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This paper describes a framework for compliance the regulatory agency requirements and internal service standards in response to service decentralization and institution of a multi-task environmental worker role. Initiation and... more
This paper describes a framework for compliance the regulatory agency requirements and internal service standards in response to service decentralization and institution of a multi-task environmental worker role. Initiation and maintenance of the compliance system and the coordination of institutionally specific service standards are described. Five keys for success are detailed.
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Research Interests: Pediatrics, Asthma, Risk assessment, Adolescent, Medicine, and 14 moreChicago, Humans, Child, Female, Male, Risk Assessment, Cost of Illness, GuideLine, Child Health Services, Emergency Department, Child preschool, Psychology and Cognitive Sciences, Medical and Health Sciences, and Population surveillance
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Information is needed about patient-initiated device removal to guide quality initiatives addressing regulations aimed at minimizing physical restraint use. Research objectives were to determine the prevalence of device removal, describe... more
Information is needed about patient-initiated device removal to guide quality initiatives addressing regulations aimed at minimizing physical restraint use. Research objectives were to determine the prevalence of device removal, describe patient contexts, examine unit-level adjusted risk factors, and describe consequences. Prospective prevalence. Total of 49 adult intensive care units (ICUs) from a random sample of 39 hospitals in five states. Data were collected daily for 49,482 patient-days by trained nurses and included unit census, ventilator days, restraint days, and days accounted for by men and by elderly. For each device removal episode, data were collected on demographic and clinical variables. Patients removed 1,623 devices on 1,097 occasions: overall rate, 22.1 episodes/1000 patient-days; range, 0-102.4. Surgical ICUs had lower rates (16.1 episodes) than general (23.6 episodes) and medical (23.4 episodes) ICUs. ICUs with fewer resources had fewer all-type device removal relative to ICUs with greater resources (relative risk, 0.76; 95% confidence interval, 0.66-0.87) but higher self-extubation rates (relative risk, 1.27; 95% confidence interval, 1.07-1.52). Men accounted for 57% of the episodes, 44% were restrained at the time, and 30% had not received any sedation, narcotic, or psychotropic drug in the previous 24 hrs. There was no association between rates of device removal with restraint rates, proportion of men, or elderly. Self-extubation rates were inversely associated with ventilator days (rs = -0.31, p = .03). Patient harm occurred in 250 (23%) episodes; ten incurred major harm. No deaths occurred. Reinsertion rates varied by device: 23.5% of surgical drains to 88.9% of monitor leads. Additional resources (e.g., radiography) were used in 58% of the episodes. Device removal by ICU patients is common, resulting in harm in one fourth of patients and significant resource expenditure. Further examination of patient-, unit-, and practitioner-level variables may help explain variation in rates and provide direction for further targeted interventions.
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... Rosanne Leipzig is a professor of geriatrics and adult development at the College of Medicine, Mount Sinai Medical Center, New York, NY. ... Reasons for use. In most situations (85.4%), only one reason for side rail use was given... more
... Rosanne Leipzig is a professor of geriatrics and adult development at the College of Medicine, Mount Sinai Medical Center, New York, NY. ... Reasons for use. In most situations (85.4%), only one reason for side rail use was given (mean number of reasons given = 1.16). ...
Research Interests: Nursing, Benchmarking, Medicine, Motivation, Nursing Management, and 15 moreHumans, United States, Psychological Intervention, Total Quality Management, Risk factors, Organizational Policy, Safety Management, Questionnaires, Beds, Confusion, Risk Factors, Physical Restraint, Wounds and Injuries, Equipment Design, and Equipment failure
Research Interests: Nursing, Medicine, Multivariate Analysis, Humans, Needs Assessment, and 15 moreHuman Resources for Health, Descriptive Statistics, Cluster Analysis, Data Collection, Intensive Care Unit, Questionnaires, Adult, Capital Expenditures, Intensive Care Units, Physical Restraint, Nursing scholarship, Acute Disease, personnel staffing and scheduling, Health Resources, and hospital units
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This study identified program delivery preferences and barriers to physical activity and healthy eating. Ninety-nine urban dwelling American Indians completed a questionnaire at powwows, community events, and a community health center.... more
This study identified program delivery preferences and barriers to physical activity and healthy eating. Ninety-nine urban dwelling American Indians completed a questionnaire at powwows, community events, and a community health center. Most frequently selected program delivery preferences were coaching or other human contact, with fewer willing to use computer or telephone coaching. Fifty-six selected attending 8, 12, or 16 sessions. Most frequently selected barriers to physical activity were lack of time ( n = 48) and pain from existing problems ( n = 33). Frequently identified barriers to eating healthy foods included expense ( n = 42), uncertainty regarding what foods are healthy ( n = 25), extra time needed for preparation ( n = 22), and lack of knowledge of how to prepare healthy food ( n = 22). Findings showed the need for programs to focus on decreasing the barriers of time for physical activity and healthy eating and encourage doing organized physical activity (not necessari...
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The prevalence of childhood asthma and childhood overweight has increased in the last 2 decades, disproportionately burdening ethnic minority children and those living in poverty with no clear understanding of underlying mechanisms. To... more
The prevalence of childhood asthma and childhood overweight has increased in the last 2 decades, disproportionately burdening ethnic minority children and those living in poverty with no clear understanding of underlying mechanisms. To explore the influence of demographic variables, childhood obesity (adjusted body mass index > or = 95th percentile), caregivers' smoking status, and caregiver psychosocial status on asthma severity and asthma control in an urban sample of children with persistent asthma. Child (with asthma)-caregiver dyads were recruited from public and archdiocese schools in Chicago, Illinois, as part of the Chicago Initiative to Raise Asthma Health Equity. Data were collected as part of the baseline face-to-face surveys conducted within the community. The 531 dyads were divided into 2 groups: 294 taking controller medications were in the asthma control analyses and 237 taking rescue medications only were in the asthma severity analyses. In multivariate models, asthma control was significantly worse in obese children (odds ratio [OR], 1.89; 95% confidence interval [CI], 1.17-3.05), African American children (OR, 2.16; 95% CI, 1.05-4.46), and those with caregivers who had higher stress (OR, 1.09; 95% CI, 1.01-1.18). Older children had better control (OR, 0.79; 95% CI, 0.69-0.90). Children with caregivers who wanted more asthma-specific social support were more likely to have moderate to severe asthma (OR, 2.07; 95% CI, 1.06-4.05). In this community-based sample of children with active asthma, asthma control and asthma severity were associated with different factors. Caregiver variables were significant in both outcomes, and childhood obesity was associated only with poor asthma control.
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As the U.S. population ages and chronic illness prevalence increases, new approaches to care are needed. Although large health systems have begun to respond to this challenge, most Americans seek care from practitioners functioning in... more
As the U.S. population ages and chronic illness prevalence increases, new approaches to care are needed. Although large health systems have begun to respond to this challenge, most Americans seek care from practitioners functioning in small office settings. Implementing systematic sustainable changes for quality improvement in this setting remains an unresolved challenge. In this study, trained Nurse Coaches (NCs) were employed to assist practices in adopting a new model of patient care called Virtual Integrated Practice (VIP). The feasibility and treatment fidelity of this approach were assessed through process measures and interviews in three practices. Findings document high acceptance of the NC approach and consistent delivery of the intervention. Enactment of the VIP model took place across practices, although to a variable degree. The study suggests that NCs may be an effective delivery method for quality and organizational improvements in small primary care practices.