Nurses' Experience and Teamwork Contribute to Better Patient Care

A new study partially funded through the INQRI program reveals that nurse tenure and good team work improve the quality of hospital care and reduce costs. The research team, led by INQRI grantee Patricia Stone, found that patients received the best care when treated by nurses who have extensive experience in their current job. The study is in the current issue of the American Economics Journal: Applied Economics.

Stone and her team reviewed more than 900,000 patient admissions over four years at Veterans Administration Healthcare System hospitals. It is the largest study of its kind to link nurse staffing to patient outcomes, according to a statement by Columbia University Medical Center. Stone, centennial professor of health policy at Columbia Nursing, and her co-authors analyzed payroll records for individual nurses and medical records for individual patients to examine how changes in nurse staffing impacted length of stay.

"Reducing length of stay is the holy grail of hospital management because it means patients are getting higher quality, more cost-effective care," Stone said in the statement. "When the same team of nurses works together over the years, the nurses develop a rhythm and routines that lead to more efficient care. Hospitals need to keep this in mind when making staffing decisions–disrupting the balance of a team can make quality go down and costs go up."

Stone’s earlier INQRI-funded project: “The Impacts of Nurse Staffing, Skill Mix, and Experience on Quality and Costs in Long-Term Care” examined whether there is a causal relationship between nursing input and patient outcomes in long-term care facilities.

Improvement Science Research Network Offers Tips on Publishing Quality Improvement Projects

As the Improvement Science Research Network's (ISRN) 2013 Summer Institutes on Quality Improvement* are rapidly approaching, the ISRN is offering tips about publishing quality improvement projects and getting involved with their events. 

• If your quality improvement project produced ‘something to share’ with a larger readership, it may be ‘tricky’ to find a journal for publishing your message. You can locate ‘journals that publish QI projects’ in the BLOG, “Where to Publish your QI Results.”  Click here>>>
  
  
• This is a resource from the Improvement Science Research Network (ISRN), developed by the national CTSA Nursing Special Interest Group. Once this need was recognized you are invited to ADD TO THIS COLLECTION through your comments.
  
  
• Learn more about the Improvement Science Research Network (ISRN) resources and collaborate in one of the Network Research Studies by attending the Improvement Science Summit (a research methods conference), held July 9-10 in San Antonio, TX. See Page 3 of the brochure: Click here to download brochure (PDF)
  
  
• Check out the ISRN Specialty Workshops (July 10): 
• Educators’ EBP Workshop®- This year’s them is Interprofessional Education for Interprofessional Care. Expand your interprofessional education initiative by attending this specialty workshop. 
• TeamSTEPPS® Fundamentals Training Workshop-Build your agency’s capacity in this crucial skill set in team building and communication. Bring a team to this specialty workshop. 
• Essential Elements Workshop- An essential introduction to the basics of Evidence-Based Practice. Click here for details

*The 2013 Summer Institutes on Quality Improvement: A Cluster of Interprofessional Conferences will be held July 9-13 in San Antonio, TX.

Nurse Staffing Matters - New INQRI Study

A study led by Robin Newhouse and Laura Morlock published in the current issue of Medical Care underscores the importance of  nurse staffing in providing quality care. The researchers tested in 23 ruaral hospitals a quality collaborative intervention to improve care for heart failure patients.

The intervention focused on four key measures of heart failure care. At the end of the study, the researhceers found no quantitative difference between the intervention and control groups on implementation of the key measures. They did find that hospitals with more stable nurse staffing - lower turnover - implemented more of the measures. 

The researchers assert that the study speaks to the central role of nurses in quality improvement.

How my INQRI Grant Has Had an Impact on My Work

Susan Letvak PhD, RN, FAAN

Since completing my INQRI research, “The Effects of Nurse Presenteeism on Quality Care and Patient Safety,” in 2010, I believe the importance of nurse health has received much needed national and international attention. A healthy nursing workforce is not only important to the profession, but also to quality of patient care and hospital costs. We have received requests to share the survey our interdisciplinary team developed from researchers throughout the United States, as well as Australia, the Philippines, Trinidad, Iceland, and South Africa. Recently our study has received attention from other health care professions and we have also received requests for our survey tool from dental hygienists and physical therapists. Importantly, I have been actively consulting with hospitals throughout North Carolina on addressing nurses’ health concerns, especially mental health and the high rates of nurse depression identified in our study. I am now working towards researching interventions that will improve nurse health, which will ultimately improve quality of care and patient safety and decrease health system costs.

