The Early Save And Clinical Deterioration Essay

Identify two areas of nursing practice, which evidence-based practice has improved patient outcomes. State the study and its impact on patient care. How have these findings changed your nursing practice? Please support your response with a minimum of two supporting peer reviewed articles.

In addition, it also measures the quality of care and patient satisfaction. In 2015, the US Secretary of HHS has announced a goal of 85 percentages of Medicare Fee for Service payments tied to quality or value. In addition, many new payment models are associated with HRRP; for instance, forthcoming Skilled Nursing Facility VBP program and Dialysis Adequacy measure , potentially specifies preventable readmission measures. As the system is moving from quantity to quality, it is beneficial to implement quality of standards to optimize future benefits for the community and Central Health as well. Currently, Central Health has higher readmission rate than national average with an overall rating of 2 out of 5. Penalties incurred due to below standard of care could strain hospital resources to utilize for the betterment of our facility. Furthermore, the incentive structure has concerned Central Health to reevaluate the mode of practice and care provided engaging healthcare providers and patients. Central Health is committed to reducing readmission rates by identifying and sharing best practices for long term benefits. Given the flexibility of penalty under the 21st Cure Act, the initial program will focus on readmission prevention within 30 days of hospital

Interventions to Reduce Acute Care Transfers is a quality improvement program that has been used throughout health care settings worldwide. Its main goals are to decrease hospitalizations and readmissions, with an overall aim of improving quality of care (Ouslander et al., 2014). Interact’s website provides health care facilities with affordable and easy to use “tool kits” that are based on five fundamental strategies including; principles of quality improvement, early identification and evaluation of changes in condition, management of common changes in condition, improved advance care planning, and improved communication and documentation (Ouslander et al., 2014). By using the tools health care providers can help prevent unnecessary hospitalizations and related complications, at the same time receive financial

Comparing the projected rate with the existing C.M Hospital’s rate will identify the differential and will be used to set the outcome measure rate. The comparison will prove the need for conducting the implementation plan.

    The modern day emergency room is a department that is constantly busy. In the hustle of caring for patients, there are some details of the patient’s care that can be overlooked in a standard phone report to the accepting nurse. With this in mind, a change is needed so that there is an optimum patient outcome for each and every one of the people that walk through the doors of the emergency room and get admitted.

With new reforms being put in place under the Affordable Care Act such as the pay-for-performance (P4P) also known as “value-based purchasing,” which is intended to help provide maintain and efficient programs to improve health care cost. Healthcare providers, hospitals, medical groups, and physicians are offered incentives for meeting certain performance goals; it also fines for increased costs and medical errors such as incorrect medication or dosages. In two different studies quality of care was found to have improved at P4P hospitals compared to non-P4P hospitals Lindenauer et al. (2007) and Grossbart (2006). However, a study by Werner et al.(2011) found no continuing benefits in quality of care. One measure being advocated for is the Hospital Readmissions Reduction Program (HRRP) to prevent hospital readmissions as a way to improve the quality of care and at the same time cut cost. If patients are readmitted within 30 days after discharges due to conditions like acute myocardial infarction (AMI), heart failure, and pneumonia, fines can be levied such as 1 percent of Medicare payments. Others include the Hospital Value-Based Purchasing (VBP) is based on how well the hospital performs compared to other hospitals or the improvement of their own performance compared to a baseline time. The goal is to encourage better outcomes for patients and improve experience during hospital stays. And the Hospital-Acquired Condition (HAC) Reduction Program motivates hospitals to increase the safety of it patients by cut the number of hospital-acquired conditions and patient safety (Medicare.gov, n.d.) (Kruse, Polsky, Stuart, & Werner, 2012)(Gu et al.,

Organizations may have insufficient funds to initiate and complete the implementation of a new prevention protocol. Inflation, inefficiency, treatment of preventable hospital-acquired conditions, and unforeseen costs all contribute to rising expenditure. However, as a potential opportunity, a proven and efficient VTE prevention protocol can positively impact the ICU’s variance analysis (budget-control process to analyze and weigh the differences between revenue and costs, and projected/actual expenses; Yoder-Wise, 2015, p. 589). A higher level of efficiency leads to higher productivity, which saves money and could serve as the needed leverage for modifying an existing VTE prevention protocol to a more efficient prevention protocol.

This is an opportunity for hospitals to work more closely with skilled nursing facilities and other post-acute providers to improve care transitions, and experience fewer readmissions. The ACA impacted hospitals by holding back a one percent reimbursement rate. Hospitals will actually need to perform and deliver high-quality evidenced based care to recover the one percent withheld reimbursement rate while hospitals that exceed the benchmark, will received a higher reimbursement rate over the one percent. The Act is intended to help spur the trend of more integrated care throughout the continuum. The Affordable care act (ACA) of 2010 designed programs for improvements and innovation in the quality of hospital care by instituting the Medicare’s hospital readmission reduction program. Through this program, CMS reduces Medicare payment bt one percent for hospitals for hospitals that demonstrated high rate of avoidable readmissions for patients with a diagnosis of heart failure, heart attack

The monitoring of critical factors affecting positive transition of health care will lead to a decrease in re-hospitalization of patients in this population.

