Acute Care Hospitals Research Articles

Incidence of Hospital Admission of Out-of-Hospital Cardiac Arrest Patients, and Their Outcomes, in Canada, 2013-2017

BackgroundOut-of-hospital cardiac arrest (OHCA) remains a prominent medical concern worldwide. Epidemiologic metrics and trends over time for OHCA cases in Canada are not well defined. This study evaluated geographic differences in the incidence of OHCA patients being admitted to hospitals across Canada, and their outcomes, during the period 2013-2017. MethodsThis population-based retrospective cohort study included 10,492 nontraumatic OHCA patients aged 2-85 years (66% male) who were admitted to an acute-care hospital in any Canadian province or territory (excluding Quebec) between 2013 and 2017. Overall age- and sex-standardized incidence measures (per 100,000 population per year) were calculated through direct standardization to the 2016 Canadian population. Temporal trends in incidence of admission and survival to hospital discharge were evaluated. ResultsThe overall age- and sex-standardized incidence of OHCA patients being admitted to the hospital was 8.3 per 100,000 population per year, which did not change significantly from 2013 to 2017 (incidence rate ratio: 1.01, 95% confidence interval: 0.99-1.02). The incidence was highest in British Columbia (9.2), Manitoba (9.0), and Nova Scotia (9.0), and lowest in New Brunswick (6.5), Prince Edward Island (6.8), and Saskatchewan (7.5). The proportion of OHCA patients who survived to hospital discharge was highest in Prince Edward Island (57%) and lowest in Ontario (38%). No significant trend in rates of survival to hospital discharge was observed from 2013 (43%) to 2017 (42%; P = 0.86). ConclusionsThe age- and sex-standardized incidence of OHCA patients being admitted to the hospital, and their survival outcomes, was stable for the period 2013-2017 in Canada, with considerable variation noted across geographic regions.

Relationship Between Insurance Status and Receipt of Cardiac Tests and Procedures During Hospitalization: A Cross-Sectional Study.

Prior analyses of the relationship between insurance status and receipt of tests and procedures have yielded conflicting findings and have focused on outpatient care. We sought to characterize the relationship between primary payer and diagnostic and procedural intensity, comparing rates of cardiac tests and procedures in matched hospitalized Medicaid and commercially insured patients. We created a propensity score-matched sample of Medicaid and commercially insured adults hospitalized at all acute care hospitals in Kentucky, Maryland, New Jersey, and North Carolina from 2016 to 2018. The main outcome was receipt of a cardiac test or procedure: echocardiogram, stress test, cardiac catheterization (elective, in acute coronary syndrome, in ST-segment-elevation myocardial infarction), and pacemaker and subcutaneous cardiac rhythm monitor implantation. Generalized linear models with a hospital-specific indicator variable were estimated to calculate the adjusted odds of a commercially insured patient receiving a given test or procedure relative to a Medicaid patient. Models controlled for race, ethnicity, and zip code income quartile. Commercially insured patients were more likely to receive each cardiac test or procedure, with adjusted odds ratios ranging from 1.16 (95% CI, 1.00-1.34) for cardiac catheterization in ST-segment-elevation myocardial infarction to 1.40 (95% CI, 1.27-1.54) for pacemaker implantation. Hospitalized commercially insured patients were more likely to undergo a range of cardiac tests and procedures, some of which may represent low-value care. This may be driven by a combination of physician and patient preference, financial incentives, and social determinants of health. Our findings support the need for hospital payment models focused on increasing value and reducing inequities.

Multicomponent Approaches to Reduce Multidrug-Resistant Organisms in Critical Care: Determining the Ideal Strategy.

Although there is ample proof of the advantages of infection prevention and Control (IPC) in acute-care hospitals, there is still some questions about the efficacy of IPC interventions for multidrug-resistant organisms (MDROs), and there is a need for the development of evidence-based practices. No healthcare facility has found a single effective technique to reduce MDRO. However, a multicomponent intervention that included improved barrier protection, chlorhexidine bathing, microbiological monitoring, and staff involvement significantly decreased the likelihood of infection in the patient surroundings with multidrug-resistant organisms. A practical strategy suited to reducing the burden of MDROs and their transmission potential in the critical care unit must be established in light of the global development of AMR. In this review, we summarize key findings of a multicomponent approaches to reduce MDROs in critical care units.

