Julie Grunawalt

Task-specific resistance training to improve the ability of activities of daily living-impaired older adults to rise from a bed and from a chair.

OBJECTIVES: To determine the effect of a 12‐week intervention to improve the ability of disabled older adults to rise from a bed and from a chair.

Self-Reported Walking Ability Predicts Functional Mobility Performance in Frail Older Adults

OBJECTIVE: To determine how self‐reported physical function relates to performance in each of three mobility domains: walking, stance maintenance, and rising from chairs.

Chair and Bed Rise Performance in ADL‐Impaired Congregate Housing Residents

OBJECTIVES: To examine the ability of activity of daily living (ADL)‐impaired older adults to successfully rise, and, when successful, the time taken to rise, from a bed and chair under varying rise task demands.

Effects of an Educational Program and a Standardized Insulin Order Form on Glycemic Outcomes in Non-Critically Ill Hospitalized Patients

BACKGROUND The optimal approach to managing hyperglycemia in noncritically ill hospital patients is unclear. OBJECTIVE To investigate the effects of targeted quality improvement interventions on insulin prescribing and glycemic control. DESIGN A cohort study comparing an intervention group (IG) to a concurrent control group (CCG) and an historic control group (HCG). SETTING University of Michigan Hospital. PATIENTS Hyperglycemic, noncritically ill hospital patients treated with insulin. INTERVENTION Physician and nurse education and a standardized insulin order form based on the principles of physiologic insulin use. MEASUREMENTS Glycemic control and insulin prescribing patterns. RESULTS Patients in the IG were more likely to be treated with a combination of scheduled basal and nutritional insulin than in the other groups. In the final adjusted regression model, patients in the IG were more likely to be in the target glucose range (odds ratio [OR], 1.72; P = 0.01) and less likely to be severely hyperglycemic (OR, 0.65; P < 0.01) when compared to those in the CCG. Patients in the IG were also less likely to experience hypoglycemia than those in the CCG (P = 0.06) or the HCG (P = 0.01). Over 80% of all patient-days for all groups contained glucose readings outside of the target range. CONCLUSIONS Standardized interventions encouraging the physiologic use of subcutaneous insulin can lead to significant improvements in glycemic control and patient safety in hospitalized patients. However, the observed improvements are modest, and poor metabolic control remains common, despite these interventions. Additional research is needed to determine the best strategy for safely achieving metabolic control in these patients.

A mobility program for an inpatient acute care medical unit.

OverviewFor many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

Leadership at the front line: a clinical partnership model on general care inpatient units.

Hospitals strive to provide all their patients with quality care that is safe, timely, efficient, equitable, effective, and patient centered. Although hospitals have developed technology- and industry-based quality improvement models, there remains a need to better engage the frontline health care workers at the site of care to enhance communication and coordination of care. To foster the work environment and relationships in the general acute care units, the authors describe a leadership model that partners a nurse manager with a physician director to build a local clinical care environment that seeks to enhance the whole patient care experience.

Pod nursing on a medical/surgical unit: Implementation and outcomes evaluation

A medical/surgical unit at the University of Michigan Health System implemented a pod nursing model of care to improve efficiency and patient and staff satisfaction. One centralized station was replaced with 4 satellites and supplies were relocated next to patient rooms. Patients were assigned to 2 nurses who worked as partners. Three patient (satisfaction, call lights, and falls) and nurse (satisfaction and overtime) outcomes improved after implementation. Efforts should be focused on addressing patient acuity imbalances across assignments and strengthening communication among the healthcare team. Studies are needed to test the model in larger and more diverse settings.