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2. The 21st Century Cures Act: Perspectives of Clinicians in a Level-IV Neonatal Intensive Care Unit.

Author

Sullivan, Anne H. T., Healy, Helen M., DeGrazia, Michele, Toole, Cheryl, Hansen, Anne, and Leeman, Kristen T.

Subjects
HEALTH policy, NEONATAL intensive care, PSYCHOLOGY of parents, RESEARCH methodology, MOTIVATION (Psychology), NEONATAL intensive care units, PEDIATRICS, FAMILIES, NEONATAL nursing, PATIENT-centered care, QUESTIONNAIRES, PEDIATRIC nurses, HEALTH care teams, COMMUNICATION, DESCRIPTIVE statistics, THEMATIC analysis, ELECTRONIC health records, LONGITUDINAL method, NEONATOLOGISTS
Abstract

Objective Our objective is to describe the implications, anticipated and perceived, by providers in a level-IV neonatal intensive care unit (NICU) with immediate patient access to inpatient notes and test results in the wake of the 21st Century Cures Act (CCA). Study Design Using a mixed-method approach in February 2021, a preimplementation survey of neonatologists, neonatal fellows, nurse practitioners, and neonatal nurses reported their perspectives on the new 21st CCA and how they anticipated that it would change their practices, and the experience of families in the NICU. In the follow-up to implementation, a postsurvey was completed by staff reporting their experiences in July 2021. Thematic analysis was performed. Results In the preimplementation survey, staff reported the greatest perceived benefits of the changes to be an increase in families' ability to be part of the care team and prepare questions, and faster discussion of results by the care team. Also, staff's highest concerns were that family members may incorrectly interpret results delivered electronically without the context provided by the care team and be overwhelmed by the amount of information available. In the postimplementation survey, staff reported that the Act had less impact on their practice than they had anticipated preimplementation. Conclusion To maximize benefits and limit burdens to families and staff, care teams should consider a thoughtful approach to information sharing with family members in compliance with the 21st CCA. Key Points The impact of the 21 CCA on the NICU has not been studied. NICU staff have significant concerns related to the release of results to families. This study highlights the need to set expectations and provide family-centered care. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Integrating Research, Quality Improvement, and Medical Education for Better Handoffs and Safer Care: Disseminating, Adapting, and Implementing the I-PASS Program

