INQRI Director Receives Award for Leadership in Gerontological Field

The Gerontological Society of America (GSA) chose INQRI Director Mary Naylor as the 2015 recipient of the Doris Schwartz Gerontological Nursing Research Award.

This honor, presented by GSA's Health Sciences Section, is given to a member of the Society in recognition of outstanding and sustained contribution to gerontological nursing research. Naylor will receive the award at GSA's 68th Annual Scientific Meeting in November.

Among her accomplishments, Naylor developed the Transitional Care Model, which utilizes nurses to reduce hospital readmissions among elderly patients after they have been discharged. As many as one-third of re-hospitalizations are considered preventable, so reducing readmissions not only improves patients’ quality of life, but reduces health care costs.

In addition to her work with INQRI, Naylor is the Marian S. Ware Professor in Gerontology and director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. Naylor leads an interdisciplinary program of research designed to improve the quality of care, decrease unnecessary hospitalizations, and reduce health care costs for vulnerable community-based elders.

Naylor was also the 2012 recipient of GSA's Maxwell A. Pollack Award for Productive Aging.

Carrots and Sticks to Reduce Readmissions and Improve Home Health Care

Olga Jarrín, PhD, RN @OJ_RN
National Hartford Center of Gerontological Nursing Excellence, Claire M. Fagin Fellow Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing

The Affordable Care Act has generated carrots and sticks for hospitals to reduce readmissions. With the goal of achieving the Triple Aim (improving quality of patient care, improving population health, and reducing overall cost of care), innovative care delivery models are being tested locally and nationally, including the roll-out of Accountable Care Organizations and bundled payment programs. These programs create incentives in terms of shared savings for health care systems that provide high quality, coordinated care.

Olga Jarrín is a National Hartford Center of Gerontological Nursing Excellence, Claire M. Fagin Fellow at the Center for Health Outcomes and Policy Research.

Meanwhile, a readmission penalty has taken effect, and hit safety net and teaching hospitals hard. While increased referrals to home health care from hospitals might lower readmission, there is wide variation in home health agencies’ ability to keep patients safely in their homes, and out of the hospital.

Institute of Medicine Workshop on the Future of Home Health Care
Health services researchers, home health agency executives, other industry representatives, and stakeholders including patients and patient advocates met at the Institute of Medicine for a 2 day workshop on the Future of Home Health Care #FutureofHH September 30-October 1, 2014. Major challenges for home health include reduced/insufficient payment for home health care, misaligned regulatory requirements and statutes, and the image of the home health care industry, that has been tainted with fraud, abuse, and sub-optimal patient care. Core issues discussed at the meeting included the use of technology to enhance care, the need for interoperable health records, the need for statutory changes at the federal level to allow advanced practice nurses to sign orders for home health care, and new models of care.

In contrast, the existing way that home health care is provided to Medicare beneficiaries was criticized as fragmented, uncoordinated, siloed, slow, and unable to meet the functional or clinical needs of today’s population. The desire to scrap the entire system and start over was balanced by a call for action “Let's work to improve, not diminish our existing home health care system” from keynote Steve Landers, MD, President and CEO of VNA Health Group. Reminding the audience of the Jimmo v. Sebelius Settlement Agreement, Judith Stein, JD, founder and Executive Director of the Center for Medicare Advocacy, pointed out the discrepancy between how home health care has been provided to Medicare beneficiaries, and how it should be provided.

Home Health Agency Work Environment Study
Using publicly reported CMS Home Health Compare data linked with nurse-reported ratings of the home health agency work environment, researchers from the Center for Health Outcomes and Policy Research have established a mechanism for why some home health agencies have better outcomes. Hospitalizations, including both acute and long-term stays, were lowest for patients receiving services from home health agencies where nurses reported excellent working conditions. Nurses working in home health agencies with poor working conditions were much more likely to report being unable to complete necessary care coordination and patient teaching due to time constraints. These findings are published open access in the October issue of the journal Medical Care.

