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References on the importance of evidence based practice in patient care
Quality in healthcare us essay
Health care quality
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There is limited data on predictors of discharge and readmission for hospital inpatients. According to Rothman, Rothman, & (), “Unplanned hospital admissions are a major quality and cost issue in the US healthcare system”. About 20% of Medicare patients are readmitted to the hospital within 30 days, at an estimated cost of $17 billion per year (). Now that Medicare has begun to reduce payment to hospitals with high readmission rates, hospitals are looking for more effective ways of reducing readmissions. In order to develop new systems to address these concerns, there must be evidence in place to support to their use.
Evidence can come in a variety of forms. It can come from data, information, our own observations and vital signs, as well as patient/family member concerns. In order to be considered evidence however, the information must meet several criteria. It must be objective in that it does not house our personal opinions, it must be relevant towards the situation at hand, and timely in that the information is not out of date. It must also be transparent in that everyone has access to view the information as well
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The Rothman Index is a patient acuity score founded by the summation of excess risk functions that utilize additional data from the electronic medical record (Finlay, Rothman, & Smith, 2014). RI data is presented on a graph laid out over three horizontal bars of color which represent the patient 's risk for poor outcome: blue represents least risk for poor outcome; yellow indicates moderate risk for poor outcome; and red represents high risk for poor outcome (PeraHealth, 2015). Data is represented by a dot on a vertical axis, posted hourly as new results are entered. Healthcare providers can then select multiple dots or points of data on the graph to compare the scores as well as see what contributed to that calculated
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
Evidence Based Practice emerged in the late 20th century, becoming widespread in the 21st century. According to Research and Practice: The Role of Evidence-Based Program Practices in the Youth Mentoring Field ( 2009) “The concept of Evidence Based Practice (EBP) actually has its roots in the medical field, where the work of Archie Cochrane (1972) and others examined the key role that the substantial body of medical research and literature could play in how doctors make decisions in patient care” (para 6); Thus, a doctor’s decision would be an “educated” decision, based on evidence gathered (patient symptoms), history of cases they have overseen, or research of previous case diagnosed by another doctor, with a related case. Evidence Based Practices are defined as “ integration of: (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve” (“Evidence Based Practice (EBP),” 1997-2014); often described as the “Best Practices”. The evidence itself is not the basis of decisions made, but it does help support the process of care given to our clients.
Evidence-based practice (EBP) entails the use of explicit, reliable, and judicious evidence to make effective decisions about the care of patients. This DNP student will introduce EBP with the IOWA model. The IOWA model applies to this DNP proposal. The IOWA model is an EBP applicable in healthcare setting and implemented to show the applicability of evidence in nursing to give the best outcome. Doody and Doody (2011) noted that the IOWA model focuses on problem-focused triggers and knowledge in undertaking quality improvement study. The steps involved include topic selection, team formation, evidence retrieval, grading evidence, developing an EBP evidence, implementation of EBP, and evaluation of the progress. These steps apply to this DNP proposal, showing best practices, guidelines, procedures, and policies
Hospital readmission can impact the patient, nursing practice, the hospital, and the health care system. The patient’s quality of life can be altered physically, psychologically, and economically (Whittaker, 2014) and recurrent hospitalization is a good predictor of increased risk of mortality (Hummel, Katrapati, Gillespie, DeFranco, & Koellig, 2013). Moreover, a patient in an acute care setting has an increased risk of contracting hospital-acquired infections such urinary tract infections, sepsis, C. difficile, and methicillin resistant Staphylococcus aureus (medicare.gov|Hospital Compare, 2013). Nursing practice is impacted as patients spend the majority of their acute care stay with the bedside nursing staff. According to...
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
On account of theses limits other tools that are more efficient, objective and accurate are necessary to enhance acute hospital care. The National Institute for Health and Clinical Excellence (NICE 2007) have highlighted the importance of a systemic approach and advocated the use of EWS to efficiently identify and response to pa...
