Bold Voices - March 2013 - (Page 29)

AT THE BEDSIDE Checklists May Reduce Venous Thromboembolism Requiring physicians to methodically mark a simple checklist may decrease preventable thromboembolism prophylaxis events in trauma patients, says a study in the Archives of Surgery. Venous thromboembolism (VTE) is responsible for the hospitalization of 250,000 Americans per year and poses a life-threatening risk if not treated properly. Although clinical practice guidelines assist in managing these cases, clinicians may encounter a variation of VTE that is not well documented. The study sought to assess the effectiveness of mandatory support tools that send the physician through prompts and replies with the appropriate prophylaxis. Reports have already shown that the checklists have improved compliance with VTE prophylaxis guidelines and made VTE events 36 percent less likely overall, the study adds. “Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma” compared VTE at Johns Hopkins’ DVT rate fell from 2.3 level 1 trauma percent to 0.3 percent. center before the computerized checklist was added to the order entry system. Although factors such as length of stay didn’t change, medical recordkeeping jumped from 3 percent with paper health records to 98 percent with the electronic system. The VTE event rate also declined from 3 percent to 1.3 percent. And the rate of deep vein thrombosis fell even more — from 2.3 percent at baseline to 0.3 percent. VA Hospitals Achieve Surprising Decline in Readmission and Mortality A study of 129 acute care VA hospitals finds that shorter hospital stays don’t increase readmission rates or lead to more deaths, according to research at Iowa City VA Medical Center. “Associations Between Reduced Hospital Length of Stay (LOS) and 30-Day Readmission Rate and Mortality: 14-Year Experience in 129 Veterans Affairs Hospitals,” in Annals of Internal Medicine, shows that while LOS decreased 27 percent over 14 years, or 2 percent annually, the Could private VA hospitals achieved hospitals achieve surprising declines of 16 percent in the same results? readmissions and 3 percent in mortality. Researchers attributed the results to “better coordination between hospital and outpatient services, as well as the use of hospitalists.” “What we found was that they both went down simultaneously, lead researcher and hospitalist Peter Kaboli says in a related article in HealthDay. “We can improve efficiency and at the same time improve 30-day readmission rates.” Researchers are uncertain, however, whether the same results could be seen at private hospitals. They suggest future work should examine whether a tipping point exists for LOS reduction and hospital readmission. That point is suggested in two studies at the University of Maryland’s Robert H. Smith School of Business, College Park, that conclude revenue-driven surgery and poor planning drive some surgical patients home before they are healthy enough, the university reports. The studies show a correlation between readmission rates and hospital occupancy at time of discharge. Join Us Online 24/7 Dare to become an active participant in AACN’s online communities. Contribute Facebook comments and posts to and And tweets to and New for NTI 2013: NTI Network, the online community, where you can check the program schedule, sign up for free ticketed events and connect with like-minded colleagues before, during and after the NTI’s Boston experience. Read more on page 32. AACN BOLD VOICES MARCH 2013 29

Table of Contents for the Digital Edition of Bold Voices - March 2013

Front/Digital Edition Viewing Guide
Another Angle
Design an NTI Just for You
New Guidelines Set Practice Framework for Tele-ICU NursingPractice
New Methods Increase Speed of Sepsis Diagnosis
High Blood Pressure Can Injure the Brain of Young Adults
Recurrent Hypoglycemia May Not Impair Long-Term Development of Preterm Infants
Superstorm Sandy Hospital Evacuation Decisions Questioned
New STEMI Guidelines Focus on Symptom Recognition, Ease of Use
Early Communication About Resuscitation Improves EOL Quality
Vote Now for AACN Board, Nominating Committee Members
Simple Measures Reduce Pneumonia
Fresh Blood in the ICU
Meeting Veterans’ Healthcare Needs
In Our Journals
Checklists May Reduce Venous Thromboembolism
Certification Capsules
Chapter Leadership Workshop @NTI 2013
Wear Your NTI Pride on May 20
Dare To

Bold Voices - March 2013