These findings have implications for hospital and home health administrators, as well as policymakers. Hospitals should consider partnering with home health agencies that have better nurse work environments as a strategy to improve their patient outcomes, and bottom line. Home health agencies should work towards creating optimal conditions for nurses to care for patients. Policymakers should remove barriers to full scope of practice for Advanced Practice Nurses (APNs) and Registered Nurses (RNs) working in home health care, especially the requirement for physician co-signatures of APN orders for changes to the home health plan of care, including medication changes. The federal statute restricting APN authority supersedes state laws, and provides a disincentive for home health agencies to hire and collaborate with expert nurse clinicians.

Some of the “new” care models highlighted at the IOM Workshop: The Future of Home Health Care were strikingly similar to old models of home health care provided by public health district nurses and community-based family practice doctors who made both house-calls and hospital-rounds. Removing barriers to practice in home health care for APNs to direct care and directly order services is a small but important step towards raising the quality, responsiveness, and cost-effectiveness of home health care.

 This post first appeared on the Leonard Davis Institute of Health Economics Blog (LDI Blog) of the University of Pennsylvania.

RN Researching Communication Tool that could Reduce Readmissions

A nurse researcher is exploring whether or not hospital readmissions among elderly patients in assisted living could be reduced through improved communications between medical providers, the Lubbock Avalanche Journal reports.

Alyce Ashcraft, associate dean for research at the Texas Tech University School of Nursing, is conducting a study with a customized Situation, Background, Assessment and Recommendation (SBAR) tool that gathers additional patient information and forces more transparency in nurse-provider communication.

Over a 16 week-period, Ashcraft instructed nurses at a retirement community in Lubbock, Texas, to document all of their consultations with health care providers, including phone and fax communications, on SBAR forms. The intent is to eliminate repeats tests and create more efficient care by recording when nurses contact other providers about a patient’s condition, and the actions taken. The data is still be collected and analyzed.

“I don’t care if you’re here in long-term care, or the hospital or home health, it doesn’t matter,” Ashcraft, told the Journal. “Communicating the right information and getting the residents’, the patients’, the clients’ story right so that decisions can be made that are good for them; [t]hat’s what we hope to do.”

INQRI researchers at Marquette University, led by Marianne Weiss and Olga Yakusheva, studied what hospital-based nurses do to influence outcomes, including readmission rates, after a patient is discharged from a hospital. Specifically, they identified the contributions that nursing staff make to the quality of discharge teaching and the impact of that teaching on patient outcomes, readiness and readmission rates of patients who are discharged home. They found that when units had more RN hours per patient day, fewer overtime hours and fewer vacancies, the discharge teaching was of higher quality, patients reported greater readiness for hospital discharge, and post-discharge utilization of readmission and emergency room visits was lower.

RWJF Hosts Online Readmissions Discussion

The Robert Wood Johnson Foundation (RWJF) Human Capital Network is presenting an online chat on reducing hospital readmissions Monday, March 31, 2014, from 3:15 p.m.-4:00 p.m., ET.

Issues surrounding improving care transitions in order to prevent avoidable hospital readmissions will be discussed. Recent research that highlights how nurse staffing rates can improve patient outcomes will be featured. Topics will include: the variables that cause readmissions; national trends in readmission rates; and interventions for preventing unnecessary readmissions.

Presenters include RWJF Senior Program Officer Susan Mende and Matthew McHugh, associate professor of Nursing at the University of Pennsylvania School of Nursing and an RWJF Nurse Faculty Scholar.

McHugh’s research focuses on the effects of policy and organizational factors on nursing practice and health outcomes.

Mende is engaged in an RWJF national program effort to help consumers take an active role in improving the quality of health care in their communities.

Questions can be asked live during the event or in advance by emailing: hcfeedback@rwjf.org.

Registration for the chat is available here.

For more information contact Sue Stine, RWJF Human Capital Network Community Manager, (240) 221-4316; hcfeedback@rwjf.org.

One in Three Nursing Home Patients Are Harmed By Medical Errors

A recent government survey found that approximately one-third of patients who were discharged from hospitals to skilled nursing facilities, were harmed by treatments they received in the facilities. Most of the incidents could have been prevented, according to the report, which was conducted by the U.S. Health and Human Services Department, Office of the Inspector General.