A "Whole Child Approach": Parent Experiences with Acute Care Hospitalizations for Children with Autism Spectrum Disorder and Behavioral Health Needs.

Children with Autism Spectrum Disorder (ASD) experience increased hospitalizations as compared to the general population, particularly in the context of mental health crises. Given the unique needs of children with ASD and behavioral health needs that can either lead to or emerge during hospitalization, an understanding of hospital experiences is critical. To date, research on caregiver experiences in acute care medical hospital settings is limited. Therefore, the purpose of this qualitative study was to investigate caregiver experiences with inpatient care for children with ASD and behavioral health needs, including factors and practices that impacted or were desirable for care. Two focus groups were conducted with a total of 12 parents of children with ASD admitted to a large pediatric hospital. Data were analyzed using interpretive description. Emerging themes pointed to the child, family, and staff factors and practices that intersect to influence hospitalization experiences. Child factors included the child's communication, sensory, behavioral, medical, and safety needs. Family factors included the family's relationship with the healthcare team, own needs, and advocacy experiences. Staff factors included staff communication practices, comfort, and knowledge when providing care. Overall, this research demonstrates the complexity of factors and practices that impact the behavioral health hospitalization experience for children with ASD and their caregivers. Experiences varied widely and were guided by the unique needs of each child. Findings point to care practices that can be adopted to best meet the needs of all stakeholders during hospitalization and offer implications for future educational initiatives.

Teiripe sa Bhaile: ICPOP Early Supported Discharge for Frailty

Abstract Background Older adults and particularly older adults with frailty are high users of acute hospital care which results in overall higher hospital costs and reduced functional independence. Early supported discharge (ESD) was found to have a statistically significant impact in reducing length of stay in older adults admitted for medical reasons. This poster outlines the rehabilitation pathway developed by an ICPOP team to provide early supported discharge for frail older inpatients with SMART rehab goals. Methods Suitable patients are identified and assessed prior to discharge from the acute ward. Each patient receives a comprehensive geriatric assessment in their own home. All patients receive at least 2 hours of therapy per week until they have reached their goals. Standardised outcome measures including Functional Assessment Measure (FIM/FAM) and EQ5D5L are captured for each patient. Clients are discharged once they have reached their goals or are at their new functional baseline. Results 52 patients have been seen on this pathway since 2023. Hip fracture was the most common reason for referral, followed by Falls. Average length of stay on service was 40 days. Average wait time to first assessment was 1.7 days, highlighting the responsiveness of the service. 4 patients seen in 2024 live alone, indicating this service is also appropriate for patients who don’t have supports readily available in the home. FIM/FAM scores increased from 148 to 160 on average- Indicating more functional independence. Conclusion This ICPOP Rehabilitation pathway offers a safe, person-centred alternative to traditional inpatient rehabilitation. Readmission rates post discharge were low indicating the programme's safety. Given the large number of hospital bed saved without compromising functional outcomes for the patients, the ICPOP team is working on expanding this pathway.

