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Although necrotizing enterocolitis (NEC) is often catastrophic among premature infants, most cases occur in the first month after birth. This case study presents Joseph's story about a 24-week surviving twin who developed severe NEC at 5 months of age just days before he was to go home. The purpose of this case study report is to place Joseph and his parents' experience in the context of what is known about NEC risk factors, clinical presentation, and treatment, and then to offer recommendations to healthcare professionals to support families from NEC diagnosis to recovery. Now 5 years old, Joseph continues to manage consequences of NEC including deafness, developmental delay, multiple food allergies, and recurrent gastrointestinal challenges from short gut syndrome. Although NEC struck late and kept Joseph in the neonatal intensive care unit for 228 days, its consequences remain with this resilient child and his family. [ABSTRACT FROM AUTHOR]

The article discusses a study that evaluated the impact of enteral feeding on transfusion-associated necrotizing enterocolitis (TANEC). It reviews several studies which suggest that infants with TANEC are more likely to develop surgical necrotizing enterocolitis (NEC). Recommendations to reduce transfusion-associated NEC are offered, including the evaluation of unit-specific NEC rate and benchmarking of unit performance against other unit NEC rates.

Each day nurses encounter patients as they both win health victories and endure traumatic losses. When families suffer the loss of a child before delivery or after, nurses, midwives, doulas, and childbirth educators grieve with them. Perinatal nurses focus their attention on those in need, perhaps to the peril of their own health. The purpose of this paper is to highlight the experience(s) of a practicing perinatal nurse to gain an understanding of the nature and meaning of loss and bereavement caring through the eyes of the caregiver. This case study revealed an emergent framework of dynamic bereavement caregiving, including four core stages: Acknowledgement of loss, disconnecting feelings, grieving and healing, and new beginnings. [ABSTRACT FROM AUTHOR]

Necrotizing enterocolitis (NEC) is the most common cause of gastrointestinal-related morbidity and mortality in the neonatal intensive care unit (NICU). Its onset is sudden and the smallest, most premature infants are the most vulnerable. Necrotizing enterocolitis is a costly disease, accounting for nearly 20% of NICU costs annually. Necrotizing enterocolitis survivors requiring surgery often stay in the NICU more than 90 days and are among those most likely to stay more than 6 months. Significant variations exist in the incidence across regions and units. Although the only consistent independent predictors for NEC remain prematurity and formula feeding, others exist that could increase risk when combined. Awareness of NEC risk factors and adopting practices to reduce NEC risk, including human milk feeding, the use of feeding guidelines, and probiotics, have been shown to reduce the incidence of NEC. The purpose of this review is to examine the state of the science on NEC risk factors and make recommendations for practice and research. [ABSTRACT FROM AUTHOR]

Postpartum hemorrhage (PPH) is a serious, life-threatening and unexpected obstetrical event. Childbirth educators and perinatal nurses are carefully trained to prepare parents for labour and birth, including how to respond to unexpected events. Fathers are taught to perform as coaches during labour and birth, but when a PPH occurs, fathers may feel as if they are helpless bystanders. This article describes two father's experience with PPH and how they adapted as a family to "live through" the complicated post-partum course. [ABSTRACT FROM AUTHOR]

