Analysis of Risk Factors of Hospital Emergency Nursing Based on Comprehensive Nursing Methods.

In order to improve the comprehensive nursing effect of the hospital emergency treatment, this paper analyzes the process of the hospital emergency treatment. In addition, this paper combines the possible risks to analyze the risk factors of the comprehensive nursing in the hospital emergency treatment and builds an intelligent analysis model based on the actual situation of the hospital emergency treatment. At the same time, this paper conducts a systematic survey of emergency services and gives the composition and structure of the system. In addition, this paper divides the business required by the system into modules, including registration module, doctor workstation, nurse workstation, query statistics module, decision-making module, and maintenance module. Finally, this paper suggests that in the process of the clinical triage, more ideas for improving the existing evaluation model should be proposed, and experience should be transformed into advantages, so as to improve emergency triage skills; establish an objective, quantitative, and scientific concept of emergency classification and triage; and fully realize scientific triage and precise triage.

Design and Implementation of Hospital Automatic Nursing Management Information System Based on Computer Information Technology.

Clinical nursing work fails to integrate various nursing tasks such as basic care, observation of patients' conditions, medication, treatment, communication, and health guidance to provide continuous and full nursing care for patients. Based on this, this paper uses the Internet of Things (IoT) technology to optimize the infusion process and achieve closed-loop management of medications and improve the efficiency and safety of infusion and medication administration by using a rational and effective outpatient and emergency infusion and medication management system. The system was built by applying wireless network, barcode technology, RFID, infrared tube sensing, and other technologies and was combined with actual nursing work to summarize application techniques and precautions. The application of this system will become a new highlight of medical informatization, improve patient experience, monitor infusion safety, enhance nursing care, reduce emergency medical disputes, improve patient satisfaction, and will create good social and economic benefits for the hospital.

The Relationship between Patient Safety Climate and Medical Error Reporting Rate among Iranian Hospitals Using a Structural Equation Modeling.

BACKGROUND: Improving patient safety is a global health imperative, and patient safety climate is one of the components one that plays an important role in promoting patient safety. Medical error reporting is a way through which it can be evaluated and prevented in the future. The aim of this study was to assess the relationship between patient safety climate and medical error reporting in military and civilian hospitals. METHODS: This research was conducted by using structural equation modeling in the selected hospitals of Iran in 2018. The study community consisted of 200 nurses in the military and 400 nurses in the civilian hospitals. By using Structural Equation Modeling, the relationship between patient safety climate and the rate of medical error reporting in the hospitals was measured by a questionnaire. Data was analyzed using SPSS 17 and LISREL 8.8 software. RESULTS: The mean score of patient safety climate was moderate in the hospitals. There was no significant relationship between the rate of medical error reporting and patient safety climate, while a significant difference was found between patient safety climate score and age, sex, job category, and type of hospital (P < 0.05). CONCLUSION: The results suggested that patient safety climate and the rate of reporting errors were not favorable in the studied hospitals, while there was a difference between safety climate dimensions.

Factors influencing missed nursing care in public hospitals in Australia: An exploratory mixed methods study.

BACKGROUND: Missed nursing care (MNC) is a significant health care issue that impacts on the quality of health care and patient safety. It refers to delayed or omitted aspects of nursing care (totally or partially). MNC is an under-researched area in the Australian health care context. OBJECTIVE: This research sought to further explore the MNC phenomenon in the context of an acute care hospital and to identify its common elements and the factors influencing its occurrence. DESIGN: A convergent parallel mixed methods design was employed involving secondary analysis of routinely collected hospital data and a survey of 44 nursing staff using the MISSCARE survey instrument. The two sources of data were converged to address the objective. FINDINGS: The study found that the most common elements of missed nursing care include failure of patient ambulation, emotional support for patients and/or family, and the provision of full documentation. These elements are consistent with previous international studies conducted in acute care hospital settings. This study identified that local context impacting on MNC was also important and included interruptions to workflow, "perceived" lack of management support, poor handover, and communication breakdown between the nursing team and medical staff. CONCLUSION: Consideration of the local health care context is foundational in understanding the MNC phenomenon. The findings of this research may help nursing managers mitigate the possible effects of MNC and therefore improve patient safety in their acute care environment. Additional multisite studies are required to further explore factors associated with MNC in both general and local contexts.