Retracted: Do Specialised Geriatric Wards Improve Patient Outcomes

Abstract Background Older adults demonstrate a unique set of needs in an acute healthcare setting. Admissions increase risk of hospital acquired disability including delirium, infections and functional decline with heightened risk of institutionalisation. As per national guidelines, acute hospital care of older patients should be carried out on a specialised geriatric ward (SGW). This aligns with Slainte cares “right care, right time, right place”. An organisational change project was implemented to set up an SGW in a tertiary centre. Assessment and documentation of delirium along with length of stay (LOS) were assessed as a surrogate marker for improvement in patient outcomes. Methods A retrospective assessment of patient demographics, LOS and delirium documentation for a 3-month period in 2023 was reviewed and compared to the same 3-month period in 2024 post inception of the SGW as part of a service development project. Results Mean age was 83 in both groups. 11% (18/157) pre SGW and 30% (40/134) post had dementia. 91% (122/134) had a collateral history and CGA during their stay on the SGW compared to 78% (123/157). 89% (119/134) had a 4AT documented at any point in the admission post SGW compared with 16% (26/157) previously. 80% (107/157) had a 4AT documented by nursing compared with 0% prior. It was estimated that there were 1,514 bed-days saved. Conclusion The implementation of a novel SGW is a complex service development project that utilised organisational development and had a focus on the people underpinning the project at all levels in planning for success. A significant improvement was seen in delirium recognition and documentation using the 4AT at all levels. The most significant improvement was seen in nursing documentation of the 4AT. A significant improvement in “bed days” and patient LOS was observed. This project serves as the business case for further development and sustainability of our SGW.

Preventing Hospitalisation- Providing Specialist Geriatric Services To Nursing Home Patients

Abstract Background Nursing home (NH) residents often require acute hospital care in unexpected deterioration and may have repeated Emergency Department (ED) attendances. Grunier et al (2018) reported 48% of NH residents reattend ED within 1 year. Our aim is to determine if those who require acute hospital admission are more likely to reattend ED or require NH outreach services. Methods Nursing home residents who attended Mater ED in March 2023 were identified through Electronic Patient Record. Their age, gender, reattendance of ED within 28 days and 6 months, visit by NH outreach team within 28 days then 6 months and 6-month mortality were recorded. The residents were categorised as admitted or discharged from their sentinel visit in March 2023. Chi-square test was used, and statistical significance was set at p<0.05. Results Sixty-three nursing home residents attended within 1-month, median age 85 years (range 67-95), 43 were women. Forty-five (71%) required admission, 6 (9.5%) and 24 (38.1%) reattended ED within 28 days and 6 months respectively. There was no difference in 28-day or 6-month ED reattendance between those who were admitted or discharged in the sentinel visit to ED. Those discharged from ED were more likely to receive NH outreach visit within 28 days (84% vs 6.8%) and 6 months (84% vs 11%) than those who were admitted, p<0.0001. There was no difference in 6 months mortality between the groups. Conclusion Our study found that 71% of NH residents who attend ED require admissions showing that the transfer was warranted. More than one-third of NH residents reattend ED within 6 months. Those discharged from ED were more likely to be reviewed by NH outreach team as per service delivery. Working closely with the resident’s General Practitioner, NH and ED staff may help to manage these complex patients to coordinate their treatment and prevent ED reattendance.

EDAPT: The Development And Implementation Of A Novel Referral Pathway From The Emergency Department

Abstract Background The Emergency Department Admission Prevention Therapy (EDAPT) service was developed by Therapy staff of the Pathfinder team in order to facilitate timely and appropriate discharges from the Emergency Department (ED) and to maximise capacity for the follow-up team. The aim of this pilot is to provide rapid access to therapy post discharge from ED for older adults with acute decline in function in order to prevent hospital admission. The service provides a short-term reablement approach within the home aiming to facilitate patients to regain pre-acuity baseline. EDAPT was modelled from an existing service but has now been expanded to accepting direct referrals from ED Medical Staff and Advanced Nurse Practitioners (ANPs) outside of standard working hours. Methods The pilot was introduced following collaboration and consultation with a number of key stakeholders including respective Therapy Managers, ED Consultants, ANPs and ED Therapists. A new EDAPT referral pathway was created, and documentation including specific referral and assessment forms. A designated area for receipt of referrals in the ED department was chosen and checked daily. Results 64 patients with a mean age of 80.5 years were referred to the EDAPT service from November ’23 to April ’24. 53 of those patients received face-to-face input and had a mean Clinical Frailty Scale score of 5. 27% (n=17) of referrals were initiated out-of-hours via Medical and ANP staff and 48% (n=31) of referrals were falls related. Patients received an average of 2 follow-up visits during EDAPT involvement. Conclusion The EDAPT pilot is successfully facilitating timely and appropriate discharges from the ED, improving patient experience and patient flow from ED to their own home. The pilot integrates acute hospital care and community services, supporting a person-centred approach of the right care, at the right time and in the right place.

