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Bachnick S, Unbeck M, Ahmadi Shad M, Falta K, Grossmann N, Holle D, Bartakova J, Musy SN, Hellberg S, Dillner P, Atoof F, Khorasanizadeh M, Kelly-Pettersson P, Simon M. TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) Project: Protocol for an International Longitudinal Multicenter Study. JMIR Res Protoc 2024; 13:e56262. [PMID: 38648083 DOI: 10.2196/56262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Nursing-sensitive events (NSEs) are common, accounting for up to 77% of adverse events in hospitalized patients (eg, fall-related harm, pressure ulcers, and health care-associated infections). NSEs lead to adverse patient outcomes and impose an economic burden on hospitals due to increased medical costs through a prolonged hospital stay and additional medical procedures. To reduce NSEs and ensure high-quality nursing care, appropriate nurse staffing levels are needed. Although the link between nurse staffing and NSEs has been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing patient-level exposure to nurse staffing during the hospital stay. Few studies have assessed nurse staffing and patient outcomes using a single-center longitudinal design, with limited generalizability. There is a need for multicenter longitudinal studies with improved potential for generalizing the association between individual nurse staffing levels and NSEs. OBJECTIVE This study aimed (1) to determine the prevalence, preventability, type, and severity of NSEs; (2) to describe individual patient-level nurse staffing exposure across hospitals; (3) to assess the effect of nurse staffing on NSEs in patients; and (4) to identify thresholds of safe nurse staffing levels and test them against NSEs in hospitalized patients. METHODS This international multicenter study uses a longitudinal and observational research design; it involves 4 countries (Switzerland, Sweden, Germany, and Iran), with participation from 14 hospitals and 61 medical, surgery, and mixed units. The 16-week observation period will collect NSEs using systematic retrospective record reviews. A total of 3680 patient admissions will be reviewed, with 60 randomly selected admissions per unit. To be included, patients must have been hospitalized for at least 48 hours. Nurse staffing data (ie, the number of nurses and their education level) will be collected daily for each shift to assess the association between NSEs and individual nurse staffing levels. Additionally, hospital data (ie, type, teaching status, and ownership) and unit data (ie, service line and number of beds) will be collected. RESULTS As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all 4 countries. Data analyses are planned to be completed by spring 2024, with the first results expected to be published in late 2024. CONCLUSIONS This study will provide comprehensive information on NSEs, including their prevalence, preventability, type, and severity, across countries. Moreover, it seeks to enhance understanding of NSE mechanisms and the potential impact of nurse staffing on these events. We will evaluate within- and between-hospital variability to identify productive strategies to ensure safe nurse staffing levels, thereby reducing NSEs in hospitalized patients. The TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) study will focus on the optimization of scarce staffing resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56262.
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Affiliation(s)
- Stefanie Bachnick
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maryam Ahmadi Shad
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Katja Falta
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Nicole Grossmann
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Daniela Holle
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Jana Bartakova
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
| | - Sarah N Musy
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sarah Hellberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Stockholm, Sweden
| | - Pernilla Dillner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Fatemeh Atoof
- Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Paula Kelly-Pettersson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Stockholm, Sweden
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
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Coombs A. Researchers revolt against weekend conferences. Nature 2023; 623:1093-1094. [PMID: 37914874 DOI: 10.1038/d41586-023-03430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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Abstract
Nurse staffing is linked to safety, quality, and experience outcomes. In the context of the COVID-19 pandemic, staffing has become more critical as overwhelming demand has met diminishing supply of healthy nurses, capacity for care, and the innovation necessary to deliver optimal quality and experience to patients and the people who care for them. Press Ganey data scientists, along with industry experts, sought to evaluate staffing before the pandemic and its effects on clinical quality, experience, and nurse engagement. Furthermore, interviews with expert nurse researchers and nursing leaders helped to identify the kind of innovation necessary to accommodate the variable demand in patient volumes, acuity, nurse availability, and teamwork. Valuable insights from this work will help healthcare leaders in their quest to optimize nursing care.
