Free Advanced Nursing Practice: Essay Example

Healthgrade American Hospital Quality Outcomes 2014 Report

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Advanced Nursing Practice: Healthgrade American Hospital Quality Outcomes 2014 Report
Healthgrade American Hospital Quality Outcomes 2014 Report focuses on the influence of the hospital selection on patients’ health outcomes. Apart from the quality effectiveness indicators, direct healthcare costs effectiveness indicators are also assessed, being closely linked to mortality and complications rates. The report engages three major stakeholders’ groups: hospitals which should strive for process improvements, patients who should understand the influence of their hospital choice on the quality of services they get, and physicians and nurses directly contributing to the patients’ health outcomes.
One significant issue described in the report is the diversity of mortality and complications rates within the American hospitals, even on comparison of the same procedures, or the same hospital units within one geographic area. The report shows the adverse correlation of patients’ death risk with the highest hospital ranking for mortality-based procedures on COPD, stroke, sepsis, heart attack and colorectal surgeries (41.9%-81.0% reduction of death risk in 5-stars ranked hospitals) (Healthgrades,2014). The similar adverse correlation exists between the risks of complications and the highest hospital ranking for most complicated surgery procedures as knee\hip replacement, gallblader removal or carotid surgery (52.5%- 69.1% reduction of complications risk in 5-stars ranked hospitals) (Healthgrades,2014). Careful choice of the hospital and the healthcare plan under Affordable Care Act can both allow the patients avoiding the complications and significantly reduce their death risk.
Another significant issue is a positive association between mortality rates and costs of patients stay. Mortality increases the costs two-fold, and complications increase them three-fold on average (Healthgrades, 2014). When the patient’s hospital stay is accompanied by both complications and mortality, total hospital risk-adjusted direct costs increase from 2.0 to 3.8 times vs. baseline (patients without complications) (Healthgrades, 2014). Length of patients’ stay and type of operations contribute to this increase, with minimally invasive procedures accounting for the smaller part of mortality and complications rates. So minimally invasive surgery, where clinically appropriate, is recommended to patients as preferable intervention, both for the sake of their health outcomes and for healthcare costs.
The main implication of the report for advanced practice registered nurses (APRN) is potential for improvement in such hospital-acquired nursing-sensitive outcomes as mortality and complications rates. As advanced practice nurses activities are the core of the inpatient care, there is a strong link between nursing actions and patient outcomes (ANA, 1999). Thus, nurses should strive to improve such quality indicators as patient-related (e.g pressure ulcers, pulmonary embolism rate) or surgical \invasive procedures related (certain nosocomial infections) complications. The nursing care should also be aimed at reduction of one of the key healthcare cost drivers: the patients’ length of stay which may increase due to unplanned readmissions or emergency department referrals. Careful staffing policy, in compliance with ANA Principles of Nurse Staffing, is another implication for nursing practice, as the appropriate number and mix of nursing personnel (RNs, LPNs, and Unlicensed Staff), with a higher proportion of APRNs in the unit, is associated with lower incidence of adverse outcomes (ANA,1999). Ensuring decrease in morbidity and complications rates, nursing commitment to excellence can result in a cost-effective difference in providing safe and high-quality patient care (ANA, 1999).

References

1. American Nurses Association (1999). ANA Indicator History. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1/ANA-Indicator-History
2. Healthgrades (2014). American Hospital Quality Outcomes 2014. Retrieved from: https://d2dcgio3q2u5fb.cloudfront.net/56/90/e07df9f64a5fb741ab59924a9e0d/2013-american-hospital-quality-outcomes-2014-healthgrades-report-to-the-nation.pdf