Improving Outcomes in Patients Sent to the Emergency Department from Outpatient Providers: A Receiver-Driven Handoff Process Improvement.

BACKGROUND: Outpatient providers refer to emergency departments (EDs) due to findings requiring assessment beyond existing capabilities. However, poor communication surrounding these transitions may hinder safety and timeliness of emergency care. Receiver-driven handoff (RDH) is a process that helps ensure that all pertinent information is shared. This quality improvement project aimed to (1) improve knowledge of RDH, (2) increase satisfaction and perceptions surrounding RDH, (3) modify behaviors in relation to RDH, and (4) decrease referred patients leaving without being seen (LWBS). METHODS: The Iowa Model and Implementation Framework guided this evidence-based quality improvement project. A multidisciplinary team developed and implemented a standardized RDH process consisting of screening to determine whether a patient was referred to the ED, review of electronic health record (EHR), and use of EHR documentation. Process measures were collected via questionnaire pre- and postimplementation and were analyzed quantitatively. Outcome measures were trended by a statistical process control p-chart, which was developed to demonstrate changes in the percentage of patients who were referred to the ED from the outpatient setting and LWBS. RESULTS: The average response for the question "How satisfied are you with the handoff of patient information from referring clinic providers to the ED?" increased from 1.51 preintervention to 2.04 postintervention (p = 0.005). Respondents rated the information received during handoff higher postintervention (2.12 vs. 2.52, p = 0.04). Compliance with screening for referral to the ED was 84.0%. The proportion of patients LWBS after referral decreased by 6.2 percentage points (p < 0.001). CONCLUSION: Using RDH in conjunction with a standardized triage screening may improve quality of information shared during this vulnerable transition and may assist in reduction of referred patients LWBS. The RDH process should be adapted into everyday workflow to ensure sustainability and effectiveness.

Food Insecurity Experience: Building Empathy in Future Food and Nutrition Professionals.

OBJECTIVE: To assess changes in empathy in students completing a food insecurity experience. DESIGN: Mixed methods; quantitative data from survey in years 1 and 2; qualitative data extracted from students' workbooks in years 2-5. This study was conducted over 10 weeks annually for 5 years. SETTING: Northwest US land-grant university. PARTICIPANTS: Students enrolled in a community nutrition course who chose to complete the food insecurity exercise. Total included 58 students in quantitative analysis in years 1 and 2 and 119 in qualitative analysis, years 2-5. INTERVENTION(S): The intervention was a food insecurity experience in which participants spent no more than $3/d on food for 5 days ($15 total) while striving for a nutritious diet and reflecting on their experience. MAIN OUTCOME MEASURES: Empathy scores measured by Likert scales; participant responses and reflections recorded in workbook journals. ANALYSIS: Comparison of means across time using paired t tests (P < .05); coding and sorting themes from workbook journals. RESULTS: Quantitative findings indicated that both classroom content and experiential exercises were important for enhancing empathy about food insecurity. Empathy scores increased from time I to time II and from time I to time III. Qualitative reflections among participants included terms such as guilt, empathy, compassion, and raised consciousness about food insecurity. CONCLUSIONS AND IMPLICATIONS: Experiential and transformational learning to develop empathy can take place in a 5-day food insecurity experience during a typical university-level community nutrition course. This intervention can be tested for applications in other contexts.

Improving nutrition education newsletters for the food stamp eligible audience.

The purpose of this study was to identify the types of nutrition newsletter content that reading clientele perceive as relevant to them in making healthy food choices consistent with sound dietary advice, and to identify ways newsletter design and wording affect the usefulness of the content. The authors conducted five focus groups with readers of nutrition education newsletters in three different regions of Pennsylvania between January and April 2003. All participants were obtaining food from their community food pantry, where newsletters are distributed by the Pennsylvania Nutrition Education Program. Major nutrition and health concerns of participants included heart disease, diabetes, dietary fat, and sodium intake. Recipes are the most highly valued portion of the newsletters. To summarize, newsletter readers indicate that effectiveness in facilitating food and nutrition behavior change is a function of the relevance, design, and practicality of the content.

Position of the American Dietetic Association: food and nutrition professionals can implement practices to conserve natural resources and support ecological sustainability.

It is the position of the American Dietetic Association to encourage environmentally responsible practices that conserve natural resources, minimize the quantity of waste generated, and support the ecological sustainability of the food system-the process of food production, transformation, distribution, access, and consumption. Registered dietitians and dietetic technicians, registered, play various roles in the food system and work in settings where efforts to conserve can have significant effects. Natural resources that provide the foundation for the food system include biodiversity, soil, land, energy, water, and air. A food system that degrades or depletes its resource base is not sustainable. Making wise food purchases and food management decisions entails understanding the external costs of food production and foodservice and how these external costs affect food system sustainability. This position paper provides information, specific action-oriented strategies, and resources to guide registered dietitians and dietetic technicians, registered, in food decision making and professional practice. Food and nutrition professionals also can participate in policy making at the local, state, and national levels, and can support policies that encourage the development of local sustainable food systems. Our actions today have global consequences. Conserving and protecting resources will contribute to the sustainability of the global food system now and in the future.

Assessing food system attitudes among youth: development and evaluation of attitude measures.

OBJECTIVE: To design and pilot a questionnaire for assessing youth attitudes about the food system. DESIGN: Nutrition educators provided important topics for food system education through a survey using the Delphi method. The resulting questionnaire of attitude scales was piloted with high school students. SETTING: The Delphi survey of nutrition educators was conducted through the mail and electronically. A paper and pencil questionnaire was administered to high school students in Family and Consumer Science classes. PARTICIPANTS: Delphi participants were members of the Society for Nutrition Education's Division of Sustainable Food Systems. A convenience sample of high school students completed the pilot questionnaire. VARIABLES MEASURED: Scales measured attitudes about farmland protection, participation in the local food system, hunger in the United States, organic agriculture, and environmental issues related to food. ANALYSIS: Factor analysis was used to identify constructs. The internal consistency of each resulting scale was assessed using Cronbach's alpha. RESULTS: Reliability of attitude scales ranged from .59 to .73. CONCLUSIONS AND IMPLICATIONS: Attitude scales were created for the purpose of assessing youth thoughts and beliefs about the local or regional food system. Such assessments can serve as a starting point for food system educators interested in developing effective curricula on food system topics.