Factors affecting emergency department length of stay of patients admitted to telemetry and critical care units

The purpose of this study was to determine the emergency department (ED) length of stay (LOS) of patients admitted to inpatient telemetry and critical care units and to identify the factors that contribute to a prolonged ED LOS. It also examined whether there was a difference in ED LOS between clients evaluated by an ED physician, an Advanced Registered Nurse Practitioner (ARNP) or a Physician's Assistant (PA).^ A data collection tool was devised and used to record data obtained by retrospectively reviewing 110 charts of patients from this sample. The mean ED LOS was 286.75 minutes. Multiple factors were recorded as affecting the ED LOS of this sample, including: age, diagnosis, consultations, multiple radiographs, pending admission orders, nurse unable to call report/busy, relatives at bedside, observation or stabilization necessary, bed not ready and infusion in progress. No significant difference in ED LOS was noted between subjects initially evaluated by a physician, an ARNP or a PA. ^

Factors associated with critical care nurses' communication with non-communicative patients in the ICU

Hospitalized individuals are isolated from their familiar environment at the onset of illness. Those individuals who are non-communicative are detached from the world and from life, as they previously knew it. Although nurses have long since recognized the importance of communication, patients still report the lack of iy. This study was done to identify factors influencing critical care nurses to communicate with their noncommunicative patients. The overall results of the study indicate that nurses are aware of the importance of verbal communication with patients who may be intubated, paralyzed, unconscious, comatose or neurologically impaired and are not deterred by them. Despite these results, some significant observations emerged identified. CCRN certified nurses and nurses with more years of experience were less likely to have verbal communication with noncommunicative patients. Nurses with children, spouses and those working full-time were more likely to communicate with non-communicative patients.

Making Life Choices Program: A psychoeducational intervention for promoting critical cognitive and affective competencies in adolescents at-risk for problem behaviors

The long term goal of the work described is to contribute to the emerging literature of prevention science in general, and to school-based psychoeducational interventions in particular. The psychoeducational intervention reported in this study used a main effects prevention intervention model. The current study focused on promoting optimal cognitive and affective functioning. The goal of this intervention was to increase potential protective factors such as critical cognitive and communicative competencies (e.g., critical problem solving and decision making) and affective competencies (e.g., personal control and responsibility) in middle adolescents who have been identified by the school system as being at-risk for problem behaviors. The current psychoeducational intervention draws on an ongoing program of theory and research (Berman, Berman, Cass Lorente, Ferrer Wreder, Arrufat, & Kurtines 1996; Ferrer Wreder, 1996; Kurtines, Berman, Ittel, & Williamson, 1995) and extends it to include Freire's (1970) concept of transformative pedagogy in developing school-based psychoeducational programs that target troubled adolescents. The results of the quantitative and qualitative analyses indicated trends that were generally encouraging with respect to the effects of the intervention on increasing critical cognitive and affective competencies. ^

The effects of advanced practice nurses (APNs) as intensivists in a surgical intensive care unit (SICU) on patient outcomes, healthcare charges, and apn intensivist services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD = 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M = 3.27, SD = 3.32), t (202) = 1.02, p = .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU. ^

The Effects of Advanced Practice Nurses (APNs) as Intensivists in a Surgical Intensive Care Unit (SICU) on Patient Outcomes, Healthcare Charges, and APN Intensivist Services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD= 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M= 3.27, SD = 3.32), t (202) = 1.02, p= .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU.

Hearing the Child's Voice: Their Lived Experience in the Pediatric Intensive Care Unit

Background: More than 200,000 children are admitted annually to Pediatric Intensive Care Units (PICUs) in the US. Research has shown young children can provide insight into their hospitalization experiences; child reports rather than parental reports are critical to understanding the child’s experience. Information relating to children’s perceptions while still in the PICU is scarce. Aims: The purpose of this qualitative study was to investigate school age children’s and adolescents’ perceptions of PICU while in the PICU; changes in perceptions after transfer to the General Care Unit (GCU); differences in perceptions of school age children/adolescents and those with more invasive procedures. Methods: Interviews were conducted in PICU within 24-48 hours of admission and 24-48 hours after transfer to GCU. Data on demographics, clinical care and number/types of procedures were obtained. Results: Participants were 7 school age children, 13 adolescents; 10 Hispanic; 13 males. Five overarching themes: Coping Strategies, Environmental Factors, Stressors, Procedures/Medications, and Information. Children emphasized the importance of peer support and visitation; adolescents relied strongly on social media and texting. Parent visits sometimes were more stressful than peer visits. Video games, TV, visitors, and eating were diversional activities. In the PICU, they wanted windows to see outside and interesting things to see on the ceiling above them. Children expressed anticipatory fear of shots and procedures, frustration with lab work, and overwhelming PICU equipment. Number of child responses was higher in PICU (927) than GCU (593); the largest difference was in Environmental Factors. Variations between school age children and adolescents were primarily in Coping Strategies, especially in social support. Number of GCU procedures were the same (8 children) or greater (2 children) than PICU procedures. Discussion: Admission to PICU is a very stressful event. Perceptions from children while still in PICU found information not previously found in the literature. Longitudinal studies to identify children’s perceptions regarding PICU hospitalization and post-discharge outcomes are needed.