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Congratulations to the selected Spotlight posters! These featured posters are the top 10 scored posters.
Updated: 03/22/23
Updated: 03/22/23
Learning outcomes are quality improvement strategies to increase efficiency, care delivery, and patient experience in an urgent care. Urgent care’s patient experience key indicator scores were in the zero percentile, patients had three hour waits, and the providers often had a backlog of patients. Patient perception of care with how we worked together as a team scored low, which was evident with poor continuity of care throughout visits and long wait times. The current state care model involved providers seeing the next patient in order of arrival, during or after finishing up care of a patient. In evaluating our operations, it was clear that some care model changes were needed to create a better experience for our patients and our team. In addition to reviewing our internal operations, we also visited other facilities who provided similar care.
As a team we utilized the A3 continuous improvement process to guide changes to our care model. The cross-functional team included patient service representatives, medical assistants, nurses, APPs, MDs, and local level leaders. The team met weekly to discuss current state challenges including fairness of workload, processes around rooming patients, consistency and communication of care, and patient assignments. We learned that we should pair a provider, nurse, and medical assistant with set of exam rooms and assign patients as they walk in, rotating assignments to reduce influx of patients. This adjustment holds staff and providers accountable for a group of patients as well as increase consistency of who is caring for the patient. We would pull until full into open exam rooms without needing a provider to pick up the patient, reducing rooming delays and wait times. We performed small tests of change and trialed this idea before making it operational. We learned in trialing that having set exam rooms near each other was needed to maximize efficiency from a space and logistical standpoint, which also included moving supplies near each work area.
We have a visual management huddle board that we start every day at to discuss our day ahead and any changes. This board offers a place for staff to provide feedback on this new model for what is working well and any additional improvement opportunities. We also utilize this board to display our patient experience scores and comments.
Four months after implementing this change, our patient experience key indicator scores increased. In the category of likelihood to recommend clinic, we rose from 0% to 34% and in category of staff working together as a team, we rose from 7% to 47%. Our charge nurse average end time decreased from 43 minutes past scheduled end time to 13 minutes past scheduled end time. The vacancy rate has decreased in nurses from 17.1% to 9.8% and in medical assistants from 30% to 17.5%. Our ongoing success was supported by the continued meetings which have phased from weekly to biweekly to monthly as feedback wanes and opportunities for improvement decrease. We continue to seek opportunities improve.
As a team we utilized the A3 continuous improvement process to guide changes to our care model. The cross-functional team included patient service representatives, medical assistants, nurses, APPs, MDs, and local level leaders. The team met weekly to discuss current state challenges including fairness of workload, processes around rooming patients, consistency and communication of care, and patient assignments. We learned that we should pair a provider, nurse, and medical assistant with set of exam rooms and assign patients as they walk in, rotating assignments to reduce influx of patients. This adjustment holds staff and providers accountable for a group of patients as well as increase consistency of who is caring for the patient. We would pull until full into open exam rooms without needing a provider to pick up the patient, reducing rooming delays and wait times. We performed small tests of change and trialed this idea before making it operational. We learned in trialing that having set exam rooms near each other was needed to maximize efficiency from a space and logistical standpoint, which also included moving supplies near each work area.
We have a visual management huddle board that we start every day at to discuss our day ahead and any changes. This board offers a place for staff to provide feedback on this new model for what is working well and any additional improvement opportunities. We also utilize this board to display our patient experience scores and comments.
Four months after implementing this change, our patient experience key indicator scores increased. In the category of likelihood to recommend clinic, we rose from 0% to 34% and in category of staff working together as a team, we rose from 7% to 47%. Our charge nurse average end time decreased from 43 minutes past scheduled end time to 13 minutes past scheduled end time. The vacancy rate has decreased in nurses from 17.1% to 9.8% and in medical assistants from 30% to 17.5%. Our ongoing success was supported by the continued meetings which have phased from weekly to biweekly to monthly as feedback wanes and opportunities for improvement decrease. We continue to seek opportunities improve.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/14/23
Updated: 03/14/23
Progressively it is said the world of medicine was changed with the discovery of handwashing and its impact on the spread of disease. We can bestow that same accolade as we look at the use of some vaccines which have irradicated illness or the various technological advances and the discovery of medicines, both holistic and traditional, that have placed an influential stamp on patient treatment plans. But what about the situational awareness of how a disease makes its mark on those who are involved in the care of individuals who have been directly influenced by such affliction?
Healthcare workers have always been indirectly affected by their labor, but it became more evident as work-related ethical dilemmas surfaced during the COVID-19 pandemic, so much so it became known as the “parallel pandemic.. Section 5.2 of provision 5 to the nursing code of ethics pinpoints a direct correlation to patient care and nurse self-care. Recognition of the lack of self-care and understanding the difference between self-care, self-comfort, and self-compassion became more evident as time progressed and we continued to search for an end to the mental anguish in hopes of a “new normal.” We still question what a new normal will entail, but we at least know that from the parallel pandemic evolved a desire to improve the individual work experience. Priorities shifted with the pandemic, and a desire to establish a realistic work-life balance emerged.
