National Healthcare Quality and Disparities Report
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- Adverse Events (3)
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- Implementation (1)
- Injuries and Wounds (2)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (2)
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- Long-Term Care (1)
- Neonatal Intensive Care Unit (NICU) (2)
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- Transitions of Care (2)
- Workflow (4)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 31 Research Studies DisplayedRosen MA, Dietz AS, Lee N
Sensor-based measurement of critical care nursing workload: Unobtrusive measures of nursing activity complement traditional task and patient level indicators of workload to predict perceived exertion.
The purpose of this study was to establish the validity of sensor-based measures of work processes for predicting perceived mental and physical exertion of critical care nurses. Environmental sensors worn by staff in a surgical intensive care unit captured work process data. Nurses rated their mental and physical exertion for each four-hour block, and recorded patient and staffing-level workload factors. Analysis of this data yielded highly predictive models of critical care nursing workload to generate insights into workflow and work design. The researchers conclude that sensor-based measures are a viable complement to traditional task demand measures of workload.
AHRQ-funded; HS023553.
Citation: Rosen MA, Dietz AS, Lee N .
Sensor-based measurement of critical care nursing workload: Unobtrusive measures of nursing activity complement traditional task and patient level indicators of workload to predict perceived exertion.
PLoS One 2018 Oct 12;13(10):e0204819. doi: 10.1371/journal.pone.0204819..
Keywords: Critical Care, Nursing, Provider: Nurse, Patient Safety, Workflow
Law AC, Stevens JP, Hohmann S
Patient outcomes after the introduction of statewide ICU nurse staffing regulations.
The objective of this study was to assess whether Massachusetts legislation directed at ICU nurse staffing was associated with improvements in patient outcomes. The investigators found that state regulation of patient-to-nurse staffing with the aid of patient complexity scores in intensive care was not associated with either increased nurse staffing or changes in patient outcomes.
AHRQ-funded; HS024288.
Citation: Law AC, Stevens JP, Hohmann S .
Patient outcomes after the introduction of statewide ICU nurse staffing regulations.
Crit Care Med 2018 Sep 4;46(10):1563-69. doi: 10.1097/ccm.0000000000003286..
Keywords: Intensive Care Unit (ICU), Policy, Nursing, Outcomes, Patient Safety
Auger KA, Simmons JM, Tubbs-Cooley HL
Postdischarge Nurse Home Visits and Reuse: the Hospital to Home Outcomes (H2O) Trial.
In this study, the investigators evaluated the effects of a pediatric transition intervention, specifically a single nurse home visit, on postdischarge outcomes in a randomized controlled trial. The investigators concluded that children randomly assigned to the intervention had higher rates of 30-day postdischarge unplanned health care reuse. They also noted that parents in the intervention group recalled more clinical warning signs 2 weeks after discharge.
AHRQ-funded; HS024735.
Citation: Auger KA, Simmons JM, Tubbs-Cooley HL .
Postdischarge Nurse Home Visits and Reuse: the Hospital to Home Outcomes (H2O) Trial.
Pediatrics 2018 Jul;142(1). doi: 10.1542/peds.2017-3919..
Keywords: Children/Adolescents, Home Healthcare, Hospital Discharge, Nursing, Transitions of Care
Al Danaf J, Chang BH, Shaear M
Surfacing and addressing hospitalized patients' needs: proactive nurse rounding as a tool.
This paper reported on rounding interventions employed at high performing hospitals, and provided three case studies on how proactive nurse rounding was successfully implemented to improve patient-centredness. The investigators concluded that proactive rounding interventions are a feasible approach to help surface and address hospitalized patients' needs in a timely manner.
AHRQ-funded; HS021921.
Citation: Al Danaf J, Chang BH, Shaear M .
Surfacing and addressing hospitalized patients' needs: proactive nurse rounding as a tool.
J Nurs Manag 2018 Jul;26(5):540-47. doi: 10.1111/jonm.12580..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitalization, Hospitals, Inpatient Care, Nursing, Patient-Centered Healthcare, Patient Experience, Quality Improvement
Bayramzadeh S, Joseph A, San D
The impact of operating room layout on circulating nurse's work patterns and flow disruptions: a behavioral mapping study.
