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Increasing Discharge Efficiency in a Joint Replacement Unit: A Quality Improvement Project
Get PDFTitle:
Increasing Discharge Efficiency in a Joint Replacement Unit: A Quality Improvement Project
Background:
Patient discharge is a complex process. Lack of discharge expectations, standardized discharge instructions, and interprofessional communication create discharge barriers leading to an increase in post-operative length-of-stay and 30-day readmissions. Discharge delays disrupt unit workflow and increase staff workload. Readmissions within 30 days of discharge are associated with increased hospital costs and lower patient satisfaction.
SMART Aim:
By December 1, 2024, we aimed to reduce the average post-operative length-of-stay for elective joint replacement outpatients from 14.5 hours to 12 hours by implementing a standardized discharge-navigator tool to be utilized by the nursing staff.
Design:
The project implemented the IHI Model for Improvement using Plan-Do-Study-Act (PDSA) cycles.
PDSA Cycle 1: Education: The monthly unit education PowerPoint presentation introduced the project to the nursing staff. Attended monthly virtual charge nurse and nursing staff conferences to explain the project\u27s purpose and help answer any questions. Leadership engagement: Introduced the discharge-navigator tool to the unit nursing staff and demonstrated how to complete the form. Informally interviewed staff members for discharge-navigator tool improvement. Data collection: Collected interprofessional satisfaction surveys to revise the discharge-navigator tool for PDSA cycle 2. Collected and logged the number of completed discharge-navigator tools weekly. Collected weekly post-op length-of-stay and weekly 30-day readmission data.
PDSA Cycle 2: Tool revision: Incorporated feedback from satisfaction survey and from informal staff interviews to improve uptake of discharge-navigator tool. Leadership engagement: Introduced revised discharge-navigator tool and worked alongside nursing staff to champion the tool. Data collection: Collected and logged completed discharge-navigator weekly. Collected weekly post-operative length-of-stay and weekly 30-day readmission data. Collected post-project survey to assess nursing staff satisfaction.
Measures: Outcome Measure: Weekly average post-operative length-of-stay time. Process Measure: Weekly number of completed discharge-navigator tools. Balancing Measures: Interprofessional staff satisfaction and weekly average 30-day readmissions.
Results: Outcome Measure Findings: The average length of stay for joint replacement outpatients was reduced from 14 hours and 52 minutes to 14 hours and eight minutes. This marks a 44-minute reduction during the project’s implementation phase, excluding Thanksgiving week. Process Measure Findings: 162 discharge-navigator tools were collected. The nursing staff completed one tool for every three outpatient cases. Balancing Measure Findings: The project notes a 36% reduction in the average weekly outpatient 30-day readmission rate. Post-project satisfaction survey revealed that 11 out of 11 nurses were very satisfied or satisfied with the evolution of the discharge-navigator tool. One nurse stated, It was a very good tool and helpful in navigating patient needs. It was very easy to find information when giving a report.”
Conclusions:
The evidence-based discharge-navigator tool reduced post-operative length-of-stay without compromising 30-day readmission rates or staff satisfaction. This project demonstrates that implementing a standardized tool can increase discharge efficiency.
Implications for Practice:
It is essential to continue evaluating the tool\u27s efficacy in improving patient outcomes and staff satisfaction. Education and implementation of the discharge navigator tool improved patient outcomes and unit workflow. Successful integration of the discharge navigator tool into the electronic health record could further increase tool uptake and sustainability
Expanding Therapy Services for the Infant & Pediatric Population in an Acute Setting
Get PDFThis doctoral capstone project was completed through a partnership with Med Center Health, located in Bowling Green, Kentucky. Med Center Health is a non-profit health system with a mission to care for people and improve the quality of life in the communities they serve. Med Center Health – Bowling Green (MCBG) provides a broad range of services for the Southcentral Kentucky community including a level III NICU and acute pediatric unit. The purpose of this project was to enhance current therapy services and resources provided in the NICU as well as initiate development of a rehabilitation program on the pediatric floor. The process of creating this project included synthesizing the literature, communication and collaboration with various healthcare professionals, and patient interaction during observation in both the NICU and acute pediatric settings.