The survey was based on a large sampling of Medicare patients discharged from hospitals to skilled nursing facilities during a one-year period from 2011-2012, NPR reports. Problems observed in the nursing homes included errors related to patient monitoring, and medication errors.

Approximately 60 percent of nursing home residents were harmed by their treatment were readmitted to the hospital as a result, and the report estimates that such readmissions cost Medicare about $2.8 billion a year.

The American Health Care Association, which represents the nursing home industry, responded to the report, telling NPR that this study was conducted before the Association’s quality improvement initiative, which has been showing progress in skilled nursing facilities across the country.

An INQRI-funded study led by Linda Flynn and Dong-Churl Suh examined the “Impact of Nursing Structures and Processes on Medication Errors.” The multidisciplinary research team identified changes in nursing care processes needed to prevent medication errors as well as adjustments in nurse staffing and the practice environment that can facilitate interception of such errors.

Hospitals May Get Funds Cut for High Readmission Rates

Hospitals could see their Medicare payments docked as a result of Affordable Care Act (ACA) reforms that aim to reduce patient readmissions. As a result, more hospitals are focusing on patient and caregiver education to reduce re-hospitalizations.

Under ACA, reductions in Medicare payments for inpatient care will be imposed on hospitals that readmit too many patients within a month of discharge. Cuts could range from a few thousand to hundreds of thousands of dollars depending on the circumstances, the article states.

A Medicare Payment Advisory Commission study estimates that approximately 12 percent of Medicare patients readmitted to the hospital may not need to be. The Commission also found that reducing preventable readmissions by 10 percent could save Medicare $1 billion annually.

For 2014 only three types of readmissions will be penalized under ACA: pneumonia; heart attack; and heart failure. Two more types, chronic obstructive pulmonary disorder and hip and joint replacements, will be factored in next year.

INQRI grantees Dr. Marianne Weiss and Dr. Olga Yakusheva have conducted research examining how the hospital discharge process affects readmission rates. Learn more about their work:

Read "Nurse and patient perceptions of discharge readiness in relation to postdischarge utilization."
Read "Age-related differences in perception of quality of discharge teaching and readiness for hospital discharge."
Read "Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization."

How Can An iPod Reduce Hospital Readmissions?

The Cullman Regional Medical Center in Alabama is using handy technology to reduce readmissions by recording discharge instructions, as well as videos, pictures and documents on iPods which they give to patients or their caregivers. Nurses use a program called "Good to Go" which allows patients, families and other care givers  to review the discharge instructions and other important information related to a patient's care whenever they need to.

The Medical Center is beta-testing the program, but so far is reporting great success. They have seen a 15 percent decrease in 30-day readmissions.

Read more about this initiative here.

An INQRI-funded study on discharge teaching and patients' readiness conducted by Marianne Weiss and Olga Yakusheva found that the quality of nurses' discharge teaching is affected by RN hours per patient day, overtime hours and vacancies. They also found that higher quality discharge teaching was correlated with patients reporting a higher level of readiness to be discharged, lower readmission rates, and fewer emergency room visits.

Higher Nurse Staffing Levels Decrease Odds of Penalties for Excessive Readmissions

A study published in Health Affairs finds that hospitals with higher nurse-to-patient ratios are less likely to be penalized for excessive readmissions under the Hospital Readmissions Reduction Program (HRRP) of the Affordable Care Act. HRRP penalizes hospitals that have excessive 30-day readmissions for Medicare patients admitted for heart attacks, heart failure or pneumonia, it is anticipated to reduce hospital payments by roughly $280 million in fiscal year 2013.

Matthew McHugh, a Robert Wood Johnson Foundation Nurse Faculty Scholar lead the research team. He and his colleagues noted that nurses are primarily responsible for a wide range of activities that can reduce readmissions, including care coordination and oversight, discharge planning, and patient education. When nurses have adequate time to complete those activities, readmissions rates are lower.

Read the news release about this study here.

Emergency Department Early Alert System for Heart Failure Patients Reduces Readmissions

An emergency department (ED) early alert system has dramatically reduced readmission rates for heart failure patients at Indiana University Methodist Hospital. When patients are registered in the ED, their electronic medical record flags those patients admitted for heart failure, and activates an alert that is distributed via page, email and/or text message to an on-call heart failure team that includes four physicians, four nurse practitioners, the ED charge nurse and the heart failure team manager. The patient receives aggressive treatment starting in the ED that continues when the team arrives.

