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The impact of hospital nursing characteristics on 30-day mortality.

https://arctichealth.org/en/permalink/ahliterature175651
Source
Nurs Res. 2005 Mar-Apr;54(2):74-84
Publication Type
Article
Author
Carole A Estabrooks
William K Midodzi
Greta G Cummings
Kathryn L Ricker
Phyllis Giovannetti
Author Affiliation
Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Source
Nurs Res. 2005 Mar-Apr;54(2):74-84
Language
English
Publication Type
Article
Keywords
Acute Disease - mortality
Alberta
Clinical Competence - standards
Continuity of Patient Care - standards
Cross-Sectional Studies
Education, Nursing
Employment - standards
Humans
Models, organizational
Nursing Staff, Hospital - standards
Outcome Assessment (Health Care)
Physician-Nurse Relations
Quality of Health Care
Abstract
Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professional practice, namely nurse education and skill mix, continuity of care, and quality of the work environment.
To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics.
A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals.
Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance = .044, p
PubMed ID
15778649 View in PubMed
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The impact of hospital nursing characteristics on 30-day mortality.

https://arctichealth.org/en/permalink/ahliterature132380
Source
J Nurs Adm. 2011 Jul-Aug;41(7-8 Suppl):S58-68
Publication Type
Article
Author
Carole A Estabrooks
William K Midodzi
Greta G Cummings
Kathryn L Ricker
Phyllis Giovannetti
Author Affiliation
Faculty of Nursing; and Academic Codirector, Centre for Knowledge Transfer, Edmonton, Alberta, Canada. carole.estabrooks@ualberta.ca
Source
J Nurs Adm. 2011 Jul-Aug;41(7-8 Suppl):S58-68
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
Continuity of Patient Care
Cross-Sectional Studies
Educational Status
Female
Hospital Restructuring
Humans
Linear Models
Male
Middle Aged
Mortality
Multivariate Analysis
Nursing Staff, Hospital - organization & administration
Organizational Culture
Outcome Assessment (Health Care)
Personnel Administration, Hospital
Personnel Staffing and Scheduling
Physician-Nurse Relations
Abstract
Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professional practice, namely nurse education and skill mix, continuity of care, and quality of the work environment.
To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics.
A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals.
Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance .044, p
PubMed ID
21799356 View in PubMed
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Older Persons' Transitions in Care (OPTIC): a study protocol.

https://arctichealth.org/en/permalink/ahliterature118099
Source
BMC Geriatr. 2012;12:75
Publication Type
Article
Date
2012
Author
Greta G Cummings
R Colin Reid
Carole A Estabrooks
Peter G Norton
Garnet E Cummings
Brian H Rowe
Stephanie L Abel
Laura Bissell
Joan L Bottorff
Carole A Robinson
Adrian Wagg
Jacques S Lee
Susan L Lynch
Elmabrok Masaoud
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. gretac@ualberta.ca
Source
BMC Geriatr. 2012;12:75
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Alberta - epidemiology
British Columbia - epidemiology
Continuity of Patient Care - standards
Emergency Service, Hospital - standards
Health Personnel - standards
Homes for the Aged - standards
Humans
Nursing Homes - standards
Patient Care Team - standards
Quality of Health Care - standards
Abstract
Changes in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH) residents and necessitate transitions between NHs and Emergency Departments (EDs). During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adults who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to: 1. define successful and unsuccessful elements of transitions from multiple perspectives; 2. develop and test a practical tool to assess transition success; 3. assess transition processes in a discrete set of transfers in two study sites over a one year period; 4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS), and EDs, on transition success; and 5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH - ED transitions.
This is a mixed-methods observational study incorporating an integrated knowledge translation (IKT) approach. It uses data from multiple levels (facility, care unit, individual) and sources (healthcare providers, residents, health records, and administrative databases).
Key to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and researchers to participate equally in developing study goals, design, data collection, analysis and implications of findings. As preliminary and ongoing study findings are developed, their implications for practice and policy in study settings will be discussed by the research team and shared with study site administrators and staff. The study is designed to investigate the complexities of transitions and to enhance the potential for successful and sustained improvement of these transitions.
Notes
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PubMed ID
23241360 View in PubMed
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The Older Persons' Transitions in Care (OPTIC) study: pilot testing of the transition tracking tool.

