Click here to download

Indagine sul fenomeno del re-ricovero nel reparto Area a Conduzione Infermieristica (ACI) in un ospedale organizzato per intensità di cura
Journal Title: MECOSAN 
Author/s: Carlotta Patrone, Alessio Nicoli, Pasqualino Squillace, Matteo Puntoni, Isabella Cevasco 
Year:  2020 Issue: 115 Language: Italian 
Pages:  20 Pg. 29-48 FullText PDF:  433 KB
DOI:  10.3280/MESA2020-115003
(DOI is like a bar code for intellectual property: to have more infomation:  clicca qui   and here 


The phenomenon of the re-hospitalization has a strong impact on public health and has undergone increasing interest from the scientific community. It has been demonstrated that several parame Readmisters can influence this phenomenon. Therapeutic education is one of them. The aim of this work is to analyse how a nursing ward characterised by an important therapeutic education can have an impact on the reduction of this phenomenon. For this purpose, data from one year of activity of the nursing ward were extracted and compared with a control group of patients admitted to the same hospital with similar characteristics in a 1:2 ratio. Indicators of "control" with respect to the phenomenon of re-hospitalization (number of re-hospitalizations and duration of their stay) were calculated. The results of the study were: 1 episode of re-hospitalization, with a duration of 15 days, in ACI compared to 22 episodes of re-hospitalization of the control group with 188 days of hospitalization. Further parameters relating to the organisational well-being of nurses were also monitored, which led to results such as a decrease in the % of omitted activities and the zeroing of days of absence. The effectiveness of the timely recognition of 5 clinical critical events also prevented the patient from dying. In this work it was therefore demonstrated how purely nursing management and therapeutic education can have a positive impact on re-hospitalisation and considerations were made which can be extended to other contexts.
Keywords: Readmission, nurse managed ward, performance, efficiency, management, intensity of care.