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Affiliation(s)
- Christina Dempsey
- Author Affiliation: Chief Nursing Officer Emerita (Dr Dempsey) and Data Scientist (Mr Batten), Press Ganey Associates, South Bend, Indiana
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Black S. Private management consultants: evaluate their work, but don't forget to ask why their use in the NHS is so high. BMJ 2021; 375:n2545. [PMID: 34670804 DOI: 10.1136/bmj.n2545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Holmdahl I, Kahn R, Hay JA, Buckee CO, Mina MJ. Estimation of Transmission of COVID-19 in Simulated Nursing Homes With Frequent Testing and Immunity-Based Staffing. JAMA Netw Open 2021; 4:e2110071. [PMID: 33988707 PMCID: PMC8122229 DOI: 10.1001/jamanetworkopen.2021.10071] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/21/2021] [Indexed: 12/29/2022] Open
Abstract
Importance Nursing homes and other long-term care facilities have been disproportionately impacted by the COVID-19 pandemic. Strategies are urgently needed to reduce transmission in these high-risk populations. Objective To evaluate COVID-19 transmission in nursing homes associated with contact-targeted interventions and testing. Design, Setting, and Participants This decision analytical modeling study developed an agent-based susceptible-exposed-infectious (asymptomatic/symptomatic)-recovered model between July and September 2020 to examine SARS-CoV-2 transmission in nursing homes. Residents and staff of a simulated nursing home with 100 residents and 100 staff split among 3 shifts were modeled individually; residents were split into 2 cohorts based on COVID-19 diagnosis. Data were analyzed from September to October 2020. Exposures In the resident cohorting intervention, residents who had recovered from COVID-19 were moved back from the COVID-19 (ie, infected with SARS-CoV-2) cohort to the non-COVID-19 (ie, susceptible and uninfected with SARS-CoV-2) cohort. In the immunity-based staffing intervention, staff who had recovered from COVID-19 were assumed to have protective immunity and were assigned to work in the non-COVID-19 cohort, while susceptible staff worked in the COVID-19 cohort and were assumed to have high levels of protection from personal protective equipment. These interventions aimed to reduce the fraction of people's contacts that were presumed susceptible (and therefore potentially infected) and replaced them with recovered (immune) contacts. A secondary aim of was to evaluate cumulative incidence of SARS-CoV-2 infections associated with 2 types of screening tests (ie, rapid antigen testing and polymerase chain reaction [PCR] testing) conducted with varying frequency. Main Outcomes and Measures Estimated cumulative incidence proportion of SARS-CoV-2 infection after 3 months. Results Among the simulated cohort of 100 residents and 100 staff members, frequency and type of testing were associated with smaller outbreaks than the cohorting and staffing interventions. The testing strategy associated with the greatest estimated reduction in infections was daily antigen testing, which reduced the mean cumulative incidence proportion by 49% in absence of contact-targeted interventions. Under all screening testing strategies, the resident cohorting intervention and the immunity-based staffing intervention were associated with reducing the final estimated size of the outbreak among residents, with the immunity-based staffing intervention reducing it more (eg, by 19% in the absence of testing) than the resident cohorting intervention (eg, by 8% in the absence of testing). The estimated reduction in transmission associated with these interventions among staff varied by testing strategy and community prevalence. Conclusions and Relevance These findings suggest that increasing the frequency of screening testing of all residents and staff, or even staff alone, in nursing homes may reduce outbreaks in this high-risk setting. Immunity-based staffing may further reduce spread at little or no additional cost and becomes particularly important when daily testing is not feasible.
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Affiliation(s)
- Inga Holmdahl
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rebecca Kahn
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - James A. Hay
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Caroline O. Buckee
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michael J. Mina
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
OBJECTIVE The aim of this study was to determine whether there are modifiable characteristics of nurses and hospitals associated with nurse specialty certification. BACKGROUND Hospitals, nurses, and patients benefit from nurse specialty certification, but little actionable evidence guides administrators seeking higher hospital certification rates. METHODS This is a cross-sectional, secondary data analysis of 20 454 nurses in 471 hospitals across 4 states. RESULTS Rates of certified nurses varied significantly across hospitals. Higher odds of certification were associated with Magnet® recognition and better hospital work environments at the facility level, and with BSN education, unit type (most notably, oncology), older age, more years of experience, and full-time employment at the individual nurse level. CONCLUSION Two strategies that hold promise for increasing nurse specialty certification are improving hospital work environments and preferentially hiring BSN nurses.
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Affiliation(s)
- Andrew M Dierkes
- Author Affiliations: Assistant Professor (Dr Dierkes), Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pennsylvania; Postdoctoral Fellow (Dr Schlak), School of Nursing, Columbia University, New York, New York; and Predoctoral Fellow (Ms French), Associate Director (Dr McHugh), and Director (Dr Aiken), Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia
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Moorer A, Klatt E, Thornton O, Groves TN, Eisenach B, Soholt K, Haylett WJ, Hessler KL, Zwink J. SOS in a pandemic: Staffing strategies for COVID-19. Nurs Manag (Harrow) 2021; 52:22-30. [PMID: 33789329 DOI: 10.1097/01.numa.0000733628.46685.bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Amanda Moorer
- In Colo., Amanda Moorer is a nurse residency program manager at UCHealth in Aurora, Elizabeth Klatt is an oncology/gynecologic-oncology/medicine unit nurse manager at the University of Colorado Hospital in Aurora, Olivia Thornton is a medical ICU and wound care associate nurse manager at the University of Colorado Hospital in Aurora, Thu-Nhi Groves is a resource office nurse manager at the University of Colorado Hospital in Aurora, Bree Eisenach is a resource management center nurse manager at the Medical Center of the Rockies in Loveland, Kate Soholt is a float pool/PRN pool/women and family support team nurse manager at Poudre Valley Hospital in Fort Collins, Wendy J. Haylett is a research nurse scientist at UCHealth in Aurora, Karen L. Hessler is a research nurse scientist at UCHealth in Windsor, and Jennifer Zwink is the vice president of nursing and ACNO at the University of Colorado Hospital in Aurora
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Abstract
The COVID-19 pandemic exhausted the nursing workforce, casting doubt that future supply will meet demand. To preserve their workforces, nursing leaders are offering emotional support to the frontline. Although these efforts are essential, leaders are overlooking an untapped opportunity to safeguard staffing levels: creating a more flexible nursing workforce. In this article, the authors discuss flexible nurse staffing and suggest 4 key opportunities for improvement.
