Improving Retention Through a Purposeful Multidisciplinary Mentorship Program.

In response to high nurse turnover, a 12-hospital health system team created a sustainable, formalized, and interprofessional mentoring model to improve nurse retention. In the 1st year of the program, 506 mentor-mentee matches were made, and nearly 5000 hours of mentoring time were logged. Data revealed that turnover was significantly reduced in both the mentor and mentee groups compared with employees who were not in the program.

Academy of Clinical Essentials: A Revolutionary Nurse Staffing and Education Model.

A revolutionary academic-practice partnership model was implemented at the University of Maryland Medical System (UMMS) with the University of Maryland School of Nursing, through which the preparation and transition to practice of new graduate nurses were reimagined, resulting in intentional support for staffing the nursing workforce. Groups of nursing students were paired with a UMMS-funded clinical instructor to take a full patient assignment for one 12-hour shift in a UMMS hospital each week. This instructor-led cohort is equivalent to one UMMS nurse and was included in the staffing numbers of participating units.

Development of an academic-practice partnership model to anchor care coordination and population health.

The National Academy of Medicine's The Future of Nursing 2020-2030 recommends the expansion of the role of nurses throughout the continuum of health care in an effort to improve the health of the nation while decreasing costs. To accomplish this goal, nursing students and nurses must be well prepared to perform at their highest capacity to meet health care demands. Currently the U.S. health care delivery system is undergoing rapid changes that affect approaches to delivering care services. These changes call for education and practice reforms in nursing. This article introduces an innovative academic-practice partnership model (the University of Maryland Nursing [UMNursing] Care Coordination Implementation Collaborative), including its background, development, and blueprint for a large implementation project. The implementation model integrates nursing education and practice in areas of care co-ordination and population health, which have a significant impact on the Triple Aim of health. The project also uniquely integrates education, practice, and research, with the ultimate outcome of higher quality patient care.

Increased Patient Satisfaction in the Postanesthesia Care Unit with the Implementation of a Controlled Noise Reduction Program.

PURPOSE: Noise in the postanesthesia care unit (PACU) is a significant source of postoperative patient discomfort and can affect patient sleep and recovery. Interventions involving structural alterations in the environment reduce noise and improve patient satisfaction; however, there are no studies focusing on staff education as a method to reduce PACU noise. DESIGN: We designed and implemented a prospective PACU noise reduction program using education and training to minimize staff contributions to noise. METHODS: Noise levels, measured hourly with a decibel meter, patient satisfaction, and patient rest were assessed before and after implementation. FINDINGS: We found statistically significant decreases in noise levels and increases in patient satisfaction scores after the implementation of our noise reduction project. CONCLUSIONS: These findings demonstrate that an inexpensive and easily implemented noise reduction program can effectively reduce environmental noise, increase patient satisfaction, and potentially improve recovery.

Preventing Retained Surgical Items During Endovascular Procedures: Bridging the Gap Between Guidelines and Practice.

A retained surgical item (RSI) can be a devastating and costly procedural complication. Although the current incidence of RSIs is unknown, perioperative personnel routinely perform surgical counts according to their facility's policies and procedures to prevent this sentinel event. The American College of Surgeons, The Joint Commission, and AORN emphasize the importance of communication and standardized protocols for the counting of surgical items. However, there is a lack of current evidence to support specific recommendations for the counting of items during endovascular procedures. After the occurrence of RSIs during endovascular procedures at our facility, we convened an interdisciplinary workgroup, conducted an analysis of root causes, reviewed the available literature, and revised the existing policy. This article reviews the available literature on RSIs, describes root causes, discusses recommendations from national organizations, and describes the process that we used to create the policy changes at our facility.

Health Information Exchange: Practical Overview and Implications for Nursing Practice.

The US healthcare system is moving into a new era of value-based care, which focuses on delivering safer and higher quality care while reducing costs. Health information exchange (HIE) has been a vital component in this process; however, there has been a lack of awareness and use of HIE among nurse leaders, clinicians, and researchers. The purpose of this article is to provide nurses and administrators with a brief overview of HIE and its impact on care delivery, as well as practical applications using specific case examples.

Results and Implications of Routine HIV Testing in the Inpatient Setting: A Descriptive Analysis.