Nursing Diagnoses, Interventions, and Activities as Described by a Nursing Minimum Data Set: A Prospective Study in an Oncology Hospital Setting.

BACKGROUND: Oncological diseases affect the biopsychosocial aspects of a person's health, resulting in the need for complex multidisciplinary care. The quality and outcomes of healthcare cannot be adequately assessed without considering the contribution of nursing care, whose essential elements such as the nursing diagnoses (NDs), nursing interventions (NIs), and nursing activities (NAs) can be recorded in the Nursing Minimum Data Set (NMDS). There has been little research using the NMDS in oncology setting. OBJECTIVE: The aim of this study was to describe the prevalence and distribution of NDs, NIs, and NAs and their relationship across patient age and medical diagnoses. METHODS: This was a prospective observational study. Data were collected between July and December 2014 through an NMDS and the hospital discharge register in an Italian hospital oncology unit. RESULTS: On average, for each of 435 enrolled patients, 5.7 NDs were identified on admission; the most frequent ND was risk for infection. During the hospital stay, 16.2 NIs per patient were planned, from which 25.2 NAs per day per patient were delivered. Only a third of NAs were based on a medical order, being the highest percentage delivered on nursing prescriptions. The number of NDs, NIs, and NAs was not related to patient age, but differed significantly among medical diagnoses. CONCLUSIONS: An NMDS can depict patient needs and nursing care delivered in oncology patients. Such data can effectively describe nursing contribution to patient care. IMPLICATIONS FOR PRACTICE: The use of an NMDS raises the visibility of nursing care in the clinical records. Such data enable comparison and benchmarking with other healthcare professions and international data.

Factors Associated With Timely Blood Glucose Testing and Insulin Administration in Patients Receiving Mealtime Insulin Coverage in Medical Surgical Units.

Purpose The purpose of the study was to identify the rate and factors associated with timely mealtime capillary blood glucose (CBG) testing and insulin coverage in hospitalized patients with diabetes. Methods A descriptive-correlational design was used with a random sample of patients (n = 77) and nurses (n = 36) on a medicine and a neuroscience unit of a large Magnet hospital. After written consent was obtained, post-meal patient and nurse interviews were conducted to collect information about patient, nurse, and situational factors known to influence timely mealtime diabetes care. Results Timely CBG testing occurred on 85.7% of the patient participants, and 71.4% received timely insulin coverage. Timely CBG testing was associated (unadjusted) with telling the patient care associate to obtain a finger stick (FS) prior to meals and patient off the unit during mealtime. The odds of having insulin administered on time was significantly and independently associated with the nurse caring for fewer patients, patients waiting for insulin prior to eating, and patients knowing pre-meal FS was high. Conclusions One situational factor and 2 patient factors were independently associated with timely insulin coverage prior to meals. Interventions aimed at raising staff awareness of these factors and providing tailored education to patients may improve the odds of having insulin administered on time.

Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home.

AIM: To determine the effectiveness of nursing discharge planning interventions on health-related outcomes for older inpatients discharged home. BACKGROUND: Inadequate discharge planning for the ageing population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing interventions for older people. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be evaluated in practice. DESIGN: Systematic review and meta-analysis. DATA SOURCES: A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000-2015. REVIEW METHODS: Critical appraisal, data extraction and meta-analysis followed the methodology of the Joanna Briggs Institute. RESULTS: Thirteen studies were included in the review, 2 of 13 were pilot studies and one had a pre-post design. Included studies involved 3,964 participants with a median age of 77 years. Nurse discharge planning did not significantly reduce hospital readmission or quality of life, except readmission was lower across studies conducted in the USA. The overall effect score for nurse discharge planning on length of stay was statistically significant and positive. CONCLUSION: Nursing discharge planning is a complex intervention and difficult to evaluate. Findings suggest that nursing discharge planning for older inpatients discharged home increases the length of stay yet neither reduces readmission rate nor improves quality of life.

Determination of nurses' mental workloads using subjective methods.

