Systematic review: Nurses' safety attitudes and their impact on patient outcomes in acute‐care hospitals

Background: Stroke quality metrics play an increasingly important role in quality improvement efforts and policies, but the relationship between quality metrics and patient-orientated outcomes are not well described. We conducted a systematic review of observational hospital-based studies examining this relationship. Methods: We searched MEDLINE and EMBASE for studies published before December 31, 2010 that examined the relationship between 2 or more stroke quality metrics and patient-oriented outcomes in acute stroke admissions. Outcomes included mortality, length of stay, discharge to home, functional status, and stroke recurrence. Results: A total of 470 hits were identified. After screening the titles and abstracts, 27 studies underwent full review, and 14 were deemed eligible. Given the variation in study characteristics, quality metrics, and outcomes utilized, it was not possible to generate summary estimates describing the relationship between quality metric compliance and patient-oriented outcomes. Evidence of a positive relationship between quality metrics and improved patient outcomes was limited by the lack of high quality studies. Four of the 14 studies found a statistically significant relationship between increased compliance with acute care quality metrics and improved patient-oriented outcomes. Two studies failed to find an association between acute care measures and improved outcomes, but did find statistically significant positive relationships between compliance with post-acute rehabilitation measures and improved patient outcomes. Five other studies reported mixed findings, while the remaining three found no relationships. Conclusions: We found a limited evidence-base addressing the impact of compliance on stroke quality metrics and patient-oriented outcomes. Generation of data clarifying the relationship between compliance with stroke quality metrics and stroke-related outcomes should be prioritized so that the current investments undertaken to improve stroke care can be sustained.

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A systematic review of nursesʼ inter-shift handoff reports in acute care hospitals

JBI Library of Systematic Reviews ◽

10.11124/jbisrir-2010-109 ◽

2010 ◽

Vol 8 (4) ◽

pp. 121-172 ◽

Cited By ~ 19

Author(s):

Eilleen B. Poletick ◽

Cheryl Holly

Keyword(s):

Systematic Review ◽

Acute Care ◽

Acute Care Hospitals

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Clostridium DifficileInfection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.324 ◽

2017 ◽

Vol 38 (4) ◽

pp. 476-482 ◽

Cited By ~ 24

Author(s):

Irene K. Louh ◽

William G. Greendyke ◽

Emilia A. Hermann ◽

Karina W. Davidson ◽

Louise Falzon ◽

...

Keyword(s):

Systematic Review ◽

Hand Hygiene ◽

Acute Care ◽

Antimicrobial Stewardship ◽

Grey Literature ◽

Quality Criteria ◽

Acute Care Hospitals ◽

Cochrane Library ◽

Chlorhexidine Bathing ◽

The Impact

OBJECTIVEPrevention ofClostridium difficileinfection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009.DESIGNWe searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015.SETTINGWe included studies performed in acute-care hospitals.PATIENTS OR PARTICIPANTSWe included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates.INTERVENTIONSWe used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible.RESULTSOf 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates.CONCLUSIONSDaily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates.Infect Control Hosp Epidemiol2017;38:476–482

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Long-term weaning centres in critical care

10.1093/med/9780199600830.003.0384 ◽

2016 ◽

Author(s):

Jeremy M. Kahn

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Acute Care ◽

Patient Outcomes ◽

Prolonged Mechanical Ventilation ◽

Multidisciplinary Care ◽

Acute Care Hospitals ◽

Optimal Timing ◽

Physician Staffing ◽

Multidisciplinary Care Team

Successfully weaning patients from prolonged mechanical ventilation requires the varied expertise of a dedicated multidisciplinary care team. Traditionally, this care was provided in acute care hospitals, increasingly these patients are transferred to specialized weaning centres. These may improve patient outcomes by concentrating weaning expertise in a low-acuity environment and implementing protocols for liberation from mechanical ventilation. However, these centres might also worsen patient outcomes because they typically offer less intense nurse and physician staffing compared with traditional intensive care units. Generally, the clinical evidence is mixed, with the best studies suggesting that weaning centres offer similar outcomes as acute care hospitals, but at lower costs. Health systems also might stand to gain from dedicated weaning centres, because they can release intensive care unit beds for more acutely-ill patients. Many gaps remain in our understanding of which patients should be transferred to dedicated weaning centres, the optimal timing of transfer, and the best approach to care for patients in this highly specialized setting.

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