Background: Necrotizing enterocolitis (NEC) remains a major complication in the neonatal population. While exact pathways to NEC remain uncertain, common risk factors have been identified—some of which are modifiable. Standard practices regarding the care of premature infants and attitudes toward NEC prevention strategies vary across neonatal intensive care units (NICUs). Evidence-based standard practices include human milk promotion, donor milk availability, antibiotic stewardship, anemia prevention, and use of feeding protocols. To close gaps between evidence and practice translation, a telehealth-delivered intervention (ie, NeoECHO) was provided to NICUs. Facilitation as an implementation strategy is a core component of the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework, but it is unknown how well its constructs apply to NICU clinicians or interventions to support adoption of NEC prevention strategies. Purpose: The purpose of the study was to enable adoption of best practice for NEC prevention using NeoECHO. Specific aims of this analysis were to (1) describe the internal facilitators' activities and experience leading their NICUs to participate in NeoECHO; and (2) identify the extent to which the facilitation activities and NeoECHO experience were consistent with constructs from the iPARIHS framework. iPARIHS constructs of interest were (1) innovation, (2) recipient, (3) context, (4) facilitation, and (5) adoption. Facilitation was explored in depth as a process (whereas those doing the facilitation were the NeoECHO team) and as a role (ie, the experience of the local NICU-embedded internal facilitator; IF). Methods: Design: Qualitative description. Sample/Setting: Six IFs were recruited, representing 7 NICUs in the Southwest (Nevada, Texas, and Arizona). Procedures: At the conclusion of 6 NeoECHO sessions over 3 months, individual interviews were conducted with each IF via zoom webconferencing and transcribed verbatim. Analysis: Content analysis was applied. Two researchers open-coded 2 transcripts, and codes were then discussed and informed by the iPARIHS framework. Then the remaining transcripts were coded. Results: Internal facilitator roles: IF roles included staff nurse, nurse manager, nurse practitioners, registered dietician, and physician. Major themes were categorized by the iPARHIS model. Per construct, they were (1) Innovation themes of quality improvement projects, Bundles of Care, and Huddle; (2) Recipient themes of Reluctant Stakeholders and Technical Modalities; (3) Context themes of Buy In, Timing, Resources, and Blame; (4) Facilitation themes of Betterment, Buddy System, Passionate Care, and Empowerment; and (5) Adoption themes of Continuous Quality Improvement (CQI), Evidence-Based Practice, and Honest Discussions. Implications for Practice: NEC prevention is complex, occurs over time, and requires team buy-in. NeoECHO fostered a learning community to share current practices, policies, and strategies to implement prevention, but the internal facilitators were essential to foster local participation. Teams were encouraged to adopt strategies for their individual units using CQI models to decrease their unit's NEC rates. Long-term impacts of NeoECHO are the focus of current research. [ABSTRACT FROM AUTHOR]

Objective: To examine mothers' internet usage, in conjunction with social, health care, and virtual peer support navigations, when congenital anomalies were diagnosed in utero., Design: Qualitative descriptive, consisting of semistructured interviews., Setting: Interview data were collected over Zoom; mothers participated from locations of their choosing., Participants: Mothers of neonates discharged postoperatively from NICUs for uterine-diagnosed congenital anomalies. The sample was purposefully recruited from private Facebook groups for parents of children with congenital anomalies., Intervention/measurements: Analysis was done with deductive coding using concepts from the third iteration of the systems engineering initiative for patient safety theory. The a priori codes were health care, social, journey-benefit, journey-risk, task, and technology., Results: Twenty-two mothers signed up for an interview; 12 completed an interview, and 10 did not. The majority (n = 8, 66%) were White, had a bachelor's or graduate degree (n = 7, 58%) and were between 24 and 33 years of age (n = 8, 66%). Nine themes emerged: (a) Providers cautioned searching for diagnosis information but encouraged private Facebook groups for peer support, (b) Mothers' inquiries for their own care are lacking, (c) Search for information while recognizing parent-partner's coping differences, (d) Pace information from friends and family with patience and appreciation, (e) Manage inquiries from friends and family with group sharing, (f) Private Facebook groups provide a means of receiving and giving peer support, (g) Exposure to difficult stories on Facebook is a risk of stress, (h) Select a NICU, learn about their children's diagnoses, participate in virtual peer support, and (i) Device features frame search strategies., Conclusion: Mothers reflected on the internet as a burden and a source of support in their health care journeys. The ubiquity of internet access calls for mothers to include in their health care journeys the complexities of managing time spent on the internet., (Published by Elsevier Inc.)