  1. Aiken L.H. (2012). Patient safety, satisfaction and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and USA. BMJ, 344: e1717.
  2. Bittman J., Nijjar A.P., Tam P., Khan N. (2017). Early Warning Scores to Predict Noncritical Events Overnight in Hospitalized Medical Patients: A Prospective Case Cohort Study. Journal of patient safety, 16(3): e169-e173.
  3. Cheng X., Wei S., Zhang H., Xue S., Wang W., Zhang K. (2018). Nurse-led interventions on quality of life for patients with cancer: A meta-analysis. Medicine, Aug., 97(34): e12037., DOI: 10.1097/MD.0000000000012037
  4. Clarke S., Aiken L. (2003). Failure to rescue: Needless deaths are prime examples of the need for more nurses at the bedside. American Journal of Nursing, 100: 42-27.
  5. Corrin I. (2018). A service evaluation to examine the experience of patients attending wound healing outpatient clinics in South Wales. Br J Community Nurs., Jun 1, 23(6): S6-S12.
  6. D.G.R. n. 862 del 15/07/2011 “Riordino del sistema della residenzialità e semiresidenzialità extra­ospedaliera...”, integrata e modificata dalla D.G.R. n. 1749 del 29/12/2011 “Integrazioni e parziali modifiche alla D.G.R. n. 862 del 15/07/2011 “Sulla residenzialità extraospedaliera e i relativi setting assistenziali”.
  7. D.G.R. n. 328 del 28/04/2017 “Continuità assistenziale ospedale territorio. Collaborazione istituzionale E.O. Ospedale Galliera e A.S.P. Emanuele Brignole. Sperimentazione.
  8. D.G.R. n. 500 del 30/06/2017 Approvazione Documento tecnico A.Li.Sa. Individuazione funzioni assistenziali ex art. 8 sexies D.Lgs. n. 502/92. Anno 2017.
  9. D.G.R. n. 81 del 04/08/2017 da parte della Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa), “Oggetto: approvazione del D.G.R. n. 81 del 04/08/2017 progetto sperimentale di collaborazione istituzionale tra E.O. Ospedali Galliera e A.S.P. Brignole, per l’integrazione del nuovo modello assistenziale di Area a Conduzione Infermieristica (A.C.I.) dall’ambito ospedaliero a quello territoriale”.
  10. D’Ivernois J.F., Gagnayre R. (2009). Educare il paziente. Un approccio pedagogico. Milano: McGraw-Hill.
  11. Elkhateeb O., Salem K. (2018). Patient and caregiver education levels and readmission and mortality rates of congestive heart failure patients. EMHJ, 24(4): 345-350., DOI: 10.26719/2018.24.4.345
  12. Fernández-Ruiz V.E., Armero-Barranco D., Paniagua-Urbano J.A., Sole-Agusti M., Ruiz-Sánchez A., Gómez-Marín J. (2018). Short-medium-long-term efficacy of interdisciplinary intervention against overweight and obesity: Randomized controlled clinical trial. Int J Nurs Pract., Dec., 24(6): e12690.
  13. Gemmel P., Vandeale D., Tambeur W. (2008). Hospital Process Orientation (HPO): The development of a measurement tool. Total Qual Manag Bus., 19(12): 1207-1217., DOI: 10.1080/14783360802351488
  14. Hammer M., Champy J. (1993). Reengineering the Corporation: A Manifesto for Business Revolution. London: Nicholas Brealey.
  15. Hatchett R. (2003). Nurse-Led Clinics: Practice Issues. New York, NY: Routledge.
  16. Kroch E., Duan M., Martin J., Bankowitz R.A. (2016). Socio-economic factors impact hospital readmissions. Journal for Healthcare Quality, 3(2): 106-15., DOI: 10.1097/JHQ.0000000000000003
  17. Kwok C.S., Martinez S.C., Pancholy S., Ahmed W., Al-Shaibi K., Potts J., Mohamed M., Kontopantelis E., Curzen N., Mamas M.A. (2018). Effect of Comorbidity On Unplanned Readmissions After Percutaneous Coronary Intervention (From The Nationwide Readmission Database). Scientific Reports, 8(1): 11156.
  18. Köksal Ö., Torun G., Ahun E., Sığırlı D., Güney S.B., Aydın M.O. (2016). The comparison of modified early warning score and Glasgow coma scale-age-systolic blood pressure scores in the assessment of nontraumatic critical patients in Emergency Department. Nigerial Journal of Critical Practice, 19(6): 761-765., DOI: 10.4103/1119-3077.178944
  19. Lam T.S., Mak P.S.K., Siu W.S., Lam M.Y., Cheung T.F., Rainer T.H. (2006). Validation of a Modified Early Warning Score (MEWS) in emergency department observation ward patients. Hong Kong Journal of Emergency Medicine, 13(1): 24-30.
  20. Legge regionale 29 luglio 2016, n. 17, “Istituzione dell’Azienda Ligure Sanitaria della Regione Liguria (A.Li.Sa.) e indirizzi per il riordino delle disposizioni regionali in materia sanitaria e sociosanitaria”.
  21. Liker J.K. (2004). The Toyota way: 14 management principles from the world’s greatest manufacturer. New York: McGraw-Hill.
  22. Love P.E.D., Gunasekaran A., Li H. (1998). Putting an engine into re-engineering: toward a process-oriented organisation. Int J Oper Prod Man., 18(9/10): 937-949., DOI: 10.1108/01443579810225531
  23. McCormack K.P., Johnson W.C. (2001). Business Process Orientation: Gaining the E-Business Competitive Advantage. Boca Raton: CRC Press LLC.
  24. Mongardi M., Bassi E. (2015). Strumenti per l’intensità di cura e la complessità assistenziale: una revisione della letteratura. Mecosan, 95: 9-25.
  25. Niesen C.R., Olson D.M., Nowdesha K.D., Tynsky D.A., Loftus C.G., Meiers S.J. (2018). Enhancing Self-management for Adults With Functional Abdominal Pain: A Registered Nurse-Led Cognitive-Behavioral Therapy Approach. Gastroenterol Nurs., Jul./Aug., 41(4): 321-332., DOI: 10.1097/SGA.0000000000000322.