https://arctichealth.org/en/permalink/ahliterature105718
Source
BMC Health Serv Res. 2013;13:515
Publication Type
Article
Date
2013
Author
Robert Colin Reid
Garnet E Cummings
Sarah L Cooper
Stephanie L Abel
Laura J Bissell
Carole A Estabrooks
Brian H Rowe
Adrian Wagg
Peter G Norton
Mike Ertel
Greta G Cummings
Author Affiliation
Faculty of Nursing, University of Alberta, 5-110 Edmonton Clinical Health Academy, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada. gretac@ualberta.ca.
Source
BMC Health Serv Res. 2013;13:515
Date
2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alberta
British Columbia
Continuity of Patient Care - standards
Emergency Medical Services - methods - standards
Emergency Service, Hospital
Female
Humans
Male
Nursing Homes
Pilot Projects
Quality Improvement - organization & administration
Time Factors
Transportation of Patients - standards
Abstract
OPTIC is a mixed method Partnership for Health System Improvement (http://www.cihr-irsc.gc.ca/e/34348.html) study focused on improving care for nursing home (NH) residents who are transferred to and from emergency departments (EDs) via emergency medical services (EMS). In the pilot study we tested feasibility of concurrently collecting individual resident data during transitions across settings using the Transition Tracking Tool (T3).
The pilot study tracked 54 residents transferred from NHs to one of two EDs in two western Canadian provinces over a three month period. The T3 is an electronic data collection tool developed for this study to record data relevant to describing and determining success of transitions in care. It comprises 800+ data elements including resident characteristics, reasons and precipitating factors for transfer, advance directives, family involvement, healthcare services provided, disposition decisions, and dates/times and timing.
Residents were elderly (mean age?=?87.1 years) and the majority were female (61.8%). Feasibility of collecting data from multiple sources across two research sites was established. We identified resources and requirements to access and retrieve specific data elements in various settings to manage data collection processes and allocate research staff resources. We present preliminary data from NH, EMS, and ED settings.
While most research in this area has focused on a unidirectional process of patient progression from one care setting to another, this study established feasibility of collecting detailed data from beginning to end of a transition across multiple settings and in multiple directions.
Notes
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PubMed ID
24330805 View in PubMed
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Sustaining Transfers through Affordable Research Translation (START): study protocol to assess knowledge translation interventions in continuing care settings.

https://arctichealth.org/en/permalink/ahliterature106495
Source
Trials. 2013;14:355
Publication Type
Article
Date
2013
Author
Susan E Slaughter
Carole A Estabrooks
C Allyson Jones
Adrian S Wagg
Misha Eliasziw
Author Affiliation
Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada. susan.slaughter@ualberta.ca.
Source
Trials. 2013;14:355
Date
2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Alberta
Allied Health Personnel - psychology
Attitude of Health Personnel
Continuity of Patient Care
Evidence-Based Medicine
Health Knowledge, Attitudes, Practice
Health Services Research
Homes for the Aged
Humans
Long-Term Care
Motor Activity
Perception
Reminder Systems
Research Design
Time Factors
Translational Medical Research
Abstract
Bridging the research-practice gap is an important research focus in continuing care facilities, because the population of older adults (aged 65 years and over) requiring continuing care services is the fastest growing demographic among countries in the Organisation for Economic Co-operation and Development (OECD). Unlicensed practitioners, known as health care aides, provide the majority of care for residents living in continuing care facilities. However, little research examines how to sustain health care aide behavior change following initial adoption of current research evidence.
We will conduct a phase III, multicentre, cluster randomized controlled trial (RCT) using a stratified 2 × 2 additive factorial design, including an embedded process evaluation, in 24 supportive living facilities within the health zone of Edmonton, AB, Canada. We will determine which combination of frequency and intensity of reminders most effectively sustains the completion of the sit-to-stand activity by health care aides with residents. Frequency refers to how often a reminder is implemented; intensity refers to whether a reminder is social or paper-based. We will compare monthly reminders with reminders implemented every 3 months, and we will compare low intensity, paper-based reminders and high intensity reminders provided by a health care aide peer.Using interviews, questionnaires, and observations, Sustaining Transfers through Affordable Research Translation (START) will evaluate the processes that inhibit or promote the mobility innovation's sustainability among health care aides in daily practice. We will examine how the reminders are implemented and perceived by health care aides and licensed practical nurses, as well as how health care aides providing peer reminders are identified, received by their peers, and supported by their supervisors.
START will connect up-to-date innovation research with the practice of health care aides providing direct care to a growing population of older Albertans. The project's reach extends to both supportive living and long-term care settings. Furthermore, START has the potential to introduce and sustain a broad range of innovations in various care areas, such as dementia care, wound care, and pain management - domains where the uptake and sustainability of innovations also encounter significant challenges. By identifying the optimal frequency and intensity of knowledge translation interventions, we hope to enable continuing care organizations to efficiently integrate care innovations into the day-to-day care of residents.
ClinicalTrials.gov, NCT01746459.
PubMed ID
24160483 View in PubMed
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