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  1. Article ; Online: How SWAT Changed the Conversation: Implementation of a Discharge SWAT Team Improves Morale and Facilitates Communication During the COVID-19 Pandemic.

    Lenhard, Amanda / Daoud, Majd / Donahue, Lisa / Jones, Sherri / Kip, Paula L / Zapf, Rachel L / Minnier, Tamra E

    Professional case management

    2024  

    Abstract: Purpose of study: Hospital overcrowding and delays in discharge are serious issues in the modern health care landscape and can lead to poor patient outcomes and health care personnel (HCP) burnout. The goal of this project was to develop a collaborative ...

    Abstract Purpose of study: Hospital overcrowding and delays in discharge are serious issues in the modern health care landscape and can lead to poor patient outcomes and health care personnel (HCP) burnout. The goal of this project was to develop a collaborative forum where HCP representing the entire spectrum of the inpatient care team, including case management team members, could connect to discuss challenges and barriers to patient discharge. The following describes the development, implementation, and outcomes of the discharge SWAT (Solutions, Wins, Actions, and Tactics) team, which is a 30-min virtual daily meeting where discussion is primarily centered around challenges in discharging individual patients and addressing case manager needs. The primary aim of SWAT meetings is fostering a positive atmosphere to address barriers to discharge while prioritizing patient care and outcomes.
    Primary practice setting: This study was conducted in a 40-hospital academic health system in the United States.
    Methodology and sample: SWAT meetings were first implemented at a representative flagship facility in a health system. HCP at this first facility were surveyed to assess satisfaction with SWAT meetings. SWAT meetings then were implemented at the majority of facilities in a 40-hospital academic health system. During SWAT implementation, average inpatient length of stay (LOS) and patient care transitions were monitored for participating and nonparticipating service lines.
    Results: Among surveyed HCP, the majority view SWAT meetings favorably and reported that it was a valuable use of their time and positively impacted their work in the patient discharge space. Nonprovider and case management staff in particular valued the SWAT meetings and found them beneficial. LOS remained stable for patients under the care of participating providers, despite the upheaval of the ongoing COVID-19 pandemic, and the research team also observed a positive impact of SWAT meetings on appropriate inpatient care transitions.
    Language English
    Publishing date 2024-02-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2277201-7
    ISSN 1932-8095 ; 1539-0675 ; 1932-8087 ; 1529-7764
    ISSN (online) 1932-8095 ; 1539-0675
    ISSN 1932-8087 ; 1529-7764
    DOI 10.1097/NCM.0000000000000712
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A Current State Assessment on Nursing Work Activities: An Observational Study.

    Perpetua, Zachary / Lennon, Jennifer / Shovel, Judith A / Appell, Katherine E / Patterson, Leah / Martin, Susan C / Minnier, Tamra E / Sackrowitz, Rachel / Zapf, Rachel L / Kip, Paula L / McLaughlin, Maribeth

    Journal of nursing care quality

    2023  Volume 38, Issue 4, Page(s) 381–387

    Abstract: Background: Nationwide nursing shortages have led to higher patient-to-nurse ratios, nursing burnout, and decreased quality of care.: Local problem: Staffing challenges and nursing burnout were becoming growing concerns and success was contingent ... ...

    Abstract Background: Nationwide nursing shortages have led to higher patient-to-nurse ratios, nursing burnout, and decreased quality of care.
    Local problem: Staffing challenges and nursing burnout were becoming growing concerns and success was contingent upon efficient use of existing resources.
    Methods: Direct observation current state assessment was completed on medical-surgical specialty units to better understand work activities of registered nurses (RNs) and unlicensed assistive personnel (UAPs).
    Results: RNs spent more time performing indirect care (eg, documentation) than direct patient care. Interruptions and problems consumed 17.4% and 5.6% of their time, respectively. UAPs performed more direct patient care but had a higher proportion of downtime. RNs underdelegated nonclinical tasks.
    Conclusions: Direct observation current state assessment offers a better understanding of workflow and workload inefficiencies. This information is critical to provide informed, evidence-based recommendations to develop future patient care models with more capacity to deliver high-quality care with greater efficiency and lessen nursing burden and burnout during the nursing shortage crisis.
    MeSH term(s) Humans ; Nursing Staff, Hospital ; Workload ; Nursing Care ; Patient Care ; Burnout, Professional ; Personnel Staffing and Scheduling
    Language English
    Publishing date 2023-06-02
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 1089089-0
    ISSN 1550-5065 ; 1057-3631
    ISSN (online) 1550-5065
    ISSN 1057-3631
    DOI 10.1097/NCQ.0000000000000723
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Implementing a Discharge Follow-up Phone Call Program Reduces Readmission Rates in an Integrated Health System.