Influence of dementia-specialized care team on clinical outcomes in a general hospital

BackgroundBecause of the increasing prevalence of dementia in Japan, the government introduced financial incentives for specialized care for dementia at acute care hospitals in 2016. Our hospital then introduced a multidisciplinary collaborative specialized team, referred to as dementia-specialized care team. The aim of this study is to examine the influence of dementia-specialized care team on clinical outcomes for elderly inpatients. MethodsIn this retrospective observational study at a general hospital with 650 beds in Japan, we compared clinical outcomes such as incidence of falls, prescription of hypnotics, length of hospital stay, in-hospital mortality, and discharge destinations in inpatients aged 65 years and older between a two-year pre-intervention period (2014–2015) and a two-year post-intervention period (2017–2018). ResultsDuring the observation period, a total of 34,097 patients were admitted, with 16,237 patients in the pre-intervention period and 17,860 patients in the post-intervention period. The proportion of patients receiving any hypnotics decreased from 21.2 % to 19.2 %, notably with benzodiazepine from 19.8 % to 13.2 %. The incidence of falls from a seated or lying position, particularly at night, was significantly lower (from 0.5 % to 0.2 %) as was the length of hospital stay (from 13.7 days to 13.2 days) during the post-intervention period. ConclusionAfter the implementation of dementia-specialized care team, favorable outcomes such as a reduction in the use of hypnotics, the incidence of falls, and the length of hospitalization were observed. Introduction of the team and associated incentives may be effective in improving clinical outcomes in elderly inpatients.

Malnutrition defined by global leadership initiative on malnutrition criteria impedes home discharge in acute care hospital admissions

Background & aimsLimited evidence exists on the association between malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) criteria in hospitalized acute care patients and their outcomes; several aspects still require clarification. This study aimed to evaluate the relationship between malnutrition, as defined by the GLIM criteria, at the time of acute hospital admission and discharge to home. MethodsThis retrospective observational study was conducted at a hospital that provides acute care in Japan. Adult patients admitted between July 2023 and April 2024 were included in this study. The primary outcome was the number of patients discharged to home, with in-hospital mortality as the secondary outcome. To ensure the reliability of the cohort-wide results, background factors were adjusted using propensity score matching. The two groups were compared based on the presence or absence of malnutrition, as defined by the GLIM criteria at admission. Furthermore, multiple logistic regression analysis was conducted, with the outcome as the dependent variable and malnutrition, diagnosed using the GLIM criteria, as the explanatory variable, adjusting for covariates. ResultsA total of 1,007 patients were included in the final analysis, of whom 492 (49%) were diagnosed without malnutrition, while 515 (51%) were diagnosed with malnutrition according to the GLIM criteria. In the multivariate logistic regression analysis after matching, malnutrition defined by the GLIM criteria emerged as an independent factor associated with discharge to home (odds ratio [OR] = 0.37, 95% confidence interval = 0.25–0.56, P < 0.001) when adjusting for age, sex, and various comorbidities. Among the GLIM sub-criteria, reduced muscle mass, reduced food intake or assimilation, and disease burden or inflammation were independently associated with discharge to home. Notably, disease burden/inflammation exhibited the lowest OR among the GLIM sub-criteria for discharge. ConclusionMalnutrition diagnosed using the GLIM criteria upon admission in patients admitted to a regional hospital providing acute care was associated with decreased rates of discharge to home and increased in-hospital mortality. Specifically, attention should be paid to the criteria for reduced muscle mass and disease burden or inflammation within the GLIM framework.

Developing a Life Story Intervention for Older Adults With Dementia or at Risk of Delirium Who Were Hospitalized: Multistage, Stakeholder-Engaged Co-Design Study.

