BackgroundUnplanned hospital readmissions increase healthcare costs and patient morbidity. We hypothesized that a program designed to reduce trauma readmissions would be effective.MethodsA Trauma Transitional Care Coordination (TTCC) program was created to support patients at high risk for readmission. TTCC interventions included call to patient (or caregiver) within 72 hours of discharge to identify barriers to care, complete medication reconciliation, coordination of appointments, and individualized problem solving. Information on all 30-day readmissions was collected. 30-day readmission rates were compared with center-specific readmission rates and population-based, risk-adjusted rates of readmission using published benchmarks.Results260 patients were enrolled in the TTCC program from January 2014 to September 2015. 30.8% (n=80) of enrollees were uninsured, 41.9% (n=109) reported current substance abuse, and 26.9% (n=70) had a current psychiatric diagnosis. 74.2% (n=193) attended outpatient trauma appointments within 14 days of discharge. 96.3% were successfully followed. Only 6.6% (n=16) of patients were readmitted in the first 30 days after discharge. This was significantly lower than both center-specific readmission rates before start of the program (6.6% vs. 11.3%, P=0.02) and recently published population-based trauma readmission rates (6.6% vs. 27%, P<0.001).DiscussionA nursing-led TTCC program successfully followed patients and was associated with a significant decrease in 30-day readmission rates for patients with high-risk trauma. Targeted outpatient support for these most vulnerable patients can lead to better utilization of outpatient resources, increased patient satisfaction, and more consistent attainment of preinjury level of functioning or better.Level of evidenceLevel IV.

Therapeutic/care management, level III.

Understanding power and learning how to use it is critical if nurses' efforts to shape their practice and work environments are to be successful. As part of our efforts to develop a Fast-Track BSN-to-PhD nursing program, we met with nurse leaders from six organizations to explore what power means, how nurses acquire it, and how they demonstrate it in their practice. Through these discussions, we identified eight characteristics of powerful nursing practice that, together, form a framework that can guide nurses’ efforts to develop a powerful practice and shape the health care delivery settings and academic institutions in which they work. In this article we review recent studies of organizational power and share discussions which helped us better understand nursing power and the ways in which it is manifested. We also reflect on what power means for individual nurses and the profession and discuss how our insights influenced our Fast-Track program.

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