In the ambulatory care setting of Emory Healthcare, our leadership sought to develop ways to support our staff in staying motivated, feeling less stressed, and identifying modalities of wellness that would be beneficial and easily adaptable for each unit. Through our research, staff not only expressed the need for transparency from our leaders, but they also sought meaningful support that was in many cases nurse initiated and nurse-driven. They looked at the community from within as they supported the community outside of the work environment.
Before COVID-19, we had considered the use of code lavender, which is a holistic tool used both for inpatient and outpatient settings to address traumatic events which may or may not be work-related. With an increased use of 120% and decreased stress by 47%, it was apparent that code lavender could be a useful tool to help in this aspect. There were many wellness tools added to our arsenal during the pandemic, but with code lavender, we felt we could tailor make it to fit the individual unit. With its many modalities, we had to identify the most beneficial options as we began to connect with leadership to pinpoint resources and finalize support to implement a program. We surveyed the clinical staff to determine the impact of code lavender and then identified the top five modality preferences. From the various stages, we developed a workable toolkit that can be adapted by ambulatory care leaders, setting the groundwork for transformative strategies to develop realistic responses to resiliency which will help staff reconnect in reclaiming the joy of the work experience.
Healthcare workers have always been indirectly affected by their labor, but it became more evident as work-related ethical dilemmas surfaced during the COVID-19 pandemic, so much so it became known as the “parallel pandemic.. Section 5.2 of provision 5 to the nursing code of ethics pinpoints a direct correlation to patient care and nurse self-care. Recognition of the lack of self-care and understanding the difference between self-care, self-comfort, and self-compassion became more evident as time progressed and we continued to search for an end to the mental anguish in hopes of a “new normal.” We still question what a new normal will entail, but we at least know that from the parallel pandemic evolved a desire to improve the individual work experience. Priorities shifted with the pandemic, and a desire to establish a realistic work-life balance emerged.
In the ambulatory care setting of Emory Healthcare, our leadership sought to develop ways to support our staff in staying motivated, feeling less stressed, and identifying modalities of wellness that would be beneficial and easily adaptable for each unit. Through our research, staff not only expressed the need for transparency from our leaders, but they also sought meaningful support that was in many cases nurse initiated and nurse-driven. They looked at the community from within as they supported the community outside of the work environment.
Before COVID-19, we had considered the use of code lavender, which is a holistic tool used both for inpatient and outpatient settings to address traumatic events which may or may not be work-related. With an increased use of 120% and decreased stress by 47%, it was apparent that code lavender could be a useful tool to help in this aspect. There were many wellness tools added to our arsenal during the pandemic, but with code lavender, we felt we could tailor make it to fit the individual unit. With its many modalities, we had to identify the most beneficial options as we began to connect with leadership to pinpoint resources and finalize support to implement a program. We surveyed the clinical staff to determine the impact of code lavender and then identified the top five modality preferences. From the various stages, we developed a workable toolkit that can be adapted by ambulatory care leaders, setting the groundwork for transformative strategies to develop realistic responses to resiliency which will help staff reconnect in reclaiming the joy of the work experience.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Laura Lopez, MS, BSN, Ambulatory Care Nursing Education Program Manager, U.S. Department of Veterans Affairs | Jodi Moberly, BSN | Melissa Morrison, MSN, RN | Linnea Werner, LPN
Updated: 03/22/23
Updated: 03/22/23
Project: A service line of 15 primary care medical homes, homeless outreach, and telehealth teams at the VA had a pre-pandemic initiative to fully integrate women’s health skills in primary care which was delayed due to competing needs of COVID-19. These skills were novice to most of the staff providing care at the sites; however, a growing population of female veterans created an urgent need for these basic skills in primary care settings. Additionally, a need to practice trauma-informed care in the context of historical military sexual trauma must be part of universal trauma precautions for healthcare at the VA. This project was designed as a train-the-trainer to teach skills that included Depo-Provera self-injection teachback, pap assist, IUD assist, birth control education, telephone triage, chaperones, and trauma-informed care.
Three nurse educators and one assistant director of nursing created a collaborative in-person training with the medical director of women’s health to train staff at all sites with simulation devices. These efforts required quick redirection to a hybrid model due to weather and a COVID-19 winter surge.
Learning outcomes: Clinical staff required a standardized set of demonstrated competencies, an understanding of trauma-informed care in this unique population, and hands-on practice with simulation devices and supplies, and all staff including providers received the same curriculum and expectations for their prospective roles.