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Affiliation(s)
- Katherine Virkstis
- Author Affiliations : Managing Director and Senior Research Partner (Dr Virkstis), Senior Consultant (Ms Herleth), Consultant (Ms Langr), Senior Analyst (Ms Rewers), and Analyst (Ms Fennell), Nursing Executive Center, Advisory Board, Washington, DC
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Chan WP, Yao MS, Lin MF, Chang HC, Kosik RO, Lee WS. Management and infection control practices in a Taiwanese radiology department during the COVID-19 outbreak. J Microbiol Immunol Infect 2021; 54:349-358. [PMID: 33863652 PMCID: PMC8007533 DOI: 10.1016/j.jmii.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/30/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022]
Abstract
The radiology department was categorized as a “high risk area” during the severe acute respiratory syndrome (SARS) outbreak in 2003 and is similarly considered a “high risk area” during the current coronavirus (COVID-19) pandemic. The purpose of infection control is to isolate patients with suspected or confirmed COVID-19 from uninfected people by utilizing separate equipment, spaces, and healthcare workers. Infection control measures should be prioritized to prevent the nosocomial spread of infection. We established a COVID-19 infection control team in our radiology department. The team's responsibilities include triaging patients with confirmed or suspected COVID-19, performing imaging and reporting, using dedicated equipment, disinfecting the equipment and the immediate environment, and staff scheduling.
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Affiliation(s)
- Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Min-Szu Yao
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Fang Lin
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Medical Imaging and Radiological Technology, Yuanpei University, Hsinchu, Taiwan
| | - Hsiu-Chin Chang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Russell Oliver Kosik
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Sen Lee
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Wells CM, Zhang Z, Spano-Szekely L, Siller J, Brannon H, Schulz K, Scott C, Dolphy M, Hughes E, Kohli-Seth R. Tiered Model of Nurse Staffing for Critical Care and Emergency Departments in the Wake of a Pandemic. J Nurs Adm 2021; 51:E1-E5. [PMID: 33449602 DOI: 10.1097/nna.0000000000000979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To identify strategies that increase hospital bed capacity, material resources, and available nurse staffing during a national pandemic. BACKGROUND The COVID-19 outbreak resulted in an influx of acutely ill patients requiring critical care. The volume and acuity of this patient population increased the demand for care and stretched hospitals beyond their capacity. While increasing hospital bed capacity and material resources are crucial, healthcare systems have noted one of the greatest limitations to rapid expansion has been the number of available medical personnel, particularly those trained in emergency and critical care nursing. EVALUATION Program evaluation occurred on a daily basis with hospital throughput, focusing on logistics including our ability to expand bed volume, resource utilization, and the ability to meet staffing needs. CONCLUSION This article describes how a quaternary care hospital in New York City prepared for the COVID-19 surge in patients by maximizing and shifting nursing resources to its most impacted services, the emergency department (ED) and the intensive care units (ICUs). A tier-based staffing model and rapid training were operationalized to address nurse-staffing shortages in the ICU and ED, identifying key factors for swift deployment. IMPLICATIONS FOR NURSING MANAGERS Frequent communication between staff and leaders improves teamwork and builds trust and buy-in during normal operations and particularly in times of crisis.
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Affiliation(s)
- Celia M Wells
- Author Affiliations: Senior Director of Nursing, Nursing Operations Management (Dr Wells), Clinical Research Assistant (Ms Zhang), Vice President of Nursing, Nursing Operations Management (Dr Spano-Szekely), Senior Director of Nursing, Department of Emergency Medicine (Dr Siller), Vice President of Mount Sinai Hospital (Ms Brannon), Director of Nursing, Education and Professional Development (Ms Schulz), Director of Nursing, Post-Anesthesia Care Unit (Ms Scott), Nurse Manager, Department of Endoscopy (Ms Dolphy), Senior Director of Nursing Cardiac Service (Ms Hughes), and Director of the Institute for Critical Care Medicine (Dr Kohli-Seth), Mount Sinai Hospital, New York
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Al-Surimi K, Alwabel AM, Bawazir A, Shaheen NA. Road towards promoting patient safety practices among hospital pharmacists: Hospital-based baseline patient safety culture assessment cross-sectional survey. Medicine (Baltimore) 2021; 100:e23670. [PMID: 33466122 PMCID: PMC7808443 DOI: 10.1097/md.0000000000023670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 09/10/2020] [Accepted: 11/09/2020] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Patient safety is a fundamental aspect of a healthcare system. The aim of this study was to assess the perception and determinants of the patient safety culture of pharmacists in hospitals, in Riyadh, Saudi Arabia.A survey was conducted with pharmacists in the pharmacies of governmental, /military and private hospitals in Riyadh, Saudi Arabia. The pharmacy survey on patient safety culture questionnaire developed by Agency for Healthcare Research and Qualtity, a hard copy was distriuted to the pharmacists. The positive response rate (RR) was calculated and compared across hospitals using a chi-square test. The predictors of patient safety grades were identified using the generalized estimating equation. The data was analyzed using SAS.A total of 538 questionnaires were distributed, of which 411 responded (RR 76.4%). Of the participants, 229 (56%) were females. The majority 255 (62%) were in the 18 to 34 years age range, and 361 (88%) had a bachelor's degree. The majority of the sample 376 (92%) was a pharmacist. The Positive RR (PRR) ranged between (25.6%-74%). The highest PRR was observed in teamwork (74.4%), followed by 'staff, training and skills' (68%), and 'organizational learning continuous improvement' (66%). The lowest PRR was observed in 'staffing, work pressure, and pace' (25.5%). Comparing the PPR of the various healthcare sectors, the governmental hospitals scored the highest in all patient safety domains. Generalized Estimating Equation analysis showed that with increase in scores of all patient safety culture domains increased the likelihood of reporting a better patient safety grade, whereas respondents' demographic characteristics had no effect except the working experience years 6 years and above had odds of poor reporting of the patient safety grade (odds ratio = 2.54, 95% confience interval (1.543, 4.194), (P = .0003).The grades achieved in the various domains of patient safety culture by pharmacists in Riyadh are below the expected standard. The highest scores were achieved in teamwork, with the lowest scores in staffing, work pressure and pace. Overall, pharmacists in government hospital settings have a better perception of patient safety than their peers in other settings. These results provide the baseline evidence for developing future interventional studies aiming at improving patient safety culture in hospital pharmacy settings.