    Lukanski, Amy / Watters, Shelley / Bilderback, Andrew L / Buchanan, Dan / Hodges, Jacob C / Burwell, David / Triola, Amy / Marroquin, Oscar C / Martin, Susan C / Zapf, Rachel L / Kip, Paula L / Minnier, Tami E

    Journal for healthcare quality : official publication of the National Association for Healthcare Quality

    2023  Volume 45, Issue 6, Page(s) 315–323

    Abstract: Abstract: In this study, we sought to determine the effect of implementing a large-scale discharge follow-up phone call program on hospital readmission rates. Previous work has shown that patients with unaddressed concerns during discharge have ... ...

    Abstract Abstract: In this study, we sought to determine the effect of implementing a large-scale discharge follow-up phone call program on hospital readmission rates. Previous work has shown that patients with unaddressed concerns during discharge have significantly higher rates of care complications and hospital readmissions. This study is an observational quality improvement project completed from April 17, 2020 to January 31, 2022 at 22 hospitals in a large, integrated academic health system. A nurse-led scripted discharge follow-up phone call program was implemented to contact all patients discharged from inpatient care within 72 hours of discharge. Readmission rates were tracked before and after project implementation. Over a 21-month span, 137,515 phone calls were placed, and 57.92% of patients were successfully contacted within 7 days of discharge. The 7-day readmission rate for contacted patients was 2.91% compared with 4.73% for noncontacted patients. The 30-day readmission rate for contacted patients was 11.00% compared with 12.17% for noncontacted patients. We have found that discharge follow-up phone calls targeting patients decreases risk of readmission, which improves overall patient outcomes.
    MeSH term(s) Humans ; Patient Discharge ; Patient Readmission ; Continuity of Patient Care ; Follow-Up Studies ; Delivery of Health Care, Integrated
    Language English
    Publishing date 2023-10-03
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 1472097-8
    ISSN 1945-1474 ; 1062-2551
    ISSN (online) 1945-1474
    ISSN 1062-2551
    DOI 10.1097/JHQ.0000000000000400
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Implementing a Serious Illness Risk Prediction Model: Impact on Goals of Care Documentation.

    Schell, Jane O / Schenker, Yael / Piscitello, Gina / Belin, Shane C / Chiu, Eric J / Zapf, Rachel L / Kip, Paula L / Marroquin, Oscar C / Donahoe, Michael P / Holder-Murray, Jennifer / Arnold, Robert M

    Journal of pain and symptom management

    2023  Volume 66, Issue 6, Page(s) 603–610.e3

    Abstract: Context: Goals of care conversations can promote high value care for patients with serious illness, yet documented discussions infrequently occur in hospital settings.: Objectives: We sought to develop a quality improvement initiative to improve ... ...

    Abstract Context: Goals of care conversations can promote high value care for patients with serious illness, yet documented discussions infrequently occur in hospital settings.
    Objectives: We sought to develop a quality improvement initiative to improve goals of care documentation for hospitalized patients.
    Methods: Implementation occurred at an academic medical center in Pittsburgh, Pennsylvania. Intervention included integration of a 90-day mortality prediction model grouping patients into low, intermediate, and high risk; a centralized goals of care note; and automated notifications and targeted palliative consults. We compared documented goals of care discussions by risk score before and after implementation.
    Results: Of the 12,571 patients hospitalized preimplementation and 10,761 postimplementation, 1% were designated high risk and 11% intermediate risk of mortality. Postimplementation, goals of care documentation increased for high (17.6%-70.8%, P< 0.0001) and intermediate risk patients (9.6%-28.0%, P < 0.0001). For intermediate risk patients, the percentage of goals of care documentation performed by palliative medicine specialists increased from pre- to postimplementation (52.3%-71.2%, P = 0.0002). For high-risk patients, the percentage of goals of care documentation completed by the primary service increased from pre-to postimplementation (36.8%-47.1%, P = 0.5898, with documentation performed by palliative medicine specialists slightly decreasing from pre- to postimplementation (63.2%-52.9%, P = 0.5898).
    Conclusions: Implementation of a goals of care initiative using a mortality prediction model significantly increased goals of care documentation especially among high-risk patients. Further study to assess strategies to increase goals of care documentation for intermediate risk patients is needed especially by nonspecialty palliative care.
    MeSH term(s) Humans ; Palliative Care ; Hospitals ; Communication ; Patient Care Planning ; Documentation
    Language English
    Publishing date 2023-07-31
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 639142-4
    ISSN 1873-6513 ; 0885-3924
    ISSN (online) 1873-6513
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2023.07.015
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Global Annotation, Expression Analysis, and Stability of Candidate sRNAs in Group B Streptococcus.

