New Hospital Initiative Involves Nurses Conducting Universal Screening for Depression

Hospital patients who have undiagnosed depression often have a slower and more difficult recovery. Now, nurses at Cedars-Sinai hospital in Los Angeles, are leading efforts to screen all patients for possible depression, Nurse.com reports.

The new process is designed to help nurses detect symptoms of clinical depression characterized by a severely disheartened mood, lowered activity level, and persistent negative thoughts lasting longer than two weeks.

“We know, based on multiple medical studies over several years, that addressing depression improves all aspects of patient health,” Linda Burnes Bolton, Cedar-Sinai’s vice president for nursing, CNO, and director of nursing research, said in a news release. Burnes Bolton served as liaison to INQRI’s national advisory committee prior to joining RWJF’s Board of Trustees. “By routinely screening our patients for depression upon admission, we can ensure that they receive the appropriate treatment and protocol.”

For the new initiative, an RN will interview each patient within 24 hours of admission, asking questions about mood and energy level. If the answers indicate possible depression, the nurse will use a standard, detailed questionnaire to assess other depression symptoms, including any thoughts of suicide. If possible depression is found, Cedars-Sinai social workers and physicians will determine an appropriate intervention for the patient. For patients who are suicidal, the nursing department will notify the patient’s physician and protect the patient from self-harm.

Hospitals' Approach to Quality Care

Kaiser Health News recently reported that the Joint Commission has released their annual report announcing which hospitals have excelled at meeting basic requirements for treating common illnesses.  The report recognizes the accomplishments of 620 hospitals, with 18% of them listed as "top performers," having followed recommended protocols at least 95% of the time.

This announcement comes at the same time that USA Today has published an interview with

Marty Makary, a surgeon at Johns Hopkins Hospital.  Dr. Makaray has recently written a new book, Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care, in which he suggests that hospitals aren't forthcoming about medical errors, readmission rates and other quality issues.

What do you think about these two sides of the quality discussion?  Comment below.

Click here to read the story about the Joint Commission's announcement.
Click here to read the interview with Dr. Makaray.

How to Better Motivate Nurses and Cut Costs

Yesterday, Karen Minich-Pourshadi, Senior Editor for HealthLeaders Media, published a fascinating piece that discussed innovative ways for hospital systems to cut costs while motivating their nursing workforce. Ms. Minich-Pourshadi recommends that hospitals take a cue from airline companies and utilize a point system, similar to 'travel miles', that rewards nurses for covering their colleagues shifts or providing exemplary care. The case study presented by Ms. Minich-Pourshadi demonstrates how hospitals are looking at other industries to solve some of their workforce issues that previously was viewed as unfeasible.

To read more about this innovative program, click here.

New Coverage on INQRI Study re: Nurse Depression

INQRI grantees, Susan Letvak, Christopher Ruhm, and their team are receiving a lot of attention for a new article they published recently in Clinical Nurse Specialist which focused on depression among nurses in hospitals.

Check out their recent clips:

• 1 in 5 Nurses is Depressed - Health Leaders Media
• Why So Gloomy?  Nurses Twice as Depressed as the General Public - Nurse Zone
• Study Looks at High Rate of Depression Among Nurses - Cleveland Plain Dealer

Learn more about their INQRI study, "The Effects of Nurse Presenteeism on Quality of Care and Patient Safety."

Depression in Hospital-Employed Nurses Is Double The National Average

An INQRI supported study, published in the May/June edition of Clinical Nurse Specialist and led by INQRI grantees Susan Letvak, PhD, RN and Christopher Ruhm, PhD, has found that hospital-employed nurses demonstrated a depressive symptom rate of 18%, double that of the national average (9%). The authors of this study also expressed their concern with depression among nurses as it may result in difficult with concentration and limiting nurses ability to perform mental and interpersonal tasks to the best of their ability. Thus, depression could be linked to not only lower total work output, but negative patient outcomes.

You can access the abstract (free) and the full-text (subscription required) of this study, here.

How Hospital Noise Harms Health

A study investigating how hospital noises may disrupt sleep and potentially have a negative effect on patient health has gained national attention this morning. The study, which was published in the June edition of the Annals of Internal Medicine, simulated typical noises that would be found in a hospital on twelve healthy adults. They found that these noises can be disruptive and have an adverse effect on patients who may not be in the best of health. This study could play a crucial role for how hospitals are designed and influence policies that are implemented in order to reduce the amount of noise patients are exposed to during the evening.

