Evaluation of a Summer Bridge: Critical Component of the Leadership 2.0 Program.

BACKGROUND: Summer bridges facilitate the transition from high school to college. Although many schools employ summer bridges, few have published outcomes. This article's purpose is to share preconceptions of college by underrepresented and disadvantaged nursing students and describe important elements and long-term impact of a summer bridge, a component of the Leadership 2.0 program. METHOD: A longitudinal study design was used to collect baseline, short-term, and long-term post-summer bridge data. Methods included pre- and postsurveys, interviews, and focus groups. RESULTS: After bridge completion, students felt more prepared for the nursing program. Students ranked socialization components as most important. The summer bridge had lasting impact through the first year, where grade point average and retention of underrepresented and disadvantaged bridge students was comparable to the majority first-year students. CONCLUSION: The summer bridge was effective in preparing nursing students for the first year of college. Through holistic evaluation, unique aspects of socialization critical to student success were uncovered.

Rapid cycle development of a multifactorial intervention achieved sustained reductions in central line-associated bloodstream infections in haematology oncology units at a children's hospital: a time series analysis.

BACKGROUND: Immunocompromised children are at high risk for central line-associated bloodstream infections (CLABSIs) and its associated morbidity and mortality. Prevention of CLABSIs depends on highly reliable care. PURPOSE: Since the summer of 2013, we saw an increase in patient volume and acuity in our centre. Additionally, CLABSIs rates more than tripled during this period. The purpose of this initiative was to rapidly identify and mitigate potential underlying drivers to the increased CLABSI rate. METHODS: Through small tests of change, we implemented a standard process for daily hygiene; increased awareness of high-risk patients with CLABSI; improved education/assistance for nurses performing high-risk central venous catheter procedures; and developed a system to improve allocation of resources to de-escalate system stress. RESULTS: The CLABSI rate from June 2013 to May 2014 was 2.03 CLABSIs/1000 line days. After implementation of our interventions, we saw a significant decrease in the CLABSI rate to 0.39 CLABSIs/1000 line days (p=0.008). Key processes have become more reliable: 100% of dressing changes are completed with the new two-person standard; daily hygiene adherence has increased from 25% to 70%; 100% of nurses are approached daily by senior nursing for assistance with high-risk procedures; and patients at risk for a CLABSI are identified daily. CONCLUSIONS: Stress to a complex system caring for high-risk patients can challenge CLABSI rates. Identifying key processes and executing them reliably can stabilise outcomes during times of system stress.

Carbon monoxide poisoning mimicking arterial gas embolism in a commercial diver.

A 32-year-old male commercial diver was working at 7,000 feet of altitude in a municipal water tank, at a depth of 27 feet for two hours. While surfacing from a compressed-air surface-supplied dive, he exhibited loss of consciousness and neurological symptoms. He was presumptively diagnosed with arterial gas embolism, flown by pressurized aircraft to a regional medical center and treated with hyperbaric oxygen. During the U.S. Navy Treatment Table 6, new information suggested the patient's air supply had been contaminated by a continuously running engine and compressor. His admission blood was then assayed for carboxyhemoglobin (COHb), which measured 8.8% six hours after surfacing, including four hours of normobaric oxygen inhalation. His estimated COHb based on rough reported half-life calculations at the conclusion of the dive was approximately 45%. The patient's diagnosis was changed to carbon monoxide poisoning from contaminated breathing gas. Upon hospital discharge, he exhibited problems with balance and gait, nystagmus, word-finding limitations and slurred speech. Also, he had cardiac injury treated with carvedilol. When evaluating diving-related casualties, including in commercial divers, clinicians should consider carbon monoxide poisoning as a differential diagnosis.

Understanding performance and behavior of tightly coupled outpatient systems using RFID: initial experience.

Understanding how clinical systems actually behave in an era of limited medical resources is critical. The purpose of this study was to determine if a radiofrequency-identification-based indoor positioning system (IPS) could objectively and unobtrusively capture outpatient clinic behavior. Primary outcomes were flowtime, wait time and patient/clinician face time. Two contrasting clinics were evaluated: a primary care clinic (PC) with templated scheduling and an urgent care clinic (UC) with unconstrained visit time and first-in, first-out scheduling. All staff wore transponders throughout the study period. Patients carried transponders from check in to check out. All patients and staff were allowed to opt out. The study was approved by hospital IRB. Standard descriptive and analytic statistical methods were used. Five hundred twenty-six patients (309 patients (PC), 217 patients (UC)) and 38 clinicians (eight (PC) and 30 (UC)) volunteered between April 30 and July 1, 2008. Total FT was not significantly different across clinics. PC wait time was significantly shorter (7.6 min [SD 15.8]) vs. UC (19.7 min [SD 25.3], p < 0.0001), and PC Face time was significantly longer (29.9 min, [SD 19.1] vs. UC (9.8 min [SD 8.5], p < 0.0001). PC Face time distributions reflected template scheduling structure. In contrast, face time distributions in UC had a smooth log normal distribution with a lower mean value. Our study seems to indicate that an IPS can successfully measure important clinic process measures in live clinical outpatient settings and capture behavioral differences across different outpatient organizational structures.