AIMS AND OBJECTIVES: To adapt the National Aeronautics and Space Administration Task Load Index scale into Turkish, to determine the nurses' mental workload using subjective methods and to identify the factors affecting the mental workloads of nurses. BACKGROUND: As the concept of safety gains prominence in healthcare services, the determination of employees' mental workloads using subjective methods is considered important in preventing errors caused by employees. DESIGN: Methodological and descriptive design. METHODS: The population of the study consisted of a total of 1900 nurses working at three hospitals and a dentistry faculty hospital affiliated with a public university in Istanbul. The sample of the study consisted of 1266 nurses who agreed to participate in the study (the rate of return was 66·6%). Language and content validity and reliability measurements were performed to adapt the National Aeronautics and Space Administration Task Load Index into Turkish, which was used as the data collection tool. RESULTS: It was found that the mean total mental workload score of the nurses was 80·48 (SD 11·76), and the weighted score of mental workload was 83·7. While the highest mean score was obtained on the subscale of mental demand (88·08, SD 16·12), the lowest mean score was obtained on the subscale of frustration (54·52, SD 29·96). The mean total mental workload score of the nurses showed a significant difference according to the units in which the nurses worked. CONCLUSION: The mean mental workload scores of nurses working at hospitals within the scope of the study were higher than the results of other studies. RELEVANCE TO CLINICAL PRACTICE: It is recommended that nurse managers perform mental workload measurements of nurses and compare the results with the quality indicators observed in units to determine and employ a labour force that is qualified for the profession and that may benefit more effectively from human resources.

Evaluación de la contaminación con agentes citotóxicos en hospitales en Colombia / Evaluation of contamination by cytotoxic agents in Colombian hospitals

Introducción: Las revisiones del 2007 a la farmacopea americana vigente en todo el hemisferio occidental (USP capítulo 797) incluyen una sección sobre el manejo de fármacos peligrosos como preparaciones magistrales estériles, donde se recomienda el muestreo ambiental para detectar trazas de fármacos peligrosos no contenidos, afirmando que esta medida de calidad debe llevarse a cabo de forma rutinaria. Objetivo: Determinar la tasa de contaminación con agentes citotóxicos en las áreas de trabajo de tres instituciones hospitalarias de Colombia. Material y métodos: Estudio descriptivo, prospectivo, transversal. Se recolectaron muestras de 18 áreas evaluando simultáneamente la presencia de tres fármacos que han sido históricamente usados como trazadores de contaminación química: Ciclofosfamida, 5-Fluorouracilo y Carboplatino. Se evalúan superficies de áreas de preparación (cabina de seguridad biológica-CSB o aislador de barrera-AB), alistamiento y administración de medicamentos oncológicos incluyendo áreas comunes a la central de mezclas y la sala de administración de medicamentos oncológicos. Resultados: En el departamento de enfermería y farmacia existe contaminación química debido a los medicamentos citostáticos. En enfermería la contaminación se dio más debido a Carboplatino mientras que en el área de central de mezclas, el fármaco que más detectado fue 5-fluoruracilo. La comparación entre ambos departamentos permite evidenciar que la mayor tasa de contaminación se ha encontrado en farmacia. El principio activo más detectado fue 5-fluoruracilo. Conclusión: Se recomienda que las instituciones revisen los estándares para la preparación y administración de fármacos peligrosos a la luz de la normatividad mundial (USP, ASHP, ISOPP) en aspectos como la política y el procedimiento actual, controles de ingeniería, procedimientos de limpieza, manipulación de los viales del fabricante, evaluación de la CSB o AB, capacitación y educación del personal tanto en las áreas de preparación y administración, uso de EPP adecuados, la incidencia de derrames recientes en el área de la farmacia o de preparación que podrían elevar los niveles de detección y la implementación de CSTD

Introduction: The reviews made in 2007 to the current American pharmacopoeia throughout the Western Hemisphere (USP Chapter 797) include a section about handling hazardous drugs as master sterile preparations. In this sense, environmental sampling is recommended to detect traces of dangerous and not contained drugs. It is stated this quality measure should be carried out routinely. Objective: To determine the rate of contamination with cytotoxic agents in the working areas of three hospitals in Colombia. Material and Methods: It was carried out a descriptive, prospective and cross-sectional study. Samples were collected simultaneously from 18 areas. It was evaluated the presence of three drugs that have been historically used as tracers of chemical contamination: Cyclophosphamide, 5-fluorouracil and carboplatin. The surface of preparation areas (biological safety cabinet or isolator CSB-barrier-AB), enlistment areas and the ones of cancer drugs administration including common areas of the central mixing and living areas of oncology drugs administration were evaluated. Results: In the department of nursing and pharmacy exists chemical contamination caused by cytostatic drugs. In nursing pollution was mainly related to carboplatin while in the central mixing area, the most detected document was 5-fluorouracil. The comparison between both departments shows that the highest rate of contamination was found in pharmacy. The most detected active substance was 5-fluorouracil. Conclusion: It is recommended that institutions review the standards for the preparation and administration of hazardous drugs in the light of global standards (USP, ASHP, Isopp) in areas such as politics and the current procedure, engineering controls, cleaning procedures, handling manufacturer’s vials, assessment of CSB or AB, training and education of the staff both, in the areas of preparation and administration, use of appropriate PPE, the incidence of recent spills in the pharmacy or preparation area that could raise detection levels and the implementation of CSTD