The objective of this scoping review was to survey the literature on the use of AI/ML applications in analyzing inpatient EHR data to identify bundles of care (groupings of interventions). If evidence suggested AI/ML models could determine bundles, the review aimed to explore whether implementing these interventions as bundles reduced practice pattern variance and positively impacted patient care outcomes for inpatients with T2DM. Six databases were searched for articles published from January 1, 2000, to January 1, 2024. Nine studies met criteria and were summarized by aims, outcome measures, clinical or practice implications, AI/ML model types, study variables, and AI/ML model outcomes. A variety of AI/ML models were used. Multiple data sources were leveraged to train the models, resulting in varying impacts on practice patterns and outcomes. Studies included aims across 4 thematic areas to address: therapeutic patterns of care, analysis of treatment pathways and their constraints, dashboard development for clinical decision support, and medication optimization and prescription pattern mining. Multiple disparate data sources (i.e., prescription payment data) were leveraged outside of those traditionally available within EHR databases. Notably missing was the use of holistic multidisciplinary data (i.e., nursing and ancillary) to train AI/ML models. AI/ML can assist in identifying the appropriateness of specific interventions to manage diabetic care and support adherence to efficacious treatment pathways if the appropriate data are incorporated into AI/ML design. Additional data sources beyond the EHR are needed to provide more complete data to develop AI/ML models that effectively discern meaningful clinical patterns. Further study is needed to better address nursing care using AI/ML to support effective inpatient diabetes management., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: The study aimed to explore the relationship between the unintended consequences of the electronic health record and cognitive load in emergency department nurses., Methods: The study utilized a correlational quantitative design with a survey method approach. This study had a 30.4 % response rate for a total of 304 ED nurse participants who were members of a national ED nursing organization. Data analysis included descriptive and correlational measurements of two instruments., Results: In this study, there was a statistically significant, weak negative relationship between CL and UC-EHR in ED nurses, r s (264) = -0.154, p 0.002. Although a significant weak relationship was identified in this study, the study variables, subscales, and demographic data groupings presented moderate-to-strong positive, statistically significant correlations. Descriptive frequency data unveiled EHR stimulated patient safety threats occurring once a week to monthly., Conclusions: The novelty of this research study provided profound implications for the future of nursing practice, policy, and nursing science. EHR optimization to minimize patient safety risks is recommended with the inclusion of end-users from this study's identified subgroups. The researchers propose a reduction of EHR burden in nursing practice., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Carolyn S. Harmon reports financial support was provided by Emergency Nursing Association Foundation. Carolyn S. Harmon reports financial support was provided by Sigma., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Clinical trial trials have become increasingly complex in their design and implementation. Investigational safety profiles are not easily accessed by clinical nurses and providers when trial participants present for clinical care, such as in emergency or urgent care. Wearable devices are now commonly used as bridging technologies to obtain participant data and house investigational product safety information. Clinical nurse identification and communication of safety information are critical to dissuade adverse events, patient injury, and trial withdrawal, which may occur when clinical care is misaligned to a research protocol. Based on a feasibility study and follow-up wearable device prototype study, this preclinical nurse-nurse communication framework guides clinical nurse verbal and nonverbal communication of safety-related trial information to direct patient care activities in the clinical setting. Communication and information theories are incorporated with Carrington's Nurse-to-Nurse Communication Framework to encompass key components of a clinical nurse's management of a trial participant safety event when a clinical trial wearable device is encountered during initial assessment. Use of the preclinical nurse-nurse communication framework may support clinical nurse awareness of trial-related wearable devices. The framework may further emphasize the importance of engaging with research nurses, patients, and caregivers to acquire trial safety details impacting clinical care decision-making., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To synthesize the evidence on the biological and behavioral effects of babywearing on mothers and infants., Data Sources: We searched PubMed, CINAHL, Embase, PsycINFO, Sociological Abstracts, SCOPUS, and Google Scholar for peer-reviewed, full-text research articles published in English in which researchers reported on the biological or behavioral effects of babywearing on mothers or infants., Study Selection: We reviewed the titles and abstracts of 200 records and abstracted 80 for full-text review. Of these, 29 studies met the eligibility criteria and were included in the review., Data Extraction: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and extracted the following data from the included articles: author(s), year of publication, setting, aim/purpose, design, description, sample, results/outcomes, and implications to practice., Data Synthesis: We synthesized data from the included studies into the following eight themes: Increased Contact, Responsiveness, and Secure Attachment; Physiologic Effects; Biomechanics and Positioning; Facilitating and Empowering; Comfort; Maternal Benefits; Speech, Vocalizations, and Tempo; and Beliefs and Perceptions About Babywearing., Conclusion: Babywearing may have a range of beneficial biological and behavioral effects on mothers and infants. The evidence, however, is insufficient to inform practice recommendations, and additional research is warranted., (Copyright © 2022 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the relationship between a modified Tisdale QTc-risk score (QTc-RS) and inpatient mortality and length of stay in a broad inpatient population with an order for a medication with a known risk of torsades de pointes (TdP)., Background: Managing the risk of TdP is challenging due to the number of medications with known risk of TdP and the complexity of precipitating factors. A model to predict risk of mortality may be useful to guide treatment decisions., Methods: This was a retrospective observational study using inpatient data from 28 healthcare facilities in the western United States. This risk score ranges from zero to 23 with weights applied to each risk factor based on a previous validation study. Logistic regression and a generalized linear model were performed to assess the relationship between QTc-RS and mortality and length of stay., Results: Between April and December 2020, a QTc-RS was calculated for 92,383 hospitalized patients. Common risk factors were female (55.0%); age > 67 years (32.1%); and receiving a medication with known risk of TdP (24.5%). A total of 2770 (3%) patients died during their hospitalization. Relative to patients with QTc-RS < 7, the odds ratio for mortality was 4.80 (95%CI:4.42-5.21) for patients with QTc-RS = 7-10 and 11.51 (95%CI:10.23-12.94) for those with QTc-RS ≥ 11. Length of hospital stay increased by 0.7 day for every unit increase in the risk score (p < 0.0001)., Conclusion: There is a strong relationship between increased mortality as well as longer duration of hospitalization with an increasing QTc-RS., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Decision support in neonatal ICUs is needed, especially for prevention and risk awareness of the devastating complication of necrotizing enterocolitis, a major cause of emergency surgery among fragile infants. The purpose of this study was to describe the current clinical workflow and sociotechnical processes among clinicians for necrotizing enterocolitis risk awareness, timely recognition of symptoms, and treatment to inform decision support design. A qualitative descriptive study was conducted. Focus groups were held in two neonatal ICUs (five groups in Unit A and six in Unit B). Transcripts were analyzed using content analysis and compared with field notes. Clinicians (N = 27) included nurses (37%), physicians (30%), neonatal nurse practitioners (19%), and other staff (16%). Workflow processes differed for nurses (who see necrotizing enterocolitis signs and notify providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide how to act). Clinicians desired (1) a necrotizing enterocolitis-relevant dashboard to support nutrition tracking and necrotizing enterocolitis recognition; (2) features to support decision-making (eg, necrotizing enterocolitis risk and adherence scoring); (3) breast milk tracking and feeding clinical decision support; (4) tools for necrotizing enterocolitis surveillance and quality reporting; and (5) general EHR optimizations to improve user experience., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Hydroxychloroquine can induce QT/QTc interval prolongation for some patients; however, little is known about its interactions with other QT-prolonging drugs., Objective: The purpose of this retrospective electronic health records study was to evaluate changes in the QTc interval in patients taking hydroxychloroquine with or without concomitant QT-prolonging medications., Methods: De-identified health records were obtained from the Cerner Health Facts ® database. Variables of interest included demographics, diagnoses, clinical procedures, laboratory tests, and medications. Patients were categorized into six cohorts based on exposure to hydroxychloroquine, methotrexate, or sulfasalazine alone, or the combination of any those drugs with any concomitant drug known to prolong the QT interval. Tisdale QTc risk score was calculated for each patient cohort. Two-sample paired t-tests were used to test differences between the mean before and after QTc measurements within each group and ANOVA was used to test for significant differences across the cohort means., Results: A statistically significant increase in QTc interval from the last measurement prior to concomitant exposure of 18.0 ms (95% CI 3.5-32.5; p < 0.05) was found in the hydroxychloroquine monotherapy cohort. QTc changes varied considerably across cohorts, with standard deviations ranging from 40.9 (hydroxychloroquine monotherapy) to 57.8 (hydroxychloroquine + sulfasalazine). There was no difference in QTc measurements among cohorts. The hydroxychloroquine + QTc-prolonging agent cohort had the highest average Tisdale Risk Score compared with those without concomitant exposure (p < 0.05)., Conclusion: Our analysis of retrospective electronic health records found hydroxychloroquine to be associated with a moderate increase in the QTc interval compared with sulfasalazine or methotrexate. However, the QTc was not significantly increased with concomitant exposure to other drugs known to increase QTc interval., (© 2022. The Author(s).)