According to Sackett, (1996) evidence–based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about patient care. Straus, Richardson, Glasziou, & Haynes (2005, p. 1) described evidence-based practice (EBP) as “the integration of the best research evidence with clinical expertise and unique patient values and circumstances.” According to Straus et al, (2005, p.3) those practicing evidence based medicine must follow five specific steps: a) Include the need for data into an answerable question, b) Track down the best evidence, c) Critically appraise the evidence for validity, impact, and application, d) Integrate the critical appraisal into clinical practice, and e) Evaluate the effectiveness and efficiency of implementing steps a-e-and seek ways to improve them. Subsequently, without current best evidence, clinical practice cam become out-dated to the detriment of patients, this is an untenable circumstance and one which should never be allowed to happen.
Evidence - Based Nursing, An introduction (2008, p.1) “ At is core evidence based ‘anything’ is concerned with using valid and relevant information in decision making” “high quality research is the most important source of valid information”.
In health care, evidence-based research is crucial. Nurses revolve their practice on evidence so that they may provide the best health care. Without research, there would be no evidence to prove health care related findings (Shmidt & Brown, 2012). With appropriate
For example, according to a CNN article entitled,” 'Blue-eyed butcher ' sentenced to 20 years,” “A medical examiner testified he was able to count 193 wounds on the body, with the actual number of stab wounds well in excess of that” (Jakobsson, 2010, para. 6). Pictures were also presented to the jury to show the disfigured body. Another piece of evidence leading to the conviction of Susan Wright was the autopsy done that showed drugs in Wright’s system. The author of CNN stated, “They also suggested she may have drugged him with gamma-hydroxybutyric acid, known as the "date-rape drug," low levels of which were found in Jeffrey Wright 's system” (Jakobsson, 2010, paragraph 10). One last conclusive piece of visual evidence was the presence of two of Jeffrey’s ex-girlfriends. “Misty McMichael testified Wright beat her repeatedly during their two-year relationship and tried to control her every move” (Jakobsson, 2010, paragraph 13). McMichael also claimed that Wright had pushed her down the stairs 104 times and at one point even locked her in a room (Jakobsson, 2010, paragraph 14). This evidence was in favor of Susan Wright. The impact of this visual evidence was significant in many ways. Evidence is proof and proof cannot be made up, only misinterpreted. Therefore, the excessive amount of stab wounds found on Wright’s body along with the drugs found in his system was
The Dickson Advanced Analytics (DA²) launched four pilot programs for the Carolinas HealthCare System (CHS) hospitals with the goals of predicting the health needs of the population they were serving, enhancing patient outcomes, and pushing for transformative solutions that dealt with pressing community health issues (Quelch & Rodriguez, 2015). Of the four pilot programs created (which also includes mapping underserved areas, advance illness management, and patient segmentation), I believe the launching of the Readmission Predictive Risk model has the most value potential for the CHS hospitals not only because it can prevent the chances of patient readmission after discharge but also impact the quality of care given to their patients and avoid
In 2015, the Centers for Medicaid and Medicare Services (CMS) released the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which implements the final rule which offers financial incentives for Medicare clinicians to deliver high-quality patient centered care.5 Essentially, taking the time to learn the patient’s goals and treatment preferences allows for the patient to walk away from the medical treatment or service feeling understood and cared for by the provider.4 Thus, resulting in a better, more comprehensive plan of care. Policy makers are hopeful that the new incentive-based payment system will accelerate improvement efforts.
One feature of evidence based practice is a problem-solving approach that draws on nurses’ experience to identify a problem or potential diagnosis. After a problem is identified, evidence based practice can be used to come up with interventions and possible risks involved with each intervention. Next, nurses will use the knowledge and theory to do clinical research and decide on the appropriate intervention. Lastly, evidence base practice allows the patients to have a voice in their own care. Each patient brings their own preferences and ideas on how their care should be handled and the expectations that they have (Fain, 2017, pg.
Evidence is a gathering of facts that grounds one’s conviction that something is true. An internal evidence contains an individual clinical expertise, procurement quality and outcome data, it includes consensus opinions, experimental information from health care professionals and quality improvement projects in a healthcare establishments (Fineout-Overholt & Mazuret-Menyk, 2015). External evidence, in other hand, refers mainly to gathering all research accessible on a specific topic, guidelines used in clinics and randomized control trials or simply information obtained from research. Both evidence are significant, through them, when further research is conducted, enhanced knowledge for decision-making and improving health care services.