Validation of a Predictive Model to Identify Patients at High Risk for Hospital Readmission.

BACKGROUND: Hospital readmission is an adverse patient outcome that is serious, common, and costly. For hospitals, identifying patients at risk for hospital readmission is a priority to reduce costs and improve care. PURPOSE: The purposes were to validate a predictive algorithm to identify patients at a high risk for preventable hospital readmission within 30 days after discharge and determine if additional risk factors enhance readmission predictability. METHODS: A retrospective study was conducted on a randomized sample of 598 patients discharged from a Southeast community hospital. Data were collected from the organization's database and manually abstracted from the electronic medical record using a structured tool. Two separate logistic regression models were fit for the probability of readmission within 30 days after discharge. The first model used the LACE index as the predictor variable, and the second model used the LACE index with additional risk factors. The two models were compared to determine if additional risk factors increased the model's predictive ability. RESULTS: The results indicate both models have reasonable prognostic capability. The LACE index with additional risk factors did little to improve prognostication, while adding to the model's complexity. CONCLUSION: Findings support the use of the LACE index as a practical tool to identify patients at risk for readmission.

A quantitative study of factors influencing quality of life in rural Mexican women diagnosed with HIV.

This quantitative study explored the level of Quality of Life (QoL) in indigenous Mexican women and identified psychosocial factors that significantly influenced their QoL, using face-to-face interviews with 101 women accessing care in an HIV clinic in Oaxaca, Mexico. Variables included demographic characteristics, levels of depression, coping style, family functioning, HIV-related beliefs, and QoL. Descriptive statistics were used to analyze participant characteristics, and women's scores on data collection instruments. Pearson's R correlational statistics were used to determine the level of significance between study variables. Multiple regression analysis examined all variables that were significantly related to QoL. Pearson's correlational analysis of relationships between Spirituality, Educating Self about HIV, Family Functioning, Emotional Support, Physical Care, and Staying Positive demonstrated positive correlation to QoL. Stigma, depression, and avoidance coping were significantly and negatively associated with QoL. The final regression model indicated that depression and avoidance coping were the best predictor variables for QoL.

War on the spore: Clostridium difficile disease among patients in a long-term acute care hospital.

The transmission of Clostridium difficile infection (CDI) is evident in healthcare facilities across the country and poses a risk for patients and communities. A comprehensive infection control program along with an active surveillance process was developed and implemented in a 50-bed long-term acute care hospital (LTACH) in the southeastern United States. Patients are admitted from surrounding hospitals, have an expected stay of at least 25 days, and are acutely ill. The majority of the patient population is ventilator dependent, immunocompromised, and treated with antimicrobials. The program, implemented in December 2009, utilized a tiered approach that included environmental cleaning and disinfection, diagnostics and surveillance, and infection control measures including antibiotic stewardship. The goal of this study was to decrease the incidence rate of CDI 15% by June 2010. Based upon year-end results, the facility achieved a 27.61% decrease in the CDI rate. During the following 12 months, the program continued to demonstrate sustainability resulting in a 23.0% decrease in the CDI rate. This program was successful in decreasing the incidence of CDI in the LTACH creating a safe and cost-effective environment for patients, families, and the community.

Psychometric validation of the revised clinical cultural competency questionnaire.

BACKGROUND AND PURPOSE: Growing diversity in health care requires culturally competent care. Assessing nurses' cultural competence is the first step in designing cultural competency education. The Clinical Cultural Competency Questionnaire (CCCQ) is one instrument to assess nurses' cultural competence. METHODS: The psychometric properties and factor structure of the revised CCCQ-PRE (CCCQ-PRE-R) for nurses was examined. RESULTS: A 1-factor solution was noted for the knowledge and skills subscales. A 2-factor solution was discovered for the comfort and awareness subscales: differentiating between comfort in dealing with positive and negative cross-cultural encounters/situations, and differentiating between importance awareness and self-awareness. Cronbach's alpha coefficients were high for all subscales. CONCLUSIONS: The findings support the use of the revised CCCQ-PRE-R with nurses. Further testing in larger, more diverse nursing populations is warranted.

Intraoperatively acquired pressure ulcers and perioperative normothermia: a look at relationships.

The risk of developing an intraoperatively acquired pressure ulcer (IAPU), which is recognized as a significant complication of deep tissue injury occurrence, is associated with duration of surgery and patient positioning. There is a strong association between hypothermia, tissue viability, and surgical site infections; however, the relationship between hypothermia and pressure ulcers has not been fully explored. We examined the incidence of pressure ulcers in surgical patients and determined that there is a relationship between maintaining perioperative normothermia and a reduction in IAPU development. We used a retrospective, explanatory, nonexperimental design, and we fit a binary logistic model to the data. This study shows that patients at higher risk for developing an IAPU include those who are critically ill, have a low Braden Scale skin assessment score, are thin, and are male with at least a 1° F (1.8° C) drop in temperature. These are important risks for perioperative nurses to take into account during care of surgical patients. More perioperative research is needed to identify ways to reduce risk, provide close assessment of high-risk patients, and implement the identified risk-reduction strategies.

An evaluation of a sitter reduction program intervention.

Hospitals use sitters as an alternative to reduce patient falls. The purpose of the study was to evaluate the effectiveness of a sitter reduction program by examining the differences between sitter use and falls in an acute care hospital. Findings indicate that a significant decrease in sitter use and falls remained constant. Reducing sitter use is possible without significantly increasing fall rates.