Research and analytics in combat trauma care: converting data and experience to practical guidelines.

Throughout history, wars have resulted in medical advancements, especially in trauma. Once clinical challenges are identified, they require documentation and analysis before changes to care are introduced. The wars in Afghanistan and Iraq led to the collection of clinically relevant data from the entire medical system into a formal trauma registry. Improvements in data collection and human research oversight have allowed more effective and efficient techniques to capture and analyze trauma data, which has enabled rapid development and dissemination of clinical practice guidelines in the midst of war. These data-driven experiences are influencing trauma practice patterns in the civilian community.

Increasing testicular self-examination in active duty soldiers: an intervention study.

In this intervention study, the researchers assessed the knowledge of and health beliefs regarding testicular cancer and testicular self-examination (TSE) in active duty Army Soldiers.

The association of shift-level nurse staffing with adverse patient events.

OBJECTIVE: The objective of this study was to demonstrate the association between nurse staffing and adverse events at the shift level. BACKGROUND: Despite a growing body of research linking nurse staffing and patient outcomes, the relationship of staffing to patient falls and medication errors remains equivocal, possibly due to dependence on aggregated data. METHODS: Thirteen military hospitals participated in creating a longitudinal nursing outcomes database to monitor nurse staffing, patient falls and medication errors, and other outcomes. Unit types were analyzed separately to stratify patient and nurse staffing characteristics. Bayesian hierarchical logistic regression modeling was used to examine associations between staffing and adverse events. RESULTS: RN skill mix, total nursing care hours, and experience, measured by a proxy variable, were associated with shift-level adverse events. CONCLUSIONS: Consideration must be given to nurse staffing and experience levels on every shift.

Towards evidence-based management: creating an informative database of nursing-sensitive indicators.

PURPOSE: The purpose of this paper is to describe the creation, evolution, and implementation of a database of nursing-sensitive and potentially nursing-sensitive indicators, the Military Nursing Outcomes Database (MilNOD). It discusses data quality, utility, and lessons learned. DESIGN/METHODS: Prospective data collected each shift include direct staff hours by levels (i.e., registered nurse, other licensed and unlicensed providers), staff categories (i.e., military, civilian, contract, and reservist), patient census, acuity, and admissions, discharges, and transfers. Retrospective adverse event data (falls, medication errors, and needle-stick injuries) were collected from existing records. Annual patient satisfaction, nurse work environment, and pressure ulcer and restraint prevalence surveys were conducted. FINDINGS AND CONCLUSIONS: The MilNOD contains shift level data from 56 units in 13 military hospitals and is used to target areas for managerial and clinical performance improvement. This methodology can be modified for use in other healthcare systems. CLINICAL RELEVANCE: As standard tools for evidence-based management, databases such as MilNOD allow nurse leaders to track the status of nursing and adverse events in their facilities.

Medication error reporting and the work environment in a military setting.

This study examined nurses' reasons for medication errors, reasons for not reporting errors, and perceived unit-reporting practices. It compared nurses' anonymous reports of medication errors with those from institutional reporting mechanisms. Qualities of the work environment, staffing, and workload were evaluated to determine associations with perceived error-reporting practices. The study findings have immediate applicability as a baseline for system improvements.

Establishing a human research protection program in a combatant command.

Extensive United States combat operations commenced for the first time in over decade in 2003. Early in 2004 there was no human research protection regulatory review and approval mechanism based in a deployed military combatant command. The absence of such a system presented a critical impediment to implementation of the time-honored tradition of a robust combat casualty care research effort. A coalition of concerned military medical personnel from the US Army proposed a novel mechanism to meet Department of Defense (DOD) requirements for the human research protection oversight of studies conducted in the combat theater of operations. In 2005, the Commander of Task Force 44 Medical Command (44th MEDCOM), who was serving as the Multi-National Corps Iraq (MNC-I) Surgeon, was charged with negotiating a DOD Assurance and implementing a new system of research review and protections. He deployed an Army Medical Department Medical Corps officer to assist in this endeavor and operationalize the plan. On March 19, 2005, the Multi-National Corps Iraq Commander signed a historic agreement with the US Army Surgeon General who developed a regulatory support and oversight mechanism to conduct research in theater. This innovative system not only honored the Army's commitment to human research protections, but also provided much needed support in the form of scientific and ethical review and compliance oversight to those deployed medical personnel with the vision to conduct healthcare studies in the combat environment. On July 20, 2005, the first DOD Assurance of Compliance for the Protection of Human Research Subjects was approved for MNC-I. This assurance allows the conduct of human subjects research in full compliance with all Federal, DOD, and Army regulatory requirements. This article describes that unique process.

Indicators of nursing care quality. Findings from a pilot study.

Staffing data (staff mix and nursing care hours) and patient outcome indicator data (falls, skin integrity, nosocomial infections, and satisfaction) from a pilot study are presented. These data provide a compelling case for developing databases and collection systems that capture standardized indicator and staffing data to address issues about the quality of nursing care. They also underscore the need for establishing benchmarks that represent targets of excellence as well as determining what constitutes adequate staffing.