Older adults with chronic or acute cognitive impairment, such as dementia or delirium, who are hospitalized face unique barriers to person-centered care and a higher risk for negative outcomes stemming from hospitalizations. There is a need for co-designed interventions adapted for these patients to the hospital setting to improve care and outcomes. Patient life storytelling interventions have demonstrated promise in enhancing person-centered care by improving patient-care team relationships and providing information to enable care tailored to individual needs and values. This study aims to engage patients, care partners, and clinical stakeholders in a co-design process to adapt an existing life storytelling model for use with older adults with dementia and at risk of delirium in the acute care hospital setting. We recruited patients with dementia or at risk of delirium who were hospitalized, their care partners, clinicians, and informaticists. A 3-stage co-design process that used a mixed methods data collection approach including in-depth interviews and surveys was completed. We used content analysis to analyze qualitative data and descriptive statistics to summarize quantitative data. In total, 27 stakeholder informants (ie, patients, care partners, and interdisciplinary care team [IDT] members) participated. Stakeholders were unanimously interested in using patient life stories as a tool for hospital care through electronic health record (EHR) integration. Stakeholders shared potential topics for life stories to cover, including social support, information on patients' key life events, and favorite activities. Participants provided insights into the logistics of integrating life stories into acute care, including interview arrangement, story-sharing methods, and barriers and facilitators. IDT members shared preferences on EHR integration, resulting in 3 co-designed mock-ups of EHR integration options. Stakeholders shared ways to optimize future acceptability and uptake, including engaging with the care team and promoting awareness of life stories, ensuring suitability to the acute environment (eg, distilling information in an easily digestible way), and addressing concerns for patient capacity and privacy (eg, engaging care partners when appropriate). Thoughts on potential impacts of life stories were also elicited, including improving patient- and care partner-IDT member relationships; humanizing patients; increasing clinical team, patient, and caregiver satisfaction; and enabling more specific, tailored care for patients with dementia and at risk of delirium. This study resulted in a co-designed life storytelling intervention for patients with dementia and at risk for delirium in an acute care hospital setting. Stakeholders provided valuable information to ensure future intervention acceptability and uptake, including potential benefits, facilitators, and challenges in the acute care setting.

Dementia Training for Nurses in Acute Care Settings: Impacts and Barriers.

The provision of consistent, high-quality dementia care training for healthcare professionals in acute care hospital settings has been largely overlooked until recent years. This study was designed to investigate the effect of current healthcare professional dementia care training courses on related knowledge, attitudes, and self-efficacy in hospital nurses and to understand their training-related experiences, willingness, and perceived barriers. Using a cross-sectional design, 201 nurses were recruited from a teaching medical center in Taiwan. A questionnaire was developed by the researchers to evaluate knowledge, attitudes, and self-efficacy related to caring for people with dementia and to elucidate participant experiences and preferences regarding dementia care training courses. Five academic and clinical dementia care experts held three content validity evaluation rounds for the developed questionnaire. Inferential statistics were used to compare the knowledge, attitudes, and self-efficacy related to caring for people with dementia between participants who had and had not attended a dementia care training course. Nearly all (96.5%) of the participants had prior experience caring for people with dementia, but only 25.9% and 7.0% respectively reported haven taken basic and advanced healthcare professional dementia care training courses. Those who had taken either the basic or advanced course earned higher mean knowledge scores than those who had taken neither (p = .009 and p = .027, respectively). Time constraints and scheduling conflicts were identified as the major barriers to attending dementia care training (n = 164, 81.6%). The participants who had attended either the basic or advanced healthcare professional dementia care training course were found to have better dementia care knowledge than those who had not. Stakeholders should work to further reduce the barriers faced by nurses to attending essential dementia care training.

A far ultraviolet-C light technology is effective for decontamination of items in proximity to sinks and is enhanced by a far UV-C reflective surface.