How can nurses play an integral role in reducing noise in order to better serve patients?

To read more about the study, click here.

To access the abstract and full text of the study (subscription required), click here.

Upcoming IHI Seminar: Rethinking Critical Care: Reducing Patient Harm from Sedation, Immobility, and Delirium

On May 15th and 16th, the Institute for Healthcare Improvement will be hosting a symposium in San Diego, CA addressing critical care and cutting edge ICU practices aimed at improving care for elderly patients. The symposium will specifically focus on innovative ways for health care practitioners to monitor patient sedation, immobility, and delirium. Since these areas of care are strong predictors of length of stay, increased morbidity and mortality, long-term cognitive impairment, and high cost of care, this symposium offers a great way for health care practitioners to expand their skill-set and improve the quality of care they deliver.

Click here to read more about this upcoming symposium.

Nurse Staffing Mandates Debated at Hospitals

Over the weekend, Ben Sutherly, staff writer for the Dayton Daily News, reported on the different viewpoints hospital administrators and nurses have on nurse staffing mandates in the state of Ohio and around the country. Mr. Sutherly cites the work of renowned nursing workforce scholar and INQRI NAC member, Linda Aiken, to support the argument that nurse staffing levels should be mandated at the state level. Dr. Aiken's research found that there would be 14% fewer surgical deaths in Pennsylvania if the state were to adopt nurse staffing mandates that are similar to those in California, the only state that has mandated nurse-to-patient ratios. However, Mr. Sutherly also presents the case for hospitals as they argue that the quality of the health care workforce is much more important than having a minimum nurse-to-patient ratio in order to provide the highest quality of care.

Click here to read the whole article.

Click here to read more blogposts relating to nurse staffing.

Minimum Nurse Staffing Level Legislation Introduced In Minnesota

Last week, Renee Passal, of local ABC affiliate WDIO, reported that the Minnesota House and Senate has introduced legislation aiming to establish minimum nurse staffing levels at hospitals. The article also features a video snippet further detailing the proposed bills.

Click here to read the article and watch the video.

Click here to read other blogposts relating to nurse staffing.

Philadelphia Hospital Boosts Use Of Registered Nurses In Bid To Improve care

Yesterday, Stacey Burling, reporting for the Philadelphia Inquirer, detailed how Hahnemann University Hospital plans to utilize more registered nurses (RNs) and reduce the amount of nurse assistants. This decision was spurred by a pilot study conducted in one nursing unit that found that using all registered nurses to care for patients instead of a combination of nurses and nursing assistants led to higher-quality care, and greater patient and nurse satisfaction. The hospital cites changing payment models that emphasize the importance of quality of care as a catalyst for this initiative. The hospital's decision also relates to INQRI studies that have found having higher levels of RN skill mix leads to better patient outcomes.

It should also be noted that the union representing the certified nursing assistants protested outside of the hospital yesterday in response to the new care model announcement?

What are your thoughts on this issue?

Click here to read the full story.

INQRI's Five Most Read Blogposts of 2011

On behalf of the INQRI program staff and leadership team, we would like to wish all of you a safe and happy holiday & New Year.

Below you will find the five most read blogposts from 2011.

Please feel free to comment and share your favorite post from this year!

Interdisciplinary Pilot Study Suggests Nurses Can Help Chronically Ill Patients Properly Manage Medication after Being Discharged from Hospital Nurses Bridged Gap Between Leaving Hospital with Prescriptions and First Visit with Primary Health Care Provider

New Study Shows Higher Nurse Staffing Levels in Hospitals Can Reduce Rates of Infection, Improve Outcomes for Patients

INQRI Project Featured in Health Services Research

Expanding Nurses' Scope-of-Practice in the News

The Future is Now for Nurse Practitioners

A New Tool to Compare Hospital Performance

Last week, Tom Avril and Dylan Purcell, of the Philadelphia Inquirer, reported on the Center of Medicare & Medicaid Services' hospital performance measurements for Philadelphia area hospitals. The Inquirer has created its own health portal for Philadelphia area residents to obtain performance data on eight serious, generally preventable conditions that may influence which facility they chose to obtain health services from when necessary.


