Notes

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Atrial fibrillation (AF) is the most common arrhythmia affecting more than six million people in the United States. The economic burden is estimated to be >$6 billion annually with catastrophic events dramatically increasing expenditure. When patients experience symptoms, they commonly present to an acute care facility; this can be costly and anxiety provoking.

Same-day access issues prohibit patients from communicating directly with their cardiology provider, forcing them to use resources and increasing psychological burden.

A convenience sample, made up of 43 patients, was given a KardiaMobile device. Eligible patients had ≥2 AF-related emergency department (ED) or urgent care (UC) visits over 12 months, needed rate control with medication titration, or were monitored for AF reoccurrence after reestablishing sinus rhythm.

Patients emailed recordings daily and when experiencing symptoms. The recordings were reviewed by a nurse practitioner (NP); abnormal readings were followed by a phone call, telehealth, or in-person visit.

An independently designed survey was conducted online; almost all respondents (97%) found value in the project and the device. Virtually all respondents (97%) felt that the program improved access. A majority (86%) reported decreased anxiety. Had the respondents not been in the program, 34% indicated that they would have presented to an ED and 25% would have presented to an UC, realizing a cost savings of $81,950 in reduced ED visits alone.

A personal electrocardiogram, with NP oversight, to manage AF is cost-effective and reduces unnecessary resource utilization. It is patient centered, improves access, and empowers patients to manage their symptoms.
A personal electrocardiogram, with NP oversight, to manage AF is cost-effective and reduces unnecessary resource utilization. It is patient centered, improves access, and empowers patients to manage their symptoms.
Pediatric food allergies (FAs) present significant health and economic problems. Currently, there are no cures for FAs. Recent studies suggest that early introduction (EI), between 4 and 6 months of age, of commonly allergenic foods (CAFs) may reduce the risk of developing FAs. This contradicts the current standard of care, food avoidance.

A federally qualified health center saw 894 patients aged 0-24 months during a 12-month period with only 18.9% receiving nutrition education. New dietary recommendations to prevent FA were not in place.

A retrospective chart review was used to evaluate use of an order set with patient education on EI to CAFs in the electronic medical record (EMR).

Providers attended training on EI to CAFs and use of the EMR order set. Data were collected on the use of the order set over a 3-month period.

Provider training significantly improved knowledge of FA as well as EI guidelines. After 3 months of implementation, 25.95% of eligible encounters contained the EI order set; 52% of patients received the order set during the measurement period. In the impact population, patients 4-12 months of age, 74.55% of patients received the order set.

Evidence-based clinical content in EMR order sets coupled with provider training ensure clinical decision support in identifying, monitoring, and optimizing quality care standards.
Evidence-based clinical content in EMR order sets coupled with provider training ensure clinical decision support in identifying, monitoring, and optimizing quality care standards.
Fifteen million residents living in rural locations in the United States struggle with mental illness, substance dependence, or comorbid conditions, and are not receiving adequate health care (CDC, 2017). Approximately 55% of the 3,075 rural communities in the United States lack psychiatric providers.

A specialty mental health treatment facility in northeast Florida cannot meet the needs of the patients because of limited psychiatric-mental health nurse practitioner (PMHNP) on site. By design, patients are expected to be seen in the clinic every three months.

A pilot project was initiated using telehealth as a venue for patient care as an alternative to a face-to-face consultation with a PMHNP. The project was implemented with adults diagnosed with schizophrenia, bipolar disorder, major depression, posttraumatic stress disorder, anxiety, and/or substance abuse.

A 3-month pilot of telehealth consultations with a remote PMHNP tracking access, medication adherence at 30 and 60 days after the consultation, appointment follow-up, and patient satisfaction.

Access increased from 4.86% to 10.19% following implementation of the telehealth model. Medication adherence was 82% at 30 days and 77.5% at 60 days, compared to a benchmark of 80%. In addition, 89% of patient responses indicated comfort with telehealth and a willingness to continue to see PMHNPs in this venue.

Telehealth with PMHNPs was shown to be a viable option in rural locations to meet the needs of mental health and dual diagnosis patients. Because of this project, the facility increased to three remote PMHNPs in the telehealth role.
Telehealth with PMHNPs was shown to be a viable option in rural locations to meet the needs of mental health and dual diagnosis patients. Because of this project, the facility increased to three remote PMHNPs in the telehealth role.
Transition to practice programs for nurse practitioners and physician assistants are gaining popularity and becoming more specialized. As these providers seek opportunities to strengthen their clinical skills and bridge the gap from school to practice, it is important to recognize the benefits and barriers of such programs. In this article, The George Washington University Hospital shares its experience in managing a transition to practice program for trauma and critical care.
Transition to practice programs for nurse practitioners and physician assistants are gaining popularity and becoming more specialized. As these providers seek opportunities to strengthen their clinical skills and bridge the gap from school to practice, it is important to recognize the benefits and barriers of such programs. GW3965 in vivo In this article, The George Washington University Hospital shares its experience in managing a transition to practice program for trauma and critical care.
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