Methods: Over a three-month span of time, nurse educators partnered with physician leadership and hosted hybrid events at each site on scheduled blocked days. Each site identified skills champions in advance that would serve as train the trainers. The exam rooms were set up with simulation supplies and signs were posted on the doors to indicate the skills stations. The Microsoft Teams platform was utilized to deliver the group lecture and host Q&A sessions throughout the day. The training day began with an interprofessional group lecture and expectation setting from leadership. Virtual lectures and LMS were delivered on an interactive agenda for the majority of staff and completed same day at the learner’s pace. During that time, the training champions rotated through the competency stations with laptops. They dialed in the nurse educators via MS Teams who were able to visualize return demonstrations and set expectations to perform teachback with the rest of the clinic by a defined date. An interactive telephone triage simulation on pelvic pain was also created and performed live with the identified trainers.
Evaluation: A mixed methods qualitative and quantitative survey was used to evaluate the training using a modified Kirkpatrick evaluation. Satisfaction and comfort for both performing and teaching the skills were collected at the end of each individual training session with the training champions and returned a score of 100%.
Results: Of the 413 interdisciplinary care team members that participated in the training, 142 returned the survey. Of survey participants, 17 were providers, 77 RNs, 42 LPNs, 3 UAPs, and 3 front office support staff. 91% of survey participants reported that they were satisfied/very satisfied with the training, and 93% overall satisfaction for the nursing role. 89% believed that the program material would contribute to future success, 92% reported being engaged in the training, and participants reported an average of 4.60 out of 5 level of commitment to apply what they learned in the workplace. A post-survey is scheduled to be released at the one-year mark in January 2023 to obtain sustainability data and measure the practical application of the training. A sustainability plan was implemented by integrating components of these trainings into other existing training venues.
Three nurse educators and one assistant director of nursing created a collaborative in-person training with the medical director of women’s health to train staff at all sites with simulation devices. These efforts required quick redirection to a hybrid model due to weather and a COVID-19 winter surge.
Learning outcomes: Clinical staff required a standardized set of demonstrated competencies, an understanding of trauma-informed care in this unique population, and hands-on practice with simulation devices and supplies, and all staff including providers received the same curriculum and expectations for their prospective roles.
Methods: Over a three-month span of time, nurse educators partnered with physician leadership and hosted hybrid events at each site on scheduled blocked days. Each site identified skills champions in advance that would serve as train the trainers. The exam rooms were set up with simulation supplies and signs were posted on the doors to indicate the skills stations. The Microsoft Teams platform was utilized to deliver the group lecture and host Q&A sessions throughout the day. The training day began with an interprofessional group lecture and expectation setting from leadership. Virtual lectures and LMS were delivered on an interactive agenda for the majority of staff and completed same day at the learner’s pace. During that time, the training champions rotated through the competency stations with laptops. They dialed in the nurse educators via MS Teams who were able to visualize return demonstrations and set expectations to perform teachback with the rest of the clinic by a defined date. An interactive telephone triage simulation on pelvic pain was also created and performed live with the identified trainers.
Evaluation: A mixed methods qualitative and quantitative survey was used to evaluate the training using a modified Kirkpatrick evaluation. Satisfaction and comfort for both performing and teaching the skills were collected at the end of each individual training session with the training champions and returned a score of 100%.
Results: Of the 413 interdisciplinary care team members that participated in the training, 142 returned the survey. Of survey participants, 17 were providers, 77 RNs, 42 LPNs, 3 UAPs, and 3 front office support staff. 91% of survey participants reported that they were satisfied/very satisfied with the training, and 93% overall satisfaction for the nursing role. 89% believed that the program material would contribute to future success, 92% reported being engaged in the training, and participants reported an average of 4.60 out of 5 level of commitment to apply what they learned in the workplace. A post-survey is scheduled to be released at the one-year mark in January 2023 to obtain sustainability data and measure the practical application of the training. A sustainability plan was implemented by integrating components of these trainings into other existing training venues.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/22/23
Updated: 03/22/23
Advanced practice providers (APPs) are an essential part of the health care system and provide high-quality access to care to patients across the country. Poor working environments and turnover of APPs can negatively affect patient care. Knowing what factors influence intent to stay can be important information for an organization to have for recruitment and retention purposes and to make positive change.
This study examined the factors that impact an APPs intent to stay within a large health system that has a variety of different practice environments (large percentage ambulatory care). This study examined the study group demographics and compared them with the APPs resilience, decompression, and intent to stay.
The "Examining Factors that Influence an Advanced Practice Provider’s Intent to Stay" survey instrument was developed to answer the following research questions: Is there a difference in intent-to-stay scores among advanced practice providers based on group demographics? Is there a difference in resilience and decompression scores among advanced practice providers based on group demographics? Is there a difference in sense of belonging scores among advanced practice providers based on group demographics?
The survey instrument was administered to advanced practice providers (NP, PA, CNM, CRNA) via email. Data analysis is underway and will be complete by the time of this poster presentation. Preliminary data analyses are giving new insights into the factors that influence the APPs intent to stay and will provide new recommendations to leaders and administrators to assist in improving retention and reducing turnover.
