Optimizing Nurse Workflow Efficiency: An Examination of Nurse Walking Behavior and Space Accessibility in Medical Surgical Units.

OBJECTIVE: This study aimed to investigate the effect of spatial adjacencies on nurses' walking patterns and the subsequent impact on staff satisfaction with perceived accessibility and adjacency-related issues. BACKGROUND: Recognizing the crucial importance of spatial adjacencies in healthcare facilities is essential, as they significantly affect staff morale, fatigue management, operational efficiency, error reduction, and overall patient care excellence, highlighting the need for objective assessments to evaluate the impact of facility layout and space configuration on workflow patterns and staff satisfaction in patient care units. METHODS: Integrating on-site observations with survey data, we explored how spatial adjacencies affect staff walking behavior and satisfaction in two med-surgical unit floors. RESULTS: The findings highlighted a significant frequency of movements between nurse stations, patient rooms, and medication areas. Regression analysis identified several contributing factors to staff satisfaction, including the proximity of supplies, team visibility, ease of access across departments, and the location of equipment rooms. Specifically, satisfaction with the proximity of supplies was positively associated with increased provider satisfaction with workflow, quality of care, and workplace. Additionally, valuable feedback from staff revealed concerns regarding break room placement, medication area functionality, and disparities in the availability of supplies. CONCLUSION: This study highlighted the critical need for carefully planned spatial adjacency strategies to enhance workflow efficiency and raise clinical staff satisfaction within healthcare facilities. The actionable insights gleaned from this research offer valuable direction to architects, healthcare administrators, and design professionals, enabling the creation of environments that positively resonate with healthcare providers and improve healthcare operations.

Project Prescription for Hope (RxH): trauma surgeons and community aligned to reduce injury recidivism caused by violence.

The recidivism rate for violent injuries in the United States has been reported as high as 45 per cent. Based on a retrospective review, the 5-year recidivism rate at the Indiana University/Wishard Trauma Center is 31 per cent, and the 1-year recidivism rate is 8.7 per cent. Individuals who have been admitted with a violent injury are screened by one of the Prescription for Hope (RxH) support specialists (SS). If the individual consents to participate, the SS conducts an in-depth assessment of risk factors. The SS and participant identify personal goals and develop a tailored service plan, which is outlined in a formalized agreement. In the first year of the RxH program (June 1, 2009, to May 31, 2010), 64 patients were enrolled. The most-often referred community services are in the category of social integration (84%). The SS have a 99 per cent success rate in getting clients to initiate services; 82 per cent have completed the services and 12 per cent are still using the services. As of the time of this writing, 34 subjects have been in RxH for at least 1 year. One patient returned to the trauma center in September 2010 with a repeat violent injury; this represents a 2.9 per cent 1-year recidivism rate. In the first 12 months of our program we did not have any participants return with a violent injury (0% recidivism), and we have only had one patient return to date. We conclude that the RxH SS model may play a significant role in decreasing the recidivism of violent injuries.

Optimizing outcomes in emergency room thoracotomy: a 20-year experience in an urban Level I trauma center.

Emergency room thoracotomy (ERT) has remained a last resort tool of resuscitation in the management of patients with major trauma. The medical records of all patients undergoing ERT for penetrating chest trauma from January 1, 2000 through April 30, 2008 were retrospectively reviewed. The data from this study were added to data collected in two previous studies conducted at our institution for meta-analysis. A total of 102 ERTs were performed. There were 28 Class I patients (27.4%), 58 Class II (56.8%), six Class III (5.8%), and 11 Class IV (10.7%). The number of ERTs performed on Class I patients has decreased from 58.3 per cent in the 1995 group to 35.4 per cent in the 1999 group. There was an overall survival of 7.8 per cent in the current period of review. Overall survival in the 1995 group was 2.5 per cent, 1999 was 2.7 per cent, and 2008 was 7.8 per cent. The majority of the survival benefit occurs in patients who have electrical activity and a blood pressure when examined in the emergency department (Class III and IV). We intend to do future prospective research to further clarify the Class II patients when evaluating the type of rhythm shown on electrocardiogram tracing to move away from the generic pulseless electrical activity category.

Attacking the problem of hospital diversion: a report of success.

Hospital diversion is a critical issue for hospitals that affects safety and overall patient care. At Wishard Hospital, a public hospital with a level 1 trauma center, we critically reviewed our diversion policies and implemented a series of changes. This hospital-wide process significantly decreased our diversion rates, thereby providing consistent and safe care to our community.

Abnormal branching of the axillary artery: subscapular common trunk: a case report

An unusual unilateral variation in the branching pattern of axillary artery was observed in a 60 year old female embalmed cadaver. The axillary artery had only two branches arising from its proximal (first) part and no branches from its remaining distal (second & third) parts. The branches are superior thoracic (usual) and another large collateral (unusual) branch. This collateral branch is the origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. We propose to name this artery as common subscapular trunk. The course of this collateral artery (common subscapular trunk) and its branches and also clinical significance of this variation are discussed in the paper.

Una inusual variación unilateral en el patrón de ramificación de la arteria axilar se observó en un cadáver embalsamado de 60 años de edad. La arteria axilar tuvo sólo dos ramas derivadas de su parte proximal (primera) y no otorgó ramas de su parte distal (segunda y tercera). Las ramas son superiores torácica (habitual) y otra gran rama colateral (inusual). Esta rama colateral es el origen de varias arterias importantes como la circunfleja escapular, toracodorsal, circunfleja humeral posterior, taraco-acromial y torácica lateral. Proponemos el nombre variación arterial como tronco común subescapular. El curso de este tronco común subescapular y sus ramas y también el significado clínico de esta variación son discutidas en este trabajo.

Managing the hurricane Katrina disaster in the Midwest.

Displaced evacuees from the Hurricane Katrina Disaster were sent to Indianapolis requiring a disaster response system activation. Throughout the entire disaster response period, there were a total of 80 disaster patients seen in the Wishard emergency department, 1,508 prescriptions filled for 300 patients by the Wishard pharmacy, and 125 patients treated at the outpatient disaster clinic. This article reviews the incident timeline, discuss the unique challenges encountered during the protracted incident command, and provide suggestions for other health systems' management for disasters and emergency situations.