Jessica Castner

A leadership challenge: staff nurse perceptions after an organizational TeamSTEPPS initiative.

The purpose of this study was to measure RNs’ perceptions of teamwork skills and behaviors in their work environment during a multiphase multisite nursing organizational teamwork development initiative. Teamwork is essential for patient safety in healthcare organizations and nursing teams. Organizational development supporting effective teamwork should include a just culture, engaged leadership, and teamwork training. A cross-sectional survey study of bedside RNs was conducted in one 5-hospital healthcare system after a TeamSTEPPS teamwork training initiative. TeamSTEPPS teamwork training related to improved RN perceptions of leadership. Initiatives to align the perspectives and teamwork efforts of leaders and bedside nurses are indicated and should involve charge nurses in the design.

Emergency Department triage: what data are nurses collecting?

The electronic medical record (EMR) adds a new dimension to data collection and documentation of triage decisions. The EMR allows system administrators and designers to require that specific data be collected by the clinician before advancing through the patient care chart. The dynamic nature of triage may be conceptualized as a rapid sorting of patients into acuity categories or as a gateway to hospital-wide inpatient and outpatient care, creating conflicting clinical priorities in data collection and EMR requirements. These conflicting priorities present a challenge to the determination of a standardized data set and the creation of an EMR template. Triage, as a concept, has been well documented in the literature. Several triage algorithms havebeen studied worldwide to standardize the acuity ratings within triage. 1-4 The Emergency Severity Index (ESI), a common 5-level algorithm to determine triage acuity in the United States, is a valid and reliable triage tool. 5 The American Academy of Emergency Medicine recommends the adoption of ESI to improve the safety and flow of overcrowded emergency departments. 6 However, the ESI authors claim that the

Frequent Emergency Department Utilization and Behavioral Health Diagnoses

BackgroundThere are 12 million emergency department (ED) visits each year related to behavioral health diagnoses. Frequent ED utilization among subpopulations, such as those with behavioral health diagnoses, flags the need for more accessible and effective healthcare delivery systems. Reducing frequent ED use is essential to controlling healthcare cost and poor outcomes of ED overcrowding. ObjectivesThe purpose of this study is to stratify individuals by overall health complexity and examine the relationship of behavioral health diagnoses (psychiatric and substance abuse) as well as frequent treat-and-release ED utilization in a cohort of Medicaid recipients. MethodsThis study was a retrospective analysis of 2009 Medicaid claims from two Western New York State counties. The claims represented 56,491 individuals (18–64 years old). Individuals were stratified into four separate cohorts for analysis based on underlying disease complexity. Data were analyzed using logistic regression models. ResultsThe following factors significantly increased the odds of frequent treat-and-release ED use in all the four complexity cohorts: psychiatric diagnosis (ORs = 1.4–2.3), substance abuse (ORs = 2.4–3.8), and smoking (ORs = 1.7–4.0). Medicaid patients with behavioral health diagnoses show high risk of frequent treat-and-release ED use. DiscussionThe results of this study show that psychiatric diagnosis, substance abuse, and smoking are associated with increased odds of frequent treat-and-release ED utilization for Medicaid recipients in all categories of underlying disease complexity. Our findings support associations reported in the literature.

Multi-level model of missed nursing care in the context of hospital merger.

The aim of this study was to delineate the multi-level relationships of individual registered nurse (RN) and nursing unit factors on missed nursing care. This was a quantitative model-building study using a descriptive, cross-sectional design. Surveys (N = 553) and administrative unit records from nurses in one hospital system undergoing merger were included. The results showed that 36% of the variation in missed nursing care is due to the unit context, with a corresponding 64% due to individual nurse differences. At the unit level, workload, skill mix, and critical unit type affected the amount of missed nursing care. At the individual nurse level, more experience, supplies problems, communication problems, and involvement in errors of commission all increased the perception of the amount of missed nursing care. Education level was not related to the amount of missed nursing care. The findings highlight the importance of unit- and individual-level interventions to redesign hospital nursing care.