This study examined the factors that impact an APPs intent to stay within a large health system that has a variety of different practice environments (large percentage ambulatory care). This study examined the study group demographics and compared them with the APPs resilience, decompression, and intent to stay.
The "Examining Factors that Influence an Advanced Practice Provider’s Intent to Stay" survey instrument was developed to answer the following research questions: Is there a difference in intent-to-stay scores among advanced practice providers based on group demographics? Is there a difference in resilience and decompression scores among advanced practice providers based on group demographics? Is there a difference in sense of belonging scores among advanced practice providers based on group demographics?
The survey instrument was administered to advanced practice providers (NP, PA, CNM, CRNA) via email. Data analysis is underway and will be complete by the time of this poster presentation. Preliminary data analyses are giving new insights into the factors that influence the APPs intent to stay and will provide new recommendations to leaders and administrators to assist in improving retention and reducing turnover.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/22/23
Updated: 03/22/23
The purpose of this work was to examine how a large multi-site primary care-based organization established an organizational structure that supported the determination, definition, measurement, and reporting of nursing-sensitive indicators (NSIs) specific to ambulatory care nursing in the primary care setting. NSIs capture the value of care provided by nurses and are a critical component of ANCC Magnet designation. The organization considered that successful pursuit of Magnet designation in an all-ambulatory care organization would involve establishing a framework to report NSIs that included defining nursing "units" and NSIs meaningful to the organization.
A multidisciplinary team led by nursing was established to examine and identify the most meaningful metrics to collect and measure. A review of the Ambulatory Care Nurse-Sensitive Indicator Industry Report: Meaningful Measurement of Nursing in the Ambulatory Patient Care Environment and Healthcare Effectiveness Data and Information Set (HEDIS) measures was conducted and meaningful NSIs were selected. Additionally, the team worked to establish an organizational structure for NSI reporting that organized practice locations into units accounting for geography and specialty, which supported Magnet requirements for data reporting.
An electronic dashboard was built to monitor the selected NSIs for each defined unit as compared to established benchmarks. This allowed the organization to target improvements by location, monitor the results of improvement initiatives, and establish their eligibility to achieve Magnet designation. Through establishing a means to measure and benchmark NSIs meaningful in primary care, the organization is well-positioned to drive continuous improvements and was successful in their achievement of Magnet designation in July 2022.
A multidisciplinary team led by nursing was established to examine and identify the most meaningful metrics to collect and measure. A review of the Ambulatory Care Nurse-Sensitive Indicator Industry Report: Meaningful Measurement of Nursing in the Ambulatory Patient Care Environment and Healthcare Effectiveness Data and Information Set (HEDIS) measures was conducted and meaningful NSIs were selected. Additionally, the team worked to establish an organizational structure for NSI reporting that organized practice locations into units accounting for geography and specialty, which supported Magnet requirements for data reporting.
An electronic dashboard was built to monitor the selected NSIs for each defined unit as compared to established benchmarks. This allowed the organization to target improvements by location, monitor the results of improvement initiatives, and establish their eligibility to achieve Magnet designation. Through establishing a means to measure and benchmark NSIs meaningful in primary care, the organization is well-positioned to drive continuous improvements and was successful in their achievement of Magnet designation in July 2022.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/24/23
Updated: 03/24/23
The purpose of this work was to research, develop, and implement an ambulatory care nursing professional governance council (ANPGC) in support of the pursuit of Magnet designation within an ambulatory primary care-based organization. The organization is comprised of over 115 practices located throughout eight counties affiliated with five acute care hospitals. Literature supports professional governance as a mechanism to increase nurse engagement and nurse retention, improve patient outcomes, and promote partnership between front-line nurses and administration. Nursing professional governance is a pillar of the American Nurses Credentialing Center (ANCC) Magnet culture and a critical component of Magnet designation.
The organization's nursing leaders, also serving as ANPGC advisors, developed the foundation to support meaningful execution and implementation of an effective structure, ensuring adequate representation of the organization's nurses. The ANPGC advisors supported and empowered the organization's nurses throughout the implementation process. Essential to success was evaluation of the perceived baseline governance style within the organization and nurses’ understanding of professional governance.
The ANPGC advisors identified the Index of Professional Nursing Governance (IPNG) survey, an evidence-based tool, to establish baseline understanding of nurse perceptions around professional governance. The initial survey was sent to 513 ambulatory care nurses. 108 nurses responded in part with 85 completing the full survey. Demographics of respondents were collected and included education level, years in nursing, years in current specialty and years of service with the organization, age, and number of specialty certifications.
The survey response rate was 21.1%. The organization scored 1.8 on the Likert scale, indicating the presence of a traditional governance style. Council advisors shared these results with representatives during the implementation phase. Advisors harnessed this opportunity to educate council representatives on the components of transformational leadership to inspire and support their vision for change. Council representatives were empowered to promote a culture of shared decision-making through collaborative strategizing, open communication, and mutual trust. These factors served as the vehicle to promote nursing’s agenda with leadership.
