Wednesday, October 28, 2009

Digital Divide in Hospitals that Care for Poor Patients

This week in an online edition of Health Affairs, researchers resport that hospitals that serve a larger share of poor patients are lagging far behind others in adopting electronic health records (EHR). Ashish Jha, M.D., M.P.H., associate professor at the Harvard School of Public Health and colleagues at Massachusetts General Hospital and George Washington University believe that this digital divide could increase disparities in care and without federal dollars, hospitals that serve the poor will have a difficult time catching up on EHR use.

Study highlights include:

"Hospitals with higher rates of poor patients had lower levels of adoption of electronic clinical decision support tools, lower rates of electronic medication lists and electronic discharge summaries.

Among hospitals without an EHR system, inadequate capital was cited significantly more often as a barrier to adoption by high disproportionate share (DSH) hospitals than low ones.

High-DSH hospitals were significantly more likely than low-DSH hospitals to report concerns about future support."


This study will appear as the third in a series of broad reports on health information technology adoption trends in hospitals, funded by the Robert Wood Johnson Foundation and the federal government’s Office of the National Coordinator for Health Information Technology. The executive summary for this report, "Health Information Technology in the United States: On the Cusp of Change, 2009," was released Monday; the full report will be released in early November.

Read the Health Affairs article.
Download the executive summary.
Read the press release.

Tuesday, October 27, 2009

What would you do with a blank check to transform health care?

The Robert Wood Johnson Foundation's (RWJF) Pioneer Portfolio is dedicated to powering ideas that have the ability to truly transform health and health care and, to do so we’re encouraging people to think big.

From October 27-30, members of the Pioneer Team will be in San Diego as a sponsor of TEDMED2009. While there, the team will ask participants: If someone handed you a blank check—what would you do to transform the future of health and health care? Where are the breakthrough opportunities that could bring about significant improvements?

This conversation is not limited to the attendees at TEDMED. RWJF is taking the conversation to Twitter to hear your inspiring ideas. Join the conversation and share how you would transform the future of health and health care by tagging your “tweets” with the #blankcheck hashtag.

Monday, October 26, 2009

Nurses and Handwashing

In a new article, "Nurses lead the way in hand hygiene" from Endocrinology Update, Chris Kennedy writes:


"As a push for a national hand hygiene initiative gets underway, research has shown nurses outshine doctors and other medical staff by having the cleanest hands in the hospital."

***

INQRI researchers are also recognizing the impact nurses can have in this arena. A research team at Johns Hopkins University has conducted the first randomized-control trial to reduce central line associated blood stream infections among ICU patients. There are some 80,000 catheter-induced bloodstream infections each year, causing up to 28,000 deaths. This study, conducted in ICUs in 12 states, has shown in preliminary analysis that substantial reductions in infections can be widely achieved and this project did so with nurses leading the infection control efforts. Their study builds on the well-known work of Dr. Peter Pronovost, creator of the line-insertion “checklist.” Hospitals that followed the components of their ICU safety program, as well as adopted a safety improvement environment that fostered nurse involvement in quality improvement efforts, reduced, and in some cases completely eliminated, bloodstream infections for several months at a time. Their research is also showing that higher nurse turnover is related to higher infection rates.

Click here to read Chris Kennedy's article.
Click here for more information on the INQRI researchers.

Friday, October 23, 2009

José Pagán: Link Your Research To Current Debates

As the debate rages in Washington over health care reform, how can a nursing researcher get their results in front of policymakers who are making decisions? That's a question José A. Pagán, Ph.D., a member of the Interdisciplinary Nursing Quality Research Initiative (INQRI) National Advisory Committee, says INQRI grantees must consider when conducting research.

"Because of health care reform, this is an exciting time to be doing the kind of research that INQRI funds," says Pagán, Professor and Chair of the Department of Health Management and Policy at the School of Public Health, University of North Texas Health Science Center at Fort Worth. "We are learning more about the role of nurses and how nurses can improve quality and how nurses can keep costs down."

Click here to read more.

Thursday, October 22, 2009

INQRI Grantee Creating a Research Network Focusing on Nursing Care

INQRI grantee Kathleen R. Stevens (The University of Texas Health Science Center at San Antonio) will lead a new two-year project, funded by a $3 million grant from the National Institute for Nursing Research, to help improve the bedside manner of the country’s nurses. This project seeks to create the first national research network to focus on front-line hospital care delivered by nurses.

Click here to learn more about this project...

...In the meantime, watch Dr. Stevens' recent presentation on her INQRI project, "Small Troubles, Adaptive Responses [STAR]: Fostering a Quality Culture in Nursing."

Healthcare 411: Audio Podcast from AHRQ

Check out the newest edition of Healthcare 411...



This session features the first in a three part series on Clinical Decision Support.


Click here to stream the audio from your desktop.
Click here to read the transcript.
Click here to download the audio as an MP3.

Wednesday, October 21, 2009

Nursing and End-of-Life Care

"I have often heard that one of the most valuable things that nurses do for patients is to help them die well."

