[Progressive Patient Care Model and its application into hospital organization: a narrative review]. / Progressive Patient Care e organizzazione ospedaliera per intensità di cure: revisione narrativa della letteratura.

Aim of this article is to review the literature about the Progressive Patient Care Model, in particular its conceptual and practical characteristics, its implementation and effects on the current health care organization. Was conducted by an integrative-narrative literature review. The Progressive Patient Care is a model which aims at group patients according to their complexity in order to place patients in the most appropriate care setting. The original model consists on five care levels: intensive care, intermediate care, self-care, long term care, home care.In Italy the above mentioned model can be considered as a contextualization of Progressive Patient Care in the light of similarities both in terms of model purposes and care levels classification. The organization for intensive care levels is an opportunity for Italian healthcare facilities to reach continuity of care. This model emphazises care processes looking to patients' needs rather than a division according to criteria of specialties.

Use of and attitudes toward current care guidelines among primary and secondary care nurses in Finland.

Attitudes toward, familiarity with, and use of clinical guidelines in general and the national Hypertension Guideline were studied. A questionnaire study was conducted before and after an educational program (VALTIT) among primary and secondary care nurses in Päijät-Häme, Finland. The program included centralized training sessions and interactive local workshops. Prior to the program, a majority of nurses had a positive attitude toward guidelines but used guidelines seldom. Primary care nurses were better aware of the Hypertension Guideline than secondary care nurses, but the guideline was poorly used by both groups. At the follow-up, familiarity with the Hypertension Guideline and use of guidelines increased among primary care nurses. In future, primary care nurses will have a more autonomous role in patient care and should participate in clinical guideline development and related research. Our study has shown they are a potential target of such interventions.

[The complex prophylaxis of thromboembolism in oncourologic patients].

One of the major complications in oncourological patients in the hospital is the development of thromboembolic complications. This article is devoted to analysis of the results of the comprehensive prevention of thromboembolic complications in 1006 patients that have received surgical treatment in the Scientific research institute of urology in the period 2009-2011. Carried out the comparative estimation of efficiency of elastic bandaging and elastic compressive knitted wear as a means of non-medicamental prevention of thromboembolic complications in of oncourology. In the study, in addition to assessing the impact of elastic compression on various aspects of the state of the venous system of patients and the hemostasis system is shown that the use of elastic compression hosiery compared with elastic bandaging allows to reduce the incidence of thromboembolic complications.

Use of the ABC care bundle to standardize guideline implementation in a cardiac surgical population: a pilot study.

A cardiac surgical progressive care unit implemented the ABC's of Cardiovascular Risk Reduction Care Bundle to determine whether the use of a packaged approach to medication prescription and lifestyle counseling would improve adherence to secondary risk-reduction guidelines in postcoronary artery bypass graft patients. A pilot study was carried out to assess changes in adherence to guideline recommendations post-Care Bundle implementation. Findings support using a systematic strategy to improve guideline adherence in this population.

Nurse-led discharge to the ward from high dependency: a service improvement project.

Nurse-led discharge from the High Dependency Unit (HDU) was introduced in 2002 with the aim of improving access to level 2 beds (beds offering higher level of support and observation; ). The project has yet to be formally evaluated but there have been perceived benefits for both patients and staff.

Post-acute intermediate care in nursing-led units: a systematic review of effectiveness.