The purpose of this study was to assess how the adjacencies of functionally different areas within operating rooms (ORs) can influence the circulating nurse's (CN) workflow patterns and disruptions. The investigators video recorded and thematically coded a convenience sample of 25 surgeries for CN's activities, locations, and flow disruptions. The investigators suggest that optimum adjacencies should be considered while designing ORs such that they are more efficient and safer.
AHRQ-funded; HS024380.
Citation: Bayramzadeh S, Joseph A, San D .
The impact of operating room layout on circulating nurse's work patterns and flow disruptions: a behavioral mapping study.
HERD 2018 Jul;11(3):124-38. doi: 10.1177/1937586717751124..
Keywords: Surgery, Workflow, Hospitals, Nursing, Provider: Nurse, Provider, Patient Safety
Sarkhel R, Socha JJ, Mount-Campbell A
HOW nurses identify hospitalized patients on their personal notes: findings from analyzing 'brains' headers with multiple raters.
Many nurses use handwritten notes in order to avoid using electronic health records to access information about patients. At the top of these notes are patient identifiers. By identifying aspects of good and suboptimal headers, the authors began to form a model of how to effectively support identifying patients during assessments and care activities. The primary finding was that nurses use room number as the primary patient identifier in the hospital setting, not the patient's last name.
AHRQ-funded; HS024379.
Citation: Sarkhel R, Socha JJ, Mount-Campbell A .
HOW nurses identify hospitalized patients on their personal notes: findings from analyzing 'brains' headers with multiple raters.
Proc Int Symp Hum Factors Ergon Healthc 2018 Jun;7(1):205-09. doi: 10.1177/2327857918071045..
Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Inpatient Care, Nursing
Mistry B, Stewart De Ramirez S, Kelen G
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
This study assessed the accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. It found that the concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, its findings point to a need for more reliable ED triage tools.
AHRQ-funded; HS023641.
Citation: Mistry B, Stewart De Ramirez S, Kelen G .
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
Ann Emerg Med 2018 May;71(5):581-87.e3. doi: 10.1016/j.annemergmed.2017.09.036.
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Keywords: Shared Decision Making, Emergency Department, Emergency Medical Services (EMS), Health Information Technology (HIT), Nursing
Patterson ES
Workarounds to intended use of health information technology: a narrative review of the human factors engineering literature.
This narrative review sought to integrate and synthesize insights from recent studies of workarounds to the intended use of health information technology (HIT) by health care professionals. It concluded that workarounds were employed to avoid changes to workflow, enable interdisciplinary communication, coordinate activities, and have real-time portable access to summarized and synthesized information.
AHRQ-funded; HS024379.
Citation: Patterson ES .
Workarounds to intended use of health information technology: a narrative review of the human factors engineering literature.
Hum Factors 2018 May;60(3):281-92. doi: 10.1177/0018720818762546.
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Keywords: Communication, Health Information Technology (HIT), Nursing, Patient Safety
Sockolow PS, Yang Y, Bass EJ
Data visualization of home care admission nurses' decision-making.
This study investigated nurses’ decision making regarding hospital to home care admissions. They conducted a focus group case study with six admitting home health nurses at a rural agency in Pennsylvania and analyzed the data using thematic analysis.
AHRQ-funded; HS024537.
Citation: Sockolow PS, Yang Y, Bass EJ .
Data visualization of home care admission nurses' decision-making.
AMIA Annu Symp Proc 2018 Apr 16;2017:1597-606..
Keywords: Data, Shared Decision Making, Home Healthcare, Nursing, Transitions of Care
Dudding KM, Gephart SM, Carrington JM
Neonatal nurses experience unintended consequences and risks to patient safety with electronic health records.
The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record.
AHRQ-funded; HS022908.
Citation: Dudding KM, Gephart SM, Carrington JM .
Neonatal nurses experience unintended consequences and risks to patient safety with electronic health records.
