The Relationship Between Evidence-Based Practices and Emergency Department Managers’ Perceptions on Quality of Care for Self-Harm Patients

2019 ◽  
Vol 26 (3) ◽  
pp. 288-292
Author(s):  
Amaya H. Diana ◽  
Mark Olfson ◽  
Sara Wiesel Cullen ◽  
Steven C. Marcus
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Teaching Hospitals ◽  
Health Staff ◽  
Evidence Based ◽  
Mental Health Staff ◽  
Evidence Based Practices ◽  
Deliberate Self Harm ◽  
Self Harm

OBJECTIVE: To understand the extent to which implementation of evidence-based practices affects emergency department (ED) nurse managers’ perceptions of quality of care provided to deliberate self-harm patients. METHODS: ED nursing leadership from a nationally representative sample of 513 hospitals completed a survey on the ED management of deliberate self-harm patients, including the quality of care for deliberate self-harm patients on a 1 to 5 point Likert-type scale. Unadjusted and adjusted analyses, controlling for relevant hospital characteristics, examined associations between the provision of evidence-based practices and quality of care. RESULTS: The overall mean quality rating was 3.09. Adjusted quality ratings were higher for EDs that routinely engaged in discharge planning (β = 0.488) and safety planning (β = 0.736) processes. Ratings were also higher for hospitals with higher levels of mental health staff (β = 0.368) and for teaching hospitals (β = 0.319). CONCLUSION: Preliminary findings suggest a national institutional readiness for further implementation of evidence-based practices for deliberate self-harm patients.

Abstract 282: Assessing Levels of Active Participation through a VA Provider Network to Improve Quality of Care for Veterans with Heart Failure

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Anju Sahay ◽  
Paul Heidenreich
Keyword(s):  
Heart Failure ◽  
Quality Of Care ◽  
Active Participation ◽  
Teaching Hospitals ◽  
Evidence Based Practices ◽  
Provider Network ◽  
Participation Level ◽  
Level Data ◽  
Facility Level

Objective: The goal of the Dept. of Veterans Affairs (VA) Chronic Heart Failure (CHF) QUERI program is to improve the quality of care for heart failure (HF) patients and implement evidence-based practices throughout the VA system. One strategy to achieve this goal was to create a VA heart failure provider Network which occurred in 2006. We sought to characterize provider participation in this mature network. Method: We tracked all members of the HF Network including their title, location at one of 144 VA facilities; date joined and if applicable, date left the HF Network. We considered the following activities to be evidence of “active” participation: attended a web-based meeting or the annual in-person meeting, requested meeting materials, or completed a periodic survey of providers. Participation of all other members is considered “passive”. For this project we assessed each facility’s level of participation in the HF Network from July 2006 till June 2013 (7 years). Facility participation level was characterized as “None” (no member at that facility with active participation), “Low” (at least one member at that facility attended 1-2 activities) and “High” (at least one member at that facility participated in ≥3 activities). Data were linked to existing facility-level data that included presence of an HF clinic, cardiac cath lab, use of pharmacist, bed size, membership in Council on Teaching Hospitals (COTH), and presence of an Accredited Graduate Medical Education (ACGME) program. Results: Altogether, 1205 providers have participated in the HF Network. As of June 2013, 987 providers from 144 VA facilities participate in this network. They include VACO leadership (1%), VISN leadership (4%), facility leadership (9%), Chiefs of Cardiology (7%), staff physicians (32%), nurses (28%), pharmacists (5%) and others (14%). Participation at the facility-level has increased from 2008 (None=37, Low=43 and High=64) to 2013 (None=8, Low=16 and High=120, (p <0.001). High participating facilities were more likely to be classified as tertiary (p <.016), COTH members (p <0.001), having ACGME programs (p <0.001), and located in the West or Southeast United States (p =.03). High participating facilities are also more likely to have a HF clinic (p <0.001), a cardiac catheterization lab (<0.001), and use a pharmacist in routine HF care (p <.03). Conclusions: Involvement and active participation in the VA HF Network has grown and is more likely at academic facilities and those providing more intensive services.

scholarly journals Sustaining evidence-based practice for young people who self-harm: a 4-year follow-up

