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The aim of this study was to assess the differences in effectiveness between nurse educator-led and clinical coach-led intensive care unit (ICU) training programs for new graduate nurses.New graduate ICU nurses require substantial clinical training, which is often provided by peers serving as clinical coaches who have not been formally trained for an educator role. Our medical center successfully transitioned from a nurse educator-led to clinical coach-led model for initial ICU education after formally training the clinical coaches.Nurses enrolled in nurse educator-led (n = 114) or clinical coach-led (n = 166) ICU clinical training programs were compared on program pass rate, satisfaction, preparedness, turnover, and competence.There were no statistically significant differences between the groups on any of the identified measures of program effectiveness.Both educator-led and clinical coach-led models, with appropriate training, effectively prepared ICU nurses in this setting. Implementing a clinical coaching model for ICU training of new graduate nurses could assuage common resource issues, such as a shortage of nurse educators, as well as address the increasing demand for well-trained ICU nurses.

When hospitals first encountered coronavirus disease 2019 (COVID‐19), there was a dearth of therapeutic options and nearly 1 in 3 patients died from the disease. By the summer of 2020, as deaths from the disease declined nationally, multiple single‐center studies began to report declining mortality of patients with COVID‐19. To evaluate the effect of COVID‐19 on hospital‐based mortality, we searched the Vizient Clinical Data Base for outcomes data from approximately 600 participating hospitals, including 130 academic medical centers, from January 2017 through December 2020. More than 32 million hospital admissions were included in the analysis. After an initial spike, mortality from COVID‐19 declined in all regions of the country to under 10% by June 2020 and remained constant for the remainder of the year. Despite this, inpatient, all‐cause mortality has increased since the beginning of the pandemic, even those without respiratory failure. Inpatient mortality has particularly increased in elderly patients and in those requiring intubation for respiratory failure. Since June 2020, COVID‐19 kills one in every 10 patients admitted to the hospital with this diagnosis. The addition of this new disease has raised overall hospital mortality especially those who require intubation for respiratory failure., Highlights Inpatient mortality from COVID‐19 fell from 22% in March to under 10% in June and remained at similar levels for the remainder of 2020.There was an increase in all‐cause, inpatient mortality since the beginning of the pandemic, even in those without respiratory failure.Only patient with respiratory failure who required intubated had an increase in average inpatient mortality.

Background Patient flow, from emergency department admission through to discharge, influences hospital overcrowding. We aimed to improve patient flow by increasing discharge lounge (DL) usage. Local problem Patients need to receive a continuum of nursing care to encourage compliance with follow-up care after discharge from the acute care setting. Methods Baseline data revealed inefficient use of the DL. We targeted the medical-surgical unit with the lowest DL use and trialed interventions over sequential Plan-Do-Study-Act cycles. Interventions After surveying the nursing staff, we assessed the influence of 3 interventions on DL usage: educating staff on patient eligibility, engaging a recruitment scout, and displaying a visual cue notifying staff when a patient's discharge order was written. Results The unit's average DL use increased from 18% to 36%, while hospital overcrowding and discharge turnaround time decreased. Conclusion The DL is an effective tool to improve patient flow and decrease hospital overcrowding.

INTRODUCTION: Our psychiatric emergency room (ER) averages 18 patient-to-staff physical assaults annually, with some incidents resulting in multiple injuries. AIMS: The purpose of this performance improvement project was to develop, implement, and evaluate a multifaceted approach to reducing the number of physical assaults on staff. METHODS: We assessed the impact of these bundled interventions on staff assault rate: (1) increasing behavioral response team drills, (2) implementing shift doses, (3) screening for patients’ risk for violence, (4) posting signage to communicate patients’ violence propensity (Golden Hand), (5) implementing mitigating countermeasure interventions, (6) conducting postassault debriefing, and (7) providing postassault support. Psychiatric ER nurses completed questionnaires measuring their perceived self-efficacy in managing patients with a propensity for violence before, during, and after the bundled interventions. Physical assaults on staff were recorded and tracked monthly from May 2016 to September 2018 through a retrospective review of the hospital’s online incident report system. RESULTS: Staff perceived self-efficacy increased from 78% to 95% after attending at least two behavioral response team drills. The Golden Hand signage was rated useful as it flagged and communicated the presence of high-risk patients. Shift dose was evaluated as an informative tool and manageable at ≤5 minutes. The violence-screening tool was considered more accurate in identifying patients with violent tendencies than standard assaultive precautions. Physical assaults on staff by patients decreased to zero in our psychiatric ER, which was sustained for a year. CONCLUSIONS: This innovative, multifaceted, bundled approach provides an opportunity for nurse leaders to promote workplace safety while improving staff engagement and empowerment.