The Air Quality Health Index and Emergency Department Visits for Otitis Media

PURPOSE The purpose of this study was to explore novel multipollutant exposure assessments using the Air Quality Health Index in relation to emergency department visits for otitis media (OM). DESIGN This study was a retrospective analysis using information from emergency department visits for OM, air pollution, and weather databases. METHODS For children 3 years of age or younger, there were 4,815 emergency department visits for OM over a 6-year period across hospitals in Windsor, Ontario, Canada. Both time-stratified case-crossover and nonlinear time series distributed lag analyses were applied to investigate the association between the Air Quality Health Index and visits for OM. FINDINGS Using case-crossover analysis, there was an increase in emergency department visits with OM diagnoses 6 to 7 days postexposure to increased ozone and 3 to 4 days after exposure to increased particulate matter. For every 1 unit increase in the Air Quality Health Index, discharge diagnosis of OM increased 5% to 6% three days postexposure. Effects were stronger using the nonlinear time series analysis. The overall risk for OM, in the first 15 days after an increase in the Air Quality Health Index, was 1.22 times the risk of OM on days following no increase in exposures. CONCLUSIONS These findings confirm that there is an association between the multipollutant Air Quality Health Index and emergency department visits for OM. The findings can be used to inform risk communication, patient education, and policy. CLINICAL RELEVANCE Clinicians can use the Air Quality Health Index as an education and advocacy tool to promote and protect the health of those at high risk for OM to reduce exposures.

Air pollution and emergency department visits for conjunctivitis: A case-crossover study.

OBJECTIVES The purpose of this study was to examine the associations between emergency department (ED) visits for conjunctivitis and ambient air pollution levels in urban regions across the province of Ontario, Canada. MATERIAL AND METHODS Information from the National Ambulatory Care Reporting System was used to create time-series records, for the period of April 2004 to December 2011, on emergency department visits of patients suffering from conjunctivitis. A total of 77 439 emergency department visits for conjunctivitis were analyzed. A time-stratified case-crossover design was applied, completed with meta-analysis in order to pool inter-city results. Odds ratio (OR) for an emergency department visit was calculated in different population strata per one-unit increase (one interquartile range - IQR increase in a pollutants daily level) while controlling for the impacts of temperature and relative humidity. RESULTS Statistically significant positive results were observed in the female population sample, for nitrogen dioxide (NO2) exposure lagged 5-8 days, with the highest result for the 7-day lag (OR = 1.035, 95% CI: 1.018-1.052) and for fine particulate matter with a median aerodynamic diameter of less than 2.5 μm (PM2.5), for lags 6 and 7 days, with the highest result for lag 7 (OR = 1.017, 95% CI: 1.003-1.031). In the male population sample, statistically significant positive results were observed for NO2; at lag 5 days (OR = 1.024, 95% CI: 1.004-1.045) and for ozone (O3), at lags 0-3 and 7 days, with the highest result for lag 0 (OR = 1.038, 95% CI: 1.012-1.056). Also for males, statistically significant results were observed in the case of PM2.5 exposure lagged by 5 days (OR = 1.003, 95% CI: 1.000-1.038) and sulfur dioxide (SO2) exposure lagged by 1 and 2 days (OR = 1.016, 95% CI: 1.000-1.031 and OR = 1.018, 95% CI: 1.002-1.033). CONCLUSIONS The findings of this study suggest that there are associations between levels of air pollution and ED visits for conjunctivitis, with different temporal trends and strength of association by age, sex, and season.

The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post-Discharge Healthcare Utilization in a Low-Income Population

Economically disadvantaged individuals with chronic disease have high rates of in-patient (IP) readmission and emergency department (ED) utilization following initial hospitalization. The purpose of this study was to explore the relationships between chronic disease complexity, health system integration (admission to accountable care organization [ACO] hospital), availability of care management interventions (membership in managed care organization [MCO]), and 90-day post-discharge healthcare utilization. We used de-identified Medicaid claims data from two counties in western New York. The study population was 114,295 individuals who met inclusion criteria, of whom 7,179 had index hospital admissions in the first 9 months of 2013. Individuals were assigned to three disease complexity segments based on presence of 12 prevalent conditions. The 30-day inpatient (IP) readmission rates ranged from 6% in the non-chronic segment to 12% in the chronic disease complexity segment and 21% in the organ system failure complexity segment. Rehospitalization rates (both inpatient and emergency department [ED]) were lower for patients in MCOs and ACOs than for those in fee-for-service care. Complexity of chronic disease, initial hospitalization in a facility that was part of an ACO, MCO membership, female gender, and longer length of stay were associated with a significantly longer time to readmission in the first 90 days, that is, fewer readmissions. Our results add to evidence that high-value post-discharge utilization (fewer IP or ED rehospitalizations and early outpatient follow-up) require population-based transitional care strategies that improve continuity between settings and take into account the illness complexity of the Medicaid population.

