Factors Affecting Turnover of Advanced Practice Providers: A University Teaching Hospital Review.

GOAL: Retention of advanced practice providers (APPs) is an issue of critical importance to healthcare leaders. High APP turnover negatively affects an organization's ability to meet patient needs, maintain quality of care, and control costs. Our goal was to identify any association between intent to leave and specific survey factors; analyze the distribution of scale factors from the survey; and describe differences among the APP roles, specialties, and length of employment. METHODS: This study used a self-administered questionnaire for APPs at a large university medical center to determine job satisfaction rates and intent to resign. The survey used a modified Misener Nurse Practitioner Job Satisfaction Scale and Anticipated Turnover Scale. PRINCIPAL FINDINGS: We received surveys from 102 providers (for a 38.9% response rate). Results were used to determine the correlation between job satisfaction and intent to leave and to identify possible factors involved in APP commitment to the hospital and intent to stay. We found that APPs reported the most satisfaction in benefits, followed by time (i.e., time available for answering messages, reviewing laboratory and other test results, seeing patients, scheduling work). Intrapractice partnership/collegiality received the lowest satisfaction score. Extrinsic factors such as monetary bonuses available in addition to salary, reward distribution, involvement in research, conflict resolution, and opportunity to receive compensation for services performed outside normal duties were common dissatisfiers. PRACTICAL APPLICATIONS: This survey may help hospitals identify in real time the triggers of APP dissatisfaction and intent to resign. In addition, the results may guide possible revisions to hospital policies and practice procedures to improve APP commitment and decrease turnover intent. Additional surveys in similar university teaching hospital systems could confirm comparable intrinsic and extrinsic factors that are relevant to the satisfaction and turnover of APPs.

Carbon Dioxide Elimination After Sodium Bicarbonate Administration as a Novel Method to Assess Cardiac Output: A Pilot Study.

Introduction Cardiac output/pulmonary blood flow measurement is an important way to assess patients during the perioperative period, as well as patients who are critically ill. Current methods of assessing cardiac output have limitations. One indicator of cardiac output may be the expired carbon dioxide (CO2) partial pressure response to intravenous sodium bicarbonate (IVSB), which is rapidly converted to CO2. Methods We conducted an initial evaluation of the relationship between expired CO2 partial pressure and blood flow after a bolus of IVSB. To assess this relationship, we used a cardiopulmonary bypass circuit with predetermined blood flows in a laboratory trial and then assessed 18 patients undergoing surgery requiring cardiopulmonary bypass. Results For the laboratory portion of this pilot study, higher peak expired CO2, faster time to reach peak, higher area under the curve, and greater kurtosis of peak were observed at higher cardiac output flow rates, and higher mean expired CO2 was significantly associated with higher flow rates (p < 0.001). In the human study, higher mean (p = 0.023) and peak expired CO2 (p = 0.028) were both significantly associated with higher cardiac output flow rates. Conclusions This technique may be a way to intermittently assess cardiac output or improve accuracy when used in conjunction with other continuous output monitors.

Audiovisual Modules to Enhance Informed Consent in the ICU: A Pilot Study.

Obtaining informed consent for commonly performed ICU procedures is often compromised by variability in communication styles and inadequate verbal descriptions of anatomic concepts. The objective of this study was to evaluate the efficacy of an audiovisual module in improving the baseline knowledge of ICU procedures among patients and their caregivers. DESIGN: Prospective, observational study. SETTING: Forty-eight-bed adult surgical ICU at a tertiary care center. SUBJECTS: Critically ill surgical patients and their legally authorized representatives. INTERVENTIONS: An audiovisual module describing eight commonly performed ICU procedures. MEASUREMENTS AND MAIN RESULTS: Fifty-nine subjects were enrolled and completed an 11-question pre- and postvideo test of knowledge regarding commonly performed ICU procedures and a brief satisfaction survey. Twenty-nine percent had a healthcare background. High school was the highest level of education for 37% percent of all subjects. Out of 11 questions on the ICU procedure knowledge test, subjects scored an average 8.0 ± 1.9 correct on the pretest and 8.4 ± 2.0 correct on the posttest (p = 0.055). On univariate logistic regression, having a healthcare background was a negative predictor of improved knowledge (odds ratio, 0.185; 95% CI, 0.045-0.765), indicating that those with a health background had a lower probability of improving their score on the posttest. Among subjects who did not have a healthcare background, scores increased from 7.7 ± 1.9 to 8.3 ± 2.1 (p = 0.019). Seventy-five percent of all subjects indicated that the video was easy to understand, and 70% believed that the video improved their understanding of ICU procedures. CONCLUSIONS: Audiovisual modules may improve knowledge and comprehension of commonly performed ICU procedures among critically ill patients and caregivers who have no healthcare background.

Percutaneous mechanical devices for supporting the left ventricular failure.

This article reviews the indications, contraindications, functionality, and complications for various percutaneous devices that can be used to support the left ventricular failure. We also reviews the anesthetic effect for these devices. A literature review was performed using PubMed. When the heart experiences end-stage systolic ventricular failure, it is generally unable to restore its practical function with pharmacological therapy alone. Percutaneous ventricular support devices have been introduced and used successfully to support a failing ventricle in a variety of settings. These devices include intra-aortic balloon pump, TandemHeart, and Impeller, as well as veno-arterial extracorporeal membrane oxygenation for left ventricular support. These devices are typically accessed percutaneously through the femoral vessels and/or the jugular vein(s), although other sites are possible in unique cases.

Percutaneous mechanical devices for supporting the left ventricular failure / 中南大学学报(医学版)

This article reviews the indications,contraindications,functionality,and complications for various percutaneous devices that can be used to support the left ventricular failure.We also reviews the anesthetic effect for these devices.A literature review was performed using PubMed.When the heart experiences end-stage systolic ventricular failure,it is generally unable to restore its practical function with pharmacological therapy alone.Percutaneous ventricular support devices have been introduced and used successfully to support a failing ventricle in a variety of settings.These devices include intra-aortic balloon pump,TandemHeart,and Impeller,as well as veno-arterial extracorporeal membrane oxygenation for left ventricular support.These devices are typically accessed percutaneously through the femoral vessels and/or the jugular vein(s),although other sites are possible in unique cases.