Low-to-Moderate Risk Transient Ischemic Attack Patients Can Be Safely Discharged From the Emergency Department to a Nurse Practitioner-Led Clinic.

ABSTRACT: BACKGROUND: Unnecessary admissions fuel rising healthcare costs and take away resources from higher acuity patients without evidence of increased safety. The purpose of this quality improvement project was to determine whether the care diversion for transient ischemic attack (TIA), from inpatient to a nurse practitioner (NP)-led specialty clinic, resulted in no increase in stroke incidence at 90 days. METHODS: The sample included all adults presenting to the emergency department with TIA at a low-to-moderate risk for stroke. Risks were defined by the ABCD 2 score and noninvasive vessel imaging. Patients who met the criteria were discharged and evaluated by a stroke NP at the TIA clinic within 7 days. These patients were compared with those who were admitted before clinic launch. Medical record reviews were conducted to determine stroke incidence at 90 days post TIA. Descriptive statistics were used to evaluate clinical variables, and Fisher exact test was used to assess difference in stroke rates. Patient satisfaction score was collected using the existing institutional survey. RESULTS: Eighty-one participants were included, 40 in the clinic group and 41 in the admission group. The mean ages in the clinic and admission groups were 72.8 and 75.2 years, respectively ( P = .37). Women comprised 45% of patients in the clinic group, compared with 51.2% in the admission group ( P = .58). The mean ABCD 2 scores were 4.08 and 3.95 in the clinic and admission groups, respectively ( P = .63). The median clinic follow-up time was 6 days. There was no stroke incidence in the clinic group and 1 in the admission group within 90 days post TIA. Patient satisfaction score metrics for the NP exceeded the institutional benchmark of 90%. CONCLUSION: Referral to an NP-led clinic in patients with low- to moderate-risk TIA was equally safe as hospital admission.

Engagement in Nursing: One Organization's Success.

Engagement in health care has gained in importance over time. It has become increasingly important in the work that nurses do to optimize patient involvement in the management of their health care activities. Nurse leaders are being called upon to build and sustain cultures of engagement for their employees and ultimately for patients. The purpose of this article is to share an engagement process that has proven successful at a community-based academic medical center that has received Magnet designation. While engagement remains a multifaceted process for all parties involved and requires a constant focus, the authors have focused on 3 key areas to increase registered nurse engagement. These areas include professional development, autonomy, and leadership access. Each area is addressed with specific strategies that were utilized to achieve success.

A model for bridging the gap: from theory to practice to reality.

A successful future for the nursing profession requires leaders who are willing and able to lead. The Graduate Nursing Administration Program at UCLA has developed a program to prepare these future leaders. Based on the leadership model of James Kouzes and Barry Posner, this program includes the 5 practices of exemplary leadership: Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act, and Encourage the Heart.

An educational project to improve knowledge related to pulse oximetry.

BACKGROUND: Pulse oximetry is a frequently used, noninvasive monitoring tool for assessing arterial blood oxygenation. Physicians, registered nurses, and respiratory therapists are responsible for the accurate interpretation of pulse oximetry data as part of the evaluation and management of acutely and critically ill patients. OBJECTIVES: (1) To evaluate the extent of current knowledge about pulse oximetry and (2) to increase clinicians' knowledge of research-based practices related to the appropriate use of pulse oximetry and interpretation of its results. METHODS: A test/survey of 17 true-false questions based on the research-based practice protocol of the American Association of Critical-Care Nurses was developed to evaluate current knowledge of pulse oximetry. A convenience sample of medical, nursing, and respiratory therapy staff was invited to complete the test/survey before and several months after an educational program to improve staff members' knowledge of pulse oximetry. The program included educational forums, policy changes, competency checklists, and verification of inclusion of research-based principles in orientation programs. RESULTS: A total of 442 staff members completed the test/survey given before the educational program: 331 nurses, 82 physicians, and 29 respiratory therapists. The overall mean percentage of correct answers was 66%. Differences between disciplines were significant: respiratory therapists scored slightly higher (76%) than did nurses (64%) and physicians (66%) (P = .01). The scores on the test/survey given after the educational program increased significantly, from 66% to 82% (P < .01). CONCLUSIONS: This educational project improved staff members' knowledge of pulse oximetry monitoring.

Realizing your marketing influence, Part 2: marketing from the inside out.

Do your key stakeholders (staff, physicians, and patients) consider your organization to be exceptional? Has your organization invested the resources necessary to support staff and physicians in delivering the high level of care they strive to give? An organization's managers who can enthusiastically answer "yes" to these questions are in a good position to promote its healthcare system aggressively. Managers who cannot answer affirmatively, in good conscience, must invest in creating a healthy environment for staff that is rich with the resources that will enable all employees to deliver optimal care and service. Until this is achieved, no amount of promotion will be enough to move a healthcare system to a market leadership position. This is the second in a series of three articles that moves readers from broad marketing strategy to specific applications. The first article laid the foundation for developing a market-driven strategic plan; the third will focus on using professional certification as a marketing tool.