OBJECTIVE: In order to determine whether post-acute intermediate care in nursing-led inpatient units (NLUs) is effective in preparing patients for discharge from hospital we conducted a systematic review of the evidence. REVIEW METHODS: The Cochrane Library, Effective Practice and Organisation of Care specialist register, Medline, Cinahl, Embase, British Nursing Index and the HMIC databases were searched for all available dates up to mid-2003. The science and social science citation indices were searched for papers that cited key works. Authors of papers were asked to identify additional research. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time-series designs that compared the NLU to usual post-acute inpatient care for adults were included in the review. Studies were assessed for quality. Statistical meta-analysis on the results of controlled trials was performed. Sensitivity analyses were conducted to determine the impact of methodological quality on conclusions. OUTCOMES: Outcomes considered were mortality, institutionalisation after discharge, functional status early readmission, length of inpatient stay and cost. RESULTS: Nine random or quasi-random controlled trials involving 1669 patients were reviewed. Quality was variable. The mean age of patients in all studies was over 70 years. There was no statistically significant difference in inpatient mortality between NLU and usual inpatient care (OR 1.10, 95% CI 0.56-2.16). The NLU was associated with reduced odds of discharge to institutional care (OR 0.44 95% CI 0.22-0.89), better functional status at discharge (SMD 0.37, 95% CI 0.20-0.54) and reduced odds of early readmission (OR 0.52 95% CI 0.34-0.80). Length of stay until discharge home was increased by 5.13 days (WMD) (95% CI-0.5-10.76 days). At longest follow up (3-6 months) there was no statistically significant difference in the proportion of patients in institutional care (OR 0.97, 95% CI 0.60-1.58). The results were not generally sensitive to study quality. CONCLUSIONS: The NLU successfully functions as a form of intermediate care, so far there is no evidence of adverse outcome from the lower level of routine medical care. However, more research is required to confirm safety. Patients discharged from NLUs have higher levels of function although it is unclear if the benefit is simply a product of an increased stay. There is no evidence of benefit over the longer term.

Admission and discharge guidelines for the pediatric patient requiring intermediate care.

During the past three decades, the specialty of pediatric critical care medicine has grown rapidly, leading to a number of pediatric intensive care units being opened across the country. Many patients who are admitted to the hospital require a higher level of care than the routine inpatient general pediatric care, yet not to the degree of intensity as pediatric critical care; therefore, an intermediate care level has been developed in institutions providing multiple disciplinary subspecialty pediatric care. These patients may require frequent monitoring of vital signs and nursing interventions but usually do not require invasive monitoring. The admission of the pediatric intermediate care patient is guided by physiologic parameters depending on the respective organ system involved relative to the institution's resources and capacity in caring for a patient in a general care environment. This report provides admission and discharge guidelines for intermediate pediatric care. Intermediate care promotes greater flexibility in patient triage and provides a cost-effective alternative to admission to a pediatric intensive care unit. This level of care may enhance the efficiency of care and improve the healthcare affordability for patients receiving intermediate care.

Admission and discharge guidelines for the pediatric patient requiring intermediate care.

During the past 3 decades, the specialty of pediatric critical care medicine has grown rapidly, leading to a number of pediatric intensive care units opening across the country. Many patients who are admitted to the hospital require a higher level of care than routine inpatient general pediatric care, yet not to the degree of intensity of pediatric critical care; therefore, an intermediate care level has been developed in institutions providing multidisciplinary subspecialty pediatric care. These patients may require frequent monitoring of vital signs and nursing interventions, but usually they do not require invasive monitoring. The admission of the pediatric intermediate care patient is guided by physiologic parameters depending on the respective organ system involved relative to an institution's resources and capacity to care for a patient in a general care environment. This report provides admission and discharge guidelines for intermediate pediatric care. Intermediate care promotes greater flexibility in patient triage and provides a cost-effective alternative to admission to a pediatric intensive care unit. This level of care may enhance the efficiency of care and make health care more affordable for patients receiving intermediate care.

Achieve best practice with an evidence-based approach. Create a collaborative environment that improves patient care through consistent outcomes measurement.

Ensure quality and identify room for growth within your progressive care unit with pointed outcomes measurement.

Nursing observations on ward patients at risk of critical illness.

