Individual Nurse Productivity in Preparing Patients for Discharge Is Associated With Patient Likelihood of 30-Day Return to Hospital

Yakusheva, Olga; Weiss, Marianne; Bobay, Kathleen L.; Costa, Linda L.; Hughes, Ronda G.; Hamilton, Morris; Bang, James T.; Buerhaus, Peter I.

doi:10.1097/mlr.0000000000001170

Cited by 13 publications

(13 citation statements)

References 29 publications

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“…First, unmeasured confounding is an issue in all observational studies. In our prior work in acute care settings, we found that higher-productivity nurses were assigned to higher-acuity patients [24, 25, 39, 40]. Although there was no evidence of non-random nurse-patient assignments in this study and we adjusted for many patient and shift-level potential confounders, unmeasured confounding may still be present, potentially weakening statistical signals from individual nurses.…”

Section: Discussionmentioning

confidence: 78%

“…We do not know whether there is nurse-level variability in CAABU-avoidance effectiveness. In non-ICU acute care settings, nurse-level variability in patient outcomes was recently reported for the outcomes of clinical condition improvement and patient-reported readiness for discharge [24, 25]. This area of research is important because, if clinician-level variability exists, some patients may inadvertently be receiving low quality care–even in high-performing well-staffed organizations or ICUs.…”

Section: Introductionmentioning

confidence: 99%

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Variability in catheter-associated asymptomatic bacteriuria rates among individual nurses in intensive care units: An observational cross-sectional study

et al. 2019

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Catheter-associated asymptomatic bacteriuria (CAABU) is frequent in intensive care units (ICUs) and contributes to the routine use of antibiotics and to antibiotic-resistant infections. While nurses are responsible for the implementation of CAABU-prevention guidelines, variability in how individual nurses contribute to CAABU-free rates in ICUs has not been previously explored. This study’s objective was to examine the variability in CAABU-free outcomes of individual ICU nurses. This observational cross-sectional study used shift-level nurse-patient data from the electronic health records from two ICUs in a tertiary medical center in the US between July 2015 and June 2016. We included all adult (18+) catheterized patients with no prior CAABU during the hospital encounter and nurses who provided their care. The CAABU-free outcome was defined as a 0/1 indicator identifying shifts where a previously CAABU-free patient remained CAABU-free (absence of a confirmed urine sample) 24–48 hours following end of shift. The analytical approach used Value-Added Modeling and a split-sample design to estimate and validate nurse-level CAABU-free rates while adjusting for patient characteristics, shift, and ICU type. The sample included 94 nurses, 2,150 patients with 256 confirmed CAABU cases, and 21,729 patient shifts. Patients were 55% male, average age was 60 years. CAABU-free rates of individual nurses varied between 94 and 100 per 100 shifts (Wald test: 227.88, P<0.001) and were robust in cross-validation analyses (correlation coefficient: 0.66, P<0.001). Learning and disseminating effective CAABU-avoidance strategies from top-performers throughout the nursing teams could improve quality of care in ICUs.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Variability in catheter-associated asymptomatic bacteriuria rates among individual nurses in intensive care units: An observational cross-sectional study

et al. 2019

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“…Yashusheva and her colleagues have pioneered an approach to estimating nurse‐level variability in patient outcomes by applying an individual performance measurement method from the field of education economics, called Value‐Added Modeling (VAM) 26 . They have found evidence of significant individual nurse variability in patients’ clinical condition change during hospitalization on medical‐surgical units, 26 catheter‐associated asymptomatic bacteriuria in intensive care units, 27 and discharge preparation on medical‐surgical units 28 . Taken together, this seminal body of work has demonstrated that bedside nurses differ in their performance or “value‐added” as individual care providers to patients and that the differences among nurses have a measurable, significant effect on patient outcomes and cost of care, concluding that the data could be potentially used in performance evaluation and merit‐based payment schemes 26 …”