The key principles of professional governance include partnership, equity, accountability, ownership, empowerment, team building, leadership, and innovation. These key principles will drive sustainable action planning into the future toward improvements to process, quality, and outcomes that are essential for continued success. Council evolution requires revision of the current structure to allow for representation of ambulatory care specialty nurses, improving alignment with ambulatory care nursing specialty councils and the continued development of cyclical communication across the organization. Maintaining a focus on leadership development through the active engagement, participation, and empowerment of nursing representatives is another key to future success. Tracking and monitoring quantitative progress towards a state of transformational leadership using the IPNG survey is another critical component suggestive of meaningful change.
Implementation of an ANPGC has launched a structure for professional governance in the ambulatory care setting. The ability to measure and benchmark nurse perceptions surrounding professional governance in the ambulatory care environment provided the organization with meaningful information to help drive improvements and positioned the organization to achieve initial Magnet designation in July 2022.
The organization's nursing leaders, also serving as ANPGC advisors, developed the foundation to support meaningful execution and implementation of an effective structure, ensuring adequate representation of the organization's nurses. The ANPGC advisors supported and empowered the organization's nurses throughout the implementation process. Essential to success was evaluation of the perceived baseline governance style within the organization and nurses’ understanding of professional governance.
The ANPGC advisors identified the Index of Professional Nursing Governance (IPNG) survey, an evidence-based tool, to establish baseline understanding of nurse perceptions around professional governance. The initial survey was sent to 513 ambulatory care nurses. 108 nurses responded in part with 85 completing the full survey. Demographics of respondents were collected and included education level, years in nursing, years in current specialty and years of service with the organization, age, and number of specialty certifications.
The survey response rate was 21.1%. The organization scored 1.8 on the Likert scale, indicating the presence of a traditional governance style. Council advisors shared these results with representatives during the implementation phase. Advisors harnessed this opportunity to educate council representatives on the components of transformational leadership to inspire and support their vision for change. Council representatives were empowered to promote a culture of shared decision-making through collaborative strategizing, open communication, and mutual trust. These factors served as the vehicle to promote nursing’s agenda with leadership.
The key principles of professional governance include partnership, equity, accountability, ownership, empowerment, team building, leadership, and innovation. These key principles will drive sustainable action planning into the future toward improvements to process, quality, and outcomes that are essential for continued success. Council evolution requires revision of the current structure to allow for representation of ambulatory care specialty nurses, improving alignment with ambulatory care nursing specialty councils and the continued development of cyclical communication across the organization. Maintaining a focus on leadership development through the active engagement, participation, and empowerment of nursing representatives is another key to future success. Tracking and monitoring quantitative progress towards a state of transformational leadership using the IPNG survey is another critical component suggestive of meaningful change.
Implementation of an ANPGC has launched a structure for professional governance in the ambulatory care setting. The ability to measure and benchmark nurse perceptions surrounding professional governance in the ambulatory care environment provided the organization with meaningful information to help drive improvements and positioned the organization to achieve initial Magnet designation in July 2022.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/22/23
Updated: 03/22/23
For the past five years, the population health services organization (PHSO) at an academic medical center has been working to expand care coordination resources to primary care providers and our patients. The catalyst for this expansion was the result of the changing reimbursement landscape from a fee-for-service structure to a value-based care model. This shifted the expectations of primary care providers to an outcomes-based model, with emphasis on total cost of care. Value-based care focuses on reducing avoidable events through comprehensive care planning, improved access, close patient follow-up, measurement of patient outcomes, and the meeting of national quality metrics outlined by the National Accreditation Quality Assurance (NCQA). As Margaret O’Kane, President, NCQA, states, “Population health is a model of care that strives to address patients’ health needs at all points along the care continuum, including the community setting, by increasing patient participation and engagement and targeting interventions.” Knowing that providers cannot do it all, a team-based approach was employed to help their patients get the right care, in the right place, at the right time.
Housed within PHSO is the population health team, consisting of nurses, social workers, advanced practice providers, physicians, medical assistants, care navigators, digital health coaches, nursing, and public health students. The team supports in a myriad of ways seven key programs which include quality for care gap closure and performance tracking, student rotations, utilization management, transition of care, disease management/digital health, complex care management, and in-home provider visits. For each program, nurses are the first touch point, using a risk score methodology to offer patients a menu of resources based on need and patient preference. Those resources may consist of simple reminders of lab and cancer screenings that are overdue, health coaching with concerns escalated to the provider, and/or digital health equipment at home for blood pressure and blood sugar management. Other services, designed for our more complex, vulnerable patients, include post-discharge follow-up education to reinforce discharge instructions, confirmation and coordination of community resources, and performance of medication reconciliation, along with the scheduling of primary care provider appointments and in-home provider visits for more intense care management using an interdisciplinary team dynamic. In addition, and in some ways a benefit of COVID-19 pandemic, when student nurses had to find alternative clinical assignments from the hospital setting, population health provided a robust training ground and continues to engage daily nursing student cohorts in a variety of population health-based learning opportunities.