A nurse-led multidisciplinary intervention to improve cardiovascular disease profile of patients.

The aim of this study was to evaluate the impact of a structured screening and nurse-based intervention on cardiovascular risk factors. In patients with established cardiovascular disease, a cardiovascular risk profile was assessed, and lifestyle was evaluated by using an automated questionnaire. A multidisciplinary team proposed an integral individualized plan of care on the basis of these assessments. During follow-up, a nurse-led lifestyle intervention program and the best medical treatment were offered. A total of 328 outpatients were included. After screening, a follow-up term of at least 1 year was reached in 176 patients (59.9%). Low-density lipoprotein cholesterol and systolic blood pressure were significantly reduced. A reduction in the amount of smoking, alcohol consumption, and unhealthy eating habits was observed. However, the amount of physical activity was unaffected, and body mass was increased. A structural evaluation of cardiovascular risk factors and an integrated nurse-led approach can successfully reduce risk in cardiovascular patients.

Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol.

AIMS: With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs. BACKGROUND: DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively. METHODS/DESIGN: A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting quantitative and qualitative findings. CONCLUSION: The research program will produce baseline data on nursing service context factors in Swiss acute care hospitals prior to DRG introduction as well as a theoretical model and a methodology to support nursing managers and hospital executive boards in distributing resources effectively. The study was approved by the ethics committees of Basel, Bern, Solothurn and Zürich.

Nonoccupational postexposure HIV prophylaxis in sexual assault programs: a survey of SANE and FNE program coordinators.

This cross-sectional study describes sexual assault nurse examiner (SANE)/forensic nurse examiner (FNE) program practices related to HIV testing, nonoccupational postexposure prophylaxis (nPEP), and common barriers to offering HIV testing and nPEP. A convenience sample of 174 SANE/FNE programs in the United States and Canada was drawn from the International Association of Forensic Nurses database, and program coordinators completed Web-based surveys. Three fourths of programs had nPEP policies, 31% provided HIV testing, and 63% offered nPEP routinely or upon request. Using χ(2) and Fisher's exact tests, a greater proportion of Canadian programs had an nPEP protocol (p = .010), provided HIV testing (p = .004), and offered nPEP (p = .0001) than U.S.-based programs. Program coordinators rated providing pre- and/or posttest counseling and follow-up as the most important barrier to HIV testing, and medication costs as the most important barrier to providing nPEP. Our results indicate HIV-related services are offered inconsistently across SANE/FNE programs.

Patient-reported missed nursing care correlated with adverse events.

The aim of this study was to determine the extent and type of missed nursing care as reported by patients and the association with patient-reported adverse outcomes. A total of 729 inpatients on 20 units in 2 acute care hospitals were surveyed. The MISSCARE Survey-Patient was used to collect patient reports of missed care. Patients reported more missed nursing care in the domain of basic care (2.29 ± 1.06) than in communication (1.69 ± 0.71) and in time to respond (1.52 ± 0.64). The 5 most frequently reported elements of missed nursing care were the following: (a) mouth care (50.3%), (b) ambulation (41.3%), (c) getting out of bed into a chair (38.8%), (d) providing information about tests/procedures (27%), and (e) bathing (26.4%). Patients who reported skin breakdown/pressure ulcers, medication errors, new infections, IVs running dry, IVs infiltrating, and other problems during the current hospitalization reported significantly more overall missed nursing care.

[The state of quality management implementation in ambulatory care nursing and inpatient nursing]. / Der aktuelle Stand des Qualitätsmanagements in ambulanten und stationären Pflegeeinrichtungen.

