Reflections on a decade of outcomes management in women's services.

Outcomes management was theorized as a strategy for redesigning and continually enhancing interdisciplinary health care processes through the use of outcomes measurements. Regardless of the rapidly changing and oftentimes turbulent health care environment, this strategy successfully facilitated positive outcomes in one women's service for 10 years. Outcomes affected during these years included reduction in cost per case, length of stay, infant prematurity, and cesarean delivery rates.

Collaborative practice teams: from multidisciplinary to interdisciplinary.

The current competitive health care market includes consumers and payers who are demanding that providers demonstrate and validate the effectiveness of their interventions in promoting patient outcomes. Collaboration in the form of interdisciplinary teams is an effective mechanism for enhancing patient outcomes. The CPT acts as the vehicle for driving the outcomes management process. Seven skills used by CPT members enhance collaboration: clinical competence, credibility, consistency, assertiveness, structured meetings, valuing of time, and marketing of the CPT. Change is inevitable, and strategies for change will be useful in achieving the outcomes of carefully planned objectives and goals.

Linking outcomes management and practice improvement. The link between outcomes management and JCAHO functions.

Staff participating in the CABG outcomes management program continue to examine the effectiveness and efficiency of care processes and to redesign care to improve patient and organizational outcomes. In fact, this quality enhancement program is neverending as we strive continually to improve the care of CABG patients. The success, measured through improved process and outcome variables, has promoted the implementation of similar programs for other patient populations. Using foresight in the development of outcomes management programs to ensure inclusiveness of regulatory body or agency criteria encourages comprehensive programs that yield positive outcomes for both patients and organizations.

Advanced practice nurse as outcomes manager.

Outcomes management as a patient management system has been designed to impact and improve select outcomes. Central to the development and implementation of best practice senario identified throughout outcomes management is the advanced practice nurse. SLEH has been in the forefront of development and implementation of an outcomes management program. This article describes the outcomes management position and shares the job description and performance evaluation used at this institution. The tools allow for measuring and quantifying the impact of the outcomes manager position on improving patient outcomes. The improvement of outcomes has increased the value of the advanced practice nurse and provided the institution with a solid future necessary for survival in a managed care market.

Ethical concerns regarding cardiac retransplantation.

Health care professionals face many ethical dilemmas regarding cardiac transplantation and retransplantation. A thorough understanding of ethical theories and careful examination of each case encourages decisions reflective of the values of the health care team.

Political and legal aspects of transplantation.

Each year, the number of people in this country waiting for life-saving transplantation grows, spurred on by increased survival rates. This article discusses the multiple factors influencing transplantation and the selection of recipients, including political, legal, and economic aspects.

Measuring success: CNS performance appraisal.

With the current focus on quality outcomes and economic issues related to health care, clinical nurse specialists (CNSs) must effectively document their unique contributions that enhance the realization of organizational missions. This paper examines an outcome-oriented performance appraisal tool designed to quantify CNS services. Eleven performance criteria with performance behaviors were negotiated by CNSs and their respective supervisors based on job descriptions and organizational goals. A quantitative scoring system was then developed based on specific performance behaviors. This method of objective outcome based evaluation has not only substantiated the CNS's value but also has enhanced collaboration between CNSs and administrators.

TCI left ventricular assist device: nursing implications.

The use of left ventricular devices as a bridge to transplantation has gained considerable acceptance in transplant centers nationwide. A new, innovative assist device that allows for greater patient mobility with a decreased incidence of patient complications is now being used at St. Luke's Episcopal Hospital to support the potential transplant recipient while waiting for a donor heart. The authors discuss the pathophysiology related to this type of assist device, along with two case studies and the nursing diagnoses indicated for patients using this unique device as a bridge to transplant.

Crossword puzzle: renal transplantation.

Nurses working with renal transplant patients must have expertise in not only nephrology but also in immunology. The transplant patient is at great risk for rejection and infection directly related to the body's natural immune responses and immunosuppressant drug therapies. Continuing education for nurses who work with this challenging patient population is important. This crossword puzzle serves as a motivational tool for staff and is indicative of the broad knowledge base that transplant nurses must possess.