Author

Landrigan, Christopher P., Spector, Nancy D., Starmer, Amy J., Sectish, Theodore C., Srivastava, Rajendu, West, Daniel C., Menon, Aravind Ajakumar, Ali, Arshia, Allair, Brenda K., Allen, April D., Almaddah, Nureddin, Alminde, Claire, Alvarado-Little, Wilma, Anson, Elizabeth, Ashland, Michele, Atsatt, Marisa, Aylor, Megan, Baird, Jennifer D., Bale, James F., Jr, Balmer, Dorene, Barber, Aisha, Barton, Kevin, Bates, Kimberly, Beck, Carolyn, Berchelmann, Kathleen, Bhan, Renuka, Bismilla, Zia, Blankenburg, Rebecca L., Boa-Hocbo, Aileen, Bordin-Wosk, Talya, Brooks, Michelle, Calaman, Sharon, Campe, Julie, Campos, Maria Lucia, Chandler, Debra, Cheung, Yvonne, Choudhary, Amanda, Christensen, Eileen, Clark, Katherine, Coffey, Maitreya, Coghlan-McDonald, Sally, Cohen, Ellen, Cole, F. Sessions, Corless, Elizabeth, Cray, Sharon, Da Silva, Roxi, Dahale, Devesh, Dalal, Anuj K., Destino, Lauren A., Doroshow, Jonathan, Dreyer, Benard, duPont, Katharine, Eagle, Steven, Edgar-Zarate, Courtney, Etzenhouser, Angie, Everhart, Jennifer L., Feraco, Angela M., Ferrer, Alexandra, Galardy, Paul, Garcia, Briana M., Gaspar-Oishi, Maria, Goldstein, Jenna, Good, Brian P., Graham, Dionne A, Growdon, Amanda S., Gubler, LeAnn, Guiot, Amy, Hanlon, Charin, Hanna-Attisha, Mona, Harris, Roben, Haskell, Helen, Hecht, Melvyn, Hehn, Rebecca S, Held, Justin, Hepps, Jennifer H., Hillier, Debra, Hiraoka, Mark, Howell, Eric, Hrach, Christine, Hughes, Helen, Huskins, Charles, Kaatz, Scott, Kanala, Vishnu, Kantrowitz, Michael, Kaplan, Peter, Kashiwagi, Deanne, Kaul, Rajat, Keohane, Carol A., Kern, Jeremy, Khan, Alisa, Khan, Nazia Naz S., Kitch, Barry, Kocolas, Irene, Kothari, Lara, Kruvand, Elizabeth, Kuzma, Nicholas, Lacy, Mary, Lane, Michele, Langrish, Kate, Ledford, Christy J.W., LeRoux, Laura, Lewis, Kheyandra, Lipsitz, Stuart, Litterer, Katherine P., Lopreiato, Joseph O., Lyons, Aimee, Mack, Avram, Mallouk, Meghan, Maloney, Christopher G., Mangan, Amanda, Mann, Keith, Markle, Peggy, Marrese, Christine, Marseille, David, Maynard, Greg, Mehta, Bijal, Mendoza, Fernando, Mercer, Alexandra N., Micalizzi, Dale, Mims, Lisa, Mittal, Vineeta, Mueller, Stephanie, Ngo, Thuy L., Nolan, Ann, Nyenpan, Christopher, Obermeyer, Maria, O'Donnell, Katherine, O'Toole, Jennifer K., Ottolini, Mary, Owolabi, Mobola, Patel, Aarti, Patel, Rajesh, Patel, Shilpa J., Perron, Catherine, Pickler, Rita, Popa, Alina, Reppert, Patrick, Riss, Robert, Roesch, Justin, Rogers, Jayne E., Rosenbluth, Glenn, Rothschild, Jeffrey M., Sanders, Lee, Sauder, Kimberly, Schnipper, Jeff, Schnock, Kumiko O, Scholtz, Amy, Seltz, Barry, Serra, Theresa, Serwint, Janet, Shah, Samir, Sharma, Meesha, Sheppard, Kathleen, Simpkin, Arabella, Sloan, Karin A, Solan, Lauren G., Southgate, Michael W, Spackman, Jaime Blank, Stevens, Scott M., Stevenson, Adam, Stevenson, Windy, Subramony, Anupama, Surkis, William, Thangarasu, Sudhagar, Thompson, E. Douglas, Toole, Cheryl, Trueman, Laura, Trujillo, Tanner, Tse, Lisa, Turmelle, Michael P., Vaniawala, Vishwas, Wagner, Tamara, Warnick, Cindy, Webster, John, Webster, Mary, Weinerman, Adina, Welch, Chelsea, White, Andrew J., Wien, Matthew F., Winn, Ariel S., Wintch, Stephanie, Yin, H. Shonna, Yoon, Catherine S., Yu, Clifton E., Zampino, Dominick, and Zigmont, Katherine R.

Published
2017
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4. Transferring With TACT

Author

Armstrong, Alexandra, primary, Engstrand, Shannon, additional, Kunz, Sarah, additional, Cole, Alexandra, additional, Schenkel, Sara, additional, Kucharski, Keri, additional, Toole, Cheryl, additional, and DeGrazia, Michele, additional

Published
2022
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7. Transferring With TACT: A Novel Tool to Standardize Transfer Decisions From a Level IV NICU.

Author

Armstrong, Alexandra, Engstrand, Shannon, Kunz, Sarah, Cole, Alexandra, Schenkel, Sara, Kucharski, Keri, Toole, Cheryl, and DeGrazia, Michele

Subjects
NEONATAL intensive care units, NEONATAL intensive care, RETROSPECTIVE studies, BURDEN of care, COMMUNICATION, HEALTH care teams
Abstract

Background: Neonatal patients who no longer require level IV neonatal intensive care unit care are transferred to less acute levels of care. Standardized assessment tools have been shown to be beneficial in the transfer of patient care. However, no standardized tools were available to assist neonatal providers in the assessment and communication of the infants needs at transfer.Purpose: The purpose was to develop a Transfer Assessment and Communication Tool (TACT) that guides provider decision making in the transfer of infants from a level IV neonatal intensive care unit to a less acute level of care within a regionalized healthcare system.Methods: Phase 1 included developing the first draft of the TACT using retrospective data, known variables from published literature, and study team expertise. In phase 2, the final draft of the TACT was created through feedback from expert neonatal providers in the regionalized care system using e-Delphi methodology.Results: The first draft of the TACT, developed in phase 1, included 36 characteristics. In phase 2, nurses, nurse practitioners, and physician experts representing all levels of newborn care participated in 4 e-Delphi surveys to develop the final draft of the TACT, which included 74 weighted characteristics.Implications For Practice and Research: Potential benefits of the TACT include improved communication across healthcare teams, reduced risk for readmission, and increased caregiver visitation. The next steps are to validate the TACT for use either retrospectively or in real time, including characteristic weights, before implementation of this tool in the clinical setting. [ABSTRACT FROM AUTHOR]

Published
2022
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9. Informing Leadership Models