In a new article, "End-of-Life Care by Nurses in the ICU," in Medscape Today, Marilyn W. Edmunds, PhD, CRNP and Laurie Scudder, MS, NP report on a small study which was designed to explore nurses' perceptions about caring for dying patients, specifically focused on unaccompanied patients, involvement of family members and environmental facets. In their interviews with 9 experienced intensive care unit (ICU) nurses, the researchers found that nurses were most concerned with providing dignified end-of-life care and ensuring that present relatives would remember the death of their loved one as calm and dignified, despite previous suffering.

INQRI researchers Lissi Hansen, PhD, RN and Richard Mularski, MD, MSHS, MCR were recently funded to examine "Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice." Their study will explore the relationships between quality palliative nursing care delivered in ICUs and patient and family outcomes. They will also look at how to measure and to improve these outcomes. The purpose of this investigator-initiated study is to examine nursing's specific contributions to quality palliative care provided to patients and their families in the ICU.

Friday, October 16, 2009

TONIGHT - INQRI Director on PBS re: Nurse Shortage and Effect on Patient Care

Dr. Naylor’s interview on PBS regarding the ongoing shortage of nurses and the effect on patient care is being rebroadcast tonight:

NOW on PBS will rebroadcast Nurses Needed Friday, October 16th, 8:30pm

Nurses Needed, a first-of-its-kind documentary from the Emmy-winning NOW on PBS, was developed with the support of the Jonas Center for Nursing Excellence. Told through the perspectives of nurses, nurse educators, patients and families, Nurses Needed explores the projected nursing shortage and its impact on the quality of and access to health care for patients nationwide. More than two million viewers saw the documentary when it aired originally on October 24, 2008 and subsequently, the Nurses Needed page on NOW's web site has received thousands of visitors, many of whom have posted heartfelt comments. We encourage you to watch on Friday night and visit the PBS NOW webpage, for further information on how great an impact nurses and their care have made on countless lives.

Thursday, October 15, 2009

New Blog Post at the Future of Nursing Blog - A Patient Advocate Shares Views about Nurse Impact on Patient Health

The Initiative on the Future of Nursing’s blog has published a guest entry from Julia Hallisy, D.D.S., sharing her views of nurses’ impact on patient health. Hallisy will be a member of the reactor panel of the Forum on the Future of Nursing: Acute Care, which will be held on Monday, October 19, from 12:30-5:30 p.m. Pacific Time at Cedars-Sinai Medical Center in Los Angeles.

For those unable to attend the event in person, other options for participating in the meeting include:
  • Watch the Live Webcast available via www.thefutureofnursing.org. Questions and comments will be accepted through the Webcast interface and shared with the panelists.
  • Tweet your comments and observations of the meeting using #IFNacutecare. Make sure you’re following the Initiative twitter feed @FutureofNursing so you don’t miss any behind-the-scenes news from the forum.
  • Leave a comment on the Future of Nursing blog. On the blog, registered users are welcome to leave their comments for the blog authors and members of the blog community.

A draft agenda for the meeting is available at www.thefutureofnursing.org.

Read Julia Hallisy's blog post.

Friday, October 9, 2009

Future of Nursing on WIHI

WIHI will host a web-based program on the Future of Nursing on October 22 from 2p – 3p, featuring Donna Shalala, Sue Hassmiller, and Pat Rutherford. Please follow the link below to learn more about this program. (Note that registration is required for this event).

http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/WIHI.htm

The Future of Nursing
Thursday, October 22, 2009 2:00 PM – 3:00 PM Eastern Time

Donna Shalala, PhD
Former US Secretary of Health and Human Services, President, University of Miami
Sue Hassmiller, PhD, RN, FAAN
Director of the RWJF Initiative on the Future of Nursing, Institute of Medicine
Pat Rutherford, RN, MS
There may be a shortage of nurses in many parts of the US, but there’s no shortage of rethinking and redesign underway to strengthen the profession and to help nurses be more effective providers of quality patient care. Health care reform, along with a greater emphasis on primary care and prevention, are just some of the forces that point to a more prominent, satisfying, and critical role for nurses in the near future.

A new IOM committee on the future of nursing is criss-crossing the country, harnessing the best ideas to ensure that nurses, nursing educators, and the health care system are prepared. Donna Shalala and the RWJF’s Susan Hassmiller are leading this effort. On the next WIHI, they’ll be on hand to describe what they’re learning that will eventually result in a major blueprint for action. IHI’s Pat Rutherford joins this exciting lineup to share the latest on improvement innovations that can enable nurses to work to their full professional capacity. WIHI host, Madge Kaplan, invites you to come learn from people at the sharp end of a changing profession and to contribute to the discussion with your comments and questions.

There is no fee for participating in a WIHI program, but enrollment is required.

Elderly Fall Injuries Cost $20 Billion in 2006—and Price Is Rising

By: Cheryl Clark, for HealthLeaders Media, October 8, 2009

Three in 10 elderly patients who sought care in an emergency room after a fall were admitted to the hospital for treatment of their injuries, which was a major share of the $20 billion cost for treating falls in people over age 65 in 2006.