The new system has increased ED physicians comfort with aggressively treating heart failure patients and discharging them to observation at the appropriate time. It has reduced 3-day readmission rates to a mean of 18.4 percent at 12 months compared with 24.5 percent in the previous 12 months.

The study was presented at the Heart Failure Society of America annual meeting in Orlando, Fla.and reported in MedPageToday.com.

Research Brief: How Do Nurses Influence Discharge Teaching?

This week, we introduce you to the INQRI project conducted by Marianne Weiss, Olga Yakusheva, and their team.

Improving how patients are discharged from the hospital to reduce unnecessary readmissions is a critical issue now being debated at the national level. With one in five elderly readmitted to the hospital within 30 days at an annual cost to Medicare of $17 billion, policymakers are seeking cost-effective solutions to better transition patients from hospital to home. Researchers at Marquette University, led by Weiss and Yakusheva, have been studying what hospital-based nurses do to influence outcomes after a patient is discharged from a hospital. Specifically, they identified the contributions that nursing staff make to the quality of discharge teaching and the impact of that teaching on patient outcomes, readiness and readmission rates of patients who are discharged home. They have found that when units had more RN hours per patient day, fewer overtime hours and fewer vacancies, the discharge teaching was of higher quality, patients reported greater readiness for hospital discharge, and post-discharge utilization of readmission and emergency room visits was lower.

Access the research brief.

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Tips for Patients to Help Prevent Readmissions

In a recent piece for USA Weekend, RWJF President and CEO Risa Lavizzo-Mourey provides tips on how patients can help prevent hospital readmissions:

• Ask and repeat. 
• Have a discharge plan. 
• Know your meds. 
• Keep appointments. 
• Spot warning signs. 

We'd like to add one more: talk to a nurse before you leave the hospital.

INQRI researchers at Marquette University, led by Marianne Weiss and Olga Yakusheva, studied what hospital-based nurses do to influence outcomes after a patient is discharged from a hospital. Specifically, they identified the contributions that nursing staff make to the quality of discharge teaching and the impact of that teaching on patient outcomes, readiness and readmission rates of patients who are discharged home. They found that when units had more RN hours per patient day, fewer overtime hours and fewer vacancies, the discharge teaching was of higher quality, patients reported greater readiness for hospital discharge, and post-discharge utilization of readmission and emergency room visits was lower.

Click here to access the team's recent journal articles.

Higher Nurse Staffing Ratios Also Reduce Children's Hospital Readmissions

A study published in the online journal BMJ Quality and Safety in Health Care finds that higher nurse-to-patient ratios are directly correlated with reduced hospital readmissions for children with common medical and surgical conditions.

The research team was led by Heather Tubb-Cooley of Cincinnati Children's Hospital Medical Center, and included Douglas Sloane and  Linda Aiken, who have conducted research into several aspects of nursing care and nurse staffing.

The study found that an increase of just one patient in a hospital's average nurse staffing ratio increased the likelihood of readmission for medical pediatric within 15 - 30 days by 11 percent, and for surgical patients by 48 percent. Researchers examined outcomes of more than 90,000 children in 225 hospitals.

A recent post on the Human Capital blog by Nancy Ryan-Wenger addresses the importance of ascertaining children's perceptions of the care they receive in the hospital. Ryan-Wenger's study to elicit children's perceptions of nursing care was funded by INQRI. She has gone on to develop a checklist that Nationwide Children's Hospital now uses in daily interviews with pediatric patients and for nurses' daily evaluations.

Scores Predict Readmission Likelihood

Through a simple risk score, a team from Brigham and Women's Hospital in Boston, collaborating with a team in Bern, Switzerland, say they can identify roughly one-fourth of a hospital's patient population with the highest likelihood of being readmitted, and then within that group the 18% whose readmissions were potentially avoidable, for whom more expensive, intensive efforts might be worth the money.  Continue reading the article.