For the MCBG NICU, this project resulted in established criteria for infants receiving neonatal therapy orders, guidelines for therapy discharge recommendations, updated educational resources for caregivers, and an educational presentation for NICU staff. For the MCBG pediatric floor, this project resulted in a pediatric interdisciplinary rehab screening form and protocol, a pediatric OT evaluation template, supply list recommended for pediatric patients, and an educational powerpoint for staff on this floor. The overall focus of this project is to advocate for a multidisciplinary team approach to be implemented for infants and pediatric patients in order to provide holistic, patient-centered care at MCBG
Baroque and Blugrass Bowing Styles
No full textThe primary aim of this learning segment is for students to analyze and distinguish the differences between the Baroque and Country styles in their prepared pieces. This comparative exercise will enable students to identify key variations in sound, bow weight, and bow speed between the two styles. Understanding these distinctions will provide students with the foundational skills needed to adjust their playing techniques in response to the stylistic demands of each genre. By delving into the contrasting characteristics of bow weight and speed, students will gain insight into how these elements influence the overall expression of the music and how they can tailor their bowing techniques accordingly
Acute Toxicity of Chlorimuron-Ethyl to Daphnia Magna
Get PDFThe acute toxicity of a sulfonylurea herbicide, chlorimuron ethyl, to Daphnia magna was determined experimentally using acute toxicity tests
Poetry and Fiction Reading from Introduction to Creative Writing
Get PDFThis poetry and fiction reading features several student presenters from English 2430: Introduction to Creative Writing – many of whom are performing their creative work to a live audience for the first time. Whether through poetry or prose, these students\u27 inventive use of language and storytelling will hook you from beginning to end
Effects of Haptics on Virtual Reality Gameplay Experience
No full textThe present study closely analyzed the immersive world of virtual reality and gameplay experience. The question this study attempted to answer was do players who use haptics in virtual reality report higher gameplay experience. Currently, participants are still being collected, and requirements include being 18 years old or older, a current Belmont University student, and can physically stand for more than 5 minutes. Participants engaged in a drawing game using a Meta Quest headset and controllers. Every other participant was assigned to either “game 1 (haptics)” or “game 2 (no haptics)” where they would draw freely for three minutes. Next, a survey was administered through Qualtrics, and it included questions about demographics as well as rating the gameplay experience. The data will be analyzed using an independent t-test within SPSS version 29. Data is currently being collected, and results will be presented at the SPARKS Research Symposium on April 16. Overall, this study will assist in better understanding the importance of whether or not haptics creates a more immersive gameplay experience in the world of Virtual Reality
Skincare Product Recommendation System
No full textThe skincare industry is oversaturated with so many products available on the market and influencers promoting based on brand collaboration. Sponsored content on the internet especially makes it difficult to trust online reviews, and the nature of the oversaturated industry can make it challenging for users to find the right products for themselves. A skincare product recommendation system can help consumers find the best products suited to their skincare needs. The system uses cosine similarity to make recommendations to users based on factors such as skin type, concerns, product components, spending limit, and user ratings. This recommendation system is integrated into a website where users can enter a list of their skincare preferences. Once entered, the backend processes this information and calculates cosine similarity scores against the product database. The most relevant products and their details are shown to the user in a user-friendly way. This feature allows users to make well-informed decisions on their needs to obtain the best skincare regimen
COPPA in Privacy Law: Framework, Regulations, and Enforcement
No full textThe Children’s Online Privacy Protection Act (COPPA), enacted in 1998 and effective since 2000, is a key U.S. privacy law designed to protect the personal data of children under 13. It regulates how online services and websites collect, use, and disclose children\u27s information, covering identifiers such as names, addresses, email addresses, geolocation data, and multimedia content. COPPA applies to child-directed websites and platforms, as well as general-audience sites with knowledge of child users. However, certain entities, such as non-commercial organizations and sites collecting only persistent identifiers for internal operations, are exempt.
Under COPPA, parents are granted rights to control their children\u27s data, including the ability to access, review, and delete collected information. Businesses must comply by obtaining verifiable parental consent, minimizing data collection, and ensuring security measures to protect children’s information. The Federal Trade Commission (FTC) enforces COPPA, with violators facing civil penalties of up to $50,120 per infraction, legal injunctions, and reputational damage. Remedies for non-compliance include data deletion mandates, enhanced privacy protections, and regulatory audits. While COPPA does not provide direct compensation for affected individuals, enforcement actions may lead to settlements benefiting impacted users
The True Face of China: Literary Portrayals and Cultural Realities
No full textThis paper examines the complex and multifaceted representations of China and the Chinese experience through the lens of both Western literature and contemporary Chinese cinema. Drawing from works such as Mark Twain’s Roughing It and Goldsmith’s Friend Abroad Again, Maxine Hong Kingston’s China Men, and Pearl S. Buck’s The Good Earth, the study explores how these authors, shaped by their individual biases and historical contexts, portray Chinese immigrants and Chinese culture. Twain’s works, while offering a critical look at the racial discrimination faced by Chinese immigrants in 19th-century America, also reinforce racial stereotypes, revealing the limitations of Western representations of China. Kingston’s personal, layered narrative in China Men highlights the resilience of Chinese immigrants, while Buck’s idealized depiction of Chinese family life reflects Confucian values but oversimplifies the diversity of Chinese society. In contrast, contemporary Chinese films like Together (和你在一起), Cooking Up a Storm, and Everyone’s Fine offer more nuanced, insider perspectives, emphasizing the fluid and evolving nature of China’s identity. This analysis underscores that China’s identity is not a fixed entity but an ongoing dialogue shaped by historical, cultural, and political factors, demonstrating the contrast between Western misinterpretations and contemporary Chinese portrayals