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Improving Utilization of InterQual among Case Managers/Patient Care Coordinators at Santa Clara Medical Center
Get PDFProblem: The utilization management department at Santa Clara Medical Center had low compliance with InterQual criteria, at 35%. This resulted in inconsistent care decisions, poor resource allocation, and regulatory penalties, affecting patient care and performance.
Context: The project aimed to enhance InterQual utilization, aligning with Santa Clara Medical Center\u27s goals of evidence-based, patient-centered care. The initiative was guided by Jesuit values and ANA ethical standards, focusing on service, justice, excellence, patient advocacy, and professional responsibility.
Interventions: The project implemented three main interventions: comprehensive training programs, regular audits, and performance recognition. These interventions aimed to address gaps and ensure the effective use of InterQual criteria in patient care decisions.
Measures: Effectiveness was measured using several metrics: the percentage increase in InterQual utilization, the number of case managers completing InterQual training, the number of cases using InterQual criteria, and feedback on InterQual usability.
Results: Compliance rates increased from 35% at baseline to 81% by Week 8, demonstrating the effectiveness of the training programs, audits, and performance recognition.
Conclusions: The project significantly improved InterQual utilization, resulting in more consistent and evidence-based care decisions. Sustaining these improvements will involve ongoing training, regular audits, and performance recognition. There is a high potential for these interventions to be applied in other departments and institutions
Decreasing Inappropriate Wound Consults
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Background: This project was centered around the wound nurses and their workload. It also highlighted the opportunity for education for frontline staff. The wound nurses at this northern California hospital are a group of five nurses that support the whole hospital. Usually there are two staffed per day to support a facility that continues to have three to four overflow areas open to accommodate its high census.
Problem: My project focused on decreasing inappropriate wound consults. There are many consults places that do not need the intervention of a skilled wound nurse. These consults lead to time that is wasted to review and document on the consults that the frontline nurses can address themselves. On Average, 1 to 3 consults placed out of 15 are inappropriate.
Intervention: To decrease inappropriate wound consults, baseline information was gathered on day shift, float pool nurses’ knowledge regarding wound care and consulting. A wound algorithm was created by the wound nurses that was socialized to the frontline nurse. A wound champion was educated on the algorithm to help facilitate its knowledge and use.
Measures: The outcome measure for this project is to reduce inappropriate consults by 15% or to a target of 0-1 per day by August 2024. A process measures was to obtain a baseline survey for knowledge of wound care and when to consult the WOC team. Goal for participation of 60 % was not met.
Results: There was a decreased noted in the number of inappropriate consults placed from 25 % of consults placed being inappropriate to 19.6 %.
Conclusions: There’s a small decrease noted. If the project were applied to all units, as the wound nurses support the whole hospital, there could be a greater benefit to the wound nurses in decreasing their time being wasted. It is sustainable if education is continued, maybe on a yearly basis with skill fair or annual modules.
Keywords: wound nurses, wound care wound education, time managemen
Interprofessional Collaboration for Nurse Leaders: Practical Applications to Enhance Team Effectiveness on Telemetry
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Background: According to the Interprofessional Education Collaborative (IPEC), there are four core competencies that promote team engagement and collaboration among professionals: 1. Establish shared values 2. Clarify roles and responsibilities 3. Effective communication 4. Teamwork. Together, the competencies create structure and team integration that potentiates favorable outcomes in work culture and patient care when operating in complex, quality-based care settings. The setting for this quality improvement project is on a telemetry unit, assistant nurse manager (ANM) team in the greater Sacramento region of California.
Problem: The Gallup Q12 is an employee engagement survey that identifies inter-relational domains of influence on peer-peer collaboration and workplace engagement. Areas that were identified for improvement in the ANM team were working relationships, recognition, and team structure.
Interventions: Four interventions were selected as tests of change: 1. Completing and sharing the Gallup Strengthfinder tool with an ANM peer 2. Development of a transparent team charter 3. Masterclass training on crucial conversations 4. Escape room simulation.
Outcome Measures: The metric that indicated improvements to overall ANM team engagement was an increase in the post-intervention Q12 mean score from 3.6 to 4.0. The key drivers were Q12 survey questions, Q05:“My manager or someone at work seems to care about me as a person” and Q01:“I know what is expected of me at work”.
Results: Post-intervention Q12 survey resulted with an increase in the mean score from 3.6 to 4.1. Driver scores increased in Q05: “My manager or someone at work seems to care about me as a person” from 3.4 to 4.33, and Q01: “I know what is expected of me at work” from 4.1 to 4.33.
Conclusion: Achievement of the project aim signifies effective application of the interventions in enhancing interprofessional ANM team engagement as purported by IPEC. The foundational elements for enhancing teamwork are establishing clear team structure, organization, effective communication, and opportunities for team engagement
Optimizing Geriatric Care: A NICHE-Driven Daily Implementation of the 5Ms Geriatric Assessment Tool to Minimize Length of Stay
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Background: This project\u27s microsystem was a 32-bed medical-surgical telemetry unit at a small community hospital in Marin County. The unit needed a framework that focused on the unique needs of the geriatric population and daily activities that enhanced physical and cognitive activities to mitigate risks for any issues that created a prolonged Length of Stay (LOS).
