Good nursing care is a key factor in reducing the most common complications related to immobility like pressure ulcers (PU), deep vein thrombosis (DVT) in spinal cord injury (SCI) patients. ...
The ICU team created a standard “Progressive Early Mobility Program” for their patients. The expectation was set - this would be the norm for all appropriate patients.
INTRODUCTION
A major limitation in improving patient care has been the shortage of staff nurses. In the control phase
staff patient ratio was 1:3 , 1:4 which affected the delivery of quality care nursing, affecting the patient
outcome in terms of infection and mortality rate.
It is hypothesized that sudden influx of inexperienced nurses may be detrimental for patient care in the
short term especially in absence of structured training & mentorship program in place.
AIMS AND OBJECTIVES
To assess the effect of new joinees as staff nurses on patient care in neurosurgery ICU using infection
rate and mortality rate as the surrogate markers for nursing care.
MATERIALS AND METHODS
In this retro-prospective study in neurosurgery ICU over 6 months( Oct 2010- Mar 2011), the infection
rates (using blood, tracheal & urine culture reports) were calculated for a group of patients.
RESULT
Hospital Mortality Rate and Gross Infection Rates in terms of tracheal, urine and blood cultures were
assessed . severity of head injury was also assessed as it can act as a ditermental factor affecting
Hospital mortality rate in control phase 18%, in training phase 16.4 % and final phase 15.3%
Gross infection rates: tracheal culture incidence in control phase 62.3%, traning phase 59.3%, final phase
22.3% . in terms of urine culture incidence control phase 48.9%, training phase 34.2%, final phase 12.6%
and for blood culture it was 24.9% in control phase, 14.5% in training phase and 4.2 in final phase.
CONCLUSION
•
There is significant decrease in mortality following introduction of 1:1 nursing in neurosurgery
ICU.
•
The severity of head injury was approximately in the same range of all the phases hence it has
no significant role to play in the reduction of mortality rate.
•
Blood infection rate (4.25), tracheal infection rate (22.3%) & urine infection rate (12.6%) in the
final phase were significantly lower (p<0.001) than the preceding two phases
Structured programs and mentorship plays a vital role in improving the nursing practices .
•
Good nursing care is a key factor in reducing the most common complications related to immobility like pressure ulcers (PU), deep vein thrombosis (DVT) in spinal cord injury (SCI) patients. ...
The ICU team created a standard “Progressive Early Mobility Program” for their patients. The expectation was set - this would be the norm for all appropriate patients.
INTRODUCTION
A major limitation in improving patient care has been the shortage of staff nurses. In the control phase
staff patient ratio was 1:3 , 1:4 which affected the delivery of quality care nursing, affecting the patient
outcome in terms of infection and mortality rate.
It is hypothesized that sudden influx of inexperienced nurses may be detrimental for patient care in the
short term especially in absence of structured training & mentorship program in place.
AIMS AND OBJECTIVES
To assess the effect of new joinees as staff nurses on patient care in neurosurgery ICU using infection
rate and mortality rate as the surrogate markers for nursing care.
MATERIALS AND METHODS
In this retro-prospective study in neurosurgery ICU over 6 months( Oct 2010- Mar 2011), the infection
rates (using blood, tracheal & urine culture reports) were calculated for a group of patients.
RESULT
Hospital Mortality Rate and Gross Infection Rates in terms of tracheal, urine and blood cultures were
assessed . severity of head injury was also assessed as it can act as a ditermental factor affecting
Hospital mortality rate in control phase 18%, in training phase 16.4 % and final phase 15.3%
Gross infection rates: tracheal culture incidence in control phase 62.3%, traning phase 59.3%, final phase
22.3% . in terms of urine culture incidence control phase 48.9%, training phase 34.2%, final phase 12.6%
and for blood culture it was 24.9% in control phase, 14.5% in training phase and 4.2 in final phase.
