Researchers studied the effect of a quality collaborative, nurse staffing and practice environment on four heart failure core measures at 23 rural hospitals. While the intervention — a heart failure toolkit — was not associated with heart failure outcomes, nurse staffing affected all four core measures.
Higher nurse turnover was related to lower compliance with discharge instructions, smoking cessation, left ventricular ejection fraction and prescribing angiotensin converting enzyme inhibitors on discharge. A better practice environment was associated with improvement in one core measure — left ventricular ejection fraction.
The authors concluded that stable environments, defined as less nurse turnover, are important for preparing for and implementing best practices for heart failure care in rural hospitals.
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