medicaid Services Web site. Although complex barriers challenge QI efforts, results of recent studies demonstrate that the use of five key success factors reduces these barriers and accelerates improvement. Integral components of this model include administrative support that cultivates a blameless culture that strives for perfection; committed and respected champions; goals that are shared within the organization; the use of timely, credible data at the organizational and individual levels; and implementation of a QI initiative tailored to the complexity of the project. In this review article, the authors discuss how quality of care is measured, provide examples of successful QI programs, and describe how the use of a QI model composed of five key success factors can accelerate QI efforts and optimize the care of patients hospitalized with coronary artery disease.
Collapse
MESH Headings
- Benchmarking/organization & administration
- Centers for Medicare and Medicaid Services, U.S.
- Coronary Artery Disease/therapy
- Data Collection
- Data Interpretation, Statistical
- Goals
- Guideline Adherence
- Hospitalization
- Humans
- Models, Nursing
- Models, Organizational
- National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division
- Organizational Culture
- Organizational Objectives
- Practice Guidelines as Topic
- Quality Assurance, Health Care/organization & administration
- Quality Indicators, Health Care/organization & administration
- Social Support
- Total Quality Management/organization & administration
- United States
Collapse
Affiliation(s)
- Janet Parkosewich
- Yale-New Haven Hospital, New Haven, CT and Yale University School of Nursing, New Haven, CT 06510-3202, USA.
| | | | | |
Collapse
|
12
|
Bradley EH, Herrin J, Wang Y, Barton BA, Webster TR, Mattera JA, Roumanis SA, Curtis JP, Nallamothu BK, Magid DJ, McNamara RL, Parkosewich J, Loeb JM, Krumholz HM. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006; 355:2308-20. [PMID: 17101617 DOI: 10.1056/nejmsa063117] [Citation(s) in RCA: 619] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster door-to-balloon time. METHODS We surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the door-to-balloon time. RESULTS In multivariate analysis, six strategies were significantly associated with a faster door-to-balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean reduction in door-to-balloon time, 8.2 minutes), having a single call to a central page operator activate the laboratory (13.8 minutes), having the emergency department activate the catheterization laboratory while the patient is en route to the hospital (15.4 minutes), expecting staff to arrive in the catheterization laboratory within 20 minutes after being paged (vs. >30 minutes) (19.3 minutes), having an attending cardiologist always on site (14.6 minutes), and having staff in the emergency department and the catheterization laboratory use real-time data feedback (8.6 minutes). Despite the effectiveness of these strategies, only a minority of hospitals surveyed were using them. CONCLUSIONS Several specific hospital strategies are associated with a significant reduction in the door-to-balloon time in the management of myocardial infarction with ST-segment elevation.
Collapse
Affiliation(s)
- Elizabeth H Bradley
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Bradley EH, Roumanis SA, Radford MJ, Webster TR, McNamara RL, Mattera JA, Barton BA, Berg DN, Portnay EL, Moscovitz H, Parkosewich J, Holmboe ES, Blaney M, Krumholz HM. Achieving door-to-balloon times that meet quality guidelines: how do successful hospitals do it? J Am Coll Cardiol 2005; 46:1236-41. [PMID: 16198837 DOI: 10.1016/j.jacc.2005.07.009] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Revised: 11/17/2004] [Accepted: 11/22/2004] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We sought to recommend an approach for minimizing preventable delays in door-to-balloon time on the basis of experiences in top-performing hospitals nationally. BACKGROUND Prompt percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity; however, door-to-balloon times often exceed the 90-min guideline set forth by the American College of Cardiology (ACC) and the American Heart Association (AHA). METHODS We conducted a qualitative study using in-depth interviews (n = 122) of hospital staff at hospitals (n = 11) selected as top performers based on data from the National Registry of Myocardial Infarction from January 2001 to December 2002. We used the constant comparative method of qualitative data analysis to synthesize best practices across the hospitals. RESULTS Top performers were those with median door-to-balloon times of < or =90 min for their most recent 50 PCI cases through December 2002 and the greatest improvement in median door-to-balloon times during the preceding four-year period 1999 to 2002. Several critical innovations are described, including use of pre-hospital electrocardiograms (ECGs) to activate the catheterization laboratory, allowing emergency physicians to activate the catheterization laboratory, and substantial interdisciplinary collaboration throughout the process. In the ideal approach, door-to-balloon time is 60 min for patients transported by paramedics with a pre-hospital ECG and 80 min for patients who arrive without paramedic transport and a pre-hospital ECG. CONCLUSIONS Hospitals can achieve the recommended ACC/AHA guidelines for door-to-balloon time with specific process design efforts. However, the recommended best practices involve extensive interdisciplinary collaboration and will likely require explicit strategies for overcoming barriers to organizational change.