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Affiliation(s)
- Khaled Al-Surimi
- College of Public Health and Health Informatics
- King Saud bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
| | - Ali Mohammed Alwabel
- College of Public Health and Health Informatics
- King Saud bin Abdulaziz University for Health Sciences
| | - Amen Bawazir
- College of Public Health and Health Informatics
- King Saud bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
| | - Naila A. Shaheen
- King Saud bin Abdulaziz University for Health Sciences
- Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
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Toia F, Romeo M, Abate M, Avarotti E, Battiston B, Bruno G, Cannavò F F, Casamichele C, Colonna M, Catena N, Cherubino M, Coppolino S, Galvano N, Giuca G, Gullo S, Internullo G, Lazzerini A, Marcoccio I, Maruccia M, Melloni C, Pajardi G, Pugliese P, Risitano G, Spata G, Tripoli M, Troisi L, Tos P, Cordova A. Impact of COVID-19 on hand surgery in Italy: A comparison between the Northern and the Southern regions. Hand Surg Rehabil 2020; 40:139-144. [PMID: 33309793 PMCID: PMC7836699 DOI: 10.1016/j.hansur.2020.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/03/2022]
Abstract
The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also – and paradoxically even at a higher extent – in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.
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Affiliation(s)
- F Toia
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy.
| | - M Romeo
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - M Abate
- SSD di Ortopedia, ARNAS Garibaldi, Presidio di Nesima, Via Palermo 636, 95123, Catania (CT), Italy
| | - E Avarotti
- Department of Orthopedics and Traumatology, A.R.N.A.S. Piazza Santa Maria di Gesù 5, 95124, Catania (CT), Italy
| | - B Battiston
- Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, AOU Città della Salute e della Scienza, Via Nizza 138, 10126, Torino (TO), Italy
| | - G Bruno
- Department of Orthopedics and Traumatology, A.O. Vittorio Emanuele, Via Plebiscito 632, 95122, Catania (CT), Italy
| | - F Cannavò F
- U.O.S.D. Plastic Surgery A.O. Papardo, Contrada Papardo, 98158, Messina (ME), Italy
| | - C Casamichele
- Department of Orthopedics and Traumatology, A.O. "G. Paolo II", Contrada Cisternazzi, 97010, Ragusa (RG), Italy
| | - M Colonna
- Plastic Surgery Unit, Department of Human Pathology, University of Messina, Via Consolare Valeria1, 98124, Messina (ME), Italy
| | - N Catena
- Pediatric Orthopedic and Traumatology Unit, Children's Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Via Spalto Marengo 46, 15121, Alessandria (AL), Italy
| | - M Cherubino
- Department of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Via Ravasi 2, 21100, Varese (VA), Italy
| | - S Coppolino
- Hospital S. Vincenzo, Contrada Sirina, 98039, Taormina (ME), Italy
| | - N Galvano
- Department of Orthopedics and Traumatology A.O.U.P." Paolo Giaccone", Via Del Vespro 127, 90127 Palermo (PA), Italy
| | - G Giuca
- Department of Orthopedics Ospedale Maggiore, Via Resistenza Partigiana, 97015, Modica (RG), Italy
| | - S Gullo
- Department of Hand Surgery and Traumatology, A.R.N.A.S., Piazza Nicola Leotta 4, 90127, Palermo (PA), Italy
| | - G Internullo
- Department of Orthopedics, Ospedale Gravina, Via Portosalvo 9, 95041, Caltagirone (CT), Italy
| | - A Lazzerini
- Hand Surgery and Microsurgery Unit, IRCCS Humanitas Clinical Institute, Via Alessandro Manzoni 6, 20089, Milano (MI), Italy
| | - I Marcoccio
- Orthopedic Microsurgery and Upper Limb Surgery, Istituto Clinico Città di Brescia, Via Bartolomeo Gualla 15, 25128, Brescia (BS), Italy
| | - M Maruccia
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70122, Bari (BR), Italy
| | - C Melloni
- Plastic and Reconstructive Surgery A.O. P. Borsellino, Contrada Cardilla 1, 91025, Marsala (TP), Italy
| | - G Pajardi
- Department of Clinical Sciences and Community Health, The University of Milan, Via Festa del Perdono 7, 20122, Milano (MI), Italy
| | - P Pugliese
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - G Risitano
- ABC Medical, Via Porto Salvo 2, 98121, Messina (ME), Italy
| | - G Spata
- Hand Surgery, Polyclinic Morgagni, Via del Bosco 105, 95030, Catania (CT), Italy
| | - M Tripoli
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
| | - L Troisi
- Department of Clinical Sciences and Community Health, The University of Milan, Via Festa del Perdono 7, 20122, Milano (MI), Italy
| | - P Tos
- Hand Surgery and Reconstructive Microsurgery Unit, Orthopedic Institute G. Pini-CTO, Piazza Cardinale Andrea Ferrari 1, 20122, Milano (MI), Italy
| | - A Cordova
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via Del Vespro 127, 90127, Palermo (PA), Italy
