Reducing missed psychotherapy appointments: An advanced practice nurse-initiated telephone orientation protocol.

PURPOSE: Missed appointments pose significant challenges to the health care system as they contribute to the inefficient use of resources, increase costs, and result in poor outcomes. The aim of this project was to reduce the rate of missed adult psychotherapy appointments by implementing a Psychiatric-Mental Health Nurse Practitioner-initiated telephone orientation protocol (TOP). DESIGN: Quasi-experimental. METHODS: The TOP intervention combined an attendance policy review, psychoeducation, and motivational interviewing techniques. Missed appointment rates were compared before and after initiation of the TOP. FINDINGS: The TOP significantly reduced the rates of missed appointments by 55% over 12 weeks. PRACTICE IMPLICATIONS: The TOP can be implemented as standard care to increase client engagement, improve appointment attendance, and boost clinician productivity.

Weight Surveillance and Heart Failure Self-assessment in Patients with Chronic Leg Wounds: A Pilot Study.

OBJECTIVE: To determine if a weight check and heart failure symptom evaluation with each wound care visit could impact wound healing in patients with heart failure and chronic leg wounds. METHODS: This was a descriptive, correlational study at an outpatient wound healing center in the Pacific Northwest. A convenience sample of individuals currently enrolled at the center with leg wounds and heart failure was identified from standardized electronic medical records. The comparison group received standard care. The intervention group received a body weight check via digital scale and heart failure self-assessment via a standardized assessment tool. Outcome measures included healing rates with weight exacerbation, number of referrals, and hospitalizations for exacerbations. RESULTS: A total of four participants received the intervention, and three were in the control group. Descriptive analysis showed no significant differences between groups or between weight and left ventricle ejection fraction to wound surface area change. A significant positive correlation was observed between past referrals and past hospitalization (rs = 0.79; P = .033; 95% confidence interval, 0.10-0.97). The intervention group had abnormal spikes in wound size that coincided with weight gain. There were no referrals or hospitalizations during the intervention phase, and it is possible that heart failure self-assessment with every wound care visit prevented exacerbations. CONCLUSIONS: Despite the use of an evaluation tool, the intervention and comparison groups had no significantly different outcomes. It is unclear if the intervention was not effective because of the methodology or study limitations. Further research with a larger sample, standardized tools for wound assessment, and a lengthier intervention phase is recommended.