Dispersal of gram-negative bacilli from sink drains has been implicated as a source of transmission in multiple outbreaks. In an acute care hospital, we assessed how often patient care supplies and other frequently touched items were within 1 meter of sink drains. We tested the efficacy of a ceiling-mounted far ultraviolet-C (UV-C) light technology for decontamination of sink bowls and surfaces near sinks with and without a wall-mounted film that reflects far UV-C light. Of 190 sinks assessed, 55 (29%) had patient care supplies or other frequently touched items within 1 meter of the drain. The far UV-C technology reduced Pseudomonas aeruginosa, Enterobacter cloacae and Candida auris on steel disk carriers by ≥1.5 log10 colony-forming units (CFU) in 45 minutes. On inoculated real-world items, ≥1.9 log10 CFU reductions in P. aeruginosa were achieved on sites in line with the light source versus 0.4-1.8 log10 CFU reductions on shaded surfaces. The addition of the reflective surface significantly enhanced efficacy in shaded sites (P < 0.01). In a hospital setting, patient care supplies and other frequently touched items were often in proximity to sinks. The far UV-C light technology could potentially be useful for sink decontamination in high-risk areas.

Role of inpatient rehabilitation facility functional measures to predict community discharge after stroke.

This study investigated the association between stroke severity, functional status measured by the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI), and community discharge from IRF. Aim one examined the association between National Institutes of Health Stroke Scale (NIHSS) scores measured during the acute care stay and IRF admission functional status, measured by the admission IRF-PAI self-care and mobility functional measures, to deduce if functional measures can serve as a proxy for stroke severity. Aim two investigated the ability of the NIHSS and IRF-PAI admission functional measures to predict community discharge from IRF after stroke. Retrospective cohort study using electronic health records and Uniform Data System. Medical Record file data from January 1, 2018, to December 30, 2019. Academic hospital-based IRF. Five hundred forty-four patients transferred from acute care hospital to IRF after an ischemic or hemorrhagic stroke. Exclusion criteria included a transient ischemic attack, discharge against medical advice, death during IRF stay, or readmission to acute care within 48 hoursof IRF admission. Not applicable. Admission IRF-PAI self-care and mobility scores and discharge status from IRF. Of the 544 patients, 76.7% had community discharge. NIHSS scores were significantly associated with IRF-PAI admission self-care scores across each NIHSS stroke category. There was no statistically significant association between NIHSS and IRF-PAI admission mobility score. IRF admission self-care and mobility scores were each statistically significant predictors of community discharge (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.03-1.17; OR = 1.10, CI: 1.03-1.18, respectively). NIHSS scores were not a statistically significant predictor of community discharge (OR = 0.70, CI: 0.47-1.04) from IRF. IRF-PAI self-care functional measure is associated with the NIHSS and can serve as a proxy for stroke severity. IRF-PAI self-care and mobility measures each predict community discharge.

How Shift Nurses' Presenteeism is Related to Insomnia and Care Left Undone: A Cross-Sectional Study Using Generalised Structural Equation Modelling.

To examine the association between nurses' insomnia, presenteeism and care left undone and explore the mediating effect of presenteeism on the relationship between insomnia and care left undone among nurses in acute care hospitals, applying a dynamic model of presenteeism and absenteeism. A cross-sectional design. A secondary data analysis was conducted using online survey data collected in January 2023. Participants were 1154 registered nurses who provided direct nursing care to patients in tertiary or general hospitals (hospitals with 300 or more beds) in South Korea. Poisson regression analysis was used to examine the association between nurses' insomnia, presenteeism and care left undone. Generalised structural equation modelling was performed to examine the mediating effect of presenteeism on the relationship between insomnia and care left undone. The prevalence of insomnia was 15.3%. More than half of the participants (63.7%) reported experiencing presenteeism in the past 4 weeks. All reported at least one nursing care left undone during their last shift. Insomnia and presenteeism were positively associated with care left undone, and presenteeism mediated the relationship between insomnia and care left undone among nurses in acute care hospitals. Nurses experienced insomnia and presenteeism, related to higher rates of care left undone. Nurses' insomnia had a direct effect on care left undone and an indirect effect through presenteeism. Nurse managers and administrators need to make greater efforts to reduce insomnia and presenteeism among nurses, thereby reducing care left undone and improving patient safety in acute care settings. Nurse managers and administrators should consider proactive interventions to address nurses' insomnia and foster a workplace with healthy systems and culture to reduce sleep disturbance and presenteeism, which can effectively decrease care left undone. STROBE guidelines. No patient or public contribution.