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Nuñez JH, Porcel JA, Pijoan J, Batalla L, Teixidor J, Guerra-Farfan E, Minguell J. Rethinking Trauma Hospital Services in one of Spain's Largest University Hospitals during the COVID-19 pandemic. How can we organize and help? Our experience. Injury 2020; 51:2827-2833. [PMID: 33004206 PMCID: PMC7518794 DOI: 10.1016/j.injury.2020.09.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/19/2020] [Accepted: 09/24/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The severe disruptions caused by the SARS-CoV-2 coronavirus have necessitated a redistribution of resources to meet hospitals' current service needs during this pandemic. The aim is to share our experiences and outcomes during the first month of the Covid-19 pandemic, based on the strategies recommended and strategies we have implemented. METHODS Our experience comes from our work at a referral hospital within the Spanish National Health System. Changes to clinical practice have largely been guided by the current evidence and four main principles: (1) patient and health-care worker protection, (2) uninterrupted necessary care, (3) conservation of health-care resources, (4) uninterrupted formation for residents. Based on these principles, changes in the service organization, elective clinical visits, emergency visits, surgical procedures, and inpatient and outpatient care were made. RESULTS Using the guidance of experts, we were able to help the hospital address the demands of the Covid-19 outbreak. We reduced to a third of our orthopaedics and trauma hospital beds, provided coverage for general emergency services, and five ICUs, all continuing to provide care for our patients, in the form of 102 trauma surgeries, 6413 phone interviews and 520 emergency clinic visits. Also in the third week, we were able to restart morning meetings via telematics, and teaching sessions for our residents. On the other hand, eight of the healthcare personnel on our service (10.8%) became infected with Covid-19. CONCLUSIONS As priorities and resources increasingly shift towards the COVID-19 pandemic, it is possible to maintain the high standard and quality of care necessary for trauma and orthopaedics patients while the pandemic persists. We must be prepared to organize our healthcare workers in such a way that the needs of both inpatients and outpatients are met. It is still possible to operate on those patients who need it. Unfortunately, some healthcare workers will become infected. It is essential that we protect those most susceptible to severer consequences of Covid-19. Also crucial are optimized protective measures.
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Affiliation(s)
- Jorge H Nuñez
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Juan Antonio Porcel
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan Pijoan
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Lledó Batalla
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jordi Teixidor
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ernesto Guerra-Farfan
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan Minguell
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
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Oberhelman S, Boswell C, Jensen T, Swartz D, Bruhl E, O’Brien M, Angstman K. Student experiences and satisfaction with a novel clerkship patient scheduling. Med Educ Online 2020; 25:1742963. [PMID: 32174268 PMCID: PMC7144222 DOI: 10.1080/10872981.2020.1742963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
Background: Outpatient primary care clerkships are an important part of medical students' education.Traditional clerkships usually partner a student with a single preceptor in that physician's clinic. However, it can be quite difficult for the preceptor to balance the educational needs of the students, the expectations of the patients and the organizational demands of the clinic practice.Objective: An innovative scheduling model (named "Patients as Teachers" [PAT] clinic) was developed as part of our third-year Family Medicine clerkship. The goal was to increase the students' opportunities for independence and improve their satisfaction without negatively impacting the flow of the clinic or patient satisfaction.Design: The third-year medical students spent part of their clerkship working in the PAT clinic and part of the time working with an individual preceptor in that preceptor's clinic in the traditional, usual fashion (PAU clinic-precepting as usual). The students completed patient-logs regarding the patients they saw and their level of participation. They also completed a voluntary survey regarding their experiences.Results: Students performed more independent interviews (90.3 vs 59.0%) and independent exams (96.2 vs 63.3%) in the PAT clinic than while working with their traditional preceptor (both p<0.01). Students were highly satisfied with the experience with 89.5% stating they would recommend it and 87.7% finding the PAT clinic to be an equal or superior experience to the PAU experience.Conclusions: Using a combination of time in the PAT clinic and time with a one on one preceptor in the usual fashion was successful in increasing opportunities for student autonomy and achieving a high level of student satisfaction in our third-year Family Medicine clerkship. Additional opportunities for innovative scheduling could be considered for meeting a variety of clerkship and clinic needs.