Problem: The microsystem is a medical-surgical telemetry unit where the average length of stay (LOS) is five days, surpassing the organization\u27s goal of four days. Reducing LOS can enhance patient satisfaction and meet organizational targets.
Context: This project aims to reduce the extended length of stay (ELOS) by one day for patients aged 75 and older in a medical/surgical/telemetry unit by July 30, 2024.
Interventions: The goal of incorporating interventions to maximize cognitive and physical activities to promote shorter hospitalizations included music therapy, art therapy, and physical exercises. A C.A.L.M. (Cluster Care, Assess Alarms, Lights Off, and Medications Given) initiative improved sleep hygiene and aimed at preventing delirium. The 5 Ms tool (Mobility, Medications, Mentation, Multi-complexity, and Matters Most) ensured a comprehensive view of patient needs.
Measures: The goal was to reduce the ELOS from five to four days for patients aged 75 and older in a medical/surgical/telemetry unit by July 30, 2024. The aim was for 75% of patients to have a discharge order by day three, with a plan to leave by 1:00 p.m. on day four.
Results: Over a three-month PDSA cycle, interventions significantly improved re-admissions and LOS, with the NICHE certification plan showing initial success and promise. To date, 43.75% of the nursing staff and 93% of the PCTs on the pilot floor are GRN and GPCT certified. The C.A.L.M. project provided a reproducible and maintainable framework for improving patient outcomes, although the 5 Ms tool struggled throughout the PDSA cycles.
Conclusions: Implementing a multi-pronged approach to minimizing LOS and mitigating the risk of cognitive decline during a prolonged hospitalization proved challenging. Aligning a practice that highlights the unique needs of the geriatric population serves the greater good as there is recognition of a significant need. Reducing LOS is achievable with the support of a well-versed team, family involvement, and ongoing education to support the ever-changing needs of the geriatric population.
Keywords: cognitive-improvement activities, geriatrics in acute care, patients aged 65 years and older, physical exercise recommendations, and multi-disciplinary care plan
The Impact of Female Political Leadership on Intimate Partner Violence in India
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This study employs an instrumental variable approach to examine the impact of female political leadership on women’s experiences of Intimate Partner Violence (IPV). It finds that in rural areas with more female leaders, incidents of sexual and psychological IPV increase. The analysis investigates the drivers behind this impact, revealing that entrenched gender norms and expectations, such as a husband’s preference for more sons, may exacerbate IPV. Additionally, despite the increase in female leaders, attitudes toward violence remain largely unchanged. These findings highlight the need for research and policy initiatives that not only encourage female political participation but also specifically address the socio-cultural factors contributing to IPV
What Gives? Trust, Risk, Altruism, and Reciprocity Across 76 Countries
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The decades-long literature pertaining to gender-specific preferences lies at the intersection of economics and psychology with a primary focus on the correlation between economic development and gender-specific preferences. Better understanding of this correlation has helped researchers understand how individuals make decisions for their education, finances, and occupation. Falk & Hermle (2018) assess the correlation between GDP and various gender-specific preferences including trust, risk, altruism, and reciprocity. In order to better understand the relationship between economic development and gender-specific preferences, I expand on the Falk & Hermle 2018 framework by introducing new macroeconomic, prosocial, and cultural variables as additional explanatory indicators across 76 countries. Utilizing the 2012 Global Preferences Survey, I create Ordinary Least Squares models to analyze the strength of the correlation between GDP as the key indicator for economic development and the gender-specific preferences of trust, risk-taking, altruism, and reciprocity by controlling for additional explanatory variables: labor force participation, personal care, and tightness score
The Diorama of Coexistence Hypnagogia: The Liminal Space between Dream and Reality
Get PDFThe “Diorama of Coexistence” explores the imagined spaces where humans and animals share the same environments, blurring the lines between reality and fantasy. This year-long photographic project is inspired by my Christian faith and the Genesis creation narrative, where the world was originally harmonious and unspoiled. Through my work, I aim to reimagine the natural world, not as it is, but as it could be a place where animals and humans coexist peacefully.
In researching human development and its impact on nature, I found that animals are often confined to spaces like zoo, far from their natural habitats. This led me to question what it would be like if these animals were part of our everyday surroundings on urban trails, in neighborhood streets, or among the familiar landscapes where we live and work. The concept of “Hypnagogia,” the state between wakefulness and sleep, guides my approach, allowing me to create images that capture a dreamlike coexistence. Through these compositions, I seek to depict animals not as victims of destruction, but as participants in a world where they find comfort and harmony alongside human environment
Early Career Women of Color as Social Justice Change Leaders
Get PDFThe student affairs profession is predominantly female, but women, especially women of color (WOC), are disproportionately in entry-level positions. The majority of student affairs professionals also believe social justice is important but desire more support for their social justice work. This study examined how early career WOC perceived the power dynamics that they encountered in their social justice-oriented organizational change efforts, the strategies and tactics they utilized to lead change efforts, and the aspects of their identities that were the most salient to them during their change efforts. The study design used a phenomenology methodology and an intersectionality theoretical framework. Data from six study participants was analyzed using a pre-interview survey and a semi-structured interview protocol.