Policy changes and scientific advances have guided new methods of diagnosing and managing HIV that reduce mortality, morbidity, and transmission. In a high HIV prevalence urban setting, a hospital initiative was implemented to routinely perform HIV testing and provide linkage to care for those with positive results and for individuals with a prior diagnosis of HIV. Maryland's unique all-payer model presents an opportunity to implement population health initiatives in health systems. The rationale, methodology, results and lessons learned from this approach will be discussed. Providers and nurses offered routine HIV screening and activated a Linkage to Care Navigator (LCN) for all HIV positive patients. The LCN provided referrals to HIV care and supportive services. In 22 months, 28 persons were newly diagnosed with HIV. Eighty-two percent (n = 23) were linked to outpatient care; 28.6% (8) were readmitted within 30 days for an inpatient stay. Of 517 patients previously diagnosed with HIV, 27.7% (n = 143) were not engaged in outpatient HIV care. Nearly 50% of those (n = 71) were relinked to care. Of 143 patients with a previous diagnosis who were considered out of care at the time of inpatient admission, 16 (11.2%) were readmitted as an inpatient within 30 days. Routinizing HIV testing and linkage to care in an inpatient setting identifies new and previously diagnosed HIV infected individuals who are not in care. This process has potential to identify HIV earlier, lower community viral load, and decrease transmission of HIV.

Routinization of HIV Testing in an Inpatient Setting: A Systematic Process for Organizational Change.

In 2006, the U.S. Centers for Disease Control and Prevention released revised recommendations for routinization of HIV testing in healthcare settings. Health professionals have been challenged to incorporate these guidelines. In March 2013, a routine HIV testing initiative was launched at a large urban academic medical center in a high prevalence region. The goal was to routinize HIV testing by achieving a 75% offer and 75% acceptance rate and promoting linkage to care in the inpatient setting. A systematic six-step organizational change process included stakeholder buy-in, identification of an interdisciplinary leadership team, infrastructure development, staff education, implementation, and continuous quality improvement. Success was measured by monitoring the percentage of offered and accepted HIV tests from March to December 2013. The targeted offer rate was exceeded consistently once nurses became part of the consent process (September 2013). Fifteen persons were newly diagnosed with HIV. Seventy-eight persons were identified as previously diagnosed with HIV, but not engaged in care. Through this process, patients who may have remained undiagnosed or out-of-care were identified and linked to care. The authors propose that this process can be replicated in other settings. Increasing identification and treatment will improve the individual patient's health and reduce community disease burden.

Impact of preoperative briefings on operating room delays: a preliminary report.

HYPOTHESIS: Preoperative briefings have the potential to reduce operating room (OR) delays through improved teamwork and communication. DESIGN: Pre-post study. SETTING: Tertiary academic center. PARTICIPANTS: Surgeons, anesthesiologists, nurses, and other OR personnel. INTERVENTION: An OR briefings program was implemented after training all OR staff in how to conduct preoperative briefings through in-service training sessions. During the preoperative briefings, the attending surgeon led OR personnel in a 2-minute discussion using a standardized format designed to familiarize caregivers with each other and the operative plan before each surgical procedure. MAIN OUTCOME MEASURES: The OR Briefings Assessment Tool was distributed to OR personnel at the end of each operation. Survey items questioned OR personnel about unexpected delays during each procedure and the relationship between communication breakdowns and delays. Responses were compared before and after the initiation of the preoperative briefings program. RESULTS: The use of preoperative briefings was associated with a 31% reduction in unexpected delays; 36% of OR personnel reported delays in the preintervention period, and 25% reported delays in the postintervention period (P<.04). Among surgeons alone, an 82% reduction in unexpected delays was observed (P<.001). A 19% reduction in communication breakdowns leading to delays was also associated with the use of briefings (P<.006). CONCLUSIONS: Preoperative briefings reduced unexpected delays in the OR by 31% and decreased the frequency of communication breakdowns that lead to delays. Preoperative briefings have the potential to increase OR efficiency and thereby improve quality of care and reduce cost.

Achieving the National Quality Forum's "Never Events": prevention of wrong site, wrong procedure, and wrong patient operations.