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Affiliation(s)
- Sara Oberhelman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chris Boswell
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Teresa Jensen
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel Swartz
- Department of Family Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, VA, US
| | - Elliot Bruhl
- Southeast Alaska Regional Health Consortium, Juneau, AK, US
| | - Marcia O’Brien
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kurt Angstman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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Pagano MB, Rajbhandary S, Nunes E, Cohn CS. Transfusion services operations during the COVID-19 pandemic: Results from AABB survey. Transfusion 2020; 60:2760-2762. [PMID: 33217023 PMCID: PMC7753805 DOI: 10.1111/trf.15986] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Monica B. Pagano
- Department of Laboratory Medicine and PathologyUniversity of WashingtonSeattleUSA
| | | | - Eduardo Nunes
- Quality, Standards, and Accreditation AABBBethesda, MarylandUSA
| | - Claudia S. Cohn
- Transfusion Medicine Division, Department of PathologyUniversity of MinnesotaMinneapolisMinnesotaUSA
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Marshall AP, Austin DE, Chamberlain D, Chapple LAS, Cree M, Fetterplace K, Foster M, Freeman-Sanderson A, Fyfe R, Grealy BA, Hodak A, Holley A, Kruger P, Kucharski G, Pollock W, Ridley E, Stewart P, Thomas P, Torresi K, Williams L. A critical care pandemic staffing framework in Australia. Aust Crit Care 2020; 34:123-131. [PMID: 33039301 PMCID: PMC7543889 DOI: 10.1016/j.aucc.2020.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/30/2020] [Accepted: 08/31/2020] [Indexed: 11/18/2022] Open
Abstract
Background Pandemics and the large-scale outbreak of infectious disease can significantly impact morbidity and mortality worldwide. The impact on intensive care resources can be significant and often require modification of service delivery, a key element which includes rapid expansion of the critical care workforce. Pandemics are also unpredictable, which necessitates rapid decision-making and action which, in the lack of experience and guidance, may be extremely challenging. Recognising the potential strain on intensive care units (ICUs), particularly on staffing, a working group was formed for the purpose of developing recommendations to support decision-making during rapid service expansion. Methods The Critical Care Pandemic Staffing Working Party (n = 21), representing nursing, allied health, and medical disciplines, has used a modified consensus approach to provide recommendations to inform multidisciplinary workforce capacity expansion planning in critical care. Results A total of 60 recommendations have been proposed which reflect general recommendations as well as those specific to maintaining the critical care workforce, expanding the critical care workforce, rostering and allocation of the critical care workforce, nurse-specific recommendations for staffing the ICU, education support and training during ICU surge situations, workforce support, models of care, and de-escalation. Conclusion These recommendations are provided with the intent that they be used to guide interdisciplinary decision-making, and we suggest that careful consideration is given to the local context to determine which recommendations are most appropriate to implement and how they are prioritised. Ongoing evaluation of recommendation implementation and impact will be necessary, particularly in rapidly changing clinical contexts.
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Affiliation(s)
- Andrea P Marshall
- Intensive Care Unit, Gold Coast University Hospital, E 2.015, 1 Hospital Blvd, Southport, 4212, QLD, Australia; Griffith University, Parklands Drive, Southport, 4212, QLD, Australia.
| | - Danielle E Austin
- Intensive Care Unit, Liverpool Hospital, Elizabeth and Goulburn St., Liverpool, 2170, NSW, Australia; University of NSW, High Street, Kensington, 2052, NSW, Australia.
| | - Di Chamberlain
- Flinders University, Sturt Rd, Bedford Park, SA, Australia.
| | - Lee-Anne S Chapple
- Intensive Care Research, Royal Adelaide Hospital, Port Road, Adelaide, 5000, SA, Australia; Discipline of Acute Care Medicine, Faculty of Health and Medical Sciences, University of Adelaide, North Terrace, Adelaide, 5000, SA, Australia.
| | - Michele Cree
- Queensland Children's Hospital and Children's Health Queensland, 501 Stanley Street, South Brisbane, 4101, Queensland, Australi; Society of Hospital Pharmacists Australia, Collingwood, 3066, Victoria, Australia.
| | - Kate Fetterplace
- Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Parkville, 3050, Victoria, Australia; The University of Melbourne, Melbourne Medical School, Victoria, Australia.
| | - Michelle Foster
- Emergency and Assessment Services, Gold Coast Health, 1 Hospital Blvd, Southport, 4215, QLD, Australia.
| | - Amy Freeman-Sanderson
- University of Technology Sydney, Graduate School of Health, 100 Broadway, Sydney, 2007, NSW, Australia; Speech Pathology Department, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, NSW, Australia; The George Institute for Global Health, Level 10, King George V Building, Royal Prince Alfred Hospital, Missenden Road, Camperdown, 2050, NSW, Australia.
| | - Rachel Fyfe
- Society of Hospital Pharmacists Australia, Collingwood, 3066, Victoria, Australia; Pharmacy Department, Barwon Health, Bellerine Street, Geelong, 3220, Victoria, Australia.
| | - Bernadette A Grealy
- Critical Care & Perioperative Services Program, Central Adelaide Local Health Network, Port Road, Adelaide, 5000, South Australia, Australia.
| | - Alison Hodak
- High Dependency Unit, Flinders Medical Centre, SA Health, Flinders Drive, Bedford Park, 5042, SA, Australia.
| | - Anthony Holley
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield St., Herston, QLD, Australia; Australian and New Zealand Intensive Care Society, 1.01 Level 1, 277 Camberwell Road, Camberwell, VIC, 3124, Australia.
