Remote Patient Monitoring Improves Patient Falls and Reduces Harm.

BACKGROUND: Minimizing patient falls and fall-related injuries within organizational constraints is a high priority for nurse leaders. The Centers for Medicare & Medicaid Services do not reimburse hospitals for fall-related expenditures. In-person sitters are used to prevent falls but are resource intensive and costly. Remote patient monitoring (RPM) may offer alternatives to in-person sitters to reduce fall-related harm. PURPOSE: The efficacy of RPM to reduce patient falls and fall-related injuries was explored. METHODS: Electronic health record data were extracted from a 13-hospital integrated health care system. Incidence rate ratios were used to analyze the impact of RPM technology on falls and fall-related injuries. RESULTS: When used in conjunction with standard fall precautions, RPM reduced falls 33.7% and fall-related injuries 47.4%. Fall-related expenditures decreased $304 400 with a combined estimated savings systemwide of $2 089 600 annually. CONCLUSIONS: RPM technology minimized falls and associated harm and improved patient safety, positively impacting hospital expenditures.

Interdisciplinary Rounds on a Hospitalist Service: Impact on Palliative Care Measures, Quality, and Utilization Outcomes.

BACKGROUND: Despite growth in service availability, palliative care (PC) referrals are often underutilized or delayed, which may compromise patient outcomes. LOCAL PROBLEM: Underutilized or delayed PC referrals among hospitalized adults prompted this project aimed at improving PC measures, quality, and utilization outcomes. METHODS: Data extracted from the electronic medical record were used to identify needed improvements in PC. INTERVENTION: Interdisciplinary rounds (IDRs) were implemented on the hospitalist service in a nonintensive care setting. RESULTS: Following implementation, median time to PC referral decreased by 2 days. Length of stay (LOS), direct cost, and 30-day mortality also decreased. Postintervention patients were more likely to transition home compared with another facility. CONCLUSIONS: Results support IDRs as a mechanism to improve time to PC referral, decrease LOS, direct cost, and 30-day mortality among hospitalized adults. A more objective method of identifying patients with unmet PC needs may be warranted.

Impact of a Restraint Management Bundle on Restraint Use in an Intensive Care Unit.

Restraint use has been linked to longer lengths of stay and other undesirable outcomes. This evidence-based project explored the impact of a restraint management bundle on restraint use, quality, and safety outcomes. Results indicated that the proportion of intensive care unit patients restrained decreased significantly (24.3% vs 20.9%) following program implementation. Project results suggest that the restraint management bundle may provide a framework for guiding the process to reduce restraint use, minimize harm, and improve patient safety.

Predicting Sepsis Risk Using the "Sniffer" Algorithm in the Electronic Medical Record.

The Sepsis "Sniffer" Algorithm (SSA) has merit as a digital sepsis alert but should be considered an adjunct to versus an alternative for the Nurse Screening Tool (NST), given lower specificity and positive predictive value. The SSA reduced the risk of incorrectly categorizing patients at low risk for sepsis, detected sepsis high risk in half the time, and reduced redundant NST screens by 70% and manual screening hours by 64% to 72%. Preserving nurse hours expended on manual sepsis alerts may translate into time directed toward other patient priorities.

Efficacy of the Crisis Risk Triage Scale in Inpatient Units Within the United States.

ABSTRACT: Patient violence toward others, including doctors and nurses, is a serious concern worldwide. A wealth of literature supports the assertion that violent behavior can be prevented with proper screening and management policies. This project aimed to evaluate the Crisis Triage Rating Scale (CTRS) within a 12-hospital integrated healthcare delivery system located in the southeastern United States. An initial sample of 112,708 unique patient visits between January 2019 and December 2020 was included in this retrospective review of electronic health records. We found that the CTRS harm triage question and risk levels were significant predictors of harm to others. Consistent with previous literature, positive predictive values ranged between 0.025 and 0.070 and negative predictive values ranged between 0.991 and 0.995. Our results support the assertion that clinicians should make balanced judgments about using a positive risk score to allocate safety measures. Variations in practice were evident across our healthcare systems. Improving appropriate assessment procedures may improve the diagnostic tools and risk stratification. When documented correctly, the CTRS performed as expected in an environment where harm to others occurred infrequently.