Inpatient Nurses' Perception of Workplace Violence Based on Specialty.

OBJECTIVE: The aim of this study was to evaluate the impact of inpatient nursing specialties on the perceptions of workplace violence. BACKGROUND: The association between nursing specialty and the perception of workplace violence has not been identified. METHODS: An evaluation of inpatient nurses' perceptions of workplace violence at a single health system was conducted using a modified Survey of Violence Experienced by Staff instrument. RESULTS: Of the respondents, 87.2% experienced workplace violence, of which 96.3% was patient related. Patient-initiated verbal abuse, threats, and physical assault frequency differed significantly based on specialty. Post hoc comparisons further elucidate the differences in specialty populations. CONCLUSION: Workplace violence is a nursing concern; however, the frequency in which workplace violence occurs differs based on specialty. The frequency of threats and injuries to nursing staff was significantly higher in medical and trauma units.

Association of emergency department albuterol dispensing with pediatric asthma revisits and readmissions.

INTRODUCTION: Although pediatric asthma continues to be a highly studied disease, data to suggest clear strategies to decrease asthma related revisits or readmissions is lacking. The purpose of our study was to assess the effect of emergency department (ED) direct dispensing of beta-agonist metered dose inhalers on pediatric asthma ED revisit and readmission rates. METHODS: We conducted a retrospective cohort study of pediatric patients discharged from the pediatric ED with a diagnosis of asthma. Our primary outcome measured the rate of asthma revisits to the ED or admissions to the hospital within 28 days. Logistic regression analysis was used to assess ED beta-agonist MDI dispensing and revisit and/or readmission as the outcome. RESULTS: A total of 853 patients met eligibility for inclusion in the study, with 657 enrolled in the Baseline group and 196 enrolled in the ED-MDI group. The Baseline group experienced a revisit and readmission rate of 7.0% (46/657) versus 2.6% (5/196) in the ED-MDI group, (p = 0.026). ED direct dispensing of MDIs was found to be independently associated with a decreased risk of revisit or readmission (odds ratio 0.37; 95% confidence interval 0.14-0.95). CONCLUSIONS: In our study, ED direct dispensing of beta-agonist MDIs resulted in a reduction in 28-day revisit and readmission to the hospital. Further studies should be performed to evaluate the economic impact of reducing these revisits and readmissions against the costs of maintaining a dispensing program. Our findings may support modification of asthma programs to include dispensing MDIs from the emergency department.

Impact of a Hospitalwide Quality Improvement Initiative on Emergency Department Throughput and Crowding Measures.

BACKGROUND: This pre- and postintervention analysis evaluates the impact of a systemwide, comprehensive, executively supported quality improvement (QI) project on emergency department (ED) throughput measures and crowding in a large nonacademic community hospital. METHODS: The two primary endpoints used to assess the impact of the project were (1) the percentage of all patients who were door-in to door-out in less than three hours and (2) the percentage of patients who left without being seen (LWBS). Secondary endpoints for throughput were mean door-in to door-out, door-in to physician, physician to disposition, and disposition to door-out times for all patients. Secondary endpoints for crowding were median disposition to door-out time of admitted patients and the percentage of admitted patients with a disposition to door-out time of ≥ one, two, and six hours. RESULTS: A total of 666,640 patient visits were included in the primary endpoint analyses, with no patients excluded. The percentage of patients meeting the three-hour door-in to door-out goal after the QI project was 81.4%, versus 46.5% in the pre-QI group (difference, 34.9 percentage points; 95% confidence interval [CI] = 34.7-35.1; p < 0.0001). The postintervention LWBS rate was 0.49%, versus 4.00% in the pre-QI group (difference, 3.51 percentage points; 95% CI = 3.43-3.58; p < 0.0001). A total of 417,673 patient visits were screened for inclusion for the secondary endpoint analyses. The pre-QI and post-QI groups were also compared for secondary endpoints, and significant improvement was noted in all analyses. CONCLUSION: This study suggests that a comprehensive systemwide and executively supported QI project can make sustained multiyear improvements in ED throughput and LWBS. Further research is needed to determine if this standardized set of changes can be generalized to other hospital systems.