    Keogh, Rebecca A / Spencer, Brady L / Sorensen, Hailee M / Zapf, Rachel L / Briaud, Paul / Bonsall, Abigail E / Doran, Kelly S / Carroll, Ronan K

    mBio

    2021  Volume 12, Issue 6, Page(s) e0280321

    Abstract: Small, noncoding RNAs (sRNAs) are being increasingly identified as important regulatory molecules in prokaryotes. Due to the prevalence of next-generation sequencing-based techniques, such as RNA sequencing (RNA-seq), there is potential for increased ... ...

    Abstract Small, noncoding RNAs (sRNAs) are being increasingly identified as important regulatory molecules in prokaryotes. Due to the prevalence of next-generation sequencing-based techniques, such as RNA sequencing (RNA-seq), there is potential for increased discovery of sRNAs within bacterial genomes; however, these elements are rarely included in annotation files. Consequently, expression values for sRNAs are omitted from most transcriptomic analyses, and mechanistic studies have lagged behind those of protein regulators in numerous bacteria. Two previous studies have identified sRNAs in the human pathogen group B Streptococcus (GBS). Here, we utilize the data from these studies to create updated genome annotation files for the model GBS strains NEM316 and COH1. Using the updated COH1 annotation file, we reanalyze publicly available GBS RNA-seq whole-transcriptome data from GenBank to monitor GBS sRNA expression under a variety of conditions and genetic backgrounds. This analysis generated expression values for 232 putative sRNAs that were overlooked in previous transcriptomic analyses in 21 unique comparisons. To demonstrate the utility of these data, we identify an sRNA that is upregulated during vaginal colonization and demonstrate that overexpression of this sRNA leads to increased bacterial invasion into host epithelial cells. Finally, to monitor RNA degradation, we perform a transcript stability assay to identify highly stable sRNAs and compare stability profiles of sRNA- and protein-coding genes. Collectively, these data provide a wealth of transcriptomic data for putative sRNAs in GBS and a platform for future mechanistic studies.
    MeSH term(s) Gene Expression Profiling ; Gene Expression Regulation, Bacterial ; Genome, Bacterial ; Humans ; RNA Stability ; RNA, Bacterial/chemistry ; RNA, Bacterial/genetics ; RNA, Bacterial/metabolism ; RNA, Small Untranslated/chemistry ; RNA, Small Untranslated/genetics ; RNA, Small Untranslated/metabolism ; Streptococcal Infections/microbiology ; Streptococcus agalactiae/chemistry ; Streptococcus agalactiae/genetics ; Streptococcus agalactiae/metabolism
    Chemical Substances RNA, Bacterial ; RNA, Small Untranslated
    Language English
    Publishing date 2021-11-02
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2557172-2
    ISSN 2150-7511 ; 2161-2129
    ISSN (online) 2150-7511
    ISSN 2161-2129
    DOI 10.1128/mBio.02803-21
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Staphylococcus aureus Responds to Physiologically Relevant Temperature Changes by Altering Its Global Transcript and Protein Profile.

    Bastock, Raeven A / Marino, Emily C / Wiemels, Richard E / Holzschu, Donald L / Keogh, Rebecca A / Zapf, Rachel L / Murphy, Erin R / Carroll, Ronan K

    mSphere

    2021  Volume 6, Issue 2

    Abstract: Staphylococcus ... ...

    Abstract Staphylococcus aureus
    MeSH term(s) Bacterial Proteins/analysis ; Cells, Cultured ; Epithelial Cells/microbiology ; Gene Expression Regulation, Bacterial ; Humans ; Nose/cytology ; Proteome ; Staphylococcal Infections/microbiology ; Staphylococcus aureus/chemistry ; Staphylococcus aureus/genetics ; Staphylococcus aureus/metabolism ; Temperature ; Transcriptome ; Virulence Factors/genetics
    Chemical Substances Bacterial Proteins ; Proteome ; Virulence Factors
    Language English
    Publishing date 2021-03-17
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2379-5042
    ISSN (online) 2379-5042
    DOI 10.1128/mSphere.01303-20
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Healthcare-associated infections during the coronavirus disease 2019 (COVID-19) pandemic and the modulating effect of centralized surveillance.