Air pollution and emergency department visits for respiratory diseases: A multi-city case crossover study

&NA; Increasing evidence suggests that ambient air pollution is a major risk factor for both acute and chronic respiratory disease exacerbations and emergencies. The objective of this study was to determine the association between ambient air pollutants and emergency department (ED) visits for respiratory conditions in nine districts across the province of Ontario in Canada. Health, air pollutant (PM2.5, NO2, O3, and SO2), and meteorological data were retrieved from April 2004 to December 2011. Respiratory diseases were categorized as: chronic obstructive pulmonary disease (COPD, including bronchiectasis) and acute upper respiratory diseases. A case‐crossover design was used to test the associations between ED visits and ambient air pollutants, stratified by sex and season. For COPD among males, positive results were observed for NO2 with lags of 3–6 days, for PM2.5 with lags 1–8, and for SO2 with lags of 4–8 days. For COPD among females, positive results were observed for O3 with lags 2–4 days, and for SO2 among lags of 3–6 days. For upper respiratory disease emergencies among males, positive results were observed for NO2 (lags 5–8 days), for O3, (lags 0–6 days), PM2.5 (all lags), and SO2 (lag 8), and among females, positive results were observed for NO2 for lag 8 days, for O3, PM2.5 among all lags. Our study provides evidence of the associations between short‐term exposure to air pollution and increased risk of ED visits for upper and lower respiratory diseases in an environment where air pollutant concentrations are relatively low. HighlightsExtensive research exists on the effects of ambient air pollution on respiratory diseases.Emergency department visits for respiratory diseases increase after days with higher concentrations of air pollution.Ambient pollution, even at low concentrations, appear to adversely affect the respiratory system.

Nursing teams: behind the charts

AIMS To examine the nature and characteristics of both received and provided mutual support in a social network within an acute care hospital unit. BACKGROUND Current evidence regarding the social network in the health care workforce reveals the nature of social ties. Most studies of social network-related support that measured the characteristics of social support used self-reported perception from workers receiving support. There is a gap in studies that focus on back-up behaviour. METHODS The evaluation included a social network analysis of a nursing unit employing 54 staff members. A 12 item electronic survey was administered. Descriptive statistics were calculated using the Statistical Package for the Social Sciences. Social network analyses were carried out using ucinet, r 3.2.3 and gephi. RESULTS Based on the study findings, as providers of mutual support the nursing staff claimed to give their peers more help than these peers gave them credit for. Those who worked overtime provided more mutual support. CONCLUSION Mutual support is a key teamwork characteristic, essential to quality and safety in hospital nursing teams that can be evaluated using social network analysis. IMPLICATIONS FOR NURSING MANAGEMENT Because of a discrepancy regarding receiving and providing help, examining both receiver and provider networks is a superior approach to understanding mutual support.

A Review of Worldwide Patents: Innovations in Peak Flow Meters for Asthma.

BackgroundContemporary healthcare nurses increasingly rely on innovative technology for assessment, treatment, and patient self-management. Funding opportunities as well are increasingly steering toward technology development and innovation. Health researchers, including nursing scientists, who are engaged in medical device innovation need to assess the state of the art of current technology. This requires an intellectual property analysis, or patent search, which is not covered by the types of literature reviews customarily used in health science research. PurposeThe purposes of this article are to illustrate a methodical review of worldwide patents and to show how those results can be used to identify possible products available for use. ApproachAn application of peak flow meters for use by patients with asthma is used to illustrate the process. The Derwent Innovations Index interface with keyword searching is illustrated, as is the use of Google Patents. From the 14 patent document results, six possible technologies were identified. The patent search revealed innovations in asthma peak flow meters for use in future research and identified future directions for device development. DiscussionThese results support the claim that patent literature must be included in reviews that seek to identify technology state-of-the-art healthcare applications and that advances in the nursing research paradigm should include patents as background and scholarly products.