Tuesday, November 6, 2007

This presentation is part of : Outcomes Measurement Initiatives
The Effect of Multi-Unit Hospitalizations on Nursing Interventions and Healthcare Outcomes
Mary F. Kanak, RN, APRN, BC1, Marita Titler, PhD, RN, FAAN2, Leah L. Shever, RN3, Qiang Fei, MA4, Joanne McCloskey Dochterman, PhD, RN, FAAN3, and Debra M. Picone, PhD2. (1) College of Nursing, University of Iowa, Iowa City, IA, USA, (2) Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA, (3) Nursing Interventions and Outcomes Effectiveness Grant, University of Iowa College of Nursing, Iowa City, IA, USA, (4) College of Nursing, Nursing Interventions and Outcomes Effectiveness Grant, University of Iowa, Iowa City, IA, USA
Learning Objective #1: verbalize the effects of multi-unit hospitalizations on selected nursing interventions and healthcare outcomes.
Learning Objective #2: verbalize the contribution that outcomes effectiveness research can make to improving nursing care and healthcare outcomes in the clinical setting.

Concern has been verbalized that quality of care is compromised by patient “hand-offs” between healthcare providers. Patient hand-offs occur repeatedly as patients move between units during hospitalization. This study examined the effect of patient residence on multiple units during hospitalization upon selected nursing care indicators and quality outcomes. The sample was comprised of 7,851 acute-care patients, ³ 60 years old, at risk for falling while hospitalized at a Midwest academic medical center.  The data were obtained from a data repository that had been constructed for a larger funded study of nursing outcomes effectiveness research. The independent variable was the number of units on which the patient resided during hospitalization.  The dependent variables were: 1) the use rates for the nursing interventions of Patient Teaching and Discharge Planning, 2) length of stay, 3) total hospital costs, 4) nosocomial infection, 5) adverse occurrence, 6) mortality, 7) fall, 8) medication error, and 9) discharge disposition.  The control variables were the primary medical diagnosis, comorbid medical conditions, and severity of illness.  The analysis consisted of general linear model analysis for the continuous dependent variables and binary logistic regression analysis for the dichotomous dependent variables.  The number of units per hospitalization variable was associated (p < .001) with all dependent variables except for mortality.  An increasing number of units per hospitalization was associated with: 1) decreased use rate for Patient Teaching and Discharge Planning, 2) increased length of stay and total hospital cost, 3) an increase in the odds that an infection, adverse occurrence, fall, or medication error would occur during hospitalization, and 4) a decrease in the odds that the patient would be discharged to home.   The findings of this study suggest that care and quality may be compromised as patients are handed-off between, and reside on, multiple units during hospitalization.