Comput Inform Nurs 2018 Apr;36(4):167-76. doi: 10.1097/cin.0000000000000406.
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Keywords: Electronic Health Records (EHRs), Neonatal Intensive Care Unit (NICU), Newborns/Infants, Nursing, Patient Safety
Blaz JW, Doig AK, Cloyes KG
The symbolic functions of nurses' cognitive artifacts on a medical oncology unit.
Acute care nurses continue to rely on personally created paper-based tools-their "paper brains"-to support work during a shift, although standardized handoff tools are recommended. This interpretive descriptive study examines the functions these paper brains serve beyond handoff in the medical oncology unit at a cancer specialty hospital.
AHRQ-funded; HS022183.
Citation: Blaz JW, Doig AK, Cloyes KG .
The symbolic functions of nurses' cognitive artifacts on a medical oncology unit.
West J Nurs Res 2018 Apr;40(4):520-36. doi: 10.1177/0193945916683683.
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Keywords: Nursing, Provider: Nurse, Provider, Workflow
McArdle J, Sorensen A, Fowler CI
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
The purpose of this study using TeamSTEPPS was to assess the implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Results suggested that successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The Safety Program for Perinatal Care strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
AHRQ-funded; 2902010000241.
Citation: McArdle J, Sorensen A, Fowler CI .
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
J Obstet Gynecol Neonatal Nurs 2018 Mar;47(2):191-201. doi: 10.1016/j.jogn.2017.11.014.
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Keywords: Labor and Delivery, Newborns/Infants, Pregnancy, Adverse Events, TeamSTEPPS, Injuries and Wounds, Care Management, Education: Continuing Medical Education, Training, Tools & Toolkits, Patient Safety, Nursing, Communication, Quality of Care
Dowding D, Merrill JA, Onorato N
The impact of home care nurses' numeracy and graph literacy on comprehension of visual display information: implications for dashboard design.
This study explored home care nurses' numeracy and graph literacy and their relationship to comprehension of visualized data. Results suggest that nurses' comprehension of visualized information is influenced by their numeracy, graph literacy, and the display format of the data. Individual differences in numeracy and graph literacy skills need to be taken into account when designing dashboard technology.
AHRQ-funded; HS023855.
Citation: Dowding D, Merrill JA, Onorato N .
The impact of home care nurses' numeracy and graph literacy on comprehension of visual display information: implications for dashboard design.
J Am Med Inform Assoc 2018 Feb;25(2):175-82. doi: 10.1093/jamia/ocx042.
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Keywords: Shared Decision Making, Health Information Technology (HIT), Health Literacy, Health Information Technology (HIT), Nursing
Hinson JS, Martinez DA, Schmitz PSK
Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis.
This study sought to measure the frequency of under- and over-triage of patients by nurses using the Emergency Severity Index (ESI) in Brazil and to identify factors independently associated with each. It concluded that, despite rigorous and ongoing training of ESI users, a large number of patients in this cohort were under- or over-triaged. Advanced age, vital sign derangements, and specific chief complaints were particularly under-appreciated.
AHRQ-funded; HS023641.
Citation: Hinson JS, Martinez DA, Schmitz PSK .
Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis.
Int J Emerg Med 2018 Jan 15;11(1):3. doi: 10.1186/s12245-017-0161-8.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Healthcare Delivery, Nursing
Keenan GM, Lopez KD, Sousa VEC
A shovel-ready solution to fill the nursing data gap in the interdisciplinary clinical picture.
The purpose of this study was to critically evaluate the 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. The authors of the article present recommendations for revisions to AAN's plan as well as an evidence-based alternative to generating interoperable nursing data in the near term.
AHRQ-funded; HS015054.
Citation: Keenan GM, Lopez KD, Sousa VEC .
A shovel-ready solution to fill the nursing data gap in the interdisciplinary clinical picture.
Int J Nurs Knowl 2018 Jan;29(1):49-58. doi: 10.1111/2047-3095.12168..
Keywords: Data, Evidence-Based Practice, Nursing
Ricciardi R
AHRQ Author: Ricciardi R
The next frontier for nurses: improving quality and safety in primary care.
