Optimizing the hospital discharge process to facilitate family-centered care for well newborns.

BACKGROUND: The perceptions of discharge readiness differ among caregivers and providers. An efficient planning process ensures timely attainment of discharge readiness. Our aim was to increase the percentage of discharge orders placed by 10 a.m. from 0.5% to 10% within 6 months thereby improving discharge readiness. METHODS: We conducted a quality improvement initiative in the newborn nursery between March 2021 and June 2022 (n = 2307). We implemented a physician-led early discharge huddle and standardized the newborn screen (NBS) and circumcision process. RESULTS: By 10 a.m., our primary outcome measure, discharge orders, improved from 0.5 to 19%. Our process measures also increased. NBS specimens collected improved from 56 % to 98 % and circumcision rates increased from 66 to 88%. Balancing measure of postpartum hospital days remained stable. CONCLUSIONS: Optimizing family-centered discharge processes by addressing key drivers is essential and can be achieved without an increase in postpartum hospital days.

Accelerating Clinical Innovation in Biomedical Engineering Education by Using a Digital Portal for Collaboration.

The rapidly changing healthcare landscape requires continuous innovation by clinicians, yet generating ideas to improve patient care is often problematic. This paper describes the development of a digital tool used in an interprofessional program designed to enhance collaborations between clinicians, undergraduate, and graduate STEM students, particularly biomedical engineering (BME). The program founders began by connecting clinicians and students through a course portal in a learning management system (LMS). They eventually secured internal funding to create an open access tool for posting and viewing problems, allowing interprofessional teams to rally around healthcare challenges and create prototypes for solving them. Results after three years of the program's inception have been encouraging, as teams have created devices and processes that have led to intellectual property disclosures, provisional patents, grant funding, and other productive interprofessional relationships. The open access tool has given clinicians and STEM students an outlet for convenient team formation around unsolved clinical problems and allowed a fluid exchange of ideas between participants across a variety of clinical disciplines.

Driving Innovation in Health Care: Clinical Nurse Leader Role.

BACKGROUND: The clinical nurse leader (CNL) role was developed as a strategy for redesigning care delivery to address quality and safety gaps in health care. However, innovation competencies have never been assessed in this group. PURPOSE: The purpose of this study was to determine whether CNLs have different perceptions of innovation and their own competence to lead it, compared with other nurse leaders. METHODS: A web-enabled concurrent mixed-method survey design was used to compare self-reported innovation competencies between nurses in a leadership role and certified CNLs at a large academic medical center. RESULTS: A statistically significant difference between groups was found for only 1 competency, with non-CNLs rating themselves as more competent in the use of unconventional approaches than CNLs. Qualitative data showed wide variation in recognition of innovation and how it is defined. CONCLUSIONS: Replication of this study is needed with an increased sample size of CNLs to determine whether curriculum change is needed.

Applying the PDSA Framework to Examine the Use of the Clinical Nurse Leader to Evaluate Pressure Ulcer Reporting.

The clinical nurse leader (CNL) role has been cited as an effective strategy for improving care at the microsystem level. The purpose of this article is to describe the use of the CNL role in an academic medical center for evaluating pressure ulcer reporting. The Plan-Do-Study-Act cycle was used as the methodological framework for the study. The CNL assessment of pressure ulcers resulted in a 21% to 50% decrease in the number of hospital-acquired pressure ulcers reported in a 3-month time period. The CNL role has potential for improving the validity and reliability of pressure ulcer reporting.

Predictors of patient medication compliance on the day of surgery and the effects of providing patients with standardized yet simplified medication instructions.

BACKGROUND: Anesthesiologists are responsible for optimizing patients' preoperative medications, including maximizing their compliance with preoperative medication instructions. The authors hypothesized that a standardized, simplified instruction sheet presented and verbally reinforced during the preanesthesia clinic visit would improve patient medication compliance on the day of surgery. METHODS: An unmatched case-control design was applied, with nonrandomized, preintervention (controls) and postintervention (cases) data collected. In the preintervention group, patient education/instruction regarding taking medications on the day of surgery continued in the existing, unstandardized manner. In the postintervention group, patients were given a simplified, multicolored Preoperative Patient Medication Instruction Sheet, which was consistently verbally reviewed with patients. Group differences and independent variable associations were analyzed with conventional inferential biostatistics. RESULTS: A total of 521 and 531 patients were enrolled in the preintervention group and postintervention group, respectively. Of this, 309 patients (60%) of preintervention group versus 391 patients (74%) of postintervention group (P < 0.001) were compliant with their preoperative medication instructions on the day of surgery. Use of the Preoperative Medication Instruction Sheet (adjusted odds ratio [aOR] = 1.83; P < 0.001), Caucasian race (aOR = 1.74; P = 0.007), and recalling receiving both verbal/written preoperative medication instructions (aOR = 1.51; P = 0.006) were associated with greater patient medication compliance. Older age (aOR = 0.67; P = 0.014) and higher American Society of Anesthesiologists status (aOR = 0.60; P = 0.004) were associated with lesser patient medication compliance. CONCLUSIONS: A standardized, multicolored, pictorial Preoperative Patient Medication Instruction Sheet, with patient communication in both verbal/written forms, seems to improve patient medication compliance on the day of surgery. African-Americans, older patients, and those with greater comorbidities may require a more concerted effort to achieve an adequate preoperative medication compliance.