Guided Care

Guided Care is a new model of delivering healthcare for older adults with multiple chronic diseases.  Key to this model is the  specially trained Guided Care nurse based in the primary care office.    This nurse “… assesses patient needs, monitors conditions, educates and empowers the patient, and works with community agencies to ensure that the patient’s healthcare goals are met.”

Researchers at Johns Hopkins University, who began developing this model in 2001, are conducting studies and publishing some promising results.   At present CMS does not cover the case management services but there is the possibility that  CMS will begin covering Guided Care as a component of the Medical Home.

The Guided Care website provides describes the model in more detail and provides links to publications.  www.guidedcare.org

Nurse Staffing and Patient Outcomes in Critical Care

In this time of evidence-based management, administrators need to interpret the research concerning  nurse staffing and patient outcomes in critical care units.  Daleen A. Penoyer in her review of the literature from 1998 to 2008 finds twenty-six research studies that attempt to find an association between nurse staffing in intensive care units with patient outcomes.

She finds that “most studies suggested that decreased nurse staffing is associated with adverse outcomes in intensive care units.”  However, she cautions that  these studies were observational studies; therefore it is not possible to show a causal relationship between nurse staffing and patient outcomes.  She suggests that “additional research is necessary to demonstrate the optimal nurse staffing ratios of intensive care units.”

In addition, her review includes some key information about the variation in measuring nurse staffing.

Penoyer DA.  Nurse staffing and patient outcomes in  critical care.  Critical Care Medicine 2010 July;38(7): 1521-1528.  Pubmed PMID 20473146

Nursing: A Key to Patient Satisfaction

“This paper examines the relationship between nursing and patient satisfaction across 430 hospitals.   The nurse work environment was significantly related to all HCAHPS patient satisfaction measures.  Additionally, patient-to-nurse workloads were significantly associated with patients’ ratings and recommendations of the hospital to others, and with their satisfaction with receipt of discharge information.” PubMed.

Kutney-Lee A and others.  Nursing: a key to patient satisfaction.  Health Affairs 2009 published online June 12; 28(4).  PMID 19525287.

Why Do Patients in Hospital Fall?

The investigators in this study obtained the views of nurses and nursing assistants as to why patients in acute care hospitals fall.  Through content analysis of the descriptive data, the investigators developed a cogent frame work for implementing fall prevention strategies.

Dykes PC.  Why do patients in acute care hospitals fall?  Can falls be prevented?  JONA  2009 June;39(6):299-304  PMID 19509605

Improving Patient Discharge Process

The National Quality Forum Consensus Standards Maintenance committee identified hospital discharge as a critical area for improvement.

Brian Jack and his team at Boston Medical Center have  reengineered the hospital discharge process to decrease hospital utilization after discharge.  The clinical trial, which tested the effects of this program, found that “a package of discharge services reduced hospital utilization within 30 days of discharge.”

Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O’Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009 Feb 3;150(3):178-87. PubMed PMID:19189907.

Two articles that study the effectiveness of discharge nurses:

Maramba PJ, Richards S, Myers AL, Larrabee JH. Discharge planning process: applying a model for evidence-based practice. J Nurs Care Qual. 2004 Apr-Jun;19(2):123-9. Review. PubMed PMID: 15077829.

 
Lane BS, Jackson J, Odom SE, Cannella KA, Hinshaw L. Nurse satisfaction and creation of an admission, discharge, and teaching nurse position. J Nurs Care Qual. 2009 Apr-Jun;24(2):148-52. PubMed PMID: 19287254.

Nursing Care for Sepsis – Early Recognition and Rapid Response

The following articles provide background information for nurses in the early recognition and rapid response to sepsis.

• Recognizing Sepsis in the Adult Patient.  AJN 2009 Mar;109(3):40-45.  PMID 19240494.
• Improving Care of the Sepsis Patient.  The Joint Commission Journal on Quality and Patient Safety 2008 April;34(4): 187-191.  PMID 18468354.
• An Overview of Sepsis.  Dimensions of Critical Care Nursing 2008 Sept/Oct;27(5):195-200.  PMID 18724173
• Update on the Management of Infection in Patients with Severe Sepsis.  Dimensions of Critical Care Nursing 2008 Nov/Dec;27(6):244-248.  PMID 18953190.

Clicking on the PMID links will retrieve PubMed citations.  Articles may be requested from Mercy Medical Library.