Systematic Determination of Transplant In-Patient Acuity, Patient and Nurse Satisfaction. Objectives. Overview

Transcription

1 Systematic Determination of Transplant In-Patient Acuity, Patient and Nurse Satisfaction Michelle Floyd, RN Pre Transplant Coordinator and Presenter Ruth Tutor PhD, RN, APN, CCRN, CCNS, APRN-BC Critical Care-Transplant Advanced Practice Nurse, Researcher Shari Smith, MS, RN, APN, APRN-BC Psych-Mental Health Advanced Practice Nurse Melissa Moore, RN, CCTC Pre Transplant Coordinator, Living Liver Related Coordinator Objectives To discuss the findings of the acuity level transplant patients contrasted to medicalsurgical patients in this sample To discuss the findings of the patient and nurse satisfaction levels contrasted between transplant and a medical-surgical unit. Overview Hospitalized transplant donors and recipients have unique needs and issues Patient acuity determination is vital for validation of the need for establishment and adjustment of health care delivery needs such as staffing levels of RNs The established tools available in the literature or by ITNS query have not been utilized in a transplant specific population/setting or are not in use 1

2 Purpose To systematically determine if transplant patients have a higher acuity level than medical-surgical patients as determined by scoring of an established acuity tool To determine the patient and nurse satisfaction levels in transplant patients and medical surgical patients Setting Urban acute care multi-hospital system setting Academic Medical Center with greater than 600 bed hospital Multiple Service Lines including Cardiovascular, Cardiology, Neuro, Critical Care, Transplant, Med- Surg floors, Emergency Services, Renal Services, Operative Services Five Transplant Units within the hospital Non-ICU Transplant Unit was used General Medical-Surgical Unit was used Sample IRB exemption due to no demographic data collected Convenience sample Random week of year chosen by non-member of research team Random admission during a 5-day period of time to designated a med-surg unit and a transplant unit Random selection of patients by room number with matching numbers on both units 2

3 Methods Correlational observation study Instruments scored by one researcher Anonymous Registered Nurse Satisfaction tool collection in enclosed container Anonymous Patient Satisfaction tool collection in closed sealed envelope Instruments: Therapeutic Intervention Scoring System Cullen (1983) Nurse: Patient Ratio Tool Selection of this instrument was based on interventions (such as CVP, Antibiotics) that capture post operative transplant and medical surgical transplant interventions scores range: Tool has ranked intervention categories which add up to a total score (<10, 10-19, 20-39, > 40) The summation total defines category that patient are placed in (I, II, III, IV) The Higher the category equals a higher the nurse patient ratio N=136 Instruments: Nursing Work Index Revised: Aiken (1997, 2000) Nurse Satisfaction Tool Subscales for autonomy, RN-MD relationships, Practice, Organizational support Used in Magnet Hospital Status Research Good psychometrics Global and Subscore totals possible Anonymous N=25 3

4 Instruments: Patient Satisfaction (MLH, 2006) Anonymous Done on Discharge Outside contracted company Subcategories including nursing care attributes Global Score as percentage N=35 Acuity Results Preset alpha of < 0.05 for statistical significance SAS software used for parametric statistics for continuous variables; Non-Parametric for categorical Based on TISS acuity tool (Cullen, 1983), transplant patients were exhibited a higher acuity score than surgical patients: -Medical Surgical Patients Mean of 11 points -Transplant Patients Mean of 16 Points Mean -Statistical significance < Acuity Results Based on TISS acuity tool (Cullen, 1983), transplant patients were ranked in a higher overall category of acuity -Medical Surgical Patients Category 1.69 Mean (0.07) -Transplant Patients Category 2.13 (0.07) -Statistical significance <

5 Nurse Satisfaction Nurse satisfaction was equally high on both the Med-Surg and transplant settings. No statistically significant difference in global or subscles between contrasting settings. Patient Satisfaction Patient Satisfaction was at a very high level-overall score was 100% for both transplant and medical surgical units. No statistically significant difference in global or subscles between settings Clinical Implications These findings suggest that transplant patients have a higher acuity than medical surgical patients These findings suggest that more intensive interventions requiring nursing care are needed for transplant patients than a general medical surgical patients 5

6 Limitations of Study Convenience Sample One site Non-ICU patients limit generalizability to all transplant patients Summary Study findings suggest that transplant patients have a higher acuity than general medical surgical patients. Nurse and Patient satisfaction did not vary between settings. Questions Thank you for your time References Aiken, L., H. & Sloane, D. M. (1997). Effects of organizational innovations in AIDS care on burnout among urban hospital nurses. Work and Occupations, 24, Aiken, L. H., Sloan, D. M., & Lake, E. T. (1997). Satisfaction with inpatient acquired immunodeficiency syndrome care: A national comparison of dedicated and scatteredbed units. Medical Care. 35, Aiken, L. H., & Patrician, P. A. (2000). Measuring organizational traits of hospitals: The revised nursing work index: Nursing Research, 49, (3), Cimiotti, J.P., Quinlan, P. M., Larson, E.L., Pastor, D. K., Lin, S. X., & Stone, P. W. (2005). The magnet process and perceived work environment of nurses. Nursing Research, 54 (9), Keene, A. R., & Cullen, D. J. (1983). Therapeutic interventions scoring system: Update Critical Care Medicine, 11, (1), 1-3. Methodist LeBonheur Healthcare. (2006) Patient Satisfaction Survey. Memphis, TN: Methodist LeBonheur Healthcare. Statistical Analysis Software (SAS). (2006). Individually Licensed User to Principal Investigator. 6