Rural-Urban Disparities in Hospital Services and Outcomes for Children With Medical Complexity

Limited availability of inpatient pediatric services in rural regions has raised concerns about access, safety, and quality of hospital-based care for children. This may be particularly important for children with medical complexity (CMC). To describe differences in the availability of pediatric services at acute care hospitals where rural- and urban-residing CMC presented for hospitalization; identify rural-urban disparities in health care quality and in-hospital mortality; and determine whether the availability of pediatric services at index hospitals or the experience of interfacility transfer modified rural-urban differences in outcomes. This retrospective cohort study examined all-payer claims data from Colorado, Massachusetts, and New Hampshire from 2012 to 2017. Analysis was conducted from May 2023 to July 2024. Participants included CMC younger than 18 years residing in these states and hospitalized during the study period. Rural or urban residence was determined using Rural-Urban Commuting Area codes. Hospitals were categorized as children's hospitals or general hospitals with comprehensive, limited, or no dedicated pediatric services using American Hospital Association survey data. Interfacility transfers between index and definitive care hospitals were identified using health care claims. In-hospital mortality, all-cause 30-day readmission, medical-surgical safety events, and surgical safety events were operationalized using Agency for Healthcare Research and Quality measure specifications. Among 36 943 CMC who experienced 79 906 hospitalizations, 16 525 (44.7%) were female, 26 034 (70.5%) were Medicaid-insured, and 34 008 (92.1%) were urban-residing. Rural-residing CMC were 6.55 times more likely to present to hospitals without dedicated pediatric services (rate ratio [RR], 6.55 [95% CI, 5.86-7.33]) and 2.03 times more likely to present to hospitals without pediatric beds (RR, 2.03 [95% CI, 1.88-2.21]) than urban-residing CMC, with no significant differences in interfacility transfer rates. In unadjusted analysis, rural-residing CMC had a 44% increased risk of in-hospital mortality (RR, 1.44 [95% CI, 1.03-2.02]) with no significant differences in other outcomes. Adjusting for clinical characteristics, the difference in in-hospital mortality was no longer significant. Index hospital type was not a significant modifier of observed rural-urban outcomes, but interfacility transfer was a significant modifier of rural-urban differences in surgical safety events. In this cohort study, rural-residing CMC were significantly more likely to present to hospitals without dedicated pediatric services. These findings suggest that efforts are justified to ensure that all hospital types are prepared to care for CMC.

Managerial Support Matters: Predictors of Nurses’ Turnover Intentions During the COVID-19 Pandemic in The Bahamas

Amidst the prolonged COVID-19 pandemic, nurses in The Bahamas faced challenges such as exacerbation of severely limited job resources and heightened job demands. Anecdotal evidence suggested that these conditions jeopardized nurses&amp;rsquo; well-being and increased their turnover intentions. An incomplete understanding of factors influencing Bahamian nurses&amp;rsquo; turnover intentions, during periods of crises limits our ability to formulate appropriate retention strategies. The purpose of this study was to 1) examine the influence of job demands and job resources on nurses&amp;rsquo; turnover intentions, and 2) identify key predictors of turnover intentions of nurses employed in a public acute care hospital in The Bahamas during the COVID pandemic. Data were collected from regulated nurses between January and April 2022 using a cross-sectional, descriptive, survey design. Stepwise multiple linear regression analysis was used to predict relationships among turnover intentions and job demands and job resources. The study found that managerial support was a statistically significant job resource that predicted nurses&amp;rsquo; turnover intentions (B = -.25, p= 0.19). Support from immediate nursing supervisors was a key predictor of nurses&amp;rsquo; turnover intentions among Bahamian nurses. It is essential for nurse managers and other stakeholders to be aware of the importance of managerial support for reducing nurse turnover intentions, especially during crises.