  26. Patrone C., Cassettari L., Damiani L., Mosca R., Revetria R. (2017). Optimization of Lean Surgical Route through POCT Acquisition, Proceedings of the International MultiConference of Engineers and Computer Scientists 2017 Vol. II, IMECS 2017, March 15 – 17, 2017, Hong Kong.
  27. Patrone C., Cassettari L., Giovannini F., Cevasco I. (2018). La realizzazione di una metodologia per la misurazione delle performance dei coordinatori infermieristici in un ospedale per intensità di cura di alta specializzazione attraverso l’approccio del PDCA. Mecosan, 106: 111-127.
  28. Patrone C., Mezzano Kozlova M., Brenta M., Filauro F., Campanella D., Ribatti A., Scuderi E., Marini T., Galli G., Revetria R. (2020). Hospital Warehouse Management during the construction of a new building through Lean Techniques. Adv. Sci. Technol. Eng. Syst. J., 5(1): 256-262.
  29. Woodside M. (1953-01-01). A follow-up of psychiatric patients; one year’s survey of patients discharged from the York Clinic. Guy’s Hospital Reports, 102(1): 70-75.
  30. Pietrantonio F., Francesco Orlandini F., Moriconi L., La Regina M. (2015). Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients. European Journal of Internal Medicine, 26: 759-765.
  31. Randall S., Crawford T., Currie J., River J., Betihavas V. (2017). Impact of community based nurse-led clinics on patient outcomes, patient satisfaction, patient access and cost effectiveness: A systematic review. International Journal of Nursing Studies, 73: 24-33.
  32. Rocha T., Neves J., Viegas K. (2016). Modified early warning score: evaluation of trauma patients. Revista Brasileira de Enfermagem, 69(5): 906-911., DOI: 10.1590/0034-7167-2015-0145
  33. Sasso L., Bagnasco A., Zanini M., Catania G., Aleo G., Santullo A., Spandonaro F., Icardi G., Watson R., Sermeus W. (2017). The general results of the RN4CAST survey in Italy. Journal of advanced nursing, 73(9): 2028-2030.
  34. Schneller E.S., Smeltzer L.R. (2006). Strategic management of the health care supply chain. San Francisco: Jossey-bass.
  35. Shaddel F., Khosla V., Banerjee S. (2014). Effects of introducing MEWS on nursing staff in mental health inpatient settings. Progress in Neurology and Psychiatry, 18(2): 24-27.
  36. Sheingold S.H., Zuckerman R., Shartzer A. (2016). Understanding Medicare Hospital Readmission Rates And Differing Penalties Between Safety-Net And Other Hospitals. Health Affairs (Project Hope), 35(1): 124-131.
  37. Somarè S. (2017). Un reparto a gestione infermieristico. Tecnica ospedaliera, giugno: 8-10.
  38. Somarè S. (2018). Area Cure Infermieristiche Risparmio unito a qualità delle cure. Tecnica ospedaliera, aprile: 8-10.
  39. Stafsetha S.K., Grønbecka S., Liend T., Randend I., Lerdale A. (2016). The experiences of nurses implementing the Modified Early Warning Score and a 24-hour on-call Mobile Intensive Care Nurse: An exploratory study. Intensive and Critical Care Nursing, 34: 33-41.
  40. Subbe C.P., Kruger M., Rutherford P., Gemmel L. (2001). Validation of a modified Early Warning Score in medical admissions. Qjm, 94(10): 521-526.
  41. Tourangeau A.E., Hall L.M., Doran D.M., Petch T. (2006). Measurement of nurse job satisfaction using the McCloskey/Mueller Satisfaction Scale. Nursing Research, 55(2): 128-136.
  42. Van Merode F., Molema H., Goldschmidt H. (2004). GUM and six sigma approaches positioned as deterministic tools in quality target engineering. Accredit Qual Assur., 10: 32-36.
  43. Vera A., Kuntz L. (2007). Process-based organization design and hospital efficiency. Health Care Manage Rev., 32(1): 55-65.
  44. Vollam S., Dutton S., Lamb S., Petrinic T., Young J.D., Watkinson P. (2018). Out-of-hours discharge from intensive care, in-ospital mortality and intensive care readmission rates: a systematic review and meta-analysis. Intensive Care Med, 44(7): 1115-1129.
  45. Vos L., Chalmers S.E., Dückers M.L., Groenewegen P.P., Wagner C., Van Merode G.G. (2011). Towards an organisation-wide process-oriented organisation of care: A literature review. Implementation Science, 6(1): 8.
  46. Walker B. (2016). Insights on Patient Engagement and Behavior Change. The Top 5 Causes of Hospital Readmissions – and How to Prevent Them. Patient bond, -- https://insights.patientbond.com/blog/the-top-5-causes-of-hospital-readmissions-and-how-to-prevent-them.
  47. Wang Q., Shen Y., Chen Y., Li X. (2019). Impacts of nurse-led clinic and nurse-led prescription on hemoglobin A1c control in type 2 diabetes: A meta-analysis. Medicine, 98(23): e15971., DOI: 10.1097/MD.0000000000015971
  48. Yang L., Liu C., Huang C., Mukamel D.B. (2018). Patients’ perceptions of interactions with hospital staff are associated with hospital readmissions: a national survey of 4535 hospitals. BMC Health Services Research, 18(1): 50.

Carlotta Patrone, Alessio Nicoli, Pasqualino Squillace, Matteo Puntoni, Isabella Cevasco, in "MECOSAN" 115/2020, pp. 29-48, DOI:10.3280/MESA2020-115003

   

FrancoAngeli is a member of Publishers International Linking Association a not for profit orgasnization wich runs the CrossRef service, enabing links to and from online scholarly content