    Snyder, Graham M / Wagester, Suzanne / Harris, Patricia L / Valek, Abby L / Hodges, Jacob C / Bilderback, Andrew L / Kader, Fazrina / Tanner, Colleen A / Metzger, Amy P / DiNucci, Susan E / Colaianne, Bonnie V / Chung, Ashley / Zapf, Rachel L / Kip, Paula L / Minnier, Tamra E

    Antimicrobial stewardship & healthcare epidemiology : ASHE

    2023  Volume 3, Issue 1, Page(s) e72

    Abstract: We analyzed efficacy of a centralized surveillance infection prevention (CSIP) program in a healthcare system on healthcare-associated infection (HAI) rates amid the coronavirus disease 2019 (COVID-19) pandemic. HAI rates were variable in CSIP and non- ... ...

    Abstract We analyzed efficacy of a centralized surveillance infection prevention (CSIP) program in a healthcare system on healthcare-associated infection (HAI) rates amid the coronavirus disease 2019 (COVID-19) pandemic. HAI rates were variable in CSIP and non-CSIP facilities. Central-line-associated bloodstream infection (CLABSI),
    Language English
    Publishing date 2023-04-11
    Publishing country England
    Document type Journal Article
    ISSN 2732-494X
    ISSN (online) 2732-494X
    DOI 10.1017/ash.2023.139
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Development and implementation of a centralized surveillance infection prevention program in a multi-facility health system: A quality improvement project.

    Snyder, Graham M / Wagester, Suzanne / Harris, Patricia L / Valek, Abby L / Hodges, Jacob C / Bilderback, Andrew L / Kader, Fazrina / Tanner, Colleen A / Metzger, Amy P / DiNucci, Susan E / Colaianne, Bonnie V / Chung, Ashley / Zapf, Rachel L / Kip, Paula L / Minnier, Tamra E

    Antimicrobial stewardship & healthcare epidemiology : ASHE

    2023  Volume 3, Issue 1, Page(s) e56

    Abstract: Objective: To develop, implement, and evaluate the effectiveness of a unique centralized surveillance infection prevention (CSIP) program.: Design: Observational quality improvement project.: Setting: An integrated academic healthcare system.: ... ...

    Abstract Objective: To develop, implement, and evaluate the effectiveness of a unique centralized surveillance infection prevention (CSIP) program.
    Design: Observational quality improvement project.
    Setting: An integrated academic healthcare system.
    Intervention: The CSIP program comprises senior infection preventionists who are responsible for healthcare-associated infection (HAI) surveillance and reporting, allowing local infection preventionists (LIPs) a greater portion of their time to non-surveillance patient safety activities. Four CSIP team members accrued HAI responsibilities at 8 facilities.
    Methods: We evaluated the effectiveness of the CSIP program using 4 measures: recovery of LIP time, efficiency of surveillance activities by LIPs and CSIP staff, surveys characterizing LIP perception of their effectiveness in HAI reduction, and nursing leaders' perception of LIP effectiveness.
    Results: The amount of time spent by LIP teams on HAI surveillance was highly variable, while CSIP time commitment and efficiency was steady. Post-CSIP implementation, 76.9% of LIPs agreed that they spend adequate time on inpatient units, compared to 15.4% pre-CSIP; LIPs also reported more time to allot to non-surveillance activities. Nursing leaders reported greater satisfaction with LIP involvement with HAI reduction practices.
    Conclusion: CSIP programs are a little-reported strategy to ease burden on LIPs with reallocation of HAI surveillance. The analyses presented here will aid health systems in anticipating the benefit of CSIP programs.
    Language English
    Publishing date 2023-03-22
    Publishing country England
    Document type Journal Article
    ISSN 2732-494X
    ISSN (online) 2732-494X
    DOI 10.1017/ash.2023.126
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: COVID-19 contagious health care personnel 5-day early return-to-work program.

    Wagester, Suzanne / Smith, Patricia / Lutz, Calvin T / Chung, Ashley / Tanis, Mark D / O'Hare, Colleen / Mallon, Abbie / Minnier, Tami E / Silvaggio, Teresa / Ruscetti, Amy / Chrisman, Maddie / Zapf, Rachel L / Kip, Paula L / Snyder, Graham M

    American journal of infection control

    2022  Volume 51, Issue 7, Page(s) 746–750

    Abstract: Background: COVID-19 contagious health care personnel (HCP) who are self-isolating for a 10-day period increases burden to workforce shortages. Implementation of a 5-day early return-to-work (RTW) program may reduce self-isolation periods, without ... ...

