The need to be more efficient: lessons learned from a department of nursing reorganization.

The Department of Nursing at General Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri, recently reorganized to improve efficiency. Evening, night, and weekend supervisors were eliminated and a new "crisis nurse" role was established. Excess inpatient resources were shifted to outpatient clinics. The process of planning and implementing the reorganization is described. Evaluation was accomplished by reviewing objective criteria as well as outcomes of crisis nurse and middle management seminars and a comprehensive staff survey. The reorganization did not appear to adversely affect quality of patient care, but lessons were learned regarding staff morale, departmental communication patterns, clarification of newly established roles, and participation of middle managers in planning and decision making.

Assessing hypertension control in the community: the need for follow-up measurements to ensure clinical relevance.

In community surveys of hypertension control the diagnosis is often based on blood pressure measurements taken on only one visit. The clinical diagnosis of hypertension requires demonstration of sustained blood pressure elevation. We conducted a survey that contrasted the results of these two approaches to determining the prevalence of hypertension and the extent to which hypertension is detected and treated. A multistage random sample of 2737 people was selected, examined and interviewed on up to three occasions. Rates of hypertension prevalence and control were computed from data from one, two and three visits. The prevalence of hypertension was overestimated by 30% when the diagnosis was based on data from one rather than three visits, the rates being 149 and 115/1000. The prevalence of undetected hypertension was overestimated by 350%, the rates being 27 and 6/1000. The proportion of subjects with controlled hypertension was underestimated by 23%, at 56%, compared with 73%. These results confirm the need for follow-up measurements to provide a valid assessment of hypertension control in the community.