Biomedical subjects
Publications and source records attributed to A H Till.
A pilot project conducted in a 540-bed teaching hospital reveals more population-based data related to nursing case management, a system of patient care that promotes cost containment while ensuring quality outcomes. Positive outcomes were demonstrated in quality of care, patient satisfaction, staff satisfaction, length of stay, and cost.
Forty-nine cases of second degree burns initially treated as inpatients from April 1984 through December 1987 are reviewed. Thirty-four patients were treated with bilaminate synthetic dressing (Biobrane) application, while 15 were treated with a topical antimicrobial, usually silver sulfadiazine. The burns ranged from 1 to 25 per cent total body surface area and were comparable in both groups. The mean age in each group was 30 years. Thirty patients were successfully treated with Biobrane, and their average hospital stay was 9.1 +/- 5.4 days compared with 9.2 +/- 8.6 days for the topically treated group. The mean hospital cost for dressings and supplies for the Biobrane group was $360 +/- $90 compared with $310 +/- $190 for the topical group. Four patients (12%) required Biobrane removal during their hospitalization, one due to increasing burn depth and three due to purulent fluid collections beneath the Biobrane. These burns were subsequently treated with topical antimicrobial agents and healed primarily. The mean total hospital stay for this group was 18.0 +/- 11.9 days with the costs being much higher secondary to the initial cost of the Biobrane, the costs associated with topical antibiotic therapy, and extended hospital stay. Although there was a decrease in nursing time and a subjective decrease in patient discomfort associated with using synthetic dressing, no benefit was found in either decreasing hospital stay or total cost of hospitalization and supplies used for inpatients treated at this institution.
Recent reports indicate that nurses spend less time with their patients today than in the past (Hendrickson, Doddato, & Kovner, 1990; Misener, Frelin, & Twist, 1987 & Quist, 1992). This may lead to high frustration levels, low morale, and compromised patient care. Unlicensed assistive staff (patient care assistants and unit assistants), when used appropriately, can provide essential support and make a significant contribution to the delivery of efficient and effective patient care. Key issues, when using these staff members, are role clarity and appropriate delegation. Increased health care technology, the proliferation of nursing and medical knowledge, and new health care delivery models have impacted upon the way nurses and unlicensed assistive personnel work together. The way in which these staff members are organized and work together not only will affect the quality of nursing care that is delivered but outcomes of care as well.