    Abstract Background: COVID-19 contagious health care personnel (HCP) who are self-isolating for a 10-day period increases burden to workforce shortages. Implementation of a 5-day early return-to-work (RTW) program may reduce self-isolation periods, without increasing transmission risk, during the COVID-19 pandemic.
    Design and methods: This observational cohort quality improvement study included newly diagnosed COVID-19 HCP at a multifacility health care system. The program allowed HCP to return to work 6 days after date of a positive test result if they were not immunocompromised, had mild and improving symptoms, and self-reported a SARS-CoV-2 antigen negative test on day 5.
    Results: Between January 4 and April 3, 2022, 1,023 HCP self-enrolled and 344 (33.6%) self-reported negative test results. Among these, 161 (46.8%) self-reported negative test results on day 5 and were eligible for early RTW on day 6. A total of 714 days were saved from missed work in self-isolation. The number of tests purchased, dispensed, and reported per day of HCP time saved was 4.4. No transmission events were observed originating from HCP who participated in early RTW.
    Conclusion: Implementing a 5-day early RTW program that includes HCP self-reporting SARS-CoV-2 antigen test results can increase staffing availability, while maintaining a low risk of SARS-CoV-2 transmission.
    MeSH term(s) Humans ; COVID-19 ; SARS-CoV-2 ; Return to Work ; Pandemics/prevention & control ; COVID-19 Testing ; Health Personnel
    Language English
    Publishing date 2022-11-19
    Publishing country United States
    Document type Observational Study ; Journal Article
    ZDB-ID 392362-9
    ISSN 1527-3296 ; 0196-6553
    ISSN (online) 1527-3296
    ISSN 0196-6553
    DOI 10.1016/j.ajic.2022.11.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Healthcare personnel early return-to-work program after higher-risk SARS-CoV-2 exposure: A learning health system quality improvement project.

    Ruscetti, Amy / Chrisman, Maddie / Wagester, Suzanne / Smith, Patricia / O'Hare, Colleen / Mallon, Abbie / Chung, Ashley / Lutz, Calvin T / Minnier, Tamra E / Zapf, Rachel L / Kip, Paula L / Snyder, Graham M

    American journal of infection control

    2022  Volume 50, Issue 5, Page(s) 542–547

    Abstract: Background: Incidence of health care personnel (HCP) with a higher-risk SARS-CoV-2 exposure and subsequent 14-day quarantine period adds substantial burden on the workforce. Implementation of an early return-to-work (RTW) program may reduce quarantine ... ...

    Abstract Background: Incidence of health care personnel (HCP) with a higher-risk SARS-CoV-2 exposure and subsequent 14-day quarantine period adds substantial burden on the workforce. Implementation of an early return-to-work (RTW) program may reduce quarantine periods for asymptomatic HCP and reduce workforce shortages during the COVID-19 pandemic.
    Methods: This observational quality improvement study included asymptomatic HCP of a multi-facility health care system with higher-risk workplace or non-household community SARS-CoV-2 exposure ≤4 days. The program allowed HCP to return to work 8 days after exposure if they remained asymptomatic through day 7 with day 5-7 SARS-CoV-2 nucleic acid amplification test result negative.
    Results: Between January 4 and June 25, 2021, 384 HCP were enrolled, 333 (86.7%) remained asymptomatic and of these, 323 (97%) tested negative and were early RTW eligible. Mean days in quarantine was 8.16 (SD 2.40). Median day of early RTW was 8 (range 6-9, IQR 8-8). Mean days saved from missed work was 1.84 (SD 0.52). A total of 297 (92%) HCP did RTW ≤10 days from exposure and days saved from missed work was 546.48.
    Conclusions: Implementing an HCP early RTW program is a clinical approach for COVID-19 workplace safety that can increase staffing availability, while maintaining a low risk of SARS-CoV-2 transmission.
    MeSH term(s) COVID-19/prevention & control ; Delivery of Health Care ; Health Personnel ; Humans ; Learning Health System ; Pandemics ; Quality Improvement ; Return to Work ; SARS-CoV-2
    Language English
    Publishing date 2022-02-04
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 392362-9
    ISSN 1527-3296 ; 0196-6553
    ISSN (online) 1527-3296
    ISSN 0196-6553
    DOI 10.1016/j.ajic.2022.01.027
    Database MEDical Literature Analysis and Retrieval System OnLINE

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