Research findings and anecdotal evidence from outreach nurses across the country have suggested that key indicators of critical illness (respiratory rate and fluid balance) are being missed on the wards and that critically ill patients are not being fed adequately. A group of outreach nurses in Kent carried out a survey to confirm or refute these claims and to ascertain the variation in outreach provision in Kent. The survey found widespread deficiencies in nursing care and observations, which represent a serious threat to patients' safety.

Follow the rules to safer care delivery.

Address the safety and regulatory compliance of care and technology within your facility's progressive care units.

Measuring nurse-sensitive patient outcomes across specialty units.

In efforts to quantify the quality of care delivered to patients within their systems, nursing administrators are being called on to both privately and publicly report nursing-sensitive outcomes for their institutions. Accurate reporting with appropriate patient population or risk adjustment is essential if the reported outcomes are to provide meaningful data to consumers and providers. At present there are no effective mechanisms available that can sufficiently adjust nursing-sensitive outcomes to assure reliable reporting. This study suggests that specialty unit classification may be one method by which nursing-sensitive outcomes can be accurately reported.

Is care in alternative settings safe for infants with possible serious bacterial infection?

Febrile infants are frequently hospitalized for possible serious bacterial illness (SBI). Potential to replace hospitalization of selected febrile infants with care in alternative settings was assessed by estimating risk for deterioration and by determining resource use. Lower and upper bound estimates for the number of infants admitted to a tertiary care hospital from 1994 to 1998 for possible SBI were 537 and 836, respectively. Detailed record reviews were conducted for febrile infants among this group, who, on the basis of positive blood or cerebrospinal cultures, were considered most likely to have SBI. No infant with a positive blood culture who was eligible for alternative setting care (ASC) deteriorated. Ninety-five percent confidence interval for the worst-case (assuming denominator of 537) estimate of risk for deterioration was 0% to 0.56%. Most resource use was compatible with ASC. Alternative setting care for selected febrile infants is both safe and feasible.

Fast-tracking after ambulatory surgery.

The fast-tracking recovery concept examines different paradigms for streamlining the postoperative recovery process. Fast-tracking anesthetic techniques allow suitable outpatients to be discharged earlier after ambulatory surgery. Outpatients are normally transferred from the OR to the PACU, followed by transfer to the Phase II step-down (day-surgery unit) before discharge home. With conventional fast-tracking, it is possible to bypass the PACU and take patients directly from the OR to the step-down unit if they meet specific criteria before leaving the OR. Alternatively, if the step-down unit is already functioning at maximum capacity, the PACU can be restructured to include a fast-track area, where appropriate patients are treated as if they had been admitted directly to the step-down unit. For these PACU fast-track patients, less monitoring is performed, a family member is permitted to be with the patient, and the patient is allowed to ambulate, change into street clothes, and be discharged home directly from the PACU without any time restrictions. Preliminary studies have shown that outpatients who are fast-tracked can be discharged home earlier without any increase in complications or side effects. Importantly, fast-tracking after ambulatory surgery does not seem to compromise patient satisfaction with the surgical experience.

Urinary health in eldercare environments: an update from the NAFC.

The National Association For Continence elected to cancel its 2001 conference scheduled for October 2001 in Washington, DC in light of national events. Executive Director Nancy Muller has provided Ostomy/Wound Management with a synopsis of key issues, important considerations, and the syllabus. We are grateful for the opportunity to serve as a forum for this worthy organization.

Total knee pathway weds acute care, rehab.

The cross-continuum pathway at St. David's Medical Center in Austin, TX, has allowed case managers to reduce length of stay by four days and cut rehab costs by $300 per day by stressing early mobilization of patients and an aggressive regimen of physical therapy (PT). Because patients are expected to undergo as much as six hours of PT per day, only about half of St. David's total knee population is appropriate for the pathway. These consist of healthy older adults with few medical complications who had been somewhat active prior to surgery. Based on the pathway, case managers helped create St. David's Progressive Orthopedic Program, which allows acute care and rehabilitation nurses to work more closely in screening patients and smoothing the transition from the hospital to the outpatient setting.