AIMS: The demands being made on quality assurance and quality management in ambulatory care nursing and inpatient nursing facilities continue to grow. As opposed to health-care facilities such as hospitals and rehabilitation centres, we know of no other empirical studies addressing the current state of affairs in quality management in nursing institutions. The aim of this investigation was, by means of a questionnaire, to analyse the current (as of spring 2011) dissemination of quality management and certification in nursing facilities using a random sample as representative as possible of in- and outpatient institutions. METHOD: To obtain our sample we compiled 800 inpatient and 800 outpatient facilities as a stratified random sample. Federal state, holder and, for inpatient facilities, the number of beds were used as stratification variables. 24% of the questionnaires were returned, giving us information on 188 outpatient and 220 inpatient institutions. While the distribution in the sample of outpatient institutions is equivalent to the population distribution, we observed discrepancies in the inpatient facilities sample. As they do not seem to be related to any demonstrable bias, we assume that our data are sufficiently representative. RESULTS: 4 of 5 of the responding facilities claim to employ their own quality management system, however the degree to which the quality management mechanisms are actually in use is an estimated 75%. Almost 90% of all the facilities have a quality management representative who often possesses specific additional qualifications. Many relevant quality management instruments (i. e., nursing standards of care, questionnaires, quality circles) are used in 75% of the responding institutions. Various factors in our data give the impression that quality management and certification efforts have made more progress in the inpatient facilities. Although 80% of the outpatient institutions claim to have a quality management system, only 32.1% of them admit to having already been (or be in current preparation to be) certified, a figure that was 41.5% among the inpatient facilities. These percentages are smaller when one relies on information provided by the certifying institutions themselves rather on the nursing facilities. Most frequent is the certification according to the DIN EN ISO 9001 standard, since the care-specific certification procedures most widespread on the market enable facilities to combine a care-specific certificate with one according to DIN norms. CONCLUSION: Quality management has become very widespread in nursing facilities: every third institution claims to have been certified, and the trend to become certified has clearly intensified over the last few years. We observe overall very great acceptance of both internal quality management and external quality assurance. We suspect that the current use of quality management instruments in many nursing facilities will not fall behind such efforts in hospitals and rehabilitation centres.

La Enfermería en España: situación actual y posibles líneas estratégicas / Nursing in Spain: the current situation and possible strategies

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Réplica a Carta al Director / Reply to letter to the editor

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Input data quality control for NDNQI national comparative statistics and quarterly reports: a contrast of three robust scale estimators for multiple outlier detection.

BACKGROUND: To evaluate institutional nursing care performance in the context of national comparative statistics (benchmarks), approximately one in every three major healthcare institutions (over 1,800 hospitals) across the United States, have joined the National Database for Nursing Quality Indicators (NDNQI). With over 18,000 hospital units contributing data for nearly 200 quantitative measures at present, a reliable and efficient input data screening for all quantitative measures for data quality control is critical to the integrity, validity, and on-time delivery of NDNQI reports. METHODS: With Monte Carlo simulation and quantitative NDNQI indicator examples, we compared two ad-hoc methods using robust scale estimators, Inter Quartile Range (IQR) and Median Absolute Deviation from the Median (MAD), to the classic, theoretically-based Minimum Covariance Determinant (FAST-MCD) approach, for initial univariate outlier detection. RESULTS: While the theoretically based FAST-MCD used in one dimension can be sensitive and is better suited for identifying groups of outliers because of its high breakdown point, the ad-hoc IQR and MAD approaches are fast, easy to implement, and could be more robust and efficient, depending on the distributional property of the underlying measure of interest. CONCLUSION: With highly skewed distributions for most NDNQI indicators within a short data screen window, the FAST-MCD approach, when used in one dimensional raw data setting, could overestimate the false alarm rates for potential outliers than the IQR and MAD with the same pre-set of critical value, thus, overburden data quality control at both the data entry and administrative ends in our setting.