| | - Peter Kruger
- Intensive Care Unit, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Geraldine Kucharski
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Butterfield St., Herston, QLD, Australia.
| | - Wendy Pollock
- Nursing, Midwifery & Health, Northumbria University, Newcastle-upon-Tyne, UK.
| | - Emma Ridley
- Australia and New Zealand Intensive Care Research Centre, Monash University, 553 St Kilda Rd, Melbourne, 3004, VIC, Australia.
| | - Penny Stewart
- Intensive Care Unit, Alice Springs Hospital, 6 Gap Rd, The Gap, NT, 0870, Australia.
| | - Peter Thomas
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, Australia.
| | - Kym Torresi
- Speech Pathology Australia, 114 William St, Melbourne, 3000, VIC, Australia.
| | - Linda Williams
- Agency for Clinical Innovation, NSW Health, 1 Reserve Rd, St Leonards, NSW, 2065, Australia.
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Rothrock RJ, Maragkos GA, Schupper AJ, McNeill IT, Oermann EK, Yaeger KA, Gilligan J, Bederson JB, Mocco JD. By the Numbers Analysis of Effect of COVID-19 on a Neurosurgical Residency at the Epicenter. World Neurosurg 2020; 142:e434-e439. [PMID: 32688039 PMCID: PMC7367024 DOI: 10.1016/j.wneu.2020.07.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 pandemic has created challenges to neurosurgical patient care. Despite editorials evaluating neurosurgery responses to 2019 novel coronavirus disease (COVID-19), data reporting effects of COVID-19 on neurosurgical case volume, census, and resident illness are lacking. The aim of this study was to present a real-world analysis of neurosurgical volumes, resident deployment, and unique challenges encountered during the severe acute respiratory syndrome coronavirus 2 outbreak peak in New York City. METHODS Daily census and case volume data were prospectively collected throughout the severe acute respiratory syndrome coronavirus 2 outbreak in spring 2020. Neurosurgical census was compared against COVID-19 system-wide data. Neurosurgical cases during the crisis were analyzed and compared with 7-week periods from 2019 and early 2020. Resident deployment and illness were reviewed. RESULTS From March 16, 2020, to May 5, 2020, residents participated in 72 operations and 69 endovascular procedures compared with 448 operations and 253 endovascular procedures from January 2020 to February 2020 and 530 operations and 340 endovascular procedures from March 2019 to May 2019. There was a 59% reduction in neurosurgical census during the outbreak (median 24 patients, 2.75 average total cases daily). COVID-19 neurosurgical admissions peaked in concert with the system-wide pandemic. Three residents demonstrated COVID-19 symptoms (no hospitalizations occurred) for a total 24 workdays lost (median 7 workdays). CONCLUSIONS These data provide real-world guidance on neurosurgical infrastructure needs during a COVID-19 outbreak. While redeployment to support the COVID-19 response was required, a significant need remained to continue to provide critical neurosurgical service.
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Affiliation(s)
- Robert J Rothrock
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Georgios A Maragkos
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ian T McNeill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric K Oermann
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kurt A Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey Gilligan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua B Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J D Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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19
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Huckaby S. Making the Case: The Use of Lean Six Sigma Methodologies to Improve Staffing in an Acute Hemodialysis Department. Nephrol Nurs J 2020; 47:457-460. [PMID: 33107718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Making a business case to match staffing-to-patient care needs sometimes requires new approaches. Partnering with departments outside of nursing proved successful in one acute hemodialysis department. Working with Lean Six Sigma teammates to define our workflow processes and utilizing the resulting data led to developing a business case, which gained the department 2.5 additional full-time equivalent registered nurses. A staffing template was created to evaluate ongoing patient volumes against current staffing. This staffing template can be used by any hemodialysis unit to aid in determining ongoing staffing requirements.
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20
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Méndez-Fernández I, Lorenzo-Freire S, García-Jurado I, Costa J, Carpente L. A heuristic approach to the task planning problem in a home care business. Health Care Manag Sci 2020; 23:556-570. [PMID: 32712791 DOI: 10.1007/s10729-020-09509-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
In this paper, we study a task scheduling problem in a home care business. The company has a set of supervisors in charge of scheduling the caregivers' weekly plans. This can be a time-consuming task due to the large number of services they work with, as well as the need to consider user preferences, services required time windows and travel times between users' homes. Apart from that, it is also important to have a continuity of care, i.e., that users generally prefer not to have their caregiver changed. This problem involves both route planning and employee task planning, which are usually very challenging. We first propose to model it using integer linear programming methodology. Since the real instances that the company needs to solve are very large, we design a heuristic algorithm, based on the simulated annealing philosophy, that allows the company to obtain the caregivers' weekly schedules. Lastly, we check the algorithm's good performance, by comparing the solutions it proposes with those provided by the integer linear programming methodology, in small size problems, and we present a case study to confirm that the algorithm correctly solves real-life instances.
