Frequency and costs of hospital transfers for ambulatory care-sensitive conditions.

OBJECTIVES: Nursing home (NH) patients are frequently transferred to emergency departments (EDs) and/or hospitalized in situations in which transfer might have been avoided. This study describes the frequency of NH transfers for ambulatory care-sensitive conditions (ACSCs) and estimates associated expenditures. STUDY DESIGN: Retrospective cohort study of 62,379 NH patients with Medicare coverage receiving care in South Carolina between 2007 and 2009. METHODS: Subjects were analyzed to determine the frequency of acute ED or hospital care for conditions. Comparison is made to similar patients transferred for acute treatment of non-ACSCs. Generalized linear models were used to estimate the costs attributable to treating ACSCs. RESULTS: Over 3 years, 20,867 NH subjects were transferred from NHs to acute care facilities, and 85.3% of subjects had at least 1 episode of care for an ACSC. An average of 13,317 subjects per year were transferred for an average of 17,060 episodes of ED or hospital care per year between 2007 and 2009. More ACSC patients transferred to EDs were subsequently admitted to the hospital (50.4% vs 25%; P < .0001). In adjusted analyses, mean ED costs per episode of care ($401 vs $294; P < .0001) were higher, but mean hospitalization costs per episode of care were lower ($8356 vs $10,226; P < .0001) for ACSC patients compared with non-ACSC patients. CONCLUSIONS: A significant proportion of Medicare NH patients are treated acutely for ACSCs, which are associated with higher healthcare utilization and costs. Better access to onsite evaluation might enable significant cost savings and reduce morbidity in this population.

Three nursing interventions' impact on HCAHPS scores.

Staff on a 28-bed surgical unit in a suburban 461-bed medical center implemented 3 interventions to improve patient satisfaction. This quality improvement study investigated the effects of nurse manager rounding, postdischarge phone follow-up, and improved discharge teaching skills on patients' ratings of their care. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey scores demonstrated a steady upward trend over 18 months following implementation of the changes.

Compassion satisfaction, burnout, and compassion fatigue among emergency nurses compared with nurses in other selected inpatient specialties.

INTRODUCTION: Today the proportion of acute patients entering the health care system through emergency departments continues to grow, the number of uninsured patients relying primarily on treatment in the emergency department is increasing, and patients' average acuities are rising. At the same time, support resources are constrained, while reimbursement and reputation depends increasingly on publicly available measures of patient satisfaction. It is important to understand the potential effect of these pressures on direct care staff. This study explores the prevalence of compassion satisfaction, burnout, and compassion fatigue among emergency nurses and nurses in other selected inpatient specialties. METHODS: Emergency nurses and nurses from 3 other specialty units self-selected participation in a cross-sectional survey. Participants completed a sociodemographic profile and the Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV. Scale scores were summed for compassion satisfaction, burnout, and compassion fatigue for emergency nurses and compared with those of nurses in other specialties. RESULTS: Approximately 82% of emergency nurses had moderate to high levels of burnout, and nearly 86% had moderate to high levels of compassion fatigue. Differences between emergency nurses and those working in 3 other specialty areas, that is, oncology, nephrology, and intensive care, on the subscales for compassion satisfaction, burnout, or compassion fatigue did not reach the level of statistical significance. However, the scores of emergency nurses evidenced a risk for less compassion satisfaction, while intensive care nurses demonstrated a higher risk for burnout and oncology nurses reflected a risk for higher compassion fatigue. DISCUSSION: ED nurse managers, along with other nurse leaders, are faced with the competing demands of managing the satisfaction of patients, recruitment and retention of experienced nurses, and provision of quality and safe care customized to patients' needs and preferences. Understanding the concepts of compassion satisfaction, burnout, and compassion fatigue, recognizing the signs and symptoms, and identifying best practice interventions, will help nurses maintain caring attitudes with patients and contribute to patient satisfaction.

Implementing and measuring the impact of patient navigation at a comprehensive community cancer center.

PURPOSE/OBJECTIVES: To determine whether patient navigation in a comprehensive community cancer center affects patient and staff perceptions of patient preparation for treatment, access to care, and overall satisfaction. DESIGN: Program evaluation with patient and staff surveys. SETTING: Comprehensive community cancer center accredited by the American College of Surgeons in the southeastern United States with 1,037 analytic cases of cancer in 2007; population of the main county served is about 177,963. SAMPLE: 48 patients (28 navigator and 20 non-navigator) and 26 employees, including physicians, nurses, and other support staff. METHODS: A 10-item survey with Likert scale format was sent to a stratified sample of 100 newly diagnosed patients with cancer. A five-item survey with the same format was sent to 40 staff working with the patients. MAIN RESEARCH VARIABLE: Patient navigation. FINDINGS: Patients who received navigation services responded more positively to survey statements. Statistical significance (p > 0.05) was identified in 7 of 10 statements when patient groups were compared. Provider responses indicated agreement with all five statements included in the survey. CONCLUSIONS: Patients with cancer and oncology staff reported that patient navigation is effective in increasing patient satisfaction and decreasing barriers to care. IMPLICATIONS FOR NURSING: Patient navigation is an emerging trend in cancer care. Patient navigators can play a significant role in assisting patients with coordinating services across the continuum of care. Continued research is essential in refining the role and eminence of patient navigators.

Perioperative workflow: barriers to efficiency, risks, and satisfaction.

An in-depth, interdisciplinary case study was conducted to map and describe the information, material, and functional processes common to high-volume surgical specialty procedures at a southeastern US hospital. Researchers identified process defects and their effects using both observation and staff member interviews. Outdated information and structural barriers to communications were responsible for many procedural delays, procedural interruptions, and staff member work-arounds. Opportunities for improvement are identified, including redesigns and enhancement of information technology systems.