IMPORTANCE: Preoperative testing for cataract surgery epitomizes low-value care and still occurs frequently, even at one of the nation’s largest safety-net health systems. OBJECTIVE: To evaluate a multipronged intervention to reduce low-value preoperative care for patients undergoing cataract surgery and analyze costs from various fiscal perspectives. DESIGN, SETTING, AND PARTICIPANTS: This study took place at 2 academic safety-net medical centers, Los Angeles County and University of Southern California (LAC-USC) (intervention, n = 469) and Harbor–UCLA (University of California, Los Angeles) (control, n = 585), from April 13, 2015, through April 12, 2016, with 12 additional months (April 13, 2016, through April 13, 2017) to assess sustainability (intervention, n = 1002; control, n = 511). To compare pre- and postintervention vs control group utilization and cost changes, logistic regression assessing time-by-group interactions was used. INTERVENTIONS: Using plan-do-study-act cycles, a quality improvement nurse reviewed medical records and engaged the anesthesiology and ophthalmology chiefs with data on overuse; all 3 educated staff and trainees on reducing routine preoperative care. MAIN OUTCOMES AND MEASURES: Percentage of patients undergoing cataract surgery with preoperative medical visits, chest x-rays, laboratory tests, and electrocardiograms. Costs were estimated from LAC-USC's financially capitated perspective, and costs were simulated from fee-for-service (FFS) health system and societal perspectives. RESULTS: Of 1054 patients, 546 (51.8%) were female (mean [SD] age, 60.6 [11.1] years). Preoperative visits decreased from 93% to 24% in the intervention group and increased from 89% to 91% in the control group (between-group difference, −71%; 95% CI, –80% to –62%). Chest x-rays decreased from 90% to 24% in the intervention group and increased from 75% to 83% in the control group (between-group difference, −75%; 95% CI, –86% to –65%). Laboratory tests decreased from 92% to 37% in the intervention group and decreased from 98% to 97% in the control group (between-group difference, −56%; 95% CI, –64% to –48%). Electrocardiograms decreased from 95% to 29% in the intervention group and increased from 86% to 94% in the control group (between-group difference, −74%; 95% CI, –83% to −65%). During 12-month follow-up, visits increased in the intervention group to 67%, but chest x-rays (12%), laboratory tests (28%), and electrocardiograms (11%) remained low (P

Code Black is a documentary movie, and now television series, whose name derives from a term used to describe critical hospital overcrowding resulting in dangerously inadequate patient flow. The Los Angeles County + University of Southern California (LAC+USC) Medical Center is a large, urban, public hospital with a long history of spending substantial amounts of time in Code Black—indeed the movie was created by a former Emergency Medicine resident at LAC+USC Medical Center. To change years of inadequate inpatient flow, we implemented time-limited cardiac monitoring criteria and empowered existing staff to enforce admission and downgrade criteria for our telemetry, step-down care unit, and intensive care units. We evaluated the interventions' effects by comparing census and bed utilization before and after implementation of the criteria, and by evaluating the proportion of time the hospital spent in critical (“Code Black”) or severe (“Code Red”) overcrowding based on National Emergency Department Overcrowding Scores (NEDOCS) of ≥180 or ≥140, respectively. Implementation of utilization criteria allowed substantially better matching of unit occupancy with hospital occupancy, creating intensive care unit capacity despite a rising ward and hospital occupancy. The proportion of time spent in severe overcrowding/surge conditions declined from a baseline of 55% to less than 5%, and the time spent in critical overcrowding (Code Black) declined from 19% to less than 1%. Thus, simple, low-cost interventions markedly improved inpatient flow at a large, public hospital that has historically suffered from chronic overcrowding.

After two fatal cases of catheter overinsertion, a pilot study showed that a shorter catheter seemed to provide a safer alternative.