Nurses’ role in advancing quality and protecting the safety of patients in primary care settings is becoming more important. As primary care moves to team-based practice models to meet the needs of Accountable Care Organizations and the Quality Payment Program, RNs are well positioned to take on leading roles and new responsibilities. The author discusses the challenges and opportunities faced by the nursing profession and AHRQ’s role in assisting this process.
AHRQ-authored.
Citation: Ricciardi R .
The next frontier for nurses: improving quality and safety in primary care.
J Nurs Care Qual 2018 Jan/Mar;33(1):1-4. doi: 10.1097/ncq.0000000000000304.
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Keywords: Quality of Care, Nursing, Patient Safety, Primary Care
Gephart S, Carrington JM, Finley B
A systematic review of nurses' experiences with unintended consequences when using the electronic health record.
The purpose of this article is to present the state of the science on nurses' experiences with unintended consequences of electronic health records (EHRs). Findings demonstrate that nurses experience changes to workflow, must continually adapt to meet patient's needs in the context of imperfect EHR systems, and have difficulty accessing the information they need to make patient care decisions. Implications for nurse administrators include the need for continual engagement with nurses along the continuum of EHR design, as well as the need to encourage nurses to speak up and acknowledge workflow changes that threaten patient safety or do not support work efficiency.
AHRQ-funded; HS021074.
Citation: Gephart S, Carrington JM, Finley B .
A systematic review of nurses' experiences with unintended consequences when using the electronic health record.
Nurs Adm Q 2015 Oct-Dec;39(4):345-56. doi: 10.1097/naq.0000000000000119.
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Keywords: Adverse Events, Clinical Decision Support (CDS), Electronic Health Records (EHRs), Nursing, Workflow
Gephart SM
Fostering best practice: strategies for writing evidence-based practice briefs.
In this editorial, the author provides instructions to make the task of writing a brief manageable for even the newest of authors. From asking a compelling clinical question to telling the story of a critical appraisal of evidence to making recommendations, the overall goal of writing such a brief is to support best practice care in the neonatal intensive care unit.
AHRQ-funded; HS022908.
Citation: Gephart SM .
Fostering best practice: strategies for writing evidence-based practice briefs.
Adv Neonatal Care 2015 Oct;15(5):299-306. doi: 10.1097/anc.0000000000000222.
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Keywords: Evidence-Based Practice, Nursing, Research Methodologies, Neonatal Intensive Care Unit (NICU)
Price LE, Shea K, Gephart S
The Veterans Affairs's Corporate Data Warehouse: uses and implications for nursing research and practice.
This article described the developments in research associated with the VHA's transition into the world of Big Data analytics through Corporate Data Warehouse (CDW) utilization. The authors found that the most commonly-occurring research topics are pharmacy/medications, systems issues, and weight management/obesity. They concluded that, despite the potential benefit of data mining techniques to improve patient care and services, the CDW and alternative analytical approaches are underutilized by researchers and clinicians.
AHRQ-funded; HS022908.
Citation: Price LE, Shea K, Gephart S .
The Veterans Affairs's Corporate Data Warehouse: uses and implications for nursing research and practice.
Nurs Adm Q 2015 Oct-Dec;39(4):311-8. doi: 10.1097/naq.0000000000000118.
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Keywords: Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing
Ricciardi R
AHRQ Author: Ricciardi R
I'm in an NP state of mind: a tribute to Dr. Henry K. Silver on the 50th anniversary of the nurse practitioner profession.
The author gives a personal tribute to Dr. Henry K Silver who co-founded the nurse practitioner role with Dr. Loretta Ford and founded the Child Health Associate/Physician Assistant program at the University of Colorado.
AHRQ-authored.
Citation: Ricciardi R .
I'm in an NP state of mind: a tribute to Dr. Henry K. Silver on the 50th anniversary of the nurse practitioner profession.
J Pediatr Health Care 2015 Sep-Oct;29(5):397-9. doi: 10.1016/j.pedhc.2015.06.009..
