A new model of multidimensional discharge planning: continuity of care for frail and complex inpatients.

OBJECTIVE: Delays in patient discharge can adversely affect hospital and emergency room productivity and increase healthcare costs. The discharge should be structured from the hospital admission towards the most appropriate environment. This study aims to investigate the efficacy of the Unit, named "Continuity of Care Center" (CCC), to guarantee a safest and fastest hospital discharge in frail patients and to test the effect of our team-approach on hospital outcomes (length of stay and hospital mortality). MATERIALS AND METHODS: This is a prospective cohort study carried out in an acute care hospital with 1,558 beds and is equipped with 41 operating theaters. We collected data from October 2016 to June 2019. RESULTS: The time of patient discharge had an important reduction: 15.5±30.8 in the first 3 months vs. 11.0±20.1 in the last 3 months considered. The median of the time of discharge in all 12 months considered was 12 day. The length of stay presented an important reduction from 33.3±47.5 during the first 3 months vs. 28.8±39.5 in the last 3 months of activity of CCC; and a significant reduction of hospital deaths was recorded from 20% during the first 3 months to 14% in the last 3 months of activity of CCC. CONCLUSIONS: Results indicate a constant decrease in patient discharge time and length of hospital stay, with a consequent significant reduction of healthcare costs. According to the estimates of Italian Health Ministry concerning Latium region, every hospitalization day has a mean cost of € 674.00. Thus, the CCC activity has contributed to a reduction of approximately 12,832 days of hospitalization, in the considered period, with an estimated hospital saving of € 8,648,761.

A nursing clinical information system for the assessment of the complexity of care.

BACKGROUND: The complexity of care can be described through a clinical nursing information system, in particular through the Professional Assessment Instrument -PAI-, encoding each health care activity in time units and analysing the relationship of observed time to patient characteristics in relation to the functional models of care needs. DESIGNS: Observational study. METHODS: Data were collected for 11 months in 2016-17 in four inpatient units of an Italian hospital using the Professional Assessment Instrument, and a survey grid to measure the time of the nursing activities delivered. All activities with a frequency of 20 or more have been included. The Work Sampling technique was used for time-tracking. RESULTS: The sample included 2765 nursing activities. The mean times for each care activity were compared showing significant differences. A statistically significant correlation (Sperman's correlation coefficient) was observed both between the observed time and the level of illness severity and between time and functional models. CONCLUSIONS: Patient complexity, both in terms of illness severity and level of dependence, can be coded through a clinical nursing information system. This facilitates the classification and measurement of nursing care delivered, which includes the entire care process.

The assessment of the complexity of care through the clinical nursing information system in clinical practice: a study protocol.

BACKGROUND: The costs of nursing staff amounts to approximately 50% of the total budget of the health workforce and accounts for 20% to 30% of the total costs incurred by the health care companies. The goal of the study, by analyzing the complexity of care, is to provide a quantification of the assistance delivered, through the assessment of the technical aspects of the welfare activities according to the variable of time. Data from these activities flow into the clinical nursing information system Professional Assessment Instrument - PAI - which is used at the health facility involved in this study. This instrument allows nurses to document the nursing process in electronic format by using a standardized nursing language (nursing diagnoses, nursing interventions and nursing outcomes). METHODS: The design of the study is observational. The participants will be patients that are hospitalized in the cardiology departments, the intensive care units for cardiac and thoracic surgery, pulmonary medicine and medical oncology of the "A.Gemelli" hospital in Rome, Italy. The observers who will carry out the surveys will be students of the nursing degree course and the coordinators of the respective wards. The times recorded for each health care activity will be correlated with variables that are defined in the literature as the indicators of the complexity of care. The research protocol was approved by the Ethics Committee of the "A. Gemelli" Hospital in June 2015. RESULTS: In terms of results, this study aims to verify the reliability of the Professional Assessment Instrument tool as a system for the classification and measurement of nursing care which includes the entire care process, taking into account all of the variables deemed crucial to the nursing care effort. CONCLUSIONS: This study will provide a tool for the assessment of the complexity of care, with the goal of improving the quality of care for the patients and of interacting with the health administration system for the management of resources.

Impact of a nursing information system in clinical practice: a longitudinal study project.

BACKGROUND: The implementation of adequate clinical information systems helps to deal with the immense flow of health data to ensure the continuity of care and access to a safe and high-quality healthcare system. Currently there is an increasing awareness of the importance of evaluating and measuring the impact of such systems in clinical practice. Implementations often fail, due to inadequate interaction between technology and human elements. METHODS: This article describes a research project aimed at evaluating the impact of a clinical nursing information system (CNIS), called Professional Assessment Instrument (PAI), in clinical practice. The study will evaluate PAI Quality, Nurses Satisfaction, PAI Use, Nurses and Environment Characteristics, Net Benefits and Nurses' Experiences related to the PAI use. A theoretical model developed for this research will guide the study. A quali-quantitative longitudinal design will be performed involving two hospitals over a 9-month period. To measure different dimensions that affect the success/failure of CNIS we will use different tools/ methods of data collection (questionnaires, psychometric tools, surveys and focus groups). EXPECTED RESULTS: This study will evaluate the impact of a CNIS in hospitals providing an overview of the factors which can help and hinder the implementation of an information system. CONCLUSIONS: The results of the study will support interventions to improve and implement clinical information systems designed to computerize nursing data, with positive effects on public health and research in general, providing further evidence for health policy.

[The chronic patient and the nurse-managed hospital unit]. / Il paziente cronico e la Unità Operativa di Degenza Infermieristica.

In this article we discuss the implementation of a hospital nursing care unit in a local health authority in Rome (Italy), The hospital involved provides a wide range of healthcare and social services. The project is a very innovative one at the national level, with respect to healthcare services offered to patients with chronic disorders and associated disabilities. Starting from the concept of "centrality of the patient" in the area of healthcare services, we developed an organizational model where nursing care represents one of the basic elements.