Early mobility (EM) is vital for patients in the intensive care unit (ICU), as prolonged bed rest can create further complications. Evidence suggests performing EM in the ICU benefits critically ill patients by reducing the incidence of ICU-Acquired Weakness (ICU-AW), decreasing the number of ventilator days, and decreasing the length of stay. Literature shows several barriers to mobility, including lack of standardized protocols, safety concerns, and lack of resources. Research shows that implementing an EM protocol provides positive benefits for ICU patients and has been adopted as part of a patient’s care plan in hospitals and outside the United States. This quality improvement project aimed to modify an existing EM protocol using evidencebased practices and implementing the modified EM protocol in a medical ICU. Early mobility education was performed for one week. There was a 50% compliance rate of assessing patient’s mobility that the MICU nurses performed. Using the PDSA cycle as a guide in accomplishing the project’s purpose helped to identify barriers to performing EM in the MICU. Due to the high acuity of the ICU patients during the COVID-19 pandemic, this project’s full implementation had some limitations. The recommendation for the future is to perform another PDSA cycle to address the barriers in performing EM. Developing a multidisciplinary early mobility team also influences EM implementation success. Keywords: early mobility in the intensive care unit, progressive. mobility, ABCDEF Bundle, ICU Liberation, barriers to early mobility, ventilator days, ICU length of stay

Purpose: The purpose of this QI project was to develop, implement and evaluate a nurse education program. This program was used to develop an education protocol that followed the new Joint Commission (JC) perinatal standard requirement. The objective was to reduce morbidity and mortality caused by postpartum hypertension/preeclampsia using the guide of the new JC perinatal standard. This project aimed to examine changes in nurses’ clinical understanding of the disease state and evaluated their self-efficacy in the usage of evidence-based practices. A final objective was to assess readmission rates before and after implementing the educational intervention. Background: Recently, the JC issued two new perinatal standards that were mandated to start on January 1, 2021. The first standard focused on maternal hemorrhage, whereas the second one addressed postpartum hypertension/preeclampsia. Postpartum hypertension/preeclampsia contribute to a significant number of obstetrical readmissions. Methodology: This project employed a single-group pretest-posttest (nurse-nurses) design. Postpartum nurses were recruited to receive the nurse educational program of the project regarding postpartum hypertension/preeclampsia. The single nurse group design involved nurse participants who received an intervention. This nursing group was evaluated before and after the educational program. Data collection was conducted using the project survey at baseline and after program completion. The project survey included the Postpartum Nursing Knowledge and Teaching Survey and the Evidence-Based Nursing Practice Self-Efficacy scale. Data was collected on the nurse-provided postpartum education during maternal admission and from birth to discharge from the hospital. Results: Demographics represented the nurse population. Discussion: Educational intervention increased nurses’ knowledge and self-efficacy and readmissions. Recommendations for practice change addressed nurse education related to postpartum hypertension/preeclampsia. Keywords: postpartum hypertension, postpartum preeclampsia postpartum readmissions

Background: Workplace violence (WPV) is a serious and growing problem. Nurses have the highest risk for assault due to having more direct patient contact than any other healthcare (HC) workers (Ferri et al., 2016). In 2019, the Senate passed a bill requiring HC employers to implement a WPV prevention plan. Purpose: Implement a WPV prevention plan called the Golden Hand (GH) Tool Kit to reduce assaults on medical-surgical (MS) wards to include: • Staff education • Violence prediction assessment • Additional security for Behavioral Response Team (BRT) • Safety huddles Methods: Analyze the pre- and post-implementation staff survey results and the numbers of assaults from the Safety Intelligence (SI) system to evaluate the project's effectiveness. Results: Based on survey data n=267, staff were in favor of the project and found it beneficial. Reports from SI showed assaults decreased and the time between assaults increased on Ward A; however, no initial improvement on Ward B. In December, a process change was made on Ward B to increase the use of the violence prediction tool to all patients daily. During the 11 weeks of study that followed, there were no patient-to-staff assaults reported on Ward A or B. The project has shown the GH system has an overall positive effect on the reduction of WPV and has even more potential for success with more time and continuous improvements. Conclusion: The GH Tool Kit demonstrates an effective outcome in reducing patient-to-staff assaults in the MS setting in its post-implementation measurement. &nbsp

The ability of patients to consistently schedule appointments in a timely manner with their primary care provider (PCP) is a common problem plaguing many primary care offices within the United States (US). Timely access and continuity of care with the PCP has been associated with better health outcomes, longevity, and decreased healthcare costs. This business plan will propose a budget for a new federally qualified health center (FQHC) location outside of Albuquerque, New Mexico. The Six-Sigma quality improvement process will be used to design a new provider scheduling template to try to improve timely access and continuity of care with a PCP. Proposed measures and the recommended control charts used for monitoring the quality improvement process were identified and the rationale for their use discussed. Recommendations for future quality improvement projects regarding timely access and continuity of care will also be made.