2004 ◽  
Vol 27 (2) ◽  
pp. 94 ◽  
Author(s):  
Stewart Einfeld ◽  
Margaret Tobin ◽  
John Beard ◽  
Elizabeth Evans ◽  
Richard Buss ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Health Service ◽  
New South ◽  
Evidence Based ◽  
Deliberate Self Harm ◽  
South Wales ◽  
Self Harm ◽  
Northern Rivers

Stewart Einfeld is at the School of Psychiatry, University of New South Wales; the late Margaret Tobin was the Director of Mental Health, South Australia; John Beard is Head of the Northern Rivers University Department of Rural Health, University of Sydney; Elizabeth Evans is a Research Assistant at the School of Psychiatry, University of New South Wales; Richard Buss is the Area Manager, Northern Rivers Area Mental Health Service; Michael Dudley is a child psychiatrist at Prince of Wales Hospital and the School of Psychiatry, University of New South Wales.This report is dedicated to our late co-author Margaret Tobin, to honour her contribution to advancing the quality of mental health services.Objective: In 1998 and 1999, two NSW Area Health Services conducted the Youth At Risk of Deliberate Self Harm (YARDS) project. The YARDS project was designed to implement evidence-based service enhancements for the clinical management of young people with Deliberate Self Harm. This paper examines the extent to which service enhancements implemented during YARDS were maintained 4 years after the conclusion of the project and compares service quality with another NSW Area Health Service that did not participate in the YARDS project.Method: Staff from mental health services and emergency departments completed the Service Activity Scale, a measure developed for the YARDS project to assess the quality of health service response to individuals who present following a suicide attempt.Results: Results indicated that the service improvements made during the YARDS project were maintained 4years after the project ended. Furthermore, a significant difference was found between scores for services that participated in YARDS and services that did not participate in YARDS.Conclusions: These results suggest that projects such as YARDS which support evidence based service nhancements may be useful in improving the management of young people with deliberate self-harm, and that these improvements may be long-lasting.

scholarly journals Use of A Community of Practice For The Implementation of Evidence-Based Practices For Heart Failure Within The United States Department of Veterans Affairs

2021 ◽  
Author(s):  
Anju Sahay ◽  
Paul A. Heidenreich ◽  
Brian S Mittman ◽  
Parisa Gholami ◽  
Shoutzu Lin
Keyword(s):  
United States ◽  
Heart Failure ◽  
Quality Of Care ◽  
The United States ◽  
Veterans Affairs ◽  
Evidence Based ◽  
Department Of Veterans Affairs ◽  
Clinical Practices ◽  
Evidence Based Practices

Abstract Communities of Practice (CoPs) are a promising approach to facilitate the implementation of evidence-based practices (EBPs) to improve care for chronic conditions like heart failure (HF). COPs involve a complex process of acquiring and converting both explicit and tacit knowledge into clinical activities. Formation: In July 2006, a CoP called the Heart Failure Provider Network (HF Network) was established in the United States (US) Department of Veterans Affairs (VA) with the overarching goal of improving the quality of care for HF patients. The CoP has involved a total of 1,341 multidisciplinary and multilevel members at all 144 VA Health Care Systems (sites). Examples of CoP activities include discussions of interventions to decrease hospitalization rates and to empower patients and caregivers for self-management. Goals of the CoP include networking facilitation, information dissemination and exchange, collaboration and implementation of EBPs. Assessment: We conceptualized the assessment (formative evaluation) of the HF Network in terms of its various activities (inputs) and proximal impacts (mediators) at the individual-level, and its distal and ultimate impacts (outcomes) at the site-level leading to an improved culture of implementation of new/improved EBPs at the system-wide level. The HF Network membership grew steadily over the nine years. Most members were practicing clinicians (n = 891, 66.4%), followed by administrators (n = 342, 25.5%), researchers (n = 70, 5.2%), and others (n = 38, 2.8%). Participation was “active” for 70.9% versus “passive” for 29.4% of members. The distribution of active members (clinicians 64.7%, administrators 21.6%) was similar to the distribution of overall membership. Survey respondents perceived the HF Network as useful in terms of its varied activities and resources relevant for patient care. Members, particularly those that consider themselves influential in improving quality of care, noted multiple benefits of membership. These included confirmation of one’s own clinical practices, evidence-based changes to their practice and help in understanding facilitators and barriers in setting up or running HF clinics and other programs.