Author

Toole, Cheryl A., primary, DeGrazia, Michele, additional, Connor, Jean Anne, additional, Gauvreau, Kimberlee, additional, Kuzdeba, Hillary Bishop, additional, and Hickey, Patricia A., additional

Published
2018
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10. Integrating Research, Quality Improvement, and Medical Education for Better Handoffs and Safer Care: Disseminating, Adapting, and Implementing the I-PASS Program

Author

Starmer, Amy J., primary, Spector, Nancy D., additional, West, Daniel C., additional, Srivastava, Rajendu, additional, Sectish, Theodore C., additional, Landrigan, Christopher P., additional, Starmer, Amy J., additional, Menon, Aravind Ajakumar, additional, Ali, Arshia, additional, Allair, Brenda K., additional, Allen, April D., additional, Almaddah, Nureddin, additional, Alminde, Claire, additional, Alvarado-Little, Wilma, additional, Anson, Elizabeth, additional, Ashland, Michele, additional, Atsatt, Marisa, additional, Aylor, Megan, additional, Baird, Jennifer D., additional, Bale, James F., additional, Balmer, Dorene, additional, Barber, Aisha, additional, Barton, Kevin, additional, Bates, Kimberly, additional, Beck, Carolyn, additional, Berchelmann, Kathleen, additional, Bhan, Renuka, additional, Bismilla, Zia, additional, Blankenburg, Rebecca L., additional, Boa-Hocbo, Aileen, additional, Bordin-Wosk, Talya, additional, Brooks, Michelle, additional, Calaman, Sharon, additional, Campe, Julie, additional, Campos, Maria Lucia, additional, Chandler, Debra, additional, Cheung, Yvonne, additional, Choudhary, Amanda, additional, Christensen, Eileen, additional, Clark, Katherine, additional, Coffey, Maitreya, additional, Coghlan-McDonald, Sally, additional, Cohen, Ellen, additional, Cole, F. Sessions, additional, Corless, Elizabeth, additional, Cray, Sharon, additional, Da Silva, Roxi, additional, Dahale, Devesh, additional, Dalal, Anuj K., additional, Destino, Lauren A., additional, Doroshow, Jonathan, additional, Dreyer, Benard, additional, duPont, Katharine, additional, Eagle, Steven, additional, Edgar-Zarate, Courtney, additional, Etzenhouser, Angie, additional, Everhart, Jennifer L., additional, Feraco, Angela M., additional, Ferrer, Alexandra, additional, Galardy, Paul, additional, Garcia, Briana M., additional, Gaspar-Oishi, Maria, additional, Goldstein, Jenna, additional, Good, Brian P., additional, Graham, Dionne A, additional, Growdon, Amanda S., additional, Gubler, LeAnn, additional, Guiot, Amy, additional, Hanlon, Charin, additional, Hanna-Attisha, Mona, additional, Harris, Roben, additional, Haskell, Helen, additional, Hecht, Melvyn, additional, Hehn, Rebecca S, additional, Held, Justin, additional, Hepps, Jennifer H., additional, Hillier, Debra, additional, Hiraoka, Mark, additional, Howell, Eric, additional, Hrach, Christine, additional, Hughes, Helen, additional, Huskins, Charles, additional, Kaatz, Scott, additional, Kanala, Vishnu, additional, Kantrowitz, Michael, additional, Kaplan, Peter, additional, Kashiwagi, Deanne, additional, Kaul, Rajat, additional, Keohane, Carol A., additional, Kern, Jeremy, additional, Khan, Alisa, additional, Khan, Nazia Naz S., additional, Kitch, Barry, additional, Kocolas, Irene, additional, Kothari, Lara, additional, Kruvand, Elizabeth, additional, Kuzma, Nicholas, additional, Lacy, Mary, additional, Lane, Michele, additional, Langrish, Kate, additional, Ledford, Christy J.W., additional, LeRoux, Laura, additional, Lewis, Kheyandra, additional, Lipsitz, Stuart, additional, Litterer, Katherine P., additional, Lopreiato, Joseph O., additional, Lyons, Aimee, additional, Mack, Avram, additional, Mallouk, Meghan, additional, Maloney, Christopher G., additional, Mangan, Amanda, additional, Mann, Keith, additional, Markle, Peggy, additional, Marrese, Christine, additional, Marseille, David, additional, Maynard, Greg, additional, Mehta, Bijal, additional, Mendoza, Fernando, additional, Mercer, Alexandra N., additional, Micalizzi, Dale, additional, Mims, Lisa, additional, Mittal, Vineeta, additional, Mueller, Stephanie, additional, Ngo, Thuy L., additional, Nolan, Ann, additional, Nyenpan, Christopher, additional, Obermeyer, Maria, additional, O'Donnell, Katherine, additional, O'Toole, Jennifer K., additional, Ottolini, Mary, additional, Owolabi, Mobola, additional, Patel, Aarti, additional, Patel, Rajesh, additional, Patel, Shilpa J., additional, Perron, Catherine, additional, Pickler, Rita, additional, Popa, Alina, additional, Reppert, Patrick, additional, Riss, Robert, additional, Roesch, Justin, additional, Rogers, Jayne E., additional, Rosenbluth, Glenn, additional, Rothschild, Jeffrey M., additional, Sanders, Lee, additional, Sauder, Kimberly, additional, Schnipper, Jeff, additional, Schnock, Kumiko O, additional, Scholtz, Amy, additional, Seltz, Barry, additional, Serra, Theresa, additional, Serwint, Janet, additional, Shah, Samir, additional, Sharma, Meesha, additional, Sheppard, Kathleen, additional, Simpkin, Arabella, additional, Sloan, Karin A, additional, Solan, Lauren G., additional, Southgate, Michael W, additional, Spackman, Jaime Blank, additional, Stevens, Scott M., additional, Stevenson, Adam, additional, Stevenson, Windy, additional, Subramony, Anupama, additional, Surkis, William, additional, Thangarasu, Sudhagar, additional, Thompson, E. Douglas, additional, Toole, Cheryl, additional, Trueman, Laura, additional, Trujillo, Tanner, additional, Tse, Lisa, additional, Turmelle, Michael P., additional, Vaniawala, Vishwas, additional, Wagner, Tamara, additional, Warnick, Cindy, additional, Webster, John, additional, Webster, Mary, additional, Weinerman, Adina, additional, Welch, Chelsea, additional, White, Andrew J., additional, Wien, Matthew F., additional, Winn, Ariel S., additional, Wintch, Stephanie, additional, Yin, H. Shonna, additional, Yoon, Catherine S., additional, Yu, Clifton E., additional, Zampino, Dominick, additional, and Zigmont, Katherine R., additional

