Redesigning emergency care: financial and cost analysis of services provided.

Developing an interdiscliplinary team to monitor and implement redesign is critical to successful, quality outcomes. Analysis of the current status of the organization and national trends is essential prior to redesign. Key assessment data gathered were: profiling users, payer distribution, inpatient admissions, data on types of chronic conditions, DRGs, readmits, short-stay admissions, non-admits, and outpatient services and charges. Organizational realignment requires time and analysis of financial, clinical, and demographic data. The team-building framework used in this emergency room redesign was based on a collaborative model. A crucial initial step was to get support from the organization's executive level of leadership for the new redesign vision. Another factor considered essential for a successful outcome was commitment from each member of the interdisciplinary team. Communication between the team and staff was a top priority.

Collaboration in research: testing the PIPC model on clinical and nonclinical outcomes.

This outcomes research used a collaborative framework between a college of nursing and a medical center to test the effects of the Partners in Patient Care delivery model (PIPC) on clinical and nonclinical outcomes. An experimental pretest-postest design was used to compare selected nonclinical outcomes and clinical outcomes of care in two patient units. Results showed that there were significant differences between units in the nonclinical outcomes of nurse satisfaction, salary costs, supply costs, and productivity as measured by documentation time. In addition, there were significant differences in the clinical outcomes of care in terms of patient satisfaction. No significant differences were found in number of falls, medication errors, and intravenous infections; however, when ratios of these indicators were examined in relation to patient days, significant differences in the medication error ratio and the fall ratio were revealed. The results indicate that the PIPC delivery model did have positive effects on patient satisfaction and nurse satisfaction but that there were increased costs and increased time spent in documentation on the pilot unit.

Effects of the PIPC model on outcome measures of productivity and costs.

The purpose of this experimental research was to determine the effects of the Partners in Care Practice Model (PIPC) on the outcomes of productivity and costs. Over an 18-month study period, no significant differences were found in costs per patient day between the pilot and control units; however, significant differences were found in actual salaries, amount of time spent in documentation, and supply costs. Differences in costs and productivity reflected increased training costs and costs for additional supplies on the pilot unit.

Design, implementation, and evaluation of an educational program for a new practice model.

Redesigning patient care delivery is vital to the quality of care delivered and has resulted in the development of new nursing practice models that use some form of "nurse extender." In this article, the authors describe the design, implementation, and evaluation of an educational program for a new nursing practice model at a medical center in the Southeast. The major focus of the educational program is the use of modules to train a new nontraditional nurse extender who works in partnership with an RN. The role of the partner in patient care was developed to expedite the provision of a variety of services at the bedside and to help the nurse deliver quality patient care. The training program consisted of five modules: fundamentals of nursing, selected respiratory therapy skills, selected physical therapy skills, electrocardiogram (EKG)/arrhythmia interpretation, and phlebotomy. A major factor in the success of the program was that it was carefully developed and evaluated to meet the needs of students and staff members. This program can serve as a model for other hospitals that plan to use nurse extenders.

Team-building process in launching a practice model.

With the growing use of multiple types of nurse extenders in new patient care-delivery models, there is a need not only for outcome research on their design and use but for identification and discussion of effective team-building processes necessary to implementing these models. This article presents an analysis of the interdisciplinary team process and the levels of team building and processes needed at each level to test a new nursing practice model. The team processes included not only those within the medical center but included the collaborative process established between the college of nursing and medical center. Both of these were crucial to a successful change in nursing practice.

Effects of the partners in care practice model on nursing outcomes.

The purpose of this study was to identify the effects of an empirically-designed nursing practice model on the outcome variables of job satisfaction, autonomy, and retention/turnover of nursing staff. After 6 months significant differences were found on the experimental unit in overall job satisfaction, and on the subscales of job satisfaction in task requirements and perception of pay. Significant differences were found between the control and experimental unit on the Job Satisfaction Index subscales of interaction, task requirements, and autonomy. No significant differences were found in retention/turnover of staff between the experimental and control unit.

Redesigning nursing practice. The partners in patient care model.

Several nursing practice models use nurse extenders/partners to extend nurses' time. The authors discuss the development, implementation, and evaluation of the "partner in patient care" (PIPC) model. Unique aspects of the model are emphasized, including use of a collaborative process to generate the design and guide the implementation; staff participation throughout the design and implementation of the project; and use of evaluation at each phase of the implementation process to improve on the outcomes.

A collaborative process and framework for nursing research.

Currently, there is a need for outcome research in nursing practice. To facilitate practice-based research, collaboration between education and service is essential. Although a few studies have been reported in the literature on partnerships between education and service, there is a need to describe the nature of a successful collaborative research process between a university college of nursing and a medical center. Nursing leaders from a university college of nursing and a medical center developed a collaborative framework and process by which to obtain funding for research. The following elements were crucial to the framework and facilitated the research process: commitment from leaders and individuals; concentration on positive outcomes and communication between institutions and within groups; matching of individuals; consensus on issues; and adherence to deadlines. The major benefits to this partnership are the enhancement of and opportunity for intradisciplinary research. The process provides a study site for the research and prepared faculty to develop it. All of the above elements factors contribute to a collaborative working arrangement and ensure successful outcomes for future projects.