Expanding potential of radiofrequency nurse call systems to measure nursing time in patient rooms.

OBJECTIVE: The objective of this study was to determine the utility and feasibility of using data from a nurse call system equipped with radiofrequency identification data (RFID) to measure nursing time spent in patient rooms. BACKGROUND: Increasing the amount of time nurses spend with hospitalized patients has become a focus after several studies demonstrating that nurses spend most of their time in nondirect care activities rather than delivering patient care. Measurement of nursing time spent in direct care often involves labor-intensive time and motion studies, making frequent or continuous monitoring impractical. METHODS: Mixed methods were used for this descriptive study. We used 30 days of data from an RFID nurse call system collected on 1 unit in a community hospital to examine nurses time spent in patient rooms. Descriptive statistics were applied to calculate this percentage by role and shift. Data technologists were surveyed to assess how practical the access of data would be in a hospital setting for use in monitoring nursing time spent in patient rooms. RESULTS: The system captured 7393 staff hours. Of that time, 7% did not reflect actual patient care time, so these were eliminated from further analysis. The remaining 6880 hours represented 91% of expected worked time. RNs and nursing assistants spent 33% to 36% of their time in patient rooms, presumably providing direct care. CONCLUSIONS: Radiofrequency identification data technology was found to provide feasible and accurate means for capturing and evaluating nursing time spent in patient rooms. Depending on the outcomes per unit, leaders should work with staff to maximize patient care time.

Clinical outcomes and quality of life of home health care patients.

PURPOSE: This study aimed to evaluate the quality of life (QOL) in home health care patients according to change in health status outcomes between the start of care and discharge or 60 days, whichever came first. METHODS: This is a prospective descriptive study. The convenience sample consisted of 100 home health care patients, who started receiving home health care services from a home health care agency in the United States. The World Health Organization Quality of Life Scale-Brief (WHOQOL-BREF) was used for measuring QOL; activities of daily living (ADLs) and instrumental ADLs were collected from the Outcome and Assessment Information Set data via Centers for Medicare and Medicaid Services-required home health agencies. Descriptive statistics, paired t tests, and multiple linear regressions were used for data analysis. RESULTS: ADLs and instrumental ADLs of participants significantly improved between start of care and discharge or 60 days. Overall QOL, general health, and three of four QOL domains (physical, psychological, and environmental, but not social domain) were significantly improved at discharge or 60 days. CONCLUSION: Home health care nurses should maintain and improve the functional ability of patients, as this could improve the QOL of these patients.

Integrated primary and mental health care services: an evolving partnership model.

TOPIC: Persons with serious psychiatric disabilities experience high rates of medical co-morbidities that, if properly treated, could improve overall well-being and the course of recovery. PURPOSE: This brief reports describes how two organizations-Thresholds Psychiatric Rehabilitation Centers and University of Illinois College of Nursing-partnered to offer integrated behavioral and physical health care responsive to the needs of the population and committed to consumer-centered, holistic and preventative care. Most recently, the partnership offers primary care in different community settings through different service models-tele-monitoring, home visits, group visits. SOURCES USED: A combination of published literature, staff report, and quality assurance data informs this report. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The authors conclude that primary care outreach is a promising strategy in mental health settings and that the Chronic Care Model (CCM) provides a set of guidelines for designing and monitoring quality integrated care for a partnership model of integrated care.

Extending computer technology to hospice research: interactive pentablet measurement of symptoms by hospice cancer patients in their homes.

We aimed to determine the acceptability and feasibility of a pentablet-based software program, PAINReportIt-Plus, as a means for patients with cancer in home hospice to report their symptoms and differences in acceptability by demographic variables. Of the 131 participants (mean age = 59 +/- 13, 58% women, 48.1% African American), 44% had never used a computer, but all participants easily used the computerized tool and reported an average computer acceptability score of 10.3 +/- 1.8, indicating high acceptability. Participants required an average of 19.1 +/- 9.5 minutes to complete the pain section, 9.8 +/- 6.5 minutes for the medication section, and 4.8 +/- 2.3 minutes for the symptom section. The acceptability scores were not statistically different by demographic variables but time to complete the tool differed by racial/ethnic groups. Our findings demonstrate that terminally ill patients with cancer are willing and able to utilize computer pentablet technology to record and describe their pain and other symptoms. Visibility of pain and distress is the first step necessary for the hospice team to develop a care plan for improving control of noxious symptoms.

Non-value-added time: the million dollar nursing opportunity.

The dual crises of high healthcare costs and the nursing shortage require a better understanding of inpatient nursing unit activities and, more specifically, their costs and the drivers of inefficiencies. This includes knowing not only how staff spend their time but also how much of this time is non-value-added (NVA) because wasted time leads to both high costs and nurse dissatisfaction. The authors discuss a study that determined the NVA time and costs of acute care nursing unit staff, identified drivers of high-cost NVA time, and compared activities and costs by type of nursing unit. These data have considerable implications for developing efficient and effective nursing care delivery models and for implementing process improvement and staff satisfaction initiatives.

The balancing act: patient care time versus cost.

BACKGROUND: With demands to improve patients' clinical outcomes and decrease the escalating costs of inpatient care, nurse executives are focusing on how nurses spend their time rather than just raising staffing levels to positively impact patient outcomes. Because nursing wages constitute a high proportion of a hospital's budget, understanding the costs of nursing activities is critical to managing them. METHODS: An activity-based costing approach was used in 14 medical-surgical nursing units to study nursing activities and their related costs. Time use for 4 patient care activities (assess, teach, treat, provide psychosocial support) and 2 support activities (coordinate care and manage clinical records) including the percent of non-value-added (NVA) time for each of these activities was identified through focus groups, interviews, and timed observations. Annualized wage costs were assigned to these activities to determine average wage-related costs of each activity as well as NVA-related costs. RESULTS: More than one-third of nurses' time was considered NVA, averaging dollars 757,000 per nursing unit in wage costs annually. Nurses spent more time on support activities (56%) than in providing patient care (44%), with the least amount of time being spent on patient teaching and psychosocial support. CONCLUSION: Findings indicate a huge opportunity to both improve clinical outcomes in these units and, at the same time, reduce costs by focusing on processes to reduce the high amount time spent performing NVA and support activities and increase patient care time, particularly patient teaching and psychosocial support.