CONCLUSION
•
There is significant decrease in mortality following introduction of 1:1 nursing in neurosurgery
ICU.
•
The severity of head injury was approximately in the same range of all the phases hence it has
no significant role to play in the reduction of mortality rate.
•
Blood infection rate (4.25), tracheal infection rate (22.3%) & urine infection rate (12.6%) in the
final phase were significantly lower (p<0.001) than the preceding two phases
Structured programs and mentorship plays a vital role in improving the nursing practices .
•
As humans we are prone to making mistakes and getting things wrong, which is part of our everyday nature. However, in healthcare human errors can often lead to incidents, which can be sources of inconvenience or sometimes major consequences that can directly affect our patients.
Human factors theory plays an important role in understanding how human behavior contributes to such errors, through our interaction with colleagues, equipment, systems, and the working environment. The theory forms an integral part of aviation safety and has also found its feet in other industries, including healthcare.
This presentation was presented at the Saudi Health 2014 International Nursing Conference and introduced the basic concepts of human factors theory in nursing. Case studies were used as examples to draw on the factors that contribute to issues of care, which directly affect patients. Interventions of how to address common human factors to minimize risks were also discussed.
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
This presentation was done by RUTAYISIRE François Xavier and ISHIMWE Diane, medical students at University of RWANDA School of Medicine and pharmacy, department of medicine and surgery. They did it while they were in Year 4 (Doctorate2), under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA. It tell us about what a surgical safety checklist is, and why is it important in surgical field.
Dr Brent James: quality improvement techniques at the frontlineNuffield Trust
Dr Brent James, Intermountain Institute for Healthcare Delivery Research, presents to the Health Policy Summit 2015 on delivering quality improvement techniques at the frontline.
MAN6501: Operations Management
1
MAN6501: Operations Management
Problem Set 1: Process Analysis and Improvement
Instructions:
1. The case contains all of the necessary data to complete the assignment. If you
believe critical data is missing, make an assumption. Any assumptions you make
should be reasonable and consistent with other case data.
2. As a general rule, if you have a question about the “correct” interpretation of
some aspect of the case or the assignment, you should just state your assumption
and continue to work. In fact, these statements of logic will be used in the
evaluation of your submission.
MedNOW Clinic case
The MedNOW clinic provides convenient healthcare services for a wide range of non-emergency
medical issues. The clinic is located in Cambridge in close vicinity to a large hospital and serving
a population with diverse ethnic backgrounds. Patients can walk-in or call in advance to schedule
an appointment. The clinic operates 7AM to 7 PM on weekdays, with extended opening hours
during the weekend. The clinic can do basic x-rays including chest x-ray and extremity x-rays
(such as ankle, foot, arm and leg) and also provides lab services. On average 20 patients arrive at
the clinic per hour, including walk-ins and appointments.
Registration – The registration desk is continuously staffed with one person. They call the
patient from the waiting room and create a patient record. The patient is then told to go back to
the waiting room. The registration process takes on average one minute.
Triage – The triage nurse calls the patients from the waiting room. They create a patient chart
and register the check-in time. During triage the nurse determines the priority of patients'
treatments based on the severity of their condition. The triage is staffed with one registered nurse
(RN) and the average time for triage is about 2 minutes. On average, 10% of the patients require
medical care that is not available at the clinic and need to be sent to a hospital in the vicinity of
the clinic. The other patients are told to go back to the waiting room and wait for the doctor call.
Examination – The clinic has four examination rooms and four MDs available at all time. An
assistant calls the patients into the examination rooms and help the patient prepare for the
examination. The examination time is highly dependent on the medical condition. Based on
historical records the clinic has determined the following distribution for examination time:
MAN6501: Operations Management
2
Probability 0.4 0.4 0.2
Time 2 minutes 8 minutes 10 minutes
In 50% of cases the MD completes the diagnosis, writes a prescription and the patient is ready to
discharge. The other 50% of patients require some form of diagnostic and are sent to the medical
diagnostic lab.
