R Hader | PubMed Health

PubMed1999

Developing a registered nurse performance appraisal tool.

Hospital mergers are common events, producing highly complex corporate structures that allow the member hospitals to position themselves more competitively in a managed-care environment. Associated with this growing merger trend is the practice of performance-based employee compensation that links both individual and team efforts directly with the business strategies of the newly formed system. A unique challenge of initiating performance-based compensation for nurses is defining and quantifying the important aspects of nursing practice so that differentiation between performance levels can be identified. When highly individualized nursing cultures meet to create a performance appraisal tool, this challenge is accentuated. The authors describe the development of a performance appraisal tool for registered nurses by a newly merged healthcare system.

Clinical Competence↗

PubMed1999

Cardiopulmonary exercise testing as a screening test for perioperative management of major surgery in the elderly.

STUDY OBJECTIVE: To develop an integrated strategy for the identification and subsequent management of high-risk patients in order to reduce both morbidity and mortality. DESIGN: Prospective consecutive series in which all patients underwent cardiopulmonary exercise (CPX) testing. SETTING: CPX laboratory and level 3 ICU and high-dependency unit (HDU) of a metropolitan teaching hospital. PATIENTS: Five hundred forty-eight patients >60 years of age (or younger with known cardiopulmonary disease) scheduled for major intra-abdominal surgery. INTERVENTIONS: The patients were assigned to one of three management strategies (ICU, HDU, or ward) based on the anaerobic threshold (deltaT) and ECG evidence of myocardial ischemia as determined by CPX testing that was performed as part of the presurgery evaluation, and by the expected oxygen demand stress of the surgical procedure. RESULTS: Overall mortality was 3.9%. Forty-three percent of deaths were attributed to poor cardiopulmonary function, as detected preoperatively. There were no deaths related to cardiopulmonary complications in any patient deemed fit for major abdominal surgery and ward management, as determined by CPX testing. CONCLUSIONS: In elderly patients undergoing major intra-abdominal surgery, the AT, as determined by CPX testing, is an excellent predictor of mortality from cardiopulmonary causes in the postoperative period. Preoperative screening using CPX testing allowed the identification of high-risk patients and the appropriate selection of perioperative management.

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