Since 2006, fall-related health costs are believed to have increased substantially because of a larger number of seniors suffering falls, and because of the higher costs of treating the fractures, open wounds, and head traumas they cause.

Those were two findings from a new report from the federal Agency for Health Research and Quality, which said that each year, about one-third of elderly adults experiences a fall. Falls are the most common cause of non-fatal injuries in the senior population.

"Because many falls are preventable and their impact on the U.S. healthcare system is significant, it is important to better understand the types of fall-related injuries experienced by elderly adults, particularly those injuries requiring treatment in an ED," wrote the authors Pamela Owens, C. Allison Russo, William Spector, and Ryan Muter, who are analysts for the agency.

Throughout the country, many healthcare systems are working on programs to help older people maintain their sense of balance, wear better shoes, and get more exercise to maintain muscle strength. Nevertheless, many older people don’t realize their increased vulnerability to fall-related injuries as they age.

Here are some highlights from the report:

  • Falls prompted 2.1 million elderly adults to seek care in emergency rooms in 2006, and accounted for one in 10 emergency visits among patients age 65 or older.
  • The cost of hospital care to treat fall-related injuries among seniors was $6.8 billion of the $20 billion in 2006.
  • Falls among women over age 84 were more frequent, one in seven, compared with falls among men over age 84, one in 10.
  • Fractures were the biggest reason for fall-related injuries among seniors, accounting for 41% of emergency room visits after a fall. Superficial injuries or contusions accounted for 22.6%, and open wounds 21.4%.
  • Hip fractures accounted for one in eight injurious emergency room visits among the elderly.
  • Those seniors who were admitted to the hospital for treatment due to a fall were more likely to be discharged to a long-term care facility than elderly patients admitted to the hospital for other conditions.
  • The cost of caring for elderly patients hospitalized because of fall-related injuries was on average higher than the cost of treating elderly patients admitted with other conditions, a difference between $10,800 and $9,900.

***

INQRI grantees Patti Dykes and Blackford Middleton were funded to address gaps in knowledge about falls by establishing linkages between nursing fall risk assessment, risk communication and tailored interventions to prevent falls. The goal of this study, called "Translating Fall Risk Status into Interventions to Prevent Patient Falls," was to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention. This innovative intervention communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to interdisciplinary team members, paraprofessionals, patients and family members.

Thursday, October 8, 2009

Did you miss yesterday's webinar? Watch it now!

In 2007, INQRI worked with the Gordon and Betty Moore Foundation to plan a day-long convening which brought researchers together with stakeholders to discuss the impact of medication errors. We are continuing this investment with a series of webinars that began yesterday with a presentation by Dr. Linda Flynn.

Special thanks to Dr. Flynn for such a wonderful presentation on her project, "Examining the Impact of Nursing Structures and Processes on Medication Errors." We had a rich discussion following her presentation, but don't worry if you missed it. You can download Dr. Flynn's slides or watch the presentation right from your desktop.

***

Next up: Gordon and Betty Moore Foundation grantee Julie Kliger's presentation, "Empowering Front-Line Nurses: A Structured Intervention Enables Nurses to Improve Medication Accuracy."
Date: November 12, 2009: 2:00 p.m. - 3:00 p.m. EST
Click here to register.

Wednesday, October 7, 2009

Don't Miss Out - Register NOW for Today's Webinar

Our first presentation in the Medication Management Series is today:

"Examining the Impact of Nursing Structures and Processes on Medication Errors"
Speaker: Linda Flynn, University of Maryland
Date: October 7, 2009: 3:30 p.m. - 4:30 p.m. EST


Click HERE to register.

Monday, October 5, 2009

Taking Action to Reduce Falls

Hospitals Take Action to Reduce Risk of Patient Falls

Spurred by new Medicare policies that deny reimbursements for some patient falls and state laws that require hospitals to report fall rates, hospitals are increasingly adopting aggressive measures to prevent patient falls, NPR reports. For example, patients at Massachusetts-based Fairview Hospital are screened for fall risk upon admission and are then screened once per day throughout their hospital stay. Patients considered at high risk for falls are provided with yellow socks and yellow blankets so they can be quickly identified and are admitted to rooms equipped with bed alarms that alert staff if a patient is attempting to get out of bed unassisted. Other strategies employed by hospitals include lowering beds, avoiding medications that could impair a patient's balance and administering diuretics before bedtime so that patients are less likely to get up during the night to use the bathroom. Although some hospitals also restrain patients at high risk for falls, most concede that this should be used as a last resort only when other strategies have failed (Pfeiffer, NPR, 9/8/09).
(c) RWJF, 2009

***

INQRI grantees, Patti Dykes and Blackford Middleton are also addressing fall risk in their project "Translating Fall Risk Status into Interventions to Prevent Patient Falls." Their project is addressing gaps in knowledge by establishing linkages between nursing fall risk assessment, risk communication and tailored interventions to prevent falls. The goal of this study is to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention. This innovative intervention will communicate fall risk status and create a tailored evidence-based plan of care that is accessible to interdisciplinary team members, paraprofessionals, patients and family members.