Readmissions is an area of interest to INQRI.  Grantees Dr. Marianne Weiss and Dr. Olga Yakusheva have conducted research on the discharge process and it's relationship to readmissions.  Learn more about their work:

View "Nurse and patient perceptions of discharge readiness in relation to postdischarge utilization."
View "Age-related differences in perception of quality of discharge teaching and readiness for hospital discharge."
View "Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization."

A Continuing Collaboration

Randall Krakauer, MD 

Five years ago there was considerably less attention paid to the issue of readmissions than is the case today. Mary Naylor, Mark Pauly and the University of Pennsylvania team had already demonstrated the potential to reduce 90 day readmissions through better management of the discharge process, including the period immediately after discharge. Our team at Aetna was busy building Medicare care management infrastructure to impact chronic illness and Advanced Illness at the intersection of quality and cost - and had already seen a reduction in avoidable admissions and readmissions through telephonic case management. We needed to know whether there was incremental opportunity with on-site and home care management. So began a very productive collaboration that continues. Our program began with collaboration with Mary, Mark, and their team on Aetna Medicare Advantage members in metropolitan Philadelphia, with a Transitional Care program, measured against a clinically matched group in another region. With the demonstration of a 20% reduction in 90-day readmissions (publication 1), and considerable cost savings (impact at the intersection of quality and cost) we began building Transitional Care programs that are now nationwide. With the increased importance of Star Rating measures for Medicare programs, this experience has served us well. Such programs are still being expanded, but they are part of comprehensive care management programs everywhere - it is no longer necessary to demonstrate their value.

My collaboration with Mary, Mark, and their team has also led me to another venture: my role on the National Advisory Committee (NAC) for the Interdisciplinary Nursing Quality Research Initiative (INQRI) program. Since joining the NAC in 2006, I have been pleased to review research proposals, advise funded grantees on their project plans, and offer advice and support to Mary and Mark as they lead this impressive program. Like Aetna’s work with the Penn team, INQRI teams have continually shown the value of nurse-led interventions.

Our work and collaboration on reducing readmissions has been very productive and valuable. But since we don't actually achieve Nirvana in this world, this work and collaboration will continue, and we expect to continue pushing the limits of our potential. Similarly, I look forward to seeing the continued impact that I know INQRI teams will have on improving healthcare quality.

Dr. Krakauer is the National Medical Director for Aetna Medicare and a member of INQRI’s National Advisory Committee. 

1) Naylor, M; Bowles, K; McCauley, K; Maislin, G; Pauly, M; Krakauer, R: "High Value Transitional Care: Translation of Research into Practice." J. Eval. Clin. Practice. 16 March 2011, 1-7.

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.

Care About Your Care Videos - Our Grantees Respond

Last month, we told you about an exciting event sponsored by the Robert Wood Johnson Foundation, "Care About Your Care," which focused on reducing hospital readmissions through improved transitions in care.

In addition to a live webcast, the event also featured the presentation of winners from a video contest featuring a series of videos submitted by care teams to demonstrate their successful strategies to improve transitions.

We continue to be impressed by this work and some of our INQRI grantees wanted to take the opportunity to comment on some of these fantastic contributions.

Northern Piedmont Community Care

"This approach to care makes so much sense to me that I have to ask myself why this isn't the prevailing model of healthcare delivery. Many chronic diseases can be managed and even prevented through a healthful lifestyle, but research shows that the majority of people do not know how to be healthy. Patient teaching and education is a core component of the nursing process, and the success of community clinics like the one featured in the video places nurses in the center of the healthcare reform and efforts to promote high-quality patient-centered cost-effective care." 
- INQRI Grantee Olga Yakusheva 

CARE Network - Transition to Better Care

"This video about care transitions tells the story so well. The patient's story is central in the video which says a lot about how the CARE Network hold their priories." 
 - INQRI Grantee Nancy Hanrahan 

U of U Health Care- Transitions Program

"A small investment in time at discharge can pay off in a big way. Ensuring that patients and their informal caregivers understand what is needed to be done upon discharge may well prevent a return to the hospital. Since hospital days are far more costly than is outpatient care, it behooves providers to devote a small amount of time and resources prior to release and just after discharge from the hospital to prevent an even greater investment due to an exacerbation of illness. This is an area where Ben Franklin's aphorism, 'Pennywise and pound foolish' is spot on." 
 - INQRI Grantee Phyllis Solomon

Reducing Readmissions: It Takes a Village

Too often, patients leave the hospital confused about how to care for themselves at home, ultimately causing them to return to the hospital. Hospitals and health care organizations are addressing the problem of avoidable readmissions by taking steps to help patients get the care they need, including simplifying discharge instructions, working one-on-one with patients at high risk for being readmitted, and improving coordination between hospitals and outpatient care facilities.