Keywords: Nursing, Children/Adolescents, Provider: Health Personnel
Stifter J, Yao Y, Lodhi MK
Nurse continuity and hospital-acquired pressure ulcers: A comparative analysis using an electronic health record "big data" set.
The aim of this study was to examine the association of nurse continuity with the prevention of hospital-acquired pressure ulcers (HAPU). It found that patient characteristics including nutrition, mobility, and perfusion were associated with HAPUs, but nurse continuity was not.
AHRQ-funded; HS023072.
Citation: Stifter J, Yao Y, Lodhi MK .
Nurse continuity and hospital-acquired pressure ulcers: A comparative analysis using an electronic health record "big data" set.
Nurs Res 2015 Sep-Oct;64(5):361-71. doi: 10.1097/nnr.0000000000000112..
Keywords: Patient Safety, Pressure Ulcers, Nursing
Brennan PF, Bakken S
Nursing needs big data and big data needs nursing.
Nursing science and nursing practice has much to gain from the data science initiatives. Existing approaches to large data set analysis provide a necessary but not sufficient foundation for nursing to participate in the big data revolution. Nursing’s Social Policy Statement provides a principled, ethical perspective on big data and data science.
AHRQ-funded; HS022961; HS02254.
Citation: Brennan PF, Bakken S .
Nursing needs big data and big data needs nursing.
J Nurs Scholarsh 2015 Sep;47(5):477-84. doi: 10.1111/jnu.12159..
Keywords: Nursing, Data, Health Information Technology (HIT)
Abbott AA, Fuji KT, Galt KA
A qualitative case study exploring nurse engagement with electronic health records and e-prescribing.
The purpose of this qualitative case study was to describe how nurses adapt to using an electronic health record with electronic prescribing (e-Rx) system in a rural ambulatory care practice. Findings showed that nurses adjust their routine in response to providers' preferential behavior yet retained focus on the patient and care coordination. e-Rx adoption increased workload and introduced safety risks.
AHRQ-funded; HS018625.
Citation: Abbott AA, Fuji KT, Galt KA .
A qualitative case study exploring nurse engagement with electronic health records and e-prescribing.
West J Nurs Res 2015 Jul;37(7):935-51. doi: 10.1177/0193945914567359.
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Keywords: Case Study, Electronic Health Records (EHRs), Electronic Prescribing (E-Prescribing), Nursing, Patient Safety
Pierson CA, Ricciardi R
AHRQ Author: Ricciardi R
A tribute to our heritage.
This article recognizes the contributions of Dr. Henry K. Silver, co-founder of the first nurse practitioner (NP) program and pioneer collaborator who has so greatly influenced the NP profession. The author, Richard Ricciardi, PhD, NP, FAAN, FAANP, knew Dr. Silver personally and professionally. This tribute was read at the June Fellows Induction Ceremony in New Orleans. There is another longer article about Dr. Silver by Dr. Ricciardi in the June 2015 issue of the FAANP Forum.
AHRQ-authored.
Citation: Pierson CA, Ricciardi R .
A tribute to our heritage.
J Am Assoc Nurse Pract 2015 Jul;27(7):350. doi: 10.1002/2327-6924.12287..
Keywords: Nursing, Children/Adolescents, Provider: Health Personnel
Ricciardi R
AHRQ Author: Ricciardi R
AHRQ focuses on ambulatory patient safety.
As AHRQ looks to expand its ambulatory safety research efforts, the agency seeks the involvement of a variety of nurses to provide expert opinion and consultation and to conduct research. The author emphasizes that this is an opportunity for both PhD and Doctor of Nursing Practice prepared nurses to lead interprofessional teams to conduct research that can translate into meaningful improvements in ambulatory quality.
AHRQ-authored.
Citation: Ricciardi R .
AHRQ focuses on ambulatory patient safety.
J Nurs Care Qual 2015 Jul-Sep;30(3):193-6. doi: 10.1097/ncq.0000000000000124..
Keywords: Patient Safety, Nursing, Primary Care, Adverse Events, Health Services Research (HSR)