In summary, over the past five years, our population health nurse-led team has reduced unplanned admissions by approximately 30%, improved blood pressure control by approximately 10%, and improved optimal diabetes care by approximately 18%. Our quality rating has been five starts for our Medicare patients and top 10% for California for our commercial patients. We continue to work on nurse-led initiatives and program development in partnership with leadership, providers, and clinics.
Housed within PHSO is the population health team, consisting of nurses, social workers, advanced practice providers, physicians, medical assistants, care navigators, digital health coaches, nursing, and public health students. The team supports in a myriad of ways seven key programs which include quality for care gap closure and performance tracking, student rotations, utilization management, transition of care, disease management/digital health, complex care management, and in-home provider visits. For each program, nurses are the first touch point, using a risk score methodology to offer patients a menu of resources based on need and patient preference. Those resources may consist of simple reminders of lab and cancer screenings that are overdue, health coaching with concerns escalated to the provider, and/or digital health equipment at home for blood pressure and blood sugar management. Other services, designed for our more complex, vulnerable patients, include post-discharge follow-up education to reinforce discharge instructions, confirmation and coordination of community resources, and performance of medication reconciliation, along with the scheduling of primary care provider appointments and in-home provider visits for more intense care management using an interdisciplinary team dynamic. In addition, and in some ways a benefit of COVID-19 pandemic, when student nurses had to find alternative clinical assignments from the hospital setting, population health provided a robust training ground and continues to engage daily nursing student cohorts in a variety of population health-based learning opportunities.
In summary, over the past five years, our population health nurse-led team has reduced unplanned admissions by approximately 30%, improved blood pressure control by approximately 10%, and improved optimal diabetes care by approximately 18%. Our quality rating has been five starts for our Medicare patients and top 10% for California for our commercial patients. We continue to work on nurse-led initiatives and program development in partnership with leadership, providers, and clinics.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/01/23
Updated: 03/01/23
This poster will describe a unique academic-practice partnership between a school of nursing and a health insurance plan. Leaders from both settings have been collaborating over the past two years to integrate ambulatory care nursing competencies into both the undergraduate and graduate curriculum in alignment with the new Future of Nursing 2020-2030 report and the revised AACN Essentials of Professional Nursing Education (2021). An additional objective of the partnership was to meet the nursing workforce needs of the health plan. The recent availability of the AAACN Best Practice Guidelines for Academic and Practice Partnerships in Ambulatory Care and Community Settings (2022) helped to clarify a shared vision for the future of the joint effort.
Health insurance plans offer their beneficiaries support in accessing care and provide nursing care coordination across the continuum to achieve the best individual and population health outcomes. Recruitment of nurses into these practice settings has been difficult due to lack of recognition of the role. Erroneously, insurance plans are often thought of predominantly as payers/restrictors of services/access. In reality, health plan nurses, in the role of care manager, can have a major impact on identifying at-risk members to effect tangible improvements in care and outcomes.
Historically, academic programs provide minimal content and experiences related to ambulatory care nursing. An elective in the undergraduate program focuses on competencies of the ambulatory care nurse and now features health plan nursing as an option for clinical practice. At the graduate level, a student DNP project has focused on building infrastructure to promote a culture of evidence-based practice utilizing the advancing research and clinical practice through close collaboration (ARCC) model by creating a champion role for nurse care managers. Subsequently, the health plan developed a comprehensive new-hire orientation and preceptorship program for new graduates to ensure acquisition of specialized knowledge and acculturation to the nurse care manager role to promote retention and job satisfaction.
Health insurance plans offer their beneficiaries support in accessing care and provide nursing care coordination across the continuum to achieve the best individual and population health outcomes. Recruitment of nurses into these practice settings has been difficult due to lack of recognition of the role. Erroneously, insurance plans are often thought of predominantly as payers/restrictors of services/access. In reality, health plan nurses, in the role of care manager, can have a major impact on identifying at-risk members to effect tangible improvements in care and outcomes.
Historically, academic programs provide minimal content and experiences related to ambulatory care nursing. An elective in the undergraduate program focuses on competencies of the ambulatory care nurse and now features health plan nursing as an option for clinical practice. At the graduate level, a student DNP project has focused on building infrastructure to promote a culture of evidence-based practice utilizing the advancing research and clinical practice through close collaboration (ARCC) model by creating a champion role for nurse care managers. Subsequently, the health plan developed a comprehensive new-hire orientation and preceptorship program for new graduates to ensure acquisition of specialized knowledge and acculturation to the nurse care manager role to promote retention and job satisfaction.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Updated: 03/22/23
Updated: 03/22/23
Background: We were tasked with organizational request to grow and implement orthopedic services at Fairview Hospital by collaboratively sharing space within a Neurological/Neurosurgery ambulatory clinic site.
