title: The effect of a transforming care initiative on patient outcomes in acute surgical units: a time series study.
abstract: OBJECTIVE
  To examine the relationship between the implementation of a transforming care initiative and two patient outcomes, inpatient falls and hospital acquired pressure ulcers.
  
  
  BACKGROUND
  Patients continue to experience harm in hospitals from adverse events such as inpatient falls and hospital acquired pressure ulcers. These and other patient safety concerns led to transforming care initiatives.
  
  
  METHODS
  This cohort study used historical controls and a time series design. The setting was two surgical units of an acute care hospital; 7125 patients discharged from these units between July 2008-December 2010 were included. Those patients discharged during the initial 3 months of implementation were excluded. Several interventions were adopted as part of the transforming care initiative such as bedside handover and bedside whiteboards. Coded administrative data were accessed to identify patients who had experienced a fall or acquired a pressure ulcer during their hospital stay. Statistical process control was used to identify changes in outcomes over time.
  
  
  RESULTS
  The findings demonstrated variation in the proportion of patients experiencing a fall in both units and for the proportion of patients acquiring a pressure ulcer in one unit, following implementation.
  
  
  CONCLUSIONS
  These results demonstrate that implementing a transforming care initiative may have some influence on the quality and safety of patient care as measured by patient falls and pressure ulcers but findings varied. Further research is required to gain an understanding of the inconsistency of the impact of these initiatives across all clinical contexts.
authors.affiliation: C/-School of Nursing and Midwifery - Gold Coast campus, Griffith University, Queensland, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Burston
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
authors.forename: Brigid
authors.initials: B
authors.lastname: Gillespie
authors.forename: Roxanne
authors.initials: R
authors.lastname: Carroll
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D009936:Organizational Innovation; D063868:Patient Outcome Assessment; D061214:Patient Safety; D003668:Pressure Ulcer / Q000517:prevention & control*; D011793:Queensland; D013503:Surgery Department, Hospital; D055815:Young Adult
keywords: Transforming care; nursing; patient outcomes; quality