This work is at the heart of Aligning Forces for Quality (AF4Q), the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in 16 targeted communities. A new, interactive suite of materials showcases lessons from AF4Q and hospitals participating in its Hospital Quality Network, demonstrating how those who give care and receive care can work together.

Click here for more information regarding lessons for health care providers on improving care transitions.

Click here to learn about INQRI researchers who have found that nurses can have a positive impact on reducing readmissions.

Initiatives Designed to Prevent Readmissions

A recent article in the L.A. Times describes an initiative launched at Cedars-Sinai, the 'frailty project,' in which a medical team works to help at-risk elderly avoid lengthy hospital stays or readmission.

Under this initiative, patients receive a holistic approach to care, focusing not just on the disease that brought them to the hospital, but also on all aspects of their health.  The project launched with a pilot in 2011 and it was expanded last year.

Cedars is now working with INQRI director Mary Naylor and her team at the University of Pennsylvania to develop a program for patients once they are discharged from the hospital.

Programs like Naylor's transitional care model and the frailty project are excellent examples of the types of initiatives needed to address the growing problem of hospital readmissions, as discussed at last week's Care About Your Care event.

Reporting Back from Care About Your Care

What a great event yesterday about preventing hospital readmissions.  If you missed out, don't worry - you can check out the Care About Your Care website for patient and provider resources and many, many videos.

The event also was trending in the "Twitterverse."  Take a look at the #yourcare posts on Twitter to read up on the conversation that occurred online during the webcast.

And don't forget - INQRI has a terrific online event planned for today - a webinar from a grantee team regarding the Creation of a Nurse Manager Development Program to Increase Patient Safety.  Join us from 3p-4pmET to learn about an  intervention to increase patient safety by enhancing the leadership and team building skills of nurse managers.

Click here to register. 

Two Days: Two Exciting Events

TODAY

Live Webcast: Care About Your Care

The Robert Wood Johnson Foundation and dozens of organizations will convene today for Care About Your Care, a national initiative that highlights what works to improve care transitions and reduce avoidable hospital readmissions.

Nancy Snyderman, MD, chief medical editor for NBC News, will lead experts and health care leaders from diverse communities in sharing how they bring together patients, care providers, and community services to foster better health care outcomes.

Feb. 13, 2013, 12:30–2:00 p.m. ET

Steps to join the event:

1. GO TO: http://www.visualwebcaster.com/event.asp?id=92212 
2. CLICK on the “Launch Webcast” button. (Note: You may need to disable pop-ups). IMPORTANT: You may access this link to perform a system check or troubleshoot in advance of the webcast.
3. PROBLEMS? If you experience problems accessing the webinar, email Joyce Kim at jkim@gymr.com or call (202) 745-5068.

Join the Twitterverse: With the hashtag #yourcare


TOMORROW

Webinar: Creation of a Nurse Manager Development Program to Increase Patient Safety 

Evidence indicates leadership skills of frontline nurse managers are key to creating magnetic work environments that promote positive outcomes. Yet, weaknesses in nurse managers' skills often result in environments that threaten patient safety. To translate evidence to practice, an INQRI team led by Linda Flynn and Joel Cantor has built upon their prior INQRI study to design an intervention to increase patient safety by enhancing the leadership and team building skills of nurse managers. They have partnered with award-winning journalist and patient safety advocate Suzanne Gordon and other interdisciplinary experts including a certified Crew Resource Management trainer to design and implement a nurse manager development program. Please join the team on Valentine's Day as they present their study results.

Feb. 14, 2013, 3:00--4:00 p.m. ET

Click here to register.