Click here to access the Philadelphia Inquirer's hospital performance data.

Click here to read the news article regarding hospital performance measurements.

Click here to read more about INQRI teams' work addressing quality/performance measurement.

Click here to access the CMS hospital compare website.

Hospital Delirium, Another Hospital Hazard for the Elderly

Yesterday, Susan Seliger wrote about her personal and family's experience with hospital delirium. Hospital delirium, a brain dysfunction characterized by sudden confusion and inattention, is not very well known yet very common in elderly patients who are admitted to a hospital. Each year 20% of all elderly patients in hospitals develop delirium and this serious illness is still not being identified or treated as effectively as it can be. The article, which appeared in the New York Times' New Old Age blog section, is not only related to the work of INQRI grantee, Dr. Michele Balas, but also included a quote from her regarding this serious topic.

Click here to read the full article.

Florida Hospitals, Nursing Homes Team Up To Cut High Readmission Rates

On Monday, Letitia Stein, of the St. Petersburg Times, detailed how Florida hospitals are collaborating with local rehabilitation and nursing facilities to prevent costly readmissions. With readmissions estimated to cost the US health care system an extra $4 billion, around half of which are preventable, Florida care providers are establishing initiatives to prevent readmissions and lower health expenditures. This month, several hospitals and nursing homes in Tampa Bay are testing out a new tool, a discharge form that seeks to put all health care providers on the same page.

Click here to read the full article and find out more information about new initiatives being undertaken at Florida hospitals.

Click here to read previous blogposts relating to reducing readmissions.

Click here to read previous blogposts discussing improvement efforts for care coordination.

Nurses Can Become Desensitized To Hospital Sounds

Yesterday, Michele Norris, host of the National Public Radio program, All Things Considered, had a conversation with Boston Globe reporter Liz Kowalczyk regarding her investigation on how hospital staff can ignore or not react with urgency to patient alarms. The interview discussed the issues with cardiac monitors whether it is the lack of nurses monitoring their status or how patients who do not require their use causing many false alarms, thus creating what the interviewee claims, 'alarm fatigue'.

Click here to access the transcript of the conversation.

Click here to download the audio interview (MP3 format).

Bloodstream Infections Tied to Excess Mortality in ICU

Last week, Nursingcenter.com featured a study conducted in Europe from the December edition of The Lancet Infectious Diseases Journal that found bloodstream infections are tied to excess mortality in ICU patients. This study is similar to one that was led by INQRI alumnae Dr. David Thompson and Dr. Jill Marsteller of Johns Hopkins University.

Click here to access the article from nursingcenter.com.

Click here to learn more about Dr. Thompson's and Dr. Marsteller's INQRI project, "Linking Blood Stream Infection Rates to Intensive Care."

Previous INQRI blog posts on this topic include:  

• New Study Shows Inconsistent Reporting Methods Related to HAIs for Pediatric Patients October 4, 2010
• It's Working! - June 21, 2010
• More News About Reducing Bloodstream Infections - June 14, 2010
• 44 Illinois Hospital ICUs Reported Zero CLABSIs Last Year - May 20, 2010
• Commonwealth Webinar on Eliminating CLABSIs - April 20, 2010
• They All Agree... - March 12, 2010

Are Hospital Rankings Popularity Contests or Measures of Quality?

In an article published yesterday, Janice Simmons wonders if hospital rankings are true measures of quality.

Each year since 1990, U.S. News & World Report has ranked more than 5,000 hospitals in a variety of categories.  They present a "Top 50" in each one, with the goal of helping consumers select the hospital that is right for them.  However, a study recently published in the Annals of Internal Medicine claims that the standings do not really reflect objective measures of quality.

Tell us what you think - are rankings true quality measures?

U.S. News and World Report... focusing on quality

U.S. News and World Report recently released two articles relating to health care quality:

America's Best Hospitals

• Last week, U.S. News released its 20th "America's Best Hospitals" report and for the 19th consecutive year, Johns Hopkins Hospital has been rated in first place.

Hospitals of the Future

• U.S. News reports that "hospitals of the future" are expected to use health information technology (IT) and innovative design elements to improve care quality, reduce the risk of medical errors and create a more healing atmosphere.