Decreasing Hospital Readmissions Utilizing an Evidence-Based COPD Care Bundle.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a chronic condition that leads to significant morbidity and mortality. Management of COPD hospitalizations utilizing an evidence-based care bundle can provide consistent quality of care and may reduce readmissions. METHODS: This single-center retrospective cohort study evaluated readmission rates in patients hospitalized with a COPD exacerbation. Patients in the pre-intervention cohort received usual care, while patients in the post-intervention cohort received an innovative inpatient COPD care bundle. The bundle focused on optimizing care in five areas: consults, inpatient interventions, education, transitions of care, and after discharge care. RESULTS: In this study, 149 subjects were included in the pre-intervention cohort and 214 subjects were included in the post-intervention cohort. Thirty-day readmission rates were lower in the post-intervention cohort compared to the pre-intervention cohort, 22.4% vs. 38.3% (p = 0.001). A reduction in 60-day and 90-day readmission rates was also observed, 13.7% vs. 40.3% (p < 0.001) and 10.1% vs. 32.2% (p < 0.001), respectively. CONCLUSION: Bundled care is an effective and inexpensive method for institutions to provide consistent and quality care. The findings of this study demonstrate that the implementation of a COPD care bundle is an effective strategy to decrease hospital readmissions.

Staffing Utilization and Fall Prevention With an Electronic Surveillance Video System: A Randomized Controlled Study.

BACKGROUND: There is limited research addressing how to optimize both staffing and patient outcomes with the use of technology to reduce falls during hospitalization. PURPOSE: We compared the effects of 2 staffing patterns in conjunction with the use of an electronic surveillance system on patient falls on an inpatient medical unit. METHODS: Study participants were randomized to receive electronic surveillance system monitoring with a dedicated rounder or electronic surveillance system without a dedicated rounder. Falls during the study period were analyzed. RESULTS: Of 1032 patients, there were 8 falls during the 3-month study. Six falls occurred in the intervention group, with no rounder, and 2 occurred in the group with a dedicated rounder. The data showed no statistical significance but had clinical implications. CONCLUSION: In response to our findings, the dedicated rounder will function as a mobility technician, providing support to our nursing staff and a resource for fall risk patients.

Reducing foley catheter device days in an intensive care unit: using the evidence to change practice.

The prolonged use of indwelling urinary catheters can lead to many complications, the most prevalent being urinary tract infections. These hospital-acquired infections can increase hospital costs, length of stay, and mortality rates. Evidence-based guidelines for the prevention of urinary tract infections are compared and discussed. Minimizing indwelling urinary catheter use is well-recognized in the literature to reduce the risk of these infections. To decrease the incidence of catheter-associated urinary tract infections, the staff of a 22-bed, mixed medical, surgical, and trauma intensive care unit focused on reducing the number of foley catheter device days. A multidisciplinary team was convened to create an evidence-based plan. Staff nurses were engaged in the development and implementation of the plan. Criteria-based foley catheter guidelines, a decision-making algorithm, and a daily checklist were implemented that led to a significant reduction in foley catheter device days and a decrease in catheter-associated urinary tract infections.