Implementation of an Advanced Practice Registered Nurse-Led Clinic to Improve Follow-up Care for Post-Ischemic Stroke Patients.

ABSTRACT: BACKGROUND: Ischemic stroke continues to be a leading cause of serious disability within the United States, affecting 795 000 people annually. Approximately 12% to 21% of post-ischemic stroke patients will be readmitted to the hospital within 30 days of discharge. Studies suggest that implementation of a follow-up appointment within 7 to 14 days of discharge improves 30-day readmission rates; however, implementation of these guidelines is uncommon, and follow-up visits within the recommended window are not often achieved. The purpose of this project was to evaluate the impact of an advanced practice registered nurse (APRN)-led stroke clinic on follow-up care for post-ischemic stroke patients. The aims were to improve time to follow-up visit and reduce 30-day unplanned readmissions. METHODS: A pre/post intervention design was used to evaluate the impact of a process to access the APRN-led stroke clinic. The intervention included a scheduling process redesign, and subsequent APRN and scheduler education. RESULTS: The time to clinic follow-up preintervention averaged 116.9 days, which significantly reduced to 33.6 days post intervention, P = .0001. Unplanned readmissions within 30 days declined from 11.5% to 9.9%; however, it was not statistically significant, P = .149. Age was not statistically different between preintervention and postintervention groups, P = .092, and other demographics were similar between the groups. CONCLUSION: An APRN-led clinic can improve follow-up care and may reduce unplanned 30-day readmissions for post-ischemic stroke patients. Further work is needed to determine the impact of alternative approaches such as telehealth.

Advanced practice nurses making a difference: implementation of a formal rounding process.

There has been growing concern for many years over the impending shortage of trauma surgeons due to attrition and the lack of residents choosing the trauma surgical specialty area. Along with this concern, trauma admissions continue to increase and many trauma services are merging with acute care surgery, increasing the overall service line volume. Adding to the burden is the 80-hour workweek residency requirement. Trauma centers are faced with gaps in patient coverage, placing the need for midlevel practitioners in high demand. This article discusses (1) the utilization of advanced practice nurses on a trauma and acute care surgery service and (2) how the implementation of a formal rounding process improves nursing and physician satisfaction as well as length of stay.

Can this spleen be saved? From complications to vaccinations, know the latest management techniques for splenic trauma.

From complications to vaccinations, know the latest management techniques for splenic trauma.

Radial artery blood gas sampling: a randomized controlled trial of lidocaine local anesthesia.

BACKGROUND: Radial artery puncture is a common procedure and yet the role of local anesthesia for reducing the pain of this procedure continues to be debated. Clinical practice is variable and there is potential for substantial financial savings. This is the first randomized trial to investigate the effectiveness of subcutaneously injected lidocaine anesthesia on the perceived pain of radial artery puncture and the financial impact. METHODS: Between December 2012 and April 2013, 43 patients in the Emergency Department were randomized into the intervention group to receive lidocaine 1% 1 mL subcutaneously or the control group (to receive no local anesthesia) prior to radial artery puncture for blood gas sampling. Pain was rated on a 10 cm visual analogue scale and procedural variables collected for between group analyses. RESULTS: Overall, 41 participants were included. Subcutaneously injected lidocaine anesthesia did not reduce the median pain of radial artery puncture (control 1.8 vs. intervention 1.6 cm, P = 0.938). Those patients who had other systemically acting analgesia appeared to report reduced pain for radial artery puncture (0.60 vs. 2.30 cm, P = 0.105) as did those where a smaller 25-gauge needle was used compared to the standard 22-gauge (1.40 vs. 4.35 cm, P = 0.150), although these were not statistically significant. Anxious patients and those requesting local anesthesia experienced relatively higher levels of pain. CONCLUSION: Local anesthesia did not reduce the perceived pain of radial artery puncture.