Medical Diagnostics – There are three areas of medical diagnostic testing each with its own staff.
Analysis ...
As humans we are prone to making mistakes and getting things wrong, which is part of our everyday nature. However, in healthcare human errors can often lead to incidents, which can be sources of inconvenience or sometimes major consequences that can directly affect our patients.
Human factors theory plays an important role in understanding how human behavior contributes to such errors, through our interaction with colleagues, equipment, systems, and the working environment. The theory forms an integral part of aviation safety and has also found its feet in other industries, including healthcare.
This presentation was presented at the Saudi Health 2014 International Nursing Conference and introduced the basic concepts of human factors theory in nursing. Case studies were used as examples to draw on the factors that contribute to issues of care, which directly affect patients. Interventions of how to address common human factors to minimize risks were also discussed.
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
This presentation was done by RUTAYISIRE François Xavier and ISHIMWE Diane, medical students at University of RWANDA School of Medicine and pharmacy, department of medicine and surgery. They did it while they were in Year 4 (Doctorate2), under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA. It tell us about what a surgical safety checklist is, and why is it important in surgical field.
Dr Brent James: quality improvement techniques at the frontlineNuffield Trust
Dr Brent James, Intermountain Institute for Healthcare Delivery Research, presents to the Health Policy Summit 2015 on delivering quality improvement techniques at the frontline.
MAN6501: Operations Management
1
MAN6501: Operations Management
Problem Set 1: Process Analysis and Improvement
Instructions:
1. The case contains all of the necessary data to complete the assignment. If you
believe critical data is missing, make an assumption. Any assumptions you make
should be reasonable and consistent with other case data.
2. As a general rule, if you have a question about the “correct” interpretation of
some aspect of the case or the assignment, you should just state your assumption
and continue to work. In fact, these statements of logic will be used in the
evaluation of your submission.
MedNOW Clinic case
The MedNOW clinic provides convenient healthcare services for a wide range of non-emergency
medical issues. The clinic is located in Cambridge in close vicinity to a large hospital and serving
a population with diverse ethnic backgrounds. Patients can walk-in or call in advance to schedule
an appointment. The clinic operates 7AM to 7 PM on weekdays, with extended opening hours
during the weekend. The clinic can do basic x-rays including chest x-ray and extremity x-rays
(such as ankle, foot, arm and leg) and also provides lab services. On average 20 patients arrive at
the clinic per hour, including walk-ins and appointments.
Registration – The registration desk is continuously staffed with one person. They call the
patient from the waiting room and create a patient record. The patient is then told to go back to
the waiting room. The registration process takes on average one minute.
Triage – The triage nurse calls the patients from the waiting room. They create a patient chart
and register the check-in time. During triage the nurse determines the priority of patients'
treatments based on the severity of their condition. The triage is staffed with one registered nurse
(RN) and the average time for triage is about 2 minutes. On average, 10% of the patients require
medical care that is not available at the clinic and need to be sent to a hospital in the vicinity of
the clinic. The other patients are told to go back to the waiting room and wait for the doctor call.
Examination – The clinic has four examination rooms and four MDs available at all time. An
assistant calls the patients into the examination rooms and help the patient prepare for the
examination. The examination time is highly dependent on the medical condition. Based on
historical records the clinic has determined the following distribution for examination time:
MAN6501: Operations Management
2
Probability 0.4 0.4 0.2
Time 2 minutes 8 minutes 10 minutes
In 50% of cases the MD completes the diagnosis, writes a prescription and the patient is ready to
discharge. The other 50% of patients require some form of diagnostic and are sent to the medical
diagnostic lab.
Medical Diagnostics – There are three areas of medical diagnostic testing each with its own staff.
Analysis ...
Use of the NEDOCS overcrowding scale in a pediatric ED. Marion Sills
Weiss SJ, Ernst AA, Johnson A, Sills MR. Use of the NEDOCS overcrowding scale in a pediatric ED. Society for Academic Emergency Medicine’s Annual Meeting, San Francisco, May 2006.
