Round 2 Grants
The Robert Wood Johnson Foundation (RWJF) awarded the second round of grants through its Interdisciplinary Nursing Quality Research Initiative (INQRI) program on September 1, 2007. Twelve teams of nurse scholars and scholars from other disciplines were selected to conduct two-year research projects to examine the link between nurses' contributions and the safety and quality of patient care.
Round 2 Grants
Translating Fall Risk Status into Interventions to Prevent Patient Falls
Brigham & Woman's Hospital
Boston, MA
Dr. Patricia Dykes
Dr. Blackford Middleton
This project addressed gaps in knowledge by establishing linkages between nursing fall risk assessment, risk communication and tailored interventions to prevent falls. The goal of this study was to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention. This innovative intervention communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to interdisciplinary team members, paraprofessionals, patients and family members.
Rural Hospital Quality Collaborative on Evidence-Based Nursing
University of Maryland
Baltimore, MD
Dr. Robin Newhouse
Dr. Laura Morlock
Recent estimates indicate that people with chronic conditions receive 55% of the recommended care with only 68% of patients with heart disease receiving the appropriate treatment. This interdisciplinary research team evaluated the effects of a rural hospital collaborative established to facilitate translation of evidence on heart failure (HF) patient care. Specifically, the team examined nursing characteristics that are associated with improvements in HF patient care.
Nursing Workforce Impact on Performance Improvement in the CMS/Premier Hospital Quality Incentive Demonstration Project [HQID]
University of Minnesota
Minneapolis, MN
Dr. Ira Moscovice
Dr. Mary Wakefield
The Deficit Reduction Act of 2005 directs the Secretary of Health and Human Services to implement a nationwide value-based purchasing program for all PPS hospitals beginning in fiscal year 2009. This interdisciplinary team examined the impact of nurse staffing and nurses' work environment on hospital performance improvement in the CMS/Premier Inc. Hospital Quality Incentive Demonstration (HQID) project. HQID is the first CMS demonstration on the impact of hospital pay-for-performance.
Quality of Pediatric Nursing Care from the Children's Perspective
Columbus Children's Hospital
Columbus, OH
Dr. Nancy Ryan-Wenger
Dr. William Gardner
This interdisciplinary research team identified hospitalized children's perceptions of the linkages between the quality of nursing care and outcomes. This study identified the nursing care processes and outcomes that matter most to children during their hospitalization, and estimated the extent to which disparities exist in the quality of their care and outcomes. The results of this study have value in themselves, but also provide valid content for new age-appropriate patient satisfaction scales for hospitalized children.
Quality and Cost Outcomes of Hospital Supplemental Nurse Staffing
University of Rochester
Rochester, NY
Dr. Ying Xue
Dr. Deborah Freund
Many hospitals use supplemental registered nurses (SRNs) hired from agencies to compensate for their nurse shortage, but their impact on quality and cost is not well understood. This interdisciplinary research team sought to understand the use of SRNs by hospitals and their impact on the quality of care and cost. The team described hospitals' uses of SRNs, including economic consequences, and examined the relationship between use of SRNs and patient outcomes and voluntary nurse turnover.
Examining the Impact of Nursing Structures and Processes on Medication Errors
Rutgers University
Newark, NJ
Dr. Linda Flynn
Dr. Dong Suh
The Institute of Medicine noted that a hospital patient on average is subject to at least one medication error per day, making medication errors the most common cause of preventable adverse events. This interdisciplinary study was designed to disentangle the effects of nursing structures and care processes on non-intercepted medication errors in acute care hospitals. The economic impact of non-intercepted medication errors was determined to explore the business case for evidence-based recommendations.
A Quality and Cost Analysis of Nurse Practice Predictors of Readiness for Hospital Discharge and Post-Discharge Outcomes
Marquette University
Milwaukee, WI
Dr. Marianne Weiss
Dr. Olga Yakusheva
Hospital readmission and emergency department utilization within the first 30 days following hospital discharge represent adverse, potentially avoidable, and costly outcomes of hospitalization. This interdisciplinary team broke new ground by linking the unit-level nurse practice environment and nursing care processes with patient outcomes at discharge and post-hospitalization. Specifically, the study examined direct and indirect causal relationships between the nursing practice environment, the discharge teaching process and readiness for hospital discharge with hospital readmission and emergency department utilization.
Linking Processes of Nursing Care and Patient Safety Outcomes: An Analysis of the Cause and Effect of Safe Practice
Medical University of South Carolina
Charleston, SC
Dr. Richard Lindrooth
Dr. John Welton
This interdisciplinary team examined how adoption of the National Quality Forum (NQF) safe practices affects nursing sensitive patient safety outcomes. Barriers to adoption of these practices were also explored. This team took a step beyond existing literature by testing whether the implementation of safe practices leads to more effective use of nurses, and whether this leads to better performance on patient safety outcomes.
Acuity-adjusted Staffing, Nurse Practice Environments and NICU Outcomes
University of Pennsylvania
Philadelphia, PA
Dr. Eileen Lake
Dr. Jeannette Rogowski
Large variations in outcomes exist across neonatal intensive care units (NICUs) that cannot be explained by patient or NICU differences. This interdisciplinary team examined acuity-adjusted nurse staffing levels and nursing practice environments in the NICU and their effects on very low birth weight (VLBW) infant mortality, morbidity, failure-to-rescue and length of stay. While VLBW infants account for only 1% of births, half of infant deaths each year occur within this population. Since NICU cases are among the most nurse-intensive hospitalizations, nursing holds promise for explaining the variations and for improving the outcomes of these high-risk infants.
Nursing Care Quality in Acute Care Hospitals: New Linkages to Patient Outcomes
University of California
San Francisco, CA
Dr. Arlyss Anderson Rothman
Dr. R. Adams Dudley
Increased public reporting of hospital performance and the emergence of hospital pay-for-performance initiatives provide new impetus to defining and maximizing all aspects of hospital care. This interdisciplinary team examined whether increases in nurse staffing and skill mix improve hospital performance on a subset of JCAHO core measures, enhance patient perceptions of nursing performance, and improve overall nursing performance as measured by composite indicators that capture patients' perceptions of care and other selected outcomes of care such as complication rates.
Impact of System-Centered Factors, and Processes of Nursing Care on Fall Prevalence and Injuries from Falls
University of Iowa
Iowa City, IA
Dr. Marita Titler
Dr. Gary Rosenthal
Patient falls represent the largest category of hospital incident reports (70%-80%) and are among the most common adverse events. This interdisciplinary team examined linkages among selected NQF nurse-sensitive measures and processes of care to prevent falls. Specifically, the team investigated linkages between level of professional nursing practice and adoption of evidence-base practices, fall prevalence and injury from falls.
Nursing-Pharmacy Collaboration on Medication Reconciliation: A Novel Approach to Information Management
Johns Hopkins Hospital
Baltimore, MD
Dr. Linda Costa
Dr. Robert Feroli
Deficits in communication across the continuum of care in regards to medication use can place patients at serious risk for harm. This interdisciplinary team examined how to economically support direct care providers in medication reconciliation in order to facilitate safe transition to and from hospital and community. The team evaluated the effectiveness of a nurse-pharmacist clinical information coordination team in improving drug information management on admission and discharge, quantified potential harm due to reconciliation failures, and determined cost-benefit related to averted harm.