Becker's Clinical Quality & Infection Control

27 QUALITY IMPROVEMENT & MEASUREMENT 58% of nurses rate their hospital's end- of-life care unfavorably, study finds By Megan Knowles M ost nurses — 58 percent — rate their hospital's end-of-life care unfavorably, and they may hold the key to improving care quality, a study published in the Journal of the American Geriatrics Society found. "Even the best hospitals have significant room for improvement when it comes to providing better care for patients at the end of life," said lead study author Karen Lasater, PhD, RN. "Hospitals are failing to capitalize on an already available cadre of skilled end- of-of-life care providers available for every patient in every hospital — registered nurses at the bedside." e study, conducted by researchers at the University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research in Philadelphia, describes the quality of end-of-life care in about 500 U.S. hospitals, using nearly 13,000 bedside nurses to inform care quality. e most common quality issue nurses (53 percent) cited is patients oen undergo painful procedures that probably won't change their clinical outcome. Additionally, more than one-third (37.7 percent) of nurses say they are discouraged from discussing alternative care options with patients and their families. A similar percentage of nurses reported they oen don't agree with their physician colleagues about end-of-life care decisions and feel these decisions are not made as a team. End-of-life care is best in hospitals with effective nurse-physician teamwork, the study found. In these hospitals, authority is delegated to nurses to act on their ex- pertise; nurses have manageable work- loads; and nurses are actively engaged in hospital decision-making. n Florida children's hospitals may have to post heart surgery death rates online By Morgan Haefner S t. Petersburg, Fla.-based Johns Hopkins All Children's and other children's hospitals in Florida may have to publish mortality statis- tics about their heart surgery programs under a new state proposal, according to the Tampa Bay Times. A state panel is considering requiring Florida children's hospitals to post the number of deaths at their heart surgery programs and update those numbers as often as every six months. The proposal comes two weeks after Nov. 28, when the Tampa Bay Times published an investigative report detailing how the mortality rate at All Children's heart institute tripled between 2015 and 2017. The hospital had the highest mortality rate of any pediatric heart surgery program in Florida in 2017, according to the report. An All Children's spokesperson told the Tampa Bay Times the hospital would support the panel's proposition to post more statistics online. As of Jan. 9, six senior officials have left the hospital, including the CEO, three vice presidents and two surgeons who held leadership positions in the Heart Institute. A seventh official stepped down from his role as chief of surgery but is still employed at the hospital. n VA hospitals outperform peers in care quality, study finds By Mackenzie Bean U .S. Department of Veterans Affairs hospitals often demonstrate high- er care quality ratings on Hospital Compare than non-VA hospitals in the same market, according to a study published in Annals of Internal Medicine. For the study, researchers analyzed care quality data from Hospital Compare for 135 VA hospitals and 2,988 non-VA hospitals across 121 regional health- care markets. The VA hospitals consistently demonstrated better performance on every quality measure than their peers in all 121 markets. For nine of 15 quality measures assessed, the VA facilities offered the best care in the region. "Assuming the measures are calculated in a fair and comparable way, our findings suggest that, for these measures, VA quality is at least as good as non-VA quality and often better," study co-author William Weeks, MD, PhD, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., told Reuters. Researchers noted the study does have some limitations, but said the findings suggest outsourcing veterans' healthcare to non-VA facilities should be reconsidered. n

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