Dr. Kellie Leitch glanced at the data on wait times collected from t.pdffaxteldelhi
Dr. Kellie Leitch glanced at the data on wait times collected from the patients in one of her
clinics. As Chief of Paediatric1 Orthopaedic surgery at the Children\'s Hospital of Western
Ontario (CHWO), she was very concerned by the long times that the young patients (and their
parents) were experiencing in the daily clinic. Long wait times tended to aggravate the already
pent-up distress and concern that they were feeling, and parents were understandably irritated at
missing significant time at work. Currently, on an average, patients were spending roughly two
hours in the clinic.
Patient health was not Dr. Leitch\'s only concern. Clinical staff had increasingly complained
about being overextended, yet budgetary pressures to reduce the cost of service continued to
mount. She was not convinced that all staff was being effectively utilized, and there was an
unresolved request from the Radiology department for more advanced equipment. Dr. Leitch
also served on several government task forces. From these, she knew that federal and provincial
policymakers were increasingly concerned with the economic impact that health-care wait times
had on national economic productivity.
In a moment of weakness, Dr. Leitch recently had volunteered her clinic to hospital management
as a “test case” to demonstrate that patient care could be done in a more timely fashion, without
increasing costs. An objective of reducing wait times by 20 per cent was established to show
meaningful improvement that would be clearly evident to patients, staff and management. A
monthly executive meeting was fast approaching, and expectations were starting to run high that
Dr. Leitch would present preliminary recommendations that would offer significant reductions.
PAEDIATRIC ORTHOPAEDIC CLINIC
As part of London Health Sciences Centre, located in the city of London, Ontario, Canada,
CHWO was a large, regional health-care centre that provided specialized paediatric services to
children. The population of the 10 counties forming the primary catchment area for CHWO was
1.4 million, including approximately 400,000 children. Many of the CHWO\'s specialty services
also attracted referrals from across Ontario, as well as from neighboring provinces and states in
Canada and the United States.
The Clinic was open for three half-day sessions per week, Monday through Wednesday, from
8:30 a.m. to 1:00 p.m. During the remainder of the week, the facilities were used by other sub-
specialties of surgery. Staffed by a surgeon, two senior resident students, three clerks and four
registered nurses, the Clinic examined about 80 patients during each half-day session, of which
60 per cent were returning for a follow-up appointment (and so termed follow-up patients). In
addition to the staff noted above, other medical students might spend up to one month training in
the Clinic.
PATIENT FLOW AT THE CLINIC
Front Desk: Registration & Verification of Documents
The Registration desk was the first point of contact.
#2 Development of a traffic light alert system to improve referral processes ...
Marini_Poster
1. Time Nurses Spent outside the ICU: Impact on Patient and Staff Safety
Abdel Latif M. Marini, MSN, RN, CPHQ, CPPS
Quality Improvement Department, The Johns Hopkins Hospital
This PI study occurred on the Neuro Critical Care Unit
(NCCU) at the Johns Hopkins Bayview Medical Center.
It measured the time nurses spend during patient transportation
and escort outside the unit during Day and Night shifts.
Like all ICUs, Neurology and Neurosurgery patients admitted to the
NCCU require intensive monitoring. This particular patient
population also requires frequent imaging studies/procedures
performed outside the unit. These include frequent CAT scan and
MRI studies done all through the course of treatment.
The NCCU was an 8 bed unit staffed with 4 nurses and no patient
care technicians.
This study aims to measure the time nurses spend during patient
transportation and escort outside the NCCU during Day and Night
shift and to offer recommendations for improvement.
