nursing management

NEED 2 REFERENCES. 

Quality Management and Control

Zanderville Healthcare Systems, a regional, acute care facility in the foothills of the Appalachians is committed to delivering quality healthcare to its local and neighboring communities. The population it serves is diverse by gender and ethnicity. The primary payer for healthcare services is CMS. Over the past six months the acute care facility has experienced a 25 % increase in readmissions from this payer group within the first 30 days of discharge. The economic impact on the health system has been negative and patients' satisfaction with their hospital experience has declined. Senior leadership has charged you, the nurse executive, to convene an ad-hoc task force to perform an outcomes audit and propose an intervention. Currently patients receive a follow-up telephone call about 7 days following discharge. You decide to use an evidence-based practice approach and have the following information for the "working" PICOT:

P: CMS patients readmitted within 30 days of discharge

I: What will we do differently to impact the improved outcome

(State what this is)

C: Follow-up phone call 7 days after discharge

O: Reduce readmission rate of CMS patients from ____ to ____.....

T: Over next six months

If this were happening in your organization, discuss:

Whom will you include in your task force?

What outcomes measures will you audit?

Where will you obtain the data to determine your baseline and goal regarding the percentage of readmissions within 30 days of discharge?

What specific outcome do you want to achieve?

What standard or benchmark will you use for the outcome? What does your organization use as a benchmark for readmissions within 30 days of discharge?

Describe the intervention you will use to achieve your goal?

Then, restate the completed PICOT using the information you have collected related to the intervention and outcomes.

PICOT EXAMPLE!

Situation:

Sunnybrook Health System has started the process for acquiring Magnet status. They have scheduled multiple planning and process meetings over the next year that require attendance of all staff. Staff must attend at least 70% of the meetings live. After three meetings, live attendance of night shift staff has been about 5%. There is concern that with the small amount of interest shown from this group, the benchmark of 70% for live attendance may be jeopardized. Currently, the meeting schedule is communicated to all staff via email and posted announcements. Suzie thinks an incentive of a free meal for live attendance might improve attendance of the night shift crew.

How could a PICOT be developed with this information?

P = Population – Describes the group upon which the intervention will have an effect.

   Ex: night shift staff

I = Intervention - What we want to do that is different from what we currently do; the thing that is going 

to impact the population identified

   Ex. coupons for a free meal in the cafeteria

C = Comparison - Here the comparison is a before and after the intervention (incentive in this case)

   Ex: communication of scheduled meetings via email and posted announcements

O = Outcome - What we want to see happen as a result of the intervention. The outcome should meet three criteria: direction (increase, decrease, etc), a baseline, and a goal.

   Ex: increased mandatory meeting live attendance from 5% to 50%

T = Timing or Timeframe - When we expect to see the outcomes.

   Ex: over the next 4 meetings

Now you can create the PICOT:

Among night shift staff(P), will offering a coupon for a free meal in the cafeteria(I), as opposed to only email invitations and posted announcements(C), increase mandatory meeting live attendance from 5% to 50% (O) over the next 4 meetings(T)?