Abstract Background High-value healthcare focuses on improving healthcare to produce cost effective care, however limited information on the role of advanced practice registered nurses (APRNs) exists. Purpose This descriptive report describes APRN-led initiatives implemented as part of a national collaborative promoting the Choosing Wisely® campaign and high-value care measures. Method An APRN national collaborative focuses on developing and implementing high-value care initiatives. Monthly calls, podcasts, and a file sharing platform are used to facilitate the work of the national collaborative. Findings A total of 16 APRN teams from 14 states are participating and have implemented a number of initiatives to reduce unnecessary testing and treatments, promote appropriate antibiotic use, and promote optimal clinical practices such as mobility for hospitalized elderly patients, among others. Discussion A national collaborative has proven to be a successful way to engage APRN teams to focus on targeting high-value care and promoting evidence-based practices in clinical care.
BACKGROUND AND PURPOSE: Daily chest radiographs (CXRs) have long been a routine part of care. However, evidence as well as changing technology has promoted on-demand CXRs as beneficial to patient care. We found that a substantial number of routine daily CXRs were being ordered, with some of the orders staying active even after extubation. METHODS: Within a 19-bed adult medical ICU, we prospectively utilized 3 intervention phases from October 1, 2014, to February 28, 2018, to reduce routine CXRs....
#2Curtis N. Sessler(VCU: Virginia Commonwealth University)H-Index: 45
Last. Marc Moss(CU: University of Colorado Boulder)H-Index: 76
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Objectives:Over-utilization of tests, treatments, and procedures is common for hospitalized patients in ICU settings. American Board of Internal Medicine Foundation’s Choosing Wisely campaign tasked professional societies to identify sources of overuse in specialty care practice. The purpose of this
#1Silas P. Trumbo(VUMC: Vanderbilt University Medical Center)H-Index: 9
#2Wade T. Iams(VUMC: Vanderbilt University Medical Center)H-Index: 17
Last. Sunil Kripalani(VUMC: Vanderbilt University Medical Center)H-Index: 62
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BACKGROUNDChoosing Wisely® is a national initiative to deimplement or reduce low-value care. However, there is limited evidence on the effectiveness of strategies to influence ordering patterns.OBJECTIVEWe aimed to describe the effectiveness of an intervention to reduce daily chest X-ray (CXR) order
Introduction: Single center work demonstrated a safe reduction in unnecessary blood culture use in critically ill children. Our objective was to develop and implement a customizable quality improvement framework to reduce unnecessary blood culture testing in critically ill children across diverse clinical settings and various institutions. Methods: Three pediatric intensive care units (14 bed medical/cardiac; 28 bed medical; 22 bed cardiac) in 2 institutions adapted and implemented a 5-part Bloo...
Background Patients admitted to the medical ICU (MICU) are often subjected to multiple radiologic studies. We hypothesized that some endure radiation dose exposure (cumulative effective dose [CED]) in excess of annual US federal occupational health standard limits (CED ≥ 50 mSv) and 5-year cumulative limit (CED ≥ 100 mSv). We also evaluated the correlation of CED with Acute Physiology and Chronic Health Evaluation (APACHE) III score and other clinical variables. Methods Retrospective observation...
Abstract Background The intensive care unit provides complex care for critically ill patients. Consequently, due to the nature of critical illness and the therapies administered in intensive care, patients are often on prolonged periods of bed rest with limited mobility. It has been recognised that mobilising critically ill patients is beneficial to patients' recovery, however implementing early mobility as a standard of care remains challenging in practice. Objectives To identify the key factor...
#2Paulo J. Oliveira(UMMS: University of Massachusetts Medical School)H-Index: 76
Last. Andres F. Sosa(UMMS: University of Massachusetts Medical School)H-Index: 3
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Background Overuse of arterial blood gas (ABG) determinations leads to increased costs, inefficient use of staff work hours, and patient discomfort and blood loss. We developed guidelines to optimize ABG use in the ICU. Methods ABG use guidelines were implemented in all adult ICUs in our institution: three medical, two trauma-surgery, one cardiovascular, and one neurosurgical ICU. Although relying on pulse oximetry, we encouraged the use of ABG determination after an acute respiratory event or f...
Last. Aamir Siddiqui(HFH: Henry Ford Hospital)H-Index: 7
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Abstract Background Pressure ulcer formation continues to be problematic in acute care settings, especially intensive care units (ICUs). Our institution developed a program for early mobility in the ICU using specially trained nursing aides. The goal was to impact hospital-acquired pressure ulcers incidence as well as factors associated with ICU deconditioning by using specially trained personnel to perform the acute early mobility interventions. Methods A 5-point mobility scale was developed an...
#1Alaine Kamm(U of C: University of Chicago)H-Index: 1
#2Jason B. Liu(U of C: University of Chicago)H-Index: 12
Last. Hugh Vondracek(Rush University Medical Center)H-Index: 3
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AIM AND OBJECTIVES To explore and understand the current practice, perceptions, and knowledge of general surgery trainees, advanced practice providers, and surgical nurses regarding opioid prescribing and administration. To this end, a novel opioid education and training was introduced to educate these practitioners on safe opioid practices in surgical patients. BACKGROUND National awareness of the opioid epidemic has increased significantly in the last several years. However, there remain a dis...