Collapse
Affiliation(s)
- Elizabeth H Bradley
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Parkosewich J, Chuong B, Ververis M, Konet L, Gerber J, Moscovitz H. Changing ED Culture to Improve Care for Patients with STEMI: The Primary PCI Project. J Emerg Nurs 2005. [DOI: 10.1016/j.jen.2004.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
15
|
Gombeski WR, Kramer RK, Freed L, Foody J, Parkosewich J, Wilson T, Wack JT, D'Onofrio G. Women's Heart Advantage Program: the impact 3 years later. J Cardiovasc Manag 2005; 16:27-34. [PMID: 16521611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Yale-New Haven Hospital, in partnership with Voluntary Hospital Association (VHA Inc), launched the Women's Heart Advantage program in March 2001. Major program components implemented include (1) a comprehensive initial and ongoing internal communication program; (2) a health promotion initiative including a 24-hour, 7-days-a-week women's heart line staffed by nurses and an Internet health question-and-answer forum; (3) significant ongoing communication with nurses and physicians; (4) a community outreach effort to educate poor and minority women; and (5) an aggressive effort to secure financial partners to underwrite the cost of the program. Before launching the program, a telephone survey of 300 randomly selected New Haven County women ages 40 to 70 years was initiated in January 2001 and repeated in January 2002, 2003, and 2004. Findings include (1) the percentage of women who recognize heart disease as the number-one killer of women their age increased from 26% in 2001 to 59% in 2004, (2) the percentage of women who would call 9-1-1 or go directly to a hospital emergency department increased from 63% in 2002 to 83% in 2004, and (3) the percentage of women aware of recent Women's Heart Advantage program promotion grew from 33% in 2002 to 50% in 2004. Perhaps most importantly, the number of women with heart problems admitted through the hospital's emergency department increased from 1528 per year in 2001 to 1870 per year in 2004 (7.5% annual increase), whereas the number of men with heart problems admitted through the emergency department during the same time period has been relatively low (0.8% annual increase). By linking clinical, public health, and marketing expertise along with finding ways to partner with other organizations, the Women's Heart Advantage program has contributed to remarkable changes in women's awareness, knowledge, and behaviors, suggesting a model for approaching similar health-related problems.
Collapse
Affiliation(s)
- William R Gombeski
- Marketing & Communications, Yale-New Haven Hospital, New Haven, CT 06510, USA
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Gombeski WR, Kramer K, Wilson T, Krauss K, Taylor J, Colihan L, Parkosewich J, Caulin-Glaser T, Freed L, D'Onofrio G. Women's Heart Advantage program: motivating rapid and assertive behavior. J Cardiovasc Manag 2002; 13:21-8. [PMID: 12412359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
|
17
|
Bacon S, Parkosewich J, Donovan CT. Critical care nurse participation in ethical and work decisions. Crit Care Nurse 1994; 14:19. [PMID: 7882683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
18
|
Bacon S, Parkosewich J, Donovan CT. Critical care nurse participation in ethical and work decisions. Crit Care Nurse 1994. [DOI: 10.4037/ccn1994.14.2.19-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|