Studies show that 43% to 76% of all the severe sepsis presentations are initially detected in the ED [9]. For the patients who died in hospital within 72 hours of ED attendance but were not admitted to ICU, the most common reason was a delay or absence of suitable treatments [20]. M eanwhile, the length of stay of the patients in the ED who need to be transferred to ICU may increase due to capacity limitations of the ICU [10]. These patients are recommended to receive early goal-directed therapy (EGDT ) and the severe sepsis resuscitation bundle, as suggested by Surviving Sepsis Campaign (Dellinger, et al. 2008). This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with oxygen demand [19]. Several studies applied the scoring systems that were initially developed for the ICU environment directly to the ED. For example, Nguyen et al. (2008) used APACHE II and SAPS to obtain a result that these existing scoring systems have limited ability to identify non-survivors from survivors (Nguyen, et al. 2008). Thus, developing a scoring system specifically targeting the ED has received increasing interest. Shapiro et al. (2003) developed a prospectively validated scoring system, Mortality in ED Sepsis (MEDS) (Shapiro, et al., 2003). Early warning score (EWS) systems were

The authors used a randomized controlled study design that implemented a 2x2 study design (experimental vs. wait-list control group) x (baseline post –treatment group) to yield a between groups comparison condition (Shapiro, et al, 2005).Participants were randomly assigned to an eight week MBSR group or a wait list control group. The control group received the identical eight-week program after the experimental group had finished their program (Shapiro, et al, 2005). Participants were recruited by posting fliers around the hospital and sending e-mails

Effective observation of patient is the first crucial phase to identify deteriorating patients and apply effective measure to care for them (Mandy, Christina & David, 2009). Nurse’s role is taking care of patients, supporting, and helping them recovery them from disease or any medical condition they came with and improving their quality of lives and get, them back to community to function as normal. However, not always things go efficiently as planned. Nurses work with other multi-disciplinary team to accomplish the goal. A nurse encounter load of temperamental cases therefore Nurse has immense responsibility for recognizing and rescuing the deteriorating patients. It’s a challenging work, which comes with plenty of clinical experiences and great deal of knowledge. This can be very overwhelming and intense at time. Not all the nurses are experienced and know how to handle it. Decision-making is very crucial to the time. Partial experience and basic-level knowledge can make it difficult to care for deteriorating patients. Reporting the doctor about any concerns regarding any changes of the patients can resolve the patients. The lack of communication between disciplinary teams and the nurses can be a cause for untimely action taken for deteriorating patients. The verbal information given to the doctor can be irrelevant sometimes. Hence, it’s very crucial in a health setting to recognize the deteriorating patients. In this paper I will be transcribing how can a nurse recognizes

The changing cores consider the following. Every 10 years, one-fourth of all current knowledge and accepted practices in the healthcare and other industries will be obsolete (Allen, 2015). Effective October 1, 2013, new rules for inpatient hospital reimbursement under the Medicare program make final two sets of proposed rules that the Centers for Medicare & Medicaid Services (CMS) published in the Spring 2013–the definition of an inpatient hospital stay based on time and a hospital rebilling option (CMS, 2013). Working at Howard County General Hospital, for individual to become an inpatient at a skilled nursing facility after a three day minimum acute hospital stay, and who meet Medicare’s qualified diagnosis and comprehensive treatment

Some of the patient data obtained by Rafferty et al. (2007) was from hospital discharge records. Selected patients were between the ages 20-85 and had been discharged from the hospital in 1998 from one of the 30 hospitals selected. Rafferty et al. (2007) wanted to analyze, does having high nurse to patient ratio effect the care of patients that suffer complications while they are in the hospital. So failure to rescue (FTR) was examined by using logistic regression models to see the effect of nurse staffing on patient outcomes mortality and FTR. For data analysis, descriptive statistics were used to show characteristics of the patients and the nurses (Rafferty et al., 2007).

If we just treats patients temporarily without the much needed follow up the care we provided is not complete. Most of the patients do not have the means to follow-up with their care or they are not well informed about the resource available after they get treated in the emergency room or do not have the means to take care of themselves. Brenner noted multiple emergency room visit for the frequent flyers and showed where the failure in the health care system exists. This made me realize patient care is not only treating disease condition but also to follow through the entire process of healing. The entire health system relies on the assumption that most patients have clear understanding of complexity of their condition. Patients are expected to navigate and follow through the entire health system. However, patients do not have a complete understanding of their health issues, which hinder them from being compliant with their care. Unfortunately this leads to multiple hospital readmission and increase cost.