The key findings were grouped in the following conceptual categories: identity, relationships, organization/institution, and social justice. The concepts of identity and relationships were especially intertwined, but awareness of identity was also a recurring theme when interviewees spoke about organization/institution and social justice. The data indicate that the difficulties experienced by early career WOC come from a combination of external challenges with their colleagues and organization and internalized challenges with self-confidence. The findings suggest some of the unique strategies and tactics that early career WOC develop to navigate these challenges and lead social justice change. Peer relationships provide a highly appreciated and valuable source of support. The discussion suggests numerous strategies that early WOC, allies, and social justice advocates can apply in their work, which include putting emphases on self-advocacy, collaboration, and community-building
PARENT STRATEGIES FOR ANTIRACIST PARENTING IN FAMILIES OF MULTIRACIAL AND ASIAN DESCENT
Get PDFThe Pew Research Center’s analysis of United States census data depicts and increasing number of individuals identifying as more than one race. From 2010 to 2020, the population had nearly doubled to 13.5 million. This is particularly evident in states with large populations of Asian American communities such as California, where nearly two million people identify as multiracial and people identifying as both White and Asian making up the largest portion of the 61% increase the state saw since 2010 (Henderson, 2022). Despite claims that an increase in multiracial individuals signifies an end of racism, multiracial children, navigating complex ethnic and racial experiences face racial oppression, discrimination, and bias to this day (Chang, 2015; Harris, 2016; Nayani, 2020; Rockquemore & Laszloffy, 2005; Rockquemore et al., 2009). Using qualitative interviews and parenting circles (focus groups) this study explored the relationship between parent agency and their children’s understanding of race, racism, and identity. The population sample of this study was families with multiracial children of Asian descent, a population that is underrepresented in research despite its significant growth. A total of nine families (11 individual parents) participated in the study. The focus on multiracial families with Asian heritage helps bridge the gap in representation in the areas of critical race theory, ethnic and racial socialization, and racial justice education, offering insights into their unique experiences. Results from interviews and focus groups highlighted three areas of focus for multiracial families with Asian heritage: ethnic identity development, racial identity development, and navigating teaching about racism and antiracism. Findings suggest parents teach and learn from their children about race, racism, and identity through the following three strategies: (1) learning to heal, (2) learning and teaching to nurture identity development, and (3) creating a family culture of antiracism. The results from this study emphasize a need to expand research on multiracial families beyond the Black and white racial binary by demonstrating the nuances of ethnic identity, racial identity, and antiracism development of Asian American parents and multiracial families with Asian American heritage. Recommendations for parents included engaging in formal learning of ethnic studies and critical race theory to empower themselves and their families in addressing intergenerational trauma. Recommendations for researchers included further research to explore the impact of parental agency in teaching about identity and antiracism, through a triangulated study that includes parents’ and children\u27s insights and perspectives
2-Tertbutylfuran at 550 and 700 K: A Multiplexed Photoionization Mass Spectrometric Investigation and Determination of Cross Sections of a Carbon- Bromine Bond and Various Brominated Organic Compounds
Get PDFThis thesis presents the combustion study of 2-tertbutylfuran (2-TBF) in reaction with atomic oxygen (O(3P)). Data was collected at the Advanced Light Source (ALS) of the Lawrence Berkeley National Lab, using tunable vacuum ultraviolet radiation coupled with a multiplexed mass spectrometer to acquire the data. These data were taken at low pressures of 7 and 8 torr at temperatures of 550 K and 700 K, respectively. Primary products of the system were identified and characterized, while reaction pathways of the products are currently being studied to ensure thermodynamic feasibility. Branching fractions of the system were also calculated, to view the ratio of the concentration of products to the concentration of the reactants. The determination of the carbon-bromine (C-Br) single bond photoionization cross section using six different bromine species. This experiment also utilized the ALS, taking data at 298 K at various pressures. Using three sp2 species and two sp3 species, the HOMO molecular orbitals of both the neutral and cationic species were analyzed to determine whether hybridization made a difference in cross section. The cross sections of each of these six bromine species were also calculated, all at 11 eV, and subtracted from literatures values of the same non-brominated molecules to determine the single bond C-Br cross section.
Chapter one of the thesis goes over volatile organic compounds (VOCS) in the atmosphere along with the reactions they undergo in the environment. This chapter also discusses how these compounds contribute to global warming and other negative environmental impacts. Chapter 2 of the thesis presents the experimental methods used, while Chapter 3 explains the theoretical and computational methods used in these experiments. The combustion reaction of 2-TBF and its products are presented in Chapter 4, while the determination of the cross section of the C-Br bond and the absolute cross sections for brominated organic compounds are discussed in Chapter 5