Purpose: To increase Fairview Hospital’s Orthopedic services and increase organizational revenue while working collaboratively in the Neurological Institute ambulatory clinic space.
Methodology: We began with allotting 4-6 exam rooms for this organizational initiative which included orthopedic supplies (DME, casting) exam tables, medications, and computers/workstations. The orthopedic services began with oncology and sports medicine in November 2020. Service lines added included hand /plastics, trauma, tendon, and podiatry incrementally through 2021 and 2022. Equipment upgrades included a mini C-arm and Ultrasound for imaging.
Literature Review: A review of the literature showed evidence supporting physician referral for orthopedic services without affecting the show rate of our Neurology patients. Physician referral was found to be the most important factor influencing patient choice of orthopedic services (Antonacci, et al., 2021).
Marketing strategies were found to be not proportionally beneficial during the first six months of an orthopedic practice start-up period (Antonacci, et al., 2021). The risk of no-show was found to be low for multiple sclerosis, movement disorder, and neuromuscular clinics (Elkhider et al., 2022).
Outcome: Our Orthopedic volume increased form 12 patients in April 2021 to 611 patients in March of 2022 demonstrating nearly a 5000% increase in 12 months.
Conclusion: Increased orthopedic services benefited patient access and organization revenue. Neurology Services were not interrupted.
References:
Antonacci, C. L., Omari, A. M., Bassora, R., Levine, H. B., Seidenstein, A., Klein, G. R., Inzerillo, C., Alberta, F. G., & Sodha, S. (2021). Success of Various Marketing Strategies for a New-to-the-Area Orthopedic Practice. Cureus, 13(9), e18122. https://doi.org/10.7759/cureus.18122
Elkhider, H., Sharma, R., Sheng, S., Thostenson, J., Kapoor, N., Veerapaneni, P., Siddamreddy, S., Ibrahim, F., Yadala, S., Onteddu, S., & Nalleballe, K. (2022). Predictors of No-Show in Neurology Clinics. Healthcare (Basel, Switzerland), 10(4), 599. https://doi.org/10.3390/healthcare10040599
Purpose: To increase Fairview Hospital’s Orthopedic services and increase organizational revenue while working collaboratively in the Neurological Institute ambulatory clinic space.
Methodology: We began with allotting 4-6 exam rooms for this organizational initiative which included orthopedic supplies (DME, casting) exam tables, medications, and computers/workstations. The orthopedic services began with oncology and sports medicine in November 2020. Service lines added included hand /plastics, trauma, tendon, and podiatry incrementally through 2021 and 2022. Equipment upgrades included a mini C-arm and Ultrasound for imaging.
Literature Review: A review of the literature showed evidence supporting physician referral for orthopedic services without affecting the show rate of our Neurology patients. Physician referral was found to be the most important factor influencing patient choice of orthopedic services (Antonacci, et al., 2021).
Marketing strategies were found to be not proportionally beneficial during the first six months of an orthopedic practice start-up period (Antonacci, et al., 2021). The risk of no-show was found to be low for multiple sclerosis, movement disorder, and neuromuscular clinics (Elkhider et al., 2022).
Outcome: Our Orthopedic volume increased form 12 patients in April 2021 to 611 patients in March of 2022 demonstrating nearly a 5000% increase in 12 months.
Conclusion: Increased orthopedic services benefited patient access and organization revenue. Neurology Services were not interrupted.
References:
Antonacci, C. L., Omari, A. M., Bassora, R., Levine, H. B., Seidenstein, A., Klein, G. R., Inzerillo, C., Alberta, F. G., & Sodha, S. (2021). Success of Various Marketing Strategies for a New-to-the-Area Orthopedic Practice. Cureus, 13(9), e18122. https://doi.org/10.7759/cureus.18122
Elkhider, H., Sharma, R., Sheng, S., Thostenson, J., Kapoor, N., Veerapaneni, P., Siddamreddy, S., Ibrahim, F., Yadala, S., Onteddu, S., & Nalleballe, K. (2022). Predictors of No-Show in Neurology Clinics. Healthcare (Basel, Switzerland), 10(4), 599. https://doi.org/10.3390/healthcare10040599
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
Jami Kyle, BSN, RN, Ambulatory Care Nurse Manager, UK Healthcare | Brittney Dees, DNP, RN, CPN, Staff Development Specialist, UK Healthcare | Ryan Marler, MSN, MBA, RN-BC, Nurse Manager, UK Healthcare | Sara Wellman, MSN, APRN, FNP-C, Clinical Nurse Specialist, University of Kentucky Healthcare
Updated: 03/22/23
Updated: 03/22/23
Learning objective: To examine the development of a program created to increase the consistency and competence of skills demonstrated by medical assistants in our clinics.
Purpose: The purpose of this project was to examine quality of care and patient safety outcomes and effectiveness of a new medical assistant skills day which was taught for the first time in January 2022.
