ABSTRACT
Evaluation and management of abnormal uterine bleeding (AUB) are possible in the office. Approaching AUB evaluation from an etiology-based perspective allows the gynecologist to focus evaluation efforts on the most probable causes of AUB for a particular patient and therefore customize the management accordingly. Developing skills with imaging such as transvaginal ultrasound, saline infusion sonography, and diagnostic hysteroscopy are important for AUB etiology diagnosis. Operative hysteroscopy experience can be developed for AUB management in the office and endometrial ablation provides a minimally invasive solution for some patients.
Subject(s)
Ambulatory Care/methods , Uterine Hemorrhage/diagnosis , Uterine Hemorrhage/therapy , Endometrial Ablation Techniques/methods , Female , Humans , Hysteroscopy/methods , Ultrasonography/methods , Vagina/diagnostic imagingABSTRACT
Value is defined as outcomes/cost of care [1]. Although nurses contribute significantly within the interdisciplinary care team, we struggle to measure the value of nursing care or the added value of each nurse caring for a patient. This presentation reveals findings of the Nursing Value Workgroup (Workgroup), a multi-year component of the Big Data and Nursing Knowledge Initiative [2]. Panelists will discuss: Construction of a common model to provide a basis for developing nursing business intelligence and analytics; development and publication of definitions and metrics for nursing value; creation of user stories to measure nurse sensitive phenomena; and establishment of a data warehouse to facilitate research. Initial findings from a multi-hospital study on pain management and value of care will be presented.
Subject(s)
Models, Nursing , Nursing Care/standards , Empathy , Humans , Outcome Assessment, Health CareABSTRACT
OBJECTIVE: This study was designed to describe variable acuity among 1 population of acute care patients. BACKGROUND: Acuity, defined as the individual patient need for nursing care, can inform level of care, nurse staffing, and the nurse-to-patient assignment. Nurse-generated data in the electronic health record can be mined and analyzed for decision support. METHODS: This study used a descriptive, retrospective analysis of repeated measures of acuity generated from 28 739 nursing assessments of 405 consecutive subjects treated for heart failure (HF) in a 455-bed southern hospital. RESULTS: Patients treated for HF have variable care needs throughout the course of treatment. Univariate analysis of variance and post hoc analysis found that gender, age, type of unit, and length of stay (LOS) had a significant impact on acuity, P < .01, with a very small effect of less than 1%, indicating that acuity should be measured instead of assumed. Patients in medical-surgical and step-down units had highly variable acuity, ranging from ready to discharge to acuity levels consistent with critical care. Across the LOS, the mean acuity stabilized at 12 hours after admission, decreased until 88 hours, then increased steadily through discharge. CONCLUSIONS: Understanding the variability in acuity within an individual patient, or a specific patient population, will contribute to decision support levels of patient care, staffing, nurse-patient assignments, and the cost of care. Frequent, sequential, and real-time measures of acuity may be valuable for tracking patient progress or measuring response to nursing interventions.
Subject(s)
Length of Stay/statistics & numerical data , Nurse-Patient Relations , Nursing Staff, Hospital/organization & administration , Patient Acuity , Personnel Staffing and Scheduling/statistics & numerical data , Critical Care/organization & administration , Female , Humans , Male , Outcome Assessment, Health Care , Retrospective StudiesABSTRACT
Essure hysteroscopic sterilization is an effective permanent contraception option for women, with a 99.83% effectiveness rate. To date, more than 600,000 Essure procedures have been performed worldwide. This case report describes bilateral Essure insert placement, after which the left insert was subsequently expelled after hysterosalpingogram (HSG)-confirmed correct bilateral insert placement and bilateral tubal occlusion. Although insert expulsion has been reported before a 3-month post-procedure HSG, this is the first published report of expulsion after a confirmatory 3-month post-procedure HSG. Because there now exists documentation of Essure insert expulsion after a 3-month confirmatory HSG, physicians and patients should be informed of this rare occurrence. Further investigation into the causes of such an event is warranted.
