Preventing and identifying hospital-acquired delirium.

Hospital-acquired delirium often goes unnoticed because the signs and symptoms resemble those of dementia and depression, making diagnosis difficult. This article explores the differences between delirium, dementia, and depression and discusses the role of nursing in patient assessment and education.

Successes and Challenges in Patient Care Transition Programming: One Hospital's Journey.

The 2013 addition of the Care Transition Measures to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey; enactment of the Patient Protection and Affordable Care Act (2010); and a greater focus on population health have brought a heightened awareness and need for action with patient transitions. Data are emerging from the additional Care Transition Measures and benchmarks have been developed. This article briefly describes the context of care transition. We describe the journey of Indiana University Health North Hospital to overcome patient care transition obstacles, ultimately achieving designation as a top performer. We will discuss our efforts to personalize patient outcomes and transition through activation and improve transitions for vulnerable populations, specifically in the bariatric and orthopedic patient populations. The article concludes with discussion of overcoming obstacles and future directions with continued focus on collaboration and improvement.

Building Connections With Patients and Families in the Intensive Care Unit: A Canadian Top-Performer Success Story.

Consumers are increasingly becoming the voice and impetus for hospital organizational change in the United States. This is in part due to their increased stake in cost sharing with hospitals, health systems, and the ambulatory setting and revisions to health plans with higher deductibles and copays. With customers wanting services better, faster, and more economical than in the past, organizations need to break the ceiling on improvement levels for exceeding expectations of patient experience. Of interest is the hospital critical care area, because of the heightened patient needs, support, and resources that are required in this acute setting. Bluewater Health, located in Sarnia, Ontario, Canada, is a top-industry performer on the patient experience access-to-care dimension. Much can be learned from the multiple practices it has used to create an environment that embraces patients and families to the fullest extent, ensuring the resources needed for optimizing care are received.

Rethinking Care Coordination: Paradigm Shifting From Volume to Value.

Although care coordination is not a new concept, it has been fraught with a myriad of definitions. Among these, core themes can be gleaned to help the home healthcare clinician understand their role and responsibilities as part of a high-functioning team. For a shift from volume to value to occur, in a way that is meaningful to the patient, a holistic paradigm needs to be fully embraced by all members of the interdisciplinary team. As healthcare continues to shift to a fair-market demand for services system, transparency becomes a driver for patient information and choice. Care coordination, clinical outcomes, and consumerism in this new era become integrally linked. Home care clinicians have a higher level of accountability to deliver patient-centered care that necessitates shifting from a "disease state" mentality to a view that encompasses mind, body, and spirit in totality. Home healthcare agencies will need to view their own organization as occurring within a maturation cycle of interdisciplinary team development and continually strive for exceptional care delivery, transparency in outcomes, and full team collaboration with a holistic mindset, in order to make the shift from volume to value that will be necessary to thrive.

Delirium and Dementia in the Intensive Care Unit: Increasing Awareness for Decreasing Risk, Improving Outcomes, and Family Engagement.

: Longer stays in the intensive care unit (ICU) can be an opportunistic battlefield where not only is the length of stay longer, but also there is increased time that lapses with the potential for a patient fall, nosocomial infection, urinary tract infection, and other untoward events (http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf; ASHRM Forum. 2014;Q3:10-14). As such, the push has become for shorter lengths of stay whenever possible. Delirium and dementia are 2 conditions that the ICU clinician must remain diligent in monitoring for status changes. Delirium poses the threat of longer-term undesirable outcomes and is a potential inherent risk in the care delivered. It rises to the level of a medical emergency that can be deadly but, when caught early, can be treated and resolved (Science Daily, September 16, 2013). Setting expectations with families, providing adequate education, and involving them in a holistic view of patient-centered care can help toward the detection of differences that may occur from an ICU stay. Interventions the ICU clinician can take for increasing self, patient, and family awareness to decrease risk and improve outcomes and ways to deepen family engagement in these populations are explored with practical applications.

Closing the transition gaps the changing context of home healthcare coordination.

Legislative enactment of the Patient Protection and Affordable Care Act in 2010 created an impetus for change within the healthcare industry. As a result, the entire healthcare continuum is under greater scrutiny and incentives for performance levels and subsequent outcomes. Home healthcare clinicians have a vital role in the emerging spotlight of care transitions from hospital to home. Home healthcare clinicians will need to understand the concepts of patient engagement and patient activation, and have tactical plans for success. Understanding best practices and recommendations will be an element of competitive differentiation. This article reviews these concepts, along with interventions to target health literacy, communication with patients and families, and the use of motivational interviewing.

Creating a new healthcare landscape.

Transitioning from fee-for-service to value-based care can be disruptive, but it's an imperativeevolution for healthcare systems to remain relevant in an ever-changing field.

Remodeling a broken system through hospital-payer partnerships.

One way to fix our broken system is to strengthen hospital-payer partnerships, which will help shift caregiver focus from volume to value.