Purpose: To investigate and describe available data on children with disabilities in the United States foster care system and examine placement disruptions., Design: This quantitative descriptive study was a secondary data analysis of the Adoption and Foster Care Analysis and Reporting System (AFCARS) and included 680,611 children., Methods: Descriptive and regression analyses were conducted., Findings: Of 680,611 children in the U.S. foster care system in 2017, 22% had a medical or disability diagnosis, requiring additional or specialized care. Children with disabilities in foster care (CDFC) had a mean of 4.0 disruptions-significantly higher than the mean 2.37 disruptions among those without a disability (p < .001, d = 0.51). CDFC spent an average of 915 days in foster care compared to 514 days for children without a disability (p < .001, d = 0.59). Predictive risk factors for disruptions were increased child age, race (American Indian or Black), and increased foster parent age. Protective factors against disruptions included married foster parents and a child being placed outside of the child's initial state of residence., Conclusions: CDFC have significantly more disruptions and longer stays in foster care. While risk and protective factors affect all foster children similarly, they have significantly greater effect on foster children with disabilities., Practice Implications: Increased disruptions compound the vulnerability of CDFC as relationships and support systems are broken. Understanding the extent to which childhood disabilities play a role allows school nurses, healthcare providers, and child advocates to better design interventions to improve lifelong health outcomes., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest or funding sources to disclose. Christine Platt, FNP, MSN, Sheila M. Gephart, RN, PhD, FAAN, FWAN., (Copyright © 2022. Published by Elsevier Inc.)

