Developing and Testing the Diagnostic Accuracy of a Brief Nursing Dysphagia Screen.

PURPOSE: The aim of the study was to develop and test the Groppo-Lawless nurse-initiated screen designed to identify patients diagnosed with pneumonia who are at risk for dysphagia. DESIGN: This is a two-phase methodological study. METHODS: Phase 1 involved three steps. First, risk factors (n = 27) for dysphagia were identified from the literature. Next, frequency of these risk factors was calculated from a chart review of patients diagnosed with pneumonia (N = 301). Finally, frequency of risk factors among those patients who failed the 3-oz water trial (n = 56) were calculated, and a five-item instrument, the Groppo-Lawless Dysphagia Screen, was constructed. In Phase 2, nurses' results using the screen were compared to blinded results of speech-language pathologists. FINDINGS: Sensitivity (81.1%), specificity (96.4%), and diagnostic odds ratio (22.43) were calculated. CONCLUSIONS/CLINICAL RELEVANCE: Given the strong psychometric properties of this screen, its use by nurses may increase the number of appropriate speech-language pathologist referrals among patients diagnosed with pneumonia.

The development and testing of the Predictor of Appropriate Discharge Destination among patients undergoing elective total knee or hip joint arthroplasty.

OBJECTIVE: The aim of this study was to develop and test a tool, the Predictor of Appropriate Discharge Destination (PADD), used postoperative day zero by healthcare professionals to identify whether patients undergoing elective total knee arthroplasty or total hip arthroplasty should go directly home or to extended rehabilitation. A secondary objective was to examine the difference in readmissions pre and post use of the PADD. DESIGN: A two-phase methodological study. SETTING: This study was conducted in a 393-bed magnet re-designated community hospital. SUBJECTS: Adults undergoing a primary total knee or hip arthroplasty. METHODS: In Phase 1, retrospective data (n = 461) was analyzed to compare recommendations for discharge destination between the PADD and physical therapists. In Phase 2 (n = 521), the predictive validity of the PADD was assessed prospectively. RESULTS: In Phase 1, the PADD cut-off score of ⩽7 demonstrated good sensitivity (0.83) and specificity (0.68) in relation to the physical therapist's discharge destination recommendation. In Phase 2, sensitivity (0.75) and specificity (0.83) calculations were similar. Analysis of 30-day readmissions between the physical therapist's recommendation and the PADD score revealed 89.7% agreement. Readmission percentages among patients discharged to home and to rehabilitation facilities were 2.37% (n = 16) and 3.41% (n = 10), respectively. CONCLUSION: The PADD has good predictive validity in relation to appropriate discharge destination for patients undergoing a total knee or hip arthroplasty.

The effect of music on mood, motivation, and exercise among patients in a cardiac rehabilitation program: A pilot study.

AIM: Exploring the effect of music on mood, motivation, and exercise performance among patients with phase III cardiac rehabilitation. BACKGROUND: Cardiac rehabilitation programs address risk factors associated with heart health following acute heart issues or cardiac surgery. In phase III, patients are involved in cardiac health maintenance. Exercise is a major component. Motivating patients to engage in exercise and remain in the program has been problematic. Evidence suggests that music could enhance patient involvement in exercise activities. METHOD: A quasi-experimental design was used in this pilot study. A convenience sample of 17 phase III cardiac rehabilitation patients participated. Data were collected on: mood, motivation, and exercise. Participants responded to the Brief Mood Introspection Scale, a 5-point visual analog scale, and an investigator-designed questionnaire on motivation. Treadmill data (speed, distance, and time) were also collected. RESULTS: At baseline participants scored high on mood, motivation to exercise, and fondness for music. Little change occurred over the 9 week period. Participants in this study walked further, on average, than individuals of the same age. CONCLUSION: Music appears to maintain patients' positive moods, motivate them to exercise and help them to continue rehabilitation efforts. Over time music may encourage patients to walk a further distance.

Patient feedback as a quality improvement strategy in an acute care, inpatient unit: An investigation of outcome and readmission rates.

High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as "patient centered." Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N = 2,247) that used a quality-improvement strategy called systematic patient feedback. Benchmarks were constructed using randomized clinical trials (RCTs) from inpatient treatment for depression, RCTs from patient feedback in outpatient settings, and national data on psychiatric hospital readmission rates. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d = 1.33 and d = 1.38 for patients diagnosed with a mood disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression. Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is "patient centered" may provide a path toward lower readmission rates in addition to other evidence-based strategies after discharge. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Evaluation of Huddles: A Multisite Study.

Regular, interdisciplinary group meetings, "huddles," may be useful in improving communication among disciplines, resolving problems, and sharing information. Daily use of huddles may contribute to the development of a highly reliable health care organization. The purpose of this study was to describe safety huddles in relation to (1) problem type, (2) timeliness of resolution, (3) attendance of representatives from each discipline, (4) amount of information sharing, and (5) attendees' satisfaction with the process. Overall, results demonstrated that the primary function of huddles was the exchange of information that posed or had the potential to pose safety risks to patients. Across seven hospitals, the range of information sharing during huddles was 61.0% to 95.6%. Regarding satisfaction with the huddle process, staff reported that huddles were useful in improving awareness of safety concerns and also improved communication between disciplines. Huddles provide a structured format in which staff can positively impact safety concerns, form a greater sense of medical community, increase sharing of information between disciplines, quickly resolve discipline-based problems, and increase awareness of safety concerns. Given the results of this study, it is recommended that health care administrators and managers develop a huddle process.

The Importance of Factors Related to Nurse Retention: Using the Baptist Health Nurse Retention Questionnaire, Part 2.

OBJECTIVE: The purpose of this study was to examine the importance of factors related to nurse retention. BACKGROUND: Retaining nurses within the healthcare system is a challenge for hospital administrators. Understanding factors important to nurse retention is essential. METHODS: Responses of nurses (n = 279) to the Baptist Health Nurse Retention Questionnaire (BHNRQ) at a 391-bed Magnet® redesignated community hospital were analyzed to explore differences in importance scores of bedside nurses. RESULTS: The results demonstrate that each of the 12 items on the BHNRQ was moderately to highly important. A multivariate analysis of variance based on generation, degree, unit, and experience revealed no significant differences on subscale scores (nursing practice, management, and staffing). Themes derived from the comment section on the BHNRQ were consistent with quantitative findings. CONCLUSION: Clinical and managerial competence, engagement with their employees, and presence on the unit are keys to retaining a satisfied nursing workforce.

The Baptist Health High-Risk Falls Assessment: One Assessment Fits All.

Assessing high risk for falling among psychiatric inpatients is particularly challenging in that assessments with strong sensitivity and specificity are not available. The purpose of this study was to determine the sensitivity, specificity, and diagnostic odds ratio of the Baptist Health High Risk Falls Assessment (BHHRFA), a medical-surgical fall risk assessment, in a psychiatric inpatient population. Data collected on 5910 psychiatric inpatients using the BHHRFA showed acceptable sensitivity, specificity, and diagnostic odds ratio (0.68/0.70/4.964).