scholarly journals Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India

2020 ◽  
Vol 5 (9) ◽  
pp. e002268
Author(s):  
Katherine EA Semrau ◽  
Kate A Miller ◽  
Stuart Lipsitz ◽  
Jennifer Fisher-Bowman ◽  
Ami Karlage ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Outcomes ◽  
Perinatal Mortality ◽  
Uttar Pradesh ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Early Neonatal Mortality ◽  
Birth Attendants ◽  
Post Hoc

BackgroundEvidence-based practices that reduce childbirth-related morbidity and mortality are core processes to quality of care. In the BetterBirth trial, a matched-pair, cluster-randomised controlled trial of a coaching-based implementation of the WHO Safe Childbirth Checklist (SCC) in Uttar Pradesh, India, we observed a significant increase in adherence to practices, but no reduction in perinatal mortality.MethodsWithin the BetterBirth trial, we observed birth attendants in a subset of study sites providing care to labouring women to assess the adherence to individual and groups of practices. We observed care from admission to the facility until 1 hour post partum. We followed observed women/newborns for 7-day perinatal health outcomes. Using this observational data, we conducted a post-hoc, exploratory analysis to understand the relationship of birth attendants’ practice adherence to perinatal mortality.FindingsAcross 30 primary health facilities, we observed 3274 deliveries and obtained 7-day health outcomes. Adherence to individual practices, containing supply preparation and direct provider care, varied widely (0·51 to 99·78%). We recorded 166 perinatal deaths (50·71 per 1000 births), including 56 (17·1 per 1000) stillbirths. Each additional practice performed was significantly associated with reduced odds of perinatal (OR: 0·82, 95% CI: 0·72, 0·93) and early neonatal mortality (OR: 0·78, 95% CI: 0·71, 0·85). Each additional practice as part of direct provider care was associated strongly with reduced odds of perinatal (OR: 0·73, 95% CI: 0·62, 0·86) and early neonatal mortality (OR: 0·67, 95% CI: 0·56, 0·80). No individual practice or single supply preparation was associated with perinatal mortality.InterpretationAdherence to practices on the WHO SCC is associated with reduced mortality, indicating that adherence is a valid indicator of higher quality of care. However, the causal relationships between practices and outcomes are complex.FundingBill & Melinda Gates Foundation.Trial registration detailsClinicalTrials.gov: NCT02148952; Universal Trial Number: U1111-1131-5647.

scholarly journals Innovative Products and Approaches Used in Nursing Services

2020 ◽  
Author(s):  
Seda Şahan ◽  
Ayşrgül Yıldız
Keyword(s):  
Quality Of Care ◽  
Information Systems ◽  
Rapid Development ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Nursing Services ◽  
The World ◽  
Innovative Products

The rapid development of technology and information systems today enables innovation to be effective in nursing services. Using innovative products in nursing improves the quality of care, reduces workload, increases evidence-based practices and enables patient procedures to be done in less time. Recently, we encounter different innovative products and approaches in the world and in our country. This review aims to give information about various innovative products applied in the world and in our country.

Deliberate self-harm in young people: attendance at a paediatric emergency department

2009 ◽  
Vol 26 (3) ◽  
pp. 114-118 ◽  
Author(s):  
Sophia Morgan ◽  
Sinead Byrne ◽  
Carole Boylan ◽  
Stephen McLearie ◽  
Carol Fitzpatrick
Keyword(s):  
Emergency Department ◽  
Young People ◽  
Medical Records ◽  
Risk Group ◽  
High Risk Group ◽  
Deliberate Self Harm ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Appropriate Treatment ◽  
Self Harm

AbstractObjectives: Deliberate self-harm (DSH) is the strongest predictor of suicidal behaviour. This retrospective study reviewed all DSH presentations to our Paediatric Emergency Department between 2002-2006.Method: Using database and medical records we profiled these presentations. Data was coded and statistically analysed.Results: There were 253 DSH attendances. Twenty-four percent were living in care, 15% were under 12 years and 14% presented more than once. Overdoses (61%) were more common than cutting (16%) and 56% had a psychiatric condition.Conclusions: DSH presents an ongoing challenge to child and adolescent mental health services and those working in suicide prevention. Identifying the characteristics of these young people is essential to providing appropriate treatment for this high-risk group.

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