Published
2017
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11. Informing Leadership Models: Nursing and Organizational Characteristics of Neonatal Intensive Care Units in Freestanding Children's Hospitals.

Author

Toole, Cheryl A., DeGrazia, Michele, Connor, Jean Anne, Gauvreau, Kimberlee, Kuzdeba, Hillary Bishop, and Hickey, Patricia A.

Subjects
*CHILDREN'S hospitals, *CLINICAL medicine, *EXPERIENTIAL learning, *WORKING hours, *INTENSIVE care nursing, *INTERPROFESSIONAL relations, *LEADERSHIP, *MASTER of arts degree, *EVALUATION of medical care, *MEDICAL personnel, *NEONATAL intensive care, *NURSE administrators, *NURSES, *CONTINUING education of nurses, *PERSONNEL management, *RESEARCH funding, *WORK, *GRADUATE nursing education, *ORGANIZATIONAL structure, *CERTIFICATION, *KEY performance indicators (Management), *NEONATAL intensive care units, *CROSS-sectional method, *DATA analysis software, *DESCRIPTIVE statistics, *BACCALAUREATE nursing education
Abstract

Background: Neonatal intensive care units (NICUs) located in freestanding children's hospitals may exhibit significant variation in nursing and organizational characteristics, which can serve as opportunities for collaboration to understand optimal staffing models and linkages to patient outcomes. Objectives: Adopting methods used by Hickey et al in pediatric cardiovascular critical care, the purpose of this study was to provide a foundational description of the nursing and organizational characteristics for NICUs located in freestanding children's hospitals in the United States. Methods: Clinical nurse leaders in NICUs located in freestanding children's hospitals were invited to participate in an electronic cross-sectional survey. Descriptive analyses were used to summarize nursing and organizational characteristics. Results: The response rate was 30% (13/43), with 69.2% of NICUs classified as level III/IV and 30.8% classified as level II/III. Licensed bed capacity varied significantly (range, 24-167), as did the proportion of full-time equivalent nurses (range, 71.78-252.3). Approximately three-quarters of staff nurses held baccalaureate degrees or higher. A quarter of nurses had 16 or more years (26.3%) of experience, and 36.9% of nurses had 11 or more years of nursing experience. Nearly one-third (29.2%) had 5 or less years of total nursing experience. Few nurses (10.6%) held neonatal specialty certification. All units had nurse educators, national and unit-based quality metrics, and procedural checklists. Conclusion: This study identified (1) variation in staffing models signaling an opportunity for collaboration, (2) the need to establish ongoing processes for sites to participate in future collaborative efforts, and (3) survey modifications necessary to ensure a more comprehensive understanding of nursing and organizational characteristics in freestanding children's hospital NICUs. [ABSTRACT FROM AUTHOR]

Published
2018
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