Automated Identification of Patients with Advanced Illness.

Early identification of advanced illness patients within an inpatient population is essential in order to establish the patient's goals of care. Having goals of care conversations enables hospital patients to dictate a plan for care in concordance with their values and wishes. These conversations allow a patient to maintain some control, rather than be subjected to a default care process that may not be desired and may not provide benefit. In this study the performance of two approaches which identify advanced illness patients within an inpatient population were evaluated: LACE (a rule-based approach that uses L - Length of stay, A- Acuity of Admission, C- Co-morbidities, E- Emergency room visits), and a novel approach: Hospital Impairment Score (HIS). The Hospital impairment score is derived by leveraging both rule-based insights and a novel machine learning algorithm. It was identified that HIS significantly outperformed the LACE score, the current model being used in production at Northwell Health. Furthermore, we describe how the HIS model was piloted at a single hospital, was launched into production, and is being successfully used by clinicians at that hospital.

Goals of care conversation education program: An intervention to help health care professionals break bad news to patients with advanced illness.

The purpose of the study was to measure the effectiveness of communication skills intervention results for healthcare professionals. A multi-site pretest-posttest survey assessing the efficacy of a Goals of Care conversation education program. The program aimed to educate healthcare professionals concerning having Goals of Care conversations with patients and families. This research was implemented in a large healthcare organization in the Northeastern United States. This study found significant differences between pretests and posttests across professions, palliative care specialty, degree types, and years of experience in the participant's self-reported ability and comfort levels in having conversations about Goals of Care with patients and families. Providing education on Goals of Care was effective in improving the knowledge and comfort of health care professionals with conducting advanced illness conversations.

Changing the Care Paradigm for Patients: Advanced Illness Beds Care Model.

BACKGROUND: Over 90 million Americans suffer from advanced illness (AI) and spend their last days of life in critical care units receiving costly, unwanted, aggressive medical care. OBJECTIVE: Evaluate the impact of a specialized care model in medical/surgical units for hospitalized geriatric patients and patients with complex care requirements where designated AI beds align care with patient's wishes/goals, minimize aggressive interventions, and influence efficient resource utilization. DESIGN: US based multi-facility retrospective, longitudinal descriptive study of screened positive AI patients in AI Beds (N = 1,237) from 3 facilities from 2015 to 2017. RESULTS: Patient outcomes included 60% referrals to AI beds from ICU, a decrease of 39-49% in average ICU LOS, a 23% reduction of AI bed patient expirations, 9.0% referrals to hospice, and projected cost savings of $4,361.66/patient, US dollars. CONCLUSION: Allocating AI beds to deliver care to AI patients resulted in a decreased cost of care by reducing overall hospital LOS, mortality, and efficient use of both critical care and hospital resources.

The development and piloting of a goals of care conversation education program for an advanced illness population.

Ten thousand Americans turn 65 daily. With age, individuals are confronted by complex medical modalities which can be difficult to understand and potentially burdensome. Historically, clinicians lacked the education, skill, and comfort level to identify the need for and address the patient's goals of care (GoC). Inter-professional content experts convened to develop a comprehensive program to educate and increase the comfort level of clinicians when having GoC conversations. The goal was to provide structured guidance to increase the practitioners' level of confidence in engaging patients/families in these conversations. A multimodal educational methodology using simulation was chosen as a learning strategy permitting clinicians to practice GoC conversations while receiving immediate feedback. A five hour inter-professional educational program called Goals of Care Conversation Education Program® (GoCCEP™) was developed and piloted. The GoCCEPTM's evaluations demonstrate success giving clinicians necessary tools and a safe practice environment increasing knowledge and confidence to have substantive GoC conversations.

Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

Impact of a sepsis educational program on nurse competence.

Sepsis is an emerging life-threatening entity and a worldwide epidemic. Nurses are in key positions to identify patients with sepsis, mobilize the medical team, and implement interventions. A study of self-assessed nurse competence was conducted to determine the influence of a specially designed sepsis education program on nurses' perceived ability to identify early, intervene, and care for patients with sepsis. The program was a multimodal design incorporating online interactive didactic presentations, video vignettes, pre- and postknowledge tests, and high-fidelity medical simulation scenarios. A sample of 82 critical care and emergency department nurses in a 1-year critical care nurse training program was used for this study. Pretest and posttest module knowledge scores and self-assessed competence data were collected and analyzed. No improvement in the overall self-assessed competence scores was found; however, self-perceived frequency of use of competence behaviors improved. Participants felt more competent on three sepsis-targeted statements, and posttest knowledge scores showed significant improvement.

Specialized new graduate RN pediatric orientation: a strategy for nursing retention and its financial impact.

New graduate RN retention in the first year of employment is a challenge for hospitals, ranging from a low of 25% to a high of 64%. In 2005, hospitals in New York state spent 11.7% of their nursing budgets on temporary nursing staffing. The objectives of this study were to determine the retention and costs associated with the employment of new graduate RNs before and after the initiation of specialized year-long pediatric critical care, emergency department, and hematology/oncology orientation programs. The major study findings were improved retention of 84% to 94%, significant retention between the two groups at 9 months, and an annual financial savings related to decreased nursing turnover in the specialized orientation group. Specialized orientation programs that support new graduate RNs have documented increased RN retention and decreased RN turnover. In concert with the increased retention and decreased turnover, health care finances were positively impacted by specialized orientation programs.

Critical thinking of registered nurses in a fellowship program.

BACKGROUND: Critical thinking is essential to nursing practice. This study examined differences in the critical thinking dispositions of registered nurses (RNs) in a nursing fellowship program. METHODS: Control and experimental groups were used to compare differences in scores on the California Critical Thinking Disposition Inventory (CCTDI) of RNs at three points during a fellowship program: baseline, week 7, and month 5. The control group consisted of RNs who received no education in critical thinking. The experimental group received education in critical thinking using simulated scenarios and reflective journaling. RESULTS: CCTDI scores examined with analysis of variance showed no significant difference within groups over time or between groups. The baseline scores of the experimental group were slightly higher than those of the control group. Chi-square analysis of demographic variables between the two groups showed no significant differences. CONCLUSION: Critical thinking dispositions are a combination of attitudes, values, and beliefs that make up one's personality based on life experience. Lack of statistical significance using a quantitative approach did not capture the development of the critical thinking dispositions of participants. A secondary qualitative analysis of journal entries is being conducted.

Specialized new graduate RN critical care orientation: retention and financial impact.

New graduate RN retention in the first year of employment is a challenge for hospitals, ranging from a low of 25% to a high of 64%. he objectives of this study were to determine the retention and costs associated with the employment of new graduate RNs before and after the initiation of a specialized year-long critical care orientation program. Retention was compared between two independent groups of graduate RNs in the critical care units of two tertiary hospitals in a multi-hospital health care system in metropolitan New York. The major study findings were a significant difference in retention between the two groups at 3 months, 9 months, and 12 months, and an annual financial savings related to decreased nursing turnover. Specialized orientation programs that support new graduate RNs have documented increased retention and decreased turnover. Health care finances are positively impacted by specialized orientation programs.