SARS-CoV-2 burden on the floor was associated with COVID-19 cases and outbreaks in two acute care hospitals: a prospective cohort study

SARS-CoV-2 burden on the floor was associated with COVID-19 cases and outbreaks in two acute care hospitals: a prospective cohort study

Identification of statewide core competencies for new graduate nurses at the beginning of practice and after a 12-month nurse residency program

AimTo inform the development of statewide core competencies for new graduate nurses at the beginning of their professional career and after completing a 12-month nurse residency program. BackgroundAlthough studies have attempted to clarify the expected core competencies of new graduate nurses at the beginning of their professional career, results are mixed. Additionally, nurse residency program competency expectations vary. DesignA retrospective cross-sectional study using a purposive sample of a national nurse residency program database. MethodsWilcoxon Signed Rank tests compared retrospective self-report data between January 1st 2017 and December 31st 2019, from 2916 acute care hospital new graduate nurses working in the state of Maryland, USA, to examine their perceptions of competency at hire and after completing a nationally standardized 12-month nurse residency program. The study used six domains from the Casey Fink Graduate Nurse Experience Survey© 2006 and the Vizient/AACN Nurse Residency Program™ Progression survey. ResultsNew graduate nurses' self-report of competency increased from a mean score of 4.81 at the beginning of a nurse residency program to 6.67 after completion of 12-month nurse residency program (scale of 0–10). At the beginning of a nurse residendy program, new graduate nursesreported a low level of comfort in three of the six survey domains: communication and leadership, high-intensity skills and patient safety. At 12 months, new graduate nurses reported higher levels of comfort in all six survey domains, with statistically significant increases (Wilcoxon Signed Rank test, α =0.05). ConclusionsFour domains for ongoing competency development were identified for the nurse residency program curriculum—communication and leadership, patient safety, complex patient assignments and end-of-life care—with the expectation that new graduate nurses achieve competency at program completion. New graduate nurses’ perceptions corroborated findings from a statewide study of academicians and practice leaders, thus helping to develop realistic core competencies for new graduate nurses entering the workforce and after completing a 12-month nurse residency program.

The quality of home-based primary care delivered by nurse practitioners: A national Medicare claims analysis.

As the US population ages, there is an increasing demand for home-based primary care (HBPC) by those with Alzheimer's/dementia, multiple chronic conditions, severe physical limitations, or those facing end-of life. Nurse practitioners (NPs) are increasingly providing HBPC, yet little is known about their quality of care in this unique setting. This observational study uses Medicare claims data from 2018 to assess the quality of care for high-intensity HBPC users (5 or more visits/year) based on provider type (NP-only, physician (MD)-only, or both NP and MDs). We employ 12 quality measures from 3 care domains: access and prevention, acute care utilization, and end-of-life. Analysis includes bivariate comparisons and logistic regression models that adjust for demographic, clinical, and geographic characteristics. Among the 574,567 beneficiaries with 5 or more HBPC visits, 37% saw an NP, 37% saw a MD, and 27% saw both NPs and MDs. In multivariate models, those receiving HBPC from an NP or both NP-MD are significantly more likely to receive a flu shot than the MD-only group, but less likely to access preventive care. NP-only care is associated with more acute care hospitalizations, avoidable ED visits, and fall-related injuries, but significantly fewer avoidable admissions. For end-of-life care, those with NP-only or both NP-MD care are significantly more likely to have an advanced directive, be in hospice in the last 3 days of life, and more likely to die in hospice. The NP group is also more likely to die in the next year. HBPC patients are complex, with both palliative and curative needs. NPs provide almost half of HBPC in the Medicare program, to patients who are possibly sicker than those treated by physicians, with similar quality to MDs.