Objective: To explore factors contributing to the greater rates of breastfeeding initiation and duration among civilian military wives (e.g., legally married to an active-duty spouse) and to determine what might be learned from these factors for intervention design for the broader population of women in the postpartum period., Design: The study was conducted online using a concurrent mixed-methods design., Setting: National and International U.S. military bases., Participants: The sample consisted of 28 civilian military wives whose ages ranged from 18 to 45 years., Interventions/measurements: The Breastfeeding Self-Efficacy Scale-Short Form and semistructured interviews., Results: Breastfeeding self-efficacy was high among civilian military wives. Seven main themes with 16 subthemes emerged from the descriptions of the semistructured interviews. The results of the integrative analysis showed that factors within the military environment influence a sense of community and that there were supportive and pro-breastfeeding health care facilitators (especially lactation consultants)., Conclusion: Civilian military wives described breastfeeding facilitators who they believed promote their greater rates of breastfeeding initiation and continuation, quantified their high level of breastfeeding self-efficacy, and identified descriptive factors that contributed to both areas, topics that are lacking in the literature among this population., Competing Interests: Author Disclosures The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2021 AWHONN. Published by Elsevier Inc. All rights reserved.)

This integrative review synthesized relevant studies in the last decade associated to nurses' experience with the electronic health record using Robert and Lesage's dimensions of User Experience: functional, physical, perceptual, cognitive, psychological, and social. A comprehensive search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance across four electronic databases. We included articles if they were specific to nurses' electronic health record experience and workflow, published between January 2008 and June 2018, and available in English. The search resulted in 793 records with 26 articles included in the final analysis. Articles ranged from quantitative, qualitative, mixed-methods, and quality improvement studies. Across studies, the suboptimal design of the electronic health record affected the functional experience of nurses, often resulting in interruptions. The navigational design contributed to nurses' perceptual experience leading to many workarounds and workflow mismatches. Most of the studies reported overall satisfaction with the electronic health record that represented the psychological dimension of nurses' experience. Communication barriers due to the use of the electronic health record prevented nurses from having meaningful interaction with other clinicians and patients. Although nurses reported substandard user experience, many stated that reverting to a linear paper-based system was not an option., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.

Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patient safety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate data entry. Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).

Although necrotizing enterocolitis (NEC) is often catastrophic among premature infants, most cases occur in the first month after birth. This case study presents Joseph's story about a 24-week surviving twin who developed severe NEC at 5 months of age just days before he was to go home. The purpose of this case study report is to place Joseph and his parents' experience in the context of what is known about NEC risk factors, clinical presentation, and treatment, and then to offer recommendations to healthcare professionals to support families from NEC diagnosis to recovery. Now 5 years old, Joseph continues to manage consequences of NEC including deafness, developmental delay, multiple food allergies, and recurrent gastrointestinal challenges from short gut syndrome. Although NEC struck late and kept Joseph in the neonatal intensive care unit for 228 days, its consequences remain with this resilient child and his family.

Communication during patient handoffs has been widely implicated in patient safety issues. However, few studies have actually been able to quantify the relationship between handoffs and patient outcomes. We used *ORA, a dynamic network analysis tool, to examine handoffs between day and night shifts on seven units in three hospitals in the Southwest. Using *ORA's visualization and analysis capabilities, we examined the relationships between the handoff communication network metrics and a variety of patient safety quality and satisfaction outcomes. Unique network patterns were observed for different types of outcome variable (eg, safety, symptom management, self-care, and patient satisfaction). This exploratory project demonstrates the power of *ORA to identify communication patterns for large groups, such as patient care units. *ORA's network metrics can then be related to specific patient outcomes.