Shift Report, Readmissions, Charge RN Education

We have had a spam attack over the last week, and lost several months of blog entries in the process. If there is information you would like to obtain the links or citations for some of the research articles we have been been discussing, please let us know by emailing us (Ruth@hansten.com or Kathy.Watkins@hansten.com) OR you can access these citations by joining us on twitter (@Rhansten) or Linkedin and see the history of postings.

Research information from our 3/25/2013 RROHC Specialist Conference call:

1) JAMA study from the Advisory Board Daily Briefing, March 21, 2013: Study by OregonHS U, John McConnell , of 600 cardiac catheterization labs compared 18 points from Lean methodology to actual performance and management practices. No surprises here but: more effective management also demonstrated better patient results and lower mortality. YES. Improving processes at the point of care as we do in RROHC’s 10 best practices does improve patient results! Management Practices and the Quality of Care in Cardiac Units. K. John McConnell, PhD; Richard C. Lindrooth, PhD; Douglas R. Wholey, PhD; Thomas M. Maddox, MD; Nick Bloom, PhD. JAMA Intern Med. 2013;():1-9. doi:10.1001/jamainternmed.2013.3577.

2) Bedside report articles we discussed in our last blog entry from February on hourly rounding and Shift Report at the Bedside, articles have been in Nursing Management in February (2 articles) and March 2013: We recommend review of the experiences from Novant Health (hourly rounding) and Kean University in NJ and we celebrate their HCAHPs results. The March 2013 article “Make it a Habit: 2 Weeks to bedside Report” by Stephen Carlson discusses the advantages of using a template for shift handovers.

3) Impact of Charge RN Education: March 2013 Nursing Management features an article by Rosemary Homer and Linda Ryan related to measurement of Charge RN education needs and results at Adventist Hinsdale Hospital in Illinois. Because I do quite a bit of charge RN education and find that in many hospitals, this crucial group has never been educated even in the basics of making assignments! I was pleased to note that qualitative analysis showed improved understanding of roles and personality impact, different methods of communication, improved conflict resolution, improved delegation skills, and more intentional creation of a healing environment.

4) Readmissions are featuring prominently in many research studies published recently due to value based purchasing incentives to keep patients healthy. A 2009 study of 2003-4 Medicare patients showed that nearly 1/5th were readmitted in 30 days, and 34% within 90 days, costing $17.4 billion. It’s not new news to us that individualized discharge instruction re: self-care and post hospital appointments must be done. Good news, though, nursing care coordinators at NYU Langone Med Ctr’s 4 hospitals showed excellent results, and at John Muir Health in CA, a patient- centered medical home with an LVN teaming with case manager RN resulted in the control group being admitted 2.42x more frequently than the patients in the medical home care management group. http://news.nurse.com/apps/pbcs.dll/article?AID=/20130225/NATIONAL01/102250031. Heather Stringer, Editor

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