Gestión de la demanda desde la consulta de acogida de Enfermería / Management of the demand for care from the host Nursing consultation

Objetivo: identificar el perfil del usuario que acude a la consulta de acogida de Enfermería, el motivo de la visita, la resolución de la misma y la satisfacción por parte del paciente. Como objetivo secundario se planteó analizar el cambio experimentando en las visitas espontáneas que lleva a cabo la enfermera de guardia, tras la implantación de la consulta de Enfermería de acogida. Material y método: estudio descriptivo transversal. La población objeto de estudio fueron los usuarios que acudían al centro de Raval Nord. Se eligió sistemáticamente una de cada tres visitas de lunes a viernes, a las que se aplicaba los criterios de inclusión y exclusión, durante los meses de abril a octubre de 2009. Variables de estudio: sexo, edad, país de procedencia, número de visitas previas del paciente, motivo de consulta (patología aguda, agudización patología crónica, otros), duración de la visita, intervención enfermera, satisfacción del usuario. También se cuantificó el número de visitas espontáneas que llevó a cabo la enfermera de guardia durante los meses de abril a octubre de 2008 y las realizadas por la enfermera de acogida con el nuevo rol durante el período de estudio. Resultados: 85 visitas analizadas, 47,1% hombres y 52,9% mujeres, media de edad 53,4 años. El 64,9% autóctonos y el 34,1% extranjeros. 47,6% no ha sido visitado por la enfermera en el último año. El motivo de visita: 60,7%patología aguda. Tiempo medio de la visita: 14 minutos. La resolución por parte de la enfermera es superior al 60%. Incremento relativo del 61% de visitas realizadas por la enfermera a partir de la nueva organización. Conclusiones: la resolución por parte de la enfermera es alta y la satisfacción del usuario también. Cambiar el acceso de la población a la consulta, para gestionar la demanda, optimiza la función de la enfermera (AU)

Objective: to identify the profile of the user who presents to the Host Nursing consultation office, the reason for the visit, the resolution of it and the satisfaction of the patient. A secondary objective was to analyze the change in the number of spontaneous visits undertaken by the nurse on duty, following the introduction of Host Nursing consultation. Material and methods: cross sectional descriptive study. The study population were users who presented to the health center of Raval Nord , one out of three visits from Monday to Friday was chosen systematically to which inclusion and exclusion criteria were applied during the months from April to October 2009. Study variables: sex, age, national origin, number of previous visits of the patient, reason for visit (acute disease, chronic disease exacerbations, others), duration of visit, nursing intervention, user satisfaction. We also measured the number of spontaneous visits conducted by the nurse on duty during the months of april to october 2008 and those made by the host nurse in her new role during the study period. Results: 85 visits analyzed, 47,1% men and 52,9% female, mean age 53,4years. 64,9% nationals and 34,1% foreigners. 47.6% has not been visited by the nurse in the last year. The reason for visit: 60,7% acute pathology. Average time of visit 14 minutes. Resolution by the nurse is over 60%. Relative increase of 61% of visits by the nurse as of the date of the new organisation. Conclusions: resolution of the visit by the nurse is high and so is customer satisfaction. Changing the population's access to consultation, to manage demand, optimizes the role of the nurse (AU)

Improving teamwork: impact of structured interdisciplinary rounds on a hospitalist unit.

BACKGROUND: Effective collaboration and teamwork is essential in providing safe and effective care. Research reveals deficiencies in teamwork on medical units involving hospitalists. OBJECTIVE: The aim of this study was to assess the impact of an intervention, Structured Inter-Disciplinary Rounds (SIDR), on nurses' ratings of collaboration and teamwork. METHODS: The study was a controlled trial involving an intervention and control hospitalist unit. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. We asked nurses to rate the quality of communication and collaboration with hospitalists using a 5-point ordinal scale. We also assessed teamwork and safety climate using a validated instrument. Multivariable regression analyses were used to assess the impact on length of stay (LOS) and cost using both a concurrent and historic control. RESULTS: A total of 49 of 58 (84%) nurses completed surveys. A larger percentage of nurses rated the quality of communication and collaboration with hospitalists as high or very high on the intervention unit compared to the control unit (80% vs. 54%; P = 0.05). Nurses also rated the teamwork and safety climate significantly higher on the intervention unit (P = 0.008 and P = 0.03 for teamwork and safety climate, respectively). Multivariable analyses demonstrated no difference in the adjusted LOS and an inconsistent effect on cost. CONCLUSIONS: SIDR had a positive effect on nurses' ratings of collaboration and teamwork on a hospitalist unit, yet no impact on LOS and cost. Further study is required to assess the impact of SIDR on patient safety measures.