On a personal note, I have received unexpected recognition because of our study results. After publishing our findings in high impact nursing journals, I was interviewed by health care writers throughout the country. Our study findings were presented in a NY Times blog, in hospital administrator newsletters, and in specialty nursing group newsletters. I have been an invited speaker for large nursing groups, including the British Columbia Nurses Union, and OR Nurse Managers, as well as for numerous regional and local nursing organizations. I was also interviewed for a live NPR program. Finally, I believe my INQRI grant was instrumental in my being selected as a Fellow in the Academy of Nursing, a life-long career goal which I did not expect to achieve for several more years.

I would not have developed such a successful interdisciplinary team without the support and funding from the RWJF INQRI program. The findings from our study have the potential to not only improve the health of nurses, but also to improve quality of care while decreasing hospital costs. They have laid the foundation for future work which will provide guidance to hospital systems on ensuring a healthy nursing workforce as well as provide the support for needed policy change.

Dr. Letvak is an Associate Professor and Chair of Adult Health Nursing at the University of North Carolina Greensboro. 

This post is part of our week-long blog carnival focused on the Medical Care supplement.  Click here to access all posts in this carnival. 

The Human Face of Hospital Readmissions

Health Affairs blogger Risa Lavizzo-Mourey explores the human face of hospital readmissions, sharing the perspectives of two individuals representative of the one in five elderly patients returning to the hospital within 30 days of leaving.

Readmissions is a growing concern, and several initiatives seek to address this costly health care issue.  Aligning Forces for Quality, one of the initiatives attempting to determine factors associated with readmissions, encourages health care providers to tailor their approach to discover methods that work best for their patients’ individual circumstances. 

Another report was commissioned by The Robert Wood Johnson Foundation to examine the issue of readmissions through the eyes of those grappling with the problem.  The report is part of the Care About Your Care initiative, devoted to improving the transition from hospital to home.

Baccalaureate Prepared Nurses Save Lives

A newly published study suggestss that hospitals can save lives by hiring more nurses with bachelor’s degrees. University of Pennsylvania researchers Ann Kutney-Lee, Douglas M. Sloane and Linda H. Aiken found that about 500 deaths among general, orthopedic, and vascular surgery patients in Pennsylvania might have been avoided during the 1999-2005 study period if the number of bachelor’s-level nurses had been 10 percentage points higher.

Click here for the abstract.

This area of research is familiar to INQRI grantees Dr. Mary Blegen and Dr. Tom Vaughn, who sought to examine the effects of registered nurse (RN) education by determining whether nurse-sensitive patient outcomes were better in hospitals with a higher proportion of RNs with baccalaureate degrees. The results of the study showed that hospitals with a higher percentage of RNs with baccalaureate or higher degrees had lower congestive heart failure mortality, decubitus ulcers, failure to rescue, and postoperative deep vein thrombosis or pulmonary embolism and shorter length of stay.

Click here to learn more about INQRI and baccalaureate education in nursing and patient outcomes.

Upcoming Opportunity: Interprofessional Faculty Development Institute for Quality Improvement and Patient Safety

The Interprofessional Education Collaborative (IPEC) is pleased to offer an opportunity for faculty teams to attend the Interprofessional Faculty Development Institute for Quality Improvement and Patient Safety on May 20-22, 2013 at the Dulles Hyatt in Herndon, VA. The overall goal of the institute is to create faculty champions who can enhance interprofessional curricula, learning experiences, and assessment of learners in quality improvement and patient safety at the point of care.

Research conducted by INQRI grantees have made multiple contributions to quality improvement and patient safety.

Click here to access the registration page

Click here to learn about the contribution INQRI has made in quality measures. 

Advancing the Science of Quality Improvement Research and Evaluation

INQRI's Senior Program Officer, Lori Melichar, invites you to participate in a virtual meeting on February 13 regarding the advancement of the science of quality improvement research and evaluation.

During the session, you will learn about five quality improvement programs that received grants for evaluation from the Robert Wood Johnson Foundation:

• Evaluation of the Perfecting Patient Care University: RAND Corporation 
• Evaluation of a Two-Pronged Training Program to Build Capacity for Quality: Emory University Rollin’s School of Public Health 
• Evaluation of Quality Improvement Training/Capacity Building: The AED Center on AIDS and Community Health
• To Achieve the Best: Evaluating Quality Improvement Training as a Means to an End: Cincinnati Children’s Hospital Medical Center 
• Evaluating the Effectiveness of NACCHO Quality Improvement Training Initiatives: The University of North Carolina Gillings School of Global Public Health 

Click here to learn more.

To participate, please email Anita Roberts (aroberts@rwjf.org) and put “ASQUIRE meeting” in the subject line of your email.