OBJECTIVE: Review the evidence regarding methods to prevent wrong site operations and present a framework that healthcare organizations can use to evaluate whether they have reduced the probability of wrong site, wrong procedure, and wrong patient operations. SUMMARY BACKGROUND DATA: Operations involving the wrong site, patient, and procedure continue despite national efforts by regulators and professional organizations. Little is known about effective policies to reduce these "never events," and healthcare professional's knowledge or appropriate use of these policies to mitigate events. METHODS: A literature review of the evidence was performed using PubMed and Google; key words used were wrong site surgery, wrong side surgery, wrong patient surgery, and wrong procedure surgery. The framework to evaluate safety includes assessing if a behaviorally specific policy or procedure exists, whether staff knows about the policy, and whether the policy is being used appropriately. RESULTS: Higher-level policies or programs have been implemented by the American Academy of Orthopaedic Surgery, Joint Commission on Accreditation of Healthcare Organizations, Veteran's Health Administration, Canadian Orthopaedic, and the North American Spine Society Associations to reduce wrong site surgery. No scientific evidence is available to guide hospitals in evaluating whether they have an effective policy, and whether staff know of the policy and appropriately use the policy to prevent "never events." CONCLUSIONS: There is limited evidence of behavioral interventions to reduce wrong site, patient, and surgical procedures. We have outlined a framework of measures that healthcare organizations can use to start evaluating whether they have reduced adverse events in operations.

Operating room briefings and wrong-site surgery.

BACKGROUND: Wrong-site surgery can be a catastrophic event for a patient, caregiver, and institution. Although communication breakdowns have been identified as the leading cause of wrong-site surgery, the efficacy of preventive strategies remains unknown. This study evaluated the impact of operating room briefings on coordination of care and risk for wrong-site surgery. STUDY DESIGN: We administered a case-based version of the Safety Attitudes Questionnaire (SAQ) to operating room (OR) staff at an academic medical center, before and after initiation of an OR briefing program. Items questioned overall coordination and awareness of the surgical site. Response options ranged from 1 (disagree strongly) to 5 (agree strongly). MANOVA was used to compare caregiver assessments before and after the implementation of briefings, and the percentage of OR staff agreeing or disagreeing with each question was reported. RESULTS: The prebriefing response rate was 85% (306 of 360 respondents), and the postbriefing response rate was 75% (116 of 154). Respondents included surgeons (34.9%), anesthesiologists (14.0%), and nurses (44.4%). Briefings were associated with caregiver perceptions of reduced risk for wrong-site surgery and improved collaboration [F (6,390)=10.15, p < 0.001]. Operating room caregiver assessments of briefing and wrong-site surgery issues improved for 5 of 6 items, eg, "Surgery and anesthesia worked together as a well-coordinated team" (67.9% agreed prebriefing, 91.5% agreed postbriefing, p < 0.0001), and "A preoperative discussion increased my awareness of the surgical site and side being operated on" (52.4% agreed prebriefing, 64.4% agreed postbriefing, p < 0.001). CONCLUSIONS: OR briefings significantly reduce perceived risk for wrong-site surgery and improve perceived collaboration among OR personnel.

Operating room debriefings.

This tool helps assess factors that positively and negatively contributed to an adverse event, near miss, or inefficiency during an operation-or any procedure.

Operating room briefings: working on the same page.

This tool, which takes one or two minutes to use, provides a structured approach to promote effective interdisciplinary communication and teamwork in the operating room--or any other area, such as an intensive care unit, inpatient unit, or outpatient clinic.

Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder.

BACKGROUND: Teamwork is an important component of patient safety. In fact, communication errors are the most common cause of sentinel events and wrong-site operations in the US. Although efforts to improve patient safety through improving teamwork are growing, there is no validated tool to scientifically measure teamwork in the surgical setting. STUDY DESIGN: Operating room personnel in 60 hospitals were surveyed using the Safety Attitudes Questionnaire. Surgeons, anesthesiologists, certified registered nurse anesthetists, and operating room nurses rated their own peers and each other using a 5-point Likert scale (1 = very low, 5 = very high). RESULTS: Overall response rate was 77.1% (2,135 of 2,769). Ratings of teamwork differed substantially by operating room caregiver type, with the greatest differences in ratings shown by physicians: surgeons (F[4, 2058] = 41.73, p < 0.001), and anesthesiologists (F[4, 1990] = 53.15, p < 0.001). The percent of operating room caregivers rating the quality of collaboration and communication as "high" or "very high" was different by caregiver role and whether they were rating a peer or another type of caregiver: surgeons rated other surgeons "high" or "very high" 85% of the time, and nurses rated their collaboration with surgeons "high" or "very high" only 48% of the time. CONCLUSIONS: Considerable discrepancies in perceptions of teamwork exist in the operating room, with physicians rating the teamwork of others as good, but at the same time, nurses perceive teamwork as mediocre. Given the importance of communication and collaboration in patient safety, health care organizations should measure teamwork using a scientifically valid method. The Safety Attitudes Questionnaire can be used to measure teamwork, identify disconnects between or within disciplines, and evaluate interventions aimed at improving patient safety.