Section: Discussionmentioning

confidence: 99%

Variability in cesarean delivery rates among individual labor and delivery nurses compared to physicians at three attribution time points

Edmonds

Weiseth

Neal

et al. 2020

Health Services Research

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Objective To examine the variability in the cesarean delivery (CD) rates of individual labor and delivery nurses compared with physicians at three attribution time points. Data Sources Medical record data from nine hospitals in Washington State from January 2016 through September 2018. Study Design Retrospective, observational cohort design using an aggregated database of birth records. Data Collection/Extraction Methods Chart‐abstracted clinical data from a subset of nulliparous, term, singleton, vertex births attributed at admission, labor management, and delivery to nurses and physicians. Two classification methods were used to categorize nurse‐ and physician‐level CD rates at three attribution time points and the reliability of these methods compared. Principal Findings The sample included 12 556 births, 319 nurses, and 126 physicians. Overall, variation in nurse‐level CD rates did not differ significantly across the three attribution time points, and the extent of variation was similar to that observed in physicians. However, agreement between attribution time points varied between 35 percent and 65 percent when classifying individual nurses into the top and bottom deciles. The average reliability of nurse‐level CD rates was 32 percent at admission (IQR 22.0 percent to 38.7 percent), 32.6 percent at labor (IQR 23.1 percent to 40.9 percent), and 29.3 percent (IQR 20.9 percent to 35.8 percent) at delivery. The average reliability of physician‐level CD rates was higher: 54.2 percent (IQR 38.7 percent to 71.4 percent) at admission, 62.5 percent (IQR 49.0 percent to 79.6 percent) at labor management, and 66.1 percent (IQR 53.7 percent to 81.2 percent) at delivery. Conclusion Feedback on nurse‐level CD rates as part of routine clinical quality audits can provide insight into nurse performance in the context of other individual‐level and unit‐level information. To reliably distinguish individual nurse performance, larger sample sizes are needed.

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“…Clearly, many parents in the current study expressed concerns about discordant family provider views of the optimal timing of hospital discharge. Disagreement about discharge readiness among physicians, nurses, and pediatric patients and families is not uncommon ( 28 – 30 ). Prior studies report higher rates of unplanned, hospital readmission when children and families are discharged before they feel ready to leave the hospital ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Parent Perspectives on Short-Term Recovery After Spinal Fusion Surgery in Children With Neuromuscular Scoliosis

Garrity

Singer

Ward

et al. 2020

Journal of Patient Experience

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Family perspectives on short-term recovery after spinal fusion for neuromuscular scoliosis are essential for improving patient outcomes. Semistructured interviews were conducted with 18 families of children within 3 months after spinal fusion performed August 2017 to January 2019 at a children’s hospital. Interviews were recorded, transcribed, and coded line-by-line by 2 independent reviewers using grounded theory to identify themes. Five themes emerged among families when reflecting back on the postoperative recovery: (1) communicating and making shared decisions regarding postoperative care in a patient- and family-centered manner, (2) setting hospital discharge goals and being ready for discharge, (3) planning for transportation from hospital to home, (4) acquiring supports for caregiving at home after discharge, and (5) anticipating a long recovery at home. Important family perceptions were elicited about the recovery of children from spinal fusion for neuromuscular scoliosis that will inform better perioperative planning for clinicians, future patients, and their families.

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Individual Nurse Productivity in Preparing Patients for Discharge Is Associated With Patient Likelihood of 30-Day Return to Hospital

Abstract: Supplemental Digital Content is available in the text.

Cited by 13 publications

References 29 publications

Variability in catheter-associated asymptomatic bacteriuria rates among individual nurses in intensive care units: An observational cross-sectional study

Variability in catheter-associated asymptomatic bacteriuria rates among individual nurses in intensive care units: An observational cross-sectional study

Variability in cesarean delivery rates among individual labor and delivery nurses compared to physicians at three attribution time points

Parent Perspectives on Short-Term Recovery After Spinal Fusion Surgery in Children With Neuromuscular Scoliosis

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