Description: The provision of quality and safe patient care is required of all licensed and unlicensed personnel. While education about patient safety has become a standard in nursing school curricula, the same educational approach is not consistently embedded in the curriculum of medical assistants (MAs). Both newly hired and established MAs come to ambulatory care clinics with varying levels of knowledge, experience, and competence. The medical assistant skills day was created to increase MA skills consistency and competence, therefore, increasing quality of care and patient safety.
The educational program was planned by first identifying and soliciting input from the key stakeholders who play a crucial role in the primary care clinics. Data collected from key stakeholders highlighted inconsistencies and inaccuracies with clinic specific training and skills performance. Key stakeholders helped to identify program objectives, goals, and implementation strategies and identified immediate, intermediate, and long-term evaluation approaches. The objectives of skills day focused primarily on legal implications, incident reporting expectations, and scope of duties for MAs; MA role in patient screening versus assessment; patient care orders; in-basket management; preparation, administration, and BCMA of injections; proper hand hygiene; and process of rooming a patient, including vital signs, required screenings, and medication review.
Program planning was based on the program objectives. Practice guidelines, policies, workflows, and standards of care were identified as sources of evidence for content. Standardization of clinical skills to improve safe, quality patient care provided the framework for education. A variety of active learning strategies were used in teaching the educational content, and in conjunction with ambulatory care nursing leadership, highly experienced medical assistants were used to assist in the skills training of participants.
Outcomes: Immediate outcomes: A pre-test/immediate post-test was used to evaluate knowledge retention in this group. A ten-item multiple choice pre-test/post-test was constructed. Of the 16 MAs who participated in the initial pre-test/post-test, the average pretest score was 55% and the average immediate post-test score was 76.9%. Comments from participants will also be presented. Intermediate outcomes: A six-month post-skills day follow-up survey will be sent to all nurse managers of the participating MAs to assess current MA skill sets and whether MA skills day was perceived to improve skills. We will also compare the following data from January 2022 (pre-skills day) to 6 months post-skills day: hand hygiene compliance, blood pressure recheck compliance, barcode scanning, pain score capture, falls screening capture, depression screening capture, and suicide screening capture. Long-term outcomes: Using our original post-test, we will test MAs again at one year to evaluate knowledge retention. Next steps: Improvements in the program based on feedback and first year evaluative data will be shared with conference participants.
Purpose: The purpose of this project was to examine quality of care and patient safety outcomes and effectiveness of a new medical assistant skills day which was taught for the first time in January 2022.
Description: The provision of quality and safe patient care is required of all licensed and unlicensed personnel. While education about patient safety has become a standard in nursing school curricula, the same educational approach is not consistently embedded in the curriculum of medical assistants (MAs). Both newly hired and established MAs come to ambulatory care clinics with varying levels of knowledge, experience, and competence. The medical assistant skills day was created to increase MA skills consistency and competence, therefore, increasing quality of care and patient safety.
The educational program was planned by first identifying and soliciting input from the key stakeholders who play a crucial role in the primary care clinics. Data collected from key stakeholders highlighted inconsistencies and inaccuracies with clinic specific training and skills performance. Key stakeholders helped to identify program objectives, goals, and implementation strategies and identified immediate, intermediate, and long-term evaluation approaches. The objectives of skills day focused primarily on legal implications, incident reporting expectations, and scope of duties for MAs; MA role in patient screening versus assessment; patient care orders; in-basket management; preparation, administration, and BCMA of injections; proper hand hygiene; and process of rooming a patient, including vital signs, required screenings, and medication review.
Program planning was based on the program objectives. Practice guidelines, policies, workflows, and standards of care were identified as sources of evidence for content. Standardization of clinical skills to improve safe, quality patient care provided the framework for education. A variety of active learning strategies were used in teaching the educational content, and in conjunction with ambulatory care nursing leadership, highly experienced medical assistants were used to assist in the skills training of participants.
Outcomes: Immediate outcomes: A pre-test/immediate post-test was used to evaluate knowledge retention in this group. A ten-item multiple choice pre-test/post-test was constructed. Of the 16 MAs who participated in the initial pre-test/post-test, the average pretest score was 55% and the average immediate post-test score was 76.9%. Comments from participants will also be presented. Intermediate outcomes: A six-month post-skills day follow-up survey will be sent to all nurse managers of the participating MAs to assess current MA skill sets and whether MA skills day was perceived to improve skills. We will also compare the following data from January 2022 (pre-skills day) to 6 months post-skills day: hand hygiene compliance, blood pressure recheck compliance, barcode scanning, pain score capture, falls screening capture, depression screening capture, and suicide screening capture. Long-term outcomes: Using our original post-test, we will test MAs again at one year to evaluate knowledge retention. Next steps: Improvements in the program based on feedback and first year evaluative data will be shared with conference participants.
Learning Objective:
- After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.
