Improving Access to Care by Admission Process Redesign in a Veterans Affairs Skilled Nursing Facility.

BACKGROUND: Inefficient and inadequate nursing home screening processes can delay care transitions from hospitals to post-acute care facilities and result in inappropriate and delayed transfers. The increased volume of admission requests and need for efficient and effective transfers between care settings converged to make the Community Living Center (CLC; skilled nursing facility in the Department of Veterans Affairs) admission screening process an organizational priority for improvement. A quality improvement (QI) project was conducted to develop a new process for a 112-bed CLC and improve efficiency and access to care. METHODS: The Model for Improvement was used to complete a 13-month continuous QI project. The multidisciplinary QI Workgroup developed aims and measures, analyzed work flow processes, and identified problem areas. Interventions were rapidly tested using Plan-Do-Study-Act cycles. Successful interventions were sustained by developing standard operating procedures and local policy. RESULTS: Several interventions were implemented that focused on standardization, automation, and streamlining. The final result was a new hybrid model that included an Admissions Team consisting of a unit nurse manager, a social worker, and administrative staff. The time from bed request to patient transfer improved from a median of 3.3 days in the baseline period to 2.3 days in the final month of the project. CONCLUSION: A highly structured and team-based QI approach enabled rapid redesign of an admission screening process that improved efficiency and decreased the time from request to admission. This redesign strategy provides instruction for other facilities interested in improving screening processes and access to care.

Electron transfer to sulfides and disulfides: intrinsic barriers and relationship between heterogeneous and homogeneous electron-transfer kinetics.

The electron-acceptor properties of series of related sulfides and disulfides were investigated in N,N-dimethylformamide with homogeneous (redox catalysis) and/or heterogeneous (cyclic voltammetry and convolution analysis) electrochemical techniques. The electron-transfer rate constants were determined as a function of the reaction free energy and the corresponding intrinsic barriers were determined. The dependence of relevant thermodynamic and kinetic parameters on substituents was assessed. The kinetic data were also analyzed in relation to corresponding data pertaining to reduction of diaryl disulfides. All investigated reductions take place by stepwise dissociative electron transfer (DET) which causes cleavage of the C(alkyl)--S or S--S bond. A generalized picture of how the intrinsic electron-transfer barrier depends on molecular features, ring substituents, and the presence of spacers between the frangible bond and aromatic groups was established. The reduction mechanism was found to undergo a progressive (and now predictable) transition between common stepwise DET and DET proceeding through formation of loose radical anions. The intrinsic barriers were compared with available results for ET to several classes of dissociative- and nondissociative-type acceptors, and this led to verification that the heterogeneous and the homogeneous data correlate as predicted by the Hush theory.

Prevention of respiratory syncytial virus infection among Puerto Rican infants.

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory illness in children. Prevention of this infection is available with the use of intravenous immunoglobulin or an intramuscular humanized monoclonal antibody (palivizumab). Palivizumab has been available in Puerto Rico since 1999. The objective of this study was to follow-up infants who received RSV prophylaxis with palivizumab in Puerto Rico to assess its efficacy and safety. A total of 230 infants who received RSV prophylaxis during the 2000-2001 and 2001-2002 seasons were followed-up. Adverse events from injections were minimal including erythema (2%), fever (5%), pain (4%), and rash (2%). In none of the patients prophylaxis was discontinued due to side effects. Forty-four infants (19%) had at least one respiratory hospitalization throughout the season, with RSV confirmed in seven (3%). Most hospitalizations occurred in the month of August when infants had received only one dose of palivizumab and on December, a peak month for RSV infections. Five infants (2.2%) required admission to an intensive care unit. In none of them, RSV was confirmed. This study confirms that monthly intramuscular administration of palivizumab is effective in preventing serious RSV infections in high risk infants.

Prevention of respiratory syncytial virus infection among Puerto Rican infants

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory illness in children. Prevention of this infection is available with the use of intravenous immunoglobulin or an intramuscular humanized monoclonal antibody (palivizumab). Palivizumab has been available in Puerto Rico since 1999. The objective of this study was to follow-up infants who received RSV prophylaxis with palivizumab in Puerto Rico to assess its efficacy and safety. A total of 230 infants who received RSV prophylaxis during the 2000-2001 and 2001-2002 seasons were followed-up. Adverse events from injections were minimal including erythema (2), fever (5), pain (4), and rash (2). In none of the patients prophylaxis was discontinued due to side effects. Forty-four infants (19) had at least one respiratory hospitalization throughout the season, with RSV confirmed in seven (3). Most hospitalizations occurred in the month of August when infants had received only one dose of palivizumab and on December, a peak month for RSV infections. Five infants (2.2) required admission to an intensive care unit. In none of them, RSV was confirmed. This study confirms that monthly intramuscular administration of palivizumab is effective in preventing serious RSV infections in high risk infants.