Theta Epsilon awarded two of its members with research grants in 2018. One of the two deserving recipients was Brian Peach, PhD, RN, CCRN. Dr. Peach answered some questions to provide our members with more information about his research and how the grant money will help him to accomplish his research goals.
-How long have you been a member of Sigma’s Theta Epsilon chapter?
I have been a member of Sigma Theta Tau since 2010, but first joined as a member of Villanova University’s Alpha Nu chapter. I graduated from Villanova’s baccalaureate and masters programs. I recently moved back to Orlando after my doctoral work at UF. I am now an Assistant Professor in the University of Central Florida's (UCF) College of Nursing. Upon arriving, I was impressed with how many members of the UCF faculty were involved in the Theta Epsilon chapter, so I quickly switched chapters in August.
-What has been the inspiration for your research?
The overall focus of my research is studying organizational factors associated with quality care provision, and how they impact patient outcomes. My interest in quality first began around 2005 when Congress passed the Patient Safety and Quality Improvement Act. The Centers for Medicare and Medicaid Services (CMS) announced shortly thereafter that they would no longer pay for the treatment of hospital-acquired wounds and infections. As a new-to-practice bedside nurse working on a medical-telemetry floor, I thought that spelled doom for healthcare. I remember in my first couple years packing several Stage IV wounds that were acquired in the hospital and hanging the antibiotics for hospital-acquired infections. I could not fathom how hospitals would cope with losing income from all the patients who acquired infections and wounds in the hospital.
However, what I saw firsthand in the years that followed were hospitals finally taking care provision seriously. Almost overnight, quality departments opened, and there was a new commitment to staff education. At the time, I worked at the Hospital of the University of Pennsylvania (HUP), and they made a significant investment in products like ceiling-mounted bed lifts, absorptive paper pads, and central line dressing kits with Chlorohexidine that would help nurses prevent these hospital-acquired conditions. Magnet certification is one organizational factor known to strongly associate with better patient outcomes. HUP was applying for Magnet certification at the time, and this further drove the organization’s commitment to quality. I began to see those Stage IV wounds that I had once packed, and those infections that I treated, less and less frequently.
Three years later, I transferred to the Medical Intensive Care Unit at HUP, and the bedside nurses were driving many of the quality improvements projects on that unit, and around the hospital. There was a strong push to remove central lines and urinary catheters to prevent hospital-acquired infections. This has become a standard nationally, but this was not the case back in 2008.
The HUP MICU nurses’ efforts inspired me to want to improve the care provided in my next workplace, the University of Florida (UF) Health, Shands Hospital’s Medical Intensive Care Unit. I chaired our Unit Practice Council, and through the efforts of the nurses on the council, we saw a reduction in our central line-associated blood stream infections by over 33% in 1 year and we had no catheter-associated urinary tract infections for over a year. It was amazing to see how many lives and dollars were saved through our efforts, and this further inspired me to want to study how organizational factors impact patient outcomes.
In addition to my own experiences as a bedside nurse, I was inspired by the research of Dr. Linda Aiken and her colleagues at the University of Pennsylvania’s Center for Health Outcomes and Policy Research. Their research on the impact of nurse staffing levels and nursing education levels on patient outcomes dramatically changed practice. Using big data, they were able to show that lower nurse:patient ratios and hiring more bachelor’s degree-prepared nurses significantly reduced inpatient mortality. Hospitals across the United States and around the world have changed their hiring practices based on their work.
As a doctoral student at the University of Florida, I was mentored by Dr. Jeannie P. Cimiotti, who works closely with Dr. Aiken and is responsible for much of the research that has transformed practice. Dr. Cimiotti recently joined the Emory University faculty, where she will continue to inspire and train the next generation of nurse scientists. As a new faculty member at the University of Central Florida, I hope my research has a similar impact on practice. I am a firm believer that when a patient comes in with one issue, they should expect not to leave with others, particularly ones that are easily avoided with quality nursing care.
-What is something you would like Theta Epsilon members to know about your research topic?
My current research project, generously funded by this chapter, is titled, “Organizational Characteristics Associated with High and Low Performance on the Centers for Medicare and Medicaid Services' Sepsis Core Measure”. In 2015, CMS adopted a sepsis core measure. For Accountable Care Organization hospitals to receive money from CMS, there are certain metrics they must meet. The sepsis core measure includes a series of timely bundled interventions that hospitals must complete for patients who are suspected to be septic, and hospitals’ overall compliance with all septic patients is scored.
Bundle interventions include tasks like assessment and reassessment of volume status, fluid resuscitation, blood culturing, and antibiotics, and there are 3 and 6-hour time frames that these interventions must be completed in. These bundles are complicated, and it is a daily challenge for hospitals to complete these interventions in a timely manner. There is discussion in the literature about the effectiveness of these bundles and whether the time frames are realistic.
For this first project, my colleague Dr. Boon Ng and I will be using data from CMS and the American Hospital Association (AHA) to study which organizational factors are associated with compliance with this core measure. I am interested in learning how hospitals with high and low compliance differ. In the future, I plan to look at the relationship between high and low compliance with this core measure and patient outcome measures like mortality. Additionally, Dr. Ng and I would like to look at hospital reimbursements and the cost of compliance in relation to hospitals’ compliance rate.
-How will the grant money from Theta Epsilon help you with your research?
I recently used the money to purchase STATA statistical software, and my AHA data. I am eagerly awaiting the arrival of the software and hope to begin this project when school resumes in January.
-Have you conducted research before?
Yes, I conducted research as a doctoral student at the University of Florida. My dissertation was titled, "Urosepsis in Older Adults: Incidence and Risk Factors Associated with Mortality." My dissertation research included 3 separate studies. The first was a systematic review looking at factors associated with the development of urosepsis and urosepsis mortality in older adults. The second was an epidemiological study examining the incidence of community and hospital-acquired urosepsis in the State of Florida over a 3-year period using data from the Healthcare Cost and Utilization Project’s State Inpatient Database (SID) and the Florida Department of Elder Affairs. In the third study, I used SID and American Hospital Association data to examine which factors were associated with inpatient mortality in older adults with community-acquired urosepsis.
-Anything you would like to add?
I want to say thank you to all the members of the Theta Epsilon chapter, and to the committee that reviewed the grant applications. This money is helping launch my program of research at UCF. I look forward to reporting my findings at future chapter events and meeting the other members of Theta Epsilon. Thank you for investing in nursing research!