Objectives
Introduction
Methods
Staff in the unit participated in brainstorming session to list impact
of the safety concerns identified:
Results
Conclusion
This study shows that maintaining an open communication with
leadership and providing supporting data help drive business
decision making to foster a safer work environment. Hospital
decision maker should continue to strive freeing up nurses to do
more of patient centered care by decreasing time spent on non-
nursing tasks that can be delegated to support staff.
Fig1. I-chart- Number of Trips per 24 hours over time
Based on the findings above, there is substantial evidence that
nurses are spending lengthy time away from the NCCU patients
serving transport/escort purposes especially during day shifts.
This study results along with recommendations were
communicated with the Leadership team.
Improvement that were implemented:
1- The unit was staffed with a PCT from 3 – 11 pm (to cover both
shifts) and help with escort trips.
2- Reinforce the need to ask for Charge nurse/Resource Nurse
help during night shift.
3- None Urgent (routine) CT scans were scheduled in EPIC order-
sets to 5 am (night shift).
Safety Concerns
One Nurse
transporting/escorting
NCCU patient
Back Injury
Two Nurses
transporting/escorting
NCCU patient
Unsafe
Nurse/Patients in
the unit
Fatigue
Call Sick
↓ Staff Satisfaction
Poor Outcomes
↓ Patient Satisfaction
• Back injury and unsafe Nurse/Patient ratio were two main safety
concerns listed by the nurses.
• A systematic data collection tool was designed to capture
elements of time, number of staff, destination and census of the
unit.
• We observed a total of 51 nurses transport over 12 days of data
collection done over 24 hrs. between March 10- 22, 2015.
• Unit Secretary/Nurses were trained to fill in the data in real time.
• Duration is calculated from Time Nurse leaves the unit, until
Nurse is back.
• Statistical analysis was conducted in Minitab to analyze the
normality, and stability of the process, and take inferences of
these observations.
13121110987654321
10
5
0
Observation
IndividualValue
_
X=3.92
UCL=9.69
LCL=-1.84
13121110987654321
8
6
4
2
0
Observation
MovingRange
__
MR=2.167
UCL=7.079
LCL=0
I-MR Chart- Count of Trips (studies) per day
Day Shift Night Shift
AVG # Transport 3.1 1
Mean Time (min) / Transport 40.1 25
Table 1. Showing distribution of Trips between Day and Night Shift.
% 1 RN transporting/escorting patients in NCCU = 25 %
Nurse Safety: This poses risks on Nurses Safety, contributing to
back pain or other problems.
% 2 RN transporting/ escorting patients in NCCU = 75 %
Patient Safety: This contributes to unsafe staffing ratio and poses
risk on Patient in the NCCU as two nurses are pulled out of the
unit for transport, keeping the remaining 7 patients with 2 nurses.
It was noted that some nurses are transporting their patients to
procedures by themselves (ie. 1 RN, due to the workload on other
patients, and the inability to ask help from other nurses):
• During the night shift, the average
number of trips was 1 and the
duration ranged between [17-
33min].
Total
Variable Shift Count Mean SE Mean StDev Minimum Q1 Median Q3 Maximum
Durat. min Day 40 40.13 5.78 36.54 5.00 20.00 30.00 37.50 175.00
Night 11 25.00 3.44 11.40 15.00 15.00 20.00 35.00 45.00
Nurses spent [1 hr 30 min to 2 hr 40 min ] during
day shift outside the NCCU
Nurses spent [17 - 30 min ] during night shift
outside the NCCU
Discussion
NightDay
200
150
100
50
0
Shift
Durat.min
Boxplot of Durat. min
Outliers (duration) were seen during day shift only.
It correlates with the fact that more MRIs (lengthy procedure)
are done during day shifts.
• Result of this study showed that
the average number of trips
during day shift is 3.1, and the
duration during Day ranged
between [28-52min] (95% CI).
Fig2. Boxplot of Transport Duration in min
Table 2. Frequency of Trips according to Destination
Acknowledgment: Johns Hopkins Bayview Medical
Center, NCCU Staff, and Nursing Director Jo Deaton.