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AJN and Hartford Institute launch geriatric assessment-tools series

The American Journal of Nursing (AJN), in collaboration with The Hartford Institute for Geriatric Nursing at New York University College of Nursing, have launched the How to Try This series of geriatric assessment tools and best practices. This free Web-based educational site at www.NursingCenter.com/AJNolderadults is designed for all nursing faculty members and students, particularly in associate degree programs, as well as clinicians and other health care professionals to enhance their ability to conduct a wide range of assessments and provide age-appropriate care for older adults. Articles and videos will be available at the site for viewing and downloading, at no cost. 

Disease management program cuts hospital stays by five days

A disease management program that focuses on case management and interdisciplinary communication for chronically and critically ill patients and their caregivers significantly reduced the cost of care after hospital discharge without increasing the hospital’s costs of delivering care, according to a report in the September issue of the American Journal of Critical Care. People with chronic conditions account for most health care costs and caring for chronically and critically ill persons carries the highest costs.
 
Sara L. Douglas, RN, PhD, Barbara J. Daly, RN, PhD, FAAN, and colleagues from Case Western Reserve University in Cleveland, Ohio, USA, evaluated how adding the program to the usual care system would affect mortality, health-related quality of life and resource use in a group of 335 intensive care patients after hospital discharge. The randomized experimental study, performed at University Hospitals of Cleveland, a 950-bed tertiary care facility associated with Case Western Reserve University, is the first description of such an intervention among patients with multiple conditions occurring at the same time, the so-called comorbid conditions that are common among chronically and critically ill patients.
 
These patients often have high costs of care and poor outcomes, and therefore can benefit from a disease management program, according to background information in the article. The 335 intensive care patients followed in the study for eight weeks all had received more than three days of mechanical ventilation, placing them at higher risk for death or prolonged hospitalization with multiorgan dysfunction and continuing care needs after discharge.
 
Among the 180 patients who survived the study period and were readmitted to the hospital, those who were assigned to the disease management program on average had 5.77 fewer hospital days than did those who were not assigned to the program.
 
“At a mean hospital charge of $3,415/day,” note the researchers, “this reduction in hospital days represents an average savings of $19,705 per patient. If similar savings were realized for each of the 93 patients in the study who were readmitted, the total reduction in hospital charges would be $1,832,523.” (Am J Crit Care. 2007;16:447-457) The disease management program carried out by advanced practice nurses more than paid for itself by reducing readmission-related charges by almost $2 million, the authors continue.

Joint Commission enhances Quality Check Web site

Patients looking for information about where to go for their health care needs can now find an even more complete listing of health care organizations on The Joint Commission’s Quality Check Web site (www.qualitycheck.org).

The site now includes health care organizations not accredited by The Joint Commission. The addition of these organizations provides health care consumers with more information and highlights the value of accreditation. According to The Joint Commission, the enhanced Web site is now the most comprehensive national directory of health care facilities available.

In addition, users can locate health care providers by the types of services they offer—for example, hospice or dementia care. This “Search by Service” feature is in addition to the existing search function by name and type of provider. The inventory of services on the application for an accreditation survey has been expanded to support the “Search by Service” feature.

Thousands of people use Quality Check each month to find information about nearly 15,000 accredited hospitals, home health agencies, health care clinics and other types of health care organizations that have earned The Joint Commission “Gold Seal of Approval.”

Laughter best practice?

Watching comedy shows helped children tolerate pain for longer periods of time, suggesting that humorous distraction could be used in clinical settings to help children and adolescents better handle painful procedures, according to a study that teamed the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA) with the nonprofit organization, Rx Laughter.

Laughter has long been viewed as good medicine. Although there are many programs that bring humor into pediatric hospitals, little research had been done on the utility of humor for children or adolescents undergoing stressful or painful procedures such as blood draws and treatments for cancer.

Rx Laughter, an organization interested in using humor for healing founded by former television executive Sherry Dunay Hilber, worked with UCLA researchers on the study, which was funded by a grant from Comedy Central. Participants watched funny classic and contemporary films and television series before, during and after a standardized pain task, in this case placing their hands in icy cold water, said Margaret Stuber, a researcher in the Jonsson Cancer Center and the first author of the study.

The group demonstrated “significantly greater pain tolerance” while viewing the funny shows, according to the study published in the October issue of the journal Evidence-based Complementary and Alternative Medicine.

Stuber said researchers documented participants’ appraisal of the pain and noted submersion times and examined them in relation to humor indicators—the number of laughs/smiles and the children’s ratings of how funny the show was for them.

“We found that viewing funny videos increased the tolerance of pain for children, but did not change their ratings of the severity of the pain,” said Stuber, who also is the Jane and Marc Nathanson Professor in the Semel Institute for Neuroscience and Human Behavior. “Although they kept their hands in the water longer, they didn’t describe the task as any less painful than when they weren’t watching the videos. However, this may mean that it simply took longer for the pain to become severe enough to remove their hand.” RNL