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Affiliation(s)
- Isabel Méndez-Fernández
- MODES Research Group, Department of Mathematics and CITIC, Faculty of Computer Science, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain.
| | - Silvia Lorenzo-Freire
- MODES Research Group, Department of Mathematics and CITIC, Faculty of Computer Science, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain
| | - Ignacio García-Jurado
- MODES Research Group, Department of Mathematics and CITIC, Faculty of Computer Science, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain
| | - Julián Costa
- MODES Research Group, Department of Mathematics and CITIC, Faculty of Computer Science, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain
| | - Luisa Carpente
- MODES Research Group, Department of Mathematics and CITIC, Faculty of Computer Science, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain
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Abstract
The pandemic creates unprecedented challenges to society and to health care systems around the world. Like all crises, these provide a unique opportunity to rethink the fundamental limiting assumptions and institutional inertia of our established systems. These inertial assumptions have obscured deeply rooted problems in health care and deflected attempts to address them. As hospitals begin to welcome all patients back, they should resist the temptation to go back to business as usual. Instead, they should retain the more deliberative, explicit, and transparent ways of thinking that have informed the development of crisis standards of care. The key lesson to be learned from those exercises in rational deliberation is that justice must be the ethical foundation of all standards of care. Justice demands that hospitals take a safety-net approach to providing services that prioritizes the most vulnerable segments of society, continue to expand telemedicine in ways that improve access without exacerbating disparities, invest in community-based care, and fully staff hospitals and clinics on nights and weekends.
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Ierardi AM, Wood BJ, Arrichiello A, Bottino N, Bracchi L, Forzenigo L, Andrisani MC, Vespro V, Bonelli C, Amalou A, Turkbey EB, Turkbey BI, Granata G, Pinto A, Grasselli G, Stocchetti N, Carrafiello G. Preparation of a radiology department in an Italian hospital dedicated to COVID-19 patients. Radiol Med 2020; 125:894-901. [PMID: 32654028 PMCID: PMC7352089 DOI: 10.1007/s11547-020-01248-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022]
Abstract
Preparedness for the ongoing coronavirus disease 2019 (COVID-19) and its spread in Italy called for setting up of adequately equipped and dedicated health facilities to manage sick patients while protecting healthcare workers, uninfected patients, and the community. In our country, in a short time span, the demand for critical care beds exceeded supply. A new sequestered hospital completely dedicated to intensive care (IC) for isolated COVID-19 patients needed to be designed, constructed, and deployed. Along with this new initiative, the new concept of "Pandemic Radiology Unit" was implemented as a practical solution to the emerging crisis, born out of a critical and urgent acute need. The present article describes logistics, planning, and practical design issues for such a pandemic radiology and critical care unit (e.g., space, infection control, safety of healthcare workers, etc.) adopted in the IC Hospital Unit for the care and management of COVID-19 patients.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy.
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Antonio Arrichiello
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Nicola Bottino
- Department of Anesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore, Milan, Italy
| | - Laura Bracchi
- Cerba Healthcare Italia, sede CURIE, Viale Liguria, 37, 20093, Cologno Monzese, MI, Italy
| | - Laura Forzenigo
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Maria Carmela Andrisani
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Valentina Vespro
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Cristian Bonelli
- Healthcare Professionals Department, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Amel Amalou
- Center for Interventional Oncology, Radiology and Imaging Sciences, NIH Clinical Center and National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Evrim B Turkbey
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Baris I Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Giuseppe Granata
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda dei Colli, Naples, Italy
| | - Giacomo Grasselli
- Department of Anesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Nino Stocchetti
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Wang W, Vetter C, Czeisler CA, Barger LK. The Association Between Resident Physician Work-Hour Regulations and Physician Safety and Health. Am J Med 2020; 133:e343-e354. [PMID: 32061733 PMCID: PMC7469904 DOI: 10.1016/j.amjmed.2019.12.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/24/2019] [Accepted: 12/28/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety. METHODS All medical students matched to a US residency program from 2002 to 2007 and 2014 to 2017 were invited to participate in prospective cohort studies. Each month participants reported hours of work, extended duration shifts, and adverse safety outcomes, including motor vehicle crashes, percutaneous injuries, and attentional failures. The incidence of each outcome was compared before and after the 2011 ACGME work-hour limit. Hypotheses were tested using generalized linear models adjusted for potential confounders. RESULTS Of all first-year resident physicians nationwide, 13% participated in the study, with 80,266 monthly reports completed by 15,276 first-year resident physicians. Following implementation of the 16-h 2011 ACGME work-hour limit, the mean number of extended duration (≥24-h) shifts per month decreased from 3.9 to 0.2. The risk of motor vehicle crash decreased 24% (relative risk [RR] 0.76; 0.67-0.85), percutaneous injury risk decreased more than 40% (relative risk 0.54; 0.48-0.61), and the rate of attentional failures was reduced 18% (incidence rate ratio [IRR] 0.82; 0.78-0.86). Extended duration shifts and prolonged weekly work hours were associated with an increased risk of adverse safety outcomes independent of cohort. CONCLUSIONS The 2011 ACGME work-hour limit was associated with meaningful improvements in physician safety and health. Surveillance is needed to monitor the ongoing impact of work hours on physician safety, health, and well-being.
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Affiliation(s)
- Matthew D Weaver
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass.
| | - Christopher P Landrigan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass; Department of Medicine, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass
| | - Jason P Sullivan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Conor S O'Brien
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Salim Qadri
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Natalie Viyaran
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Céline Vetter
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Department of Integrative Physiology, University of Colorado, Boulder
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine, Harvard Medical School, Boston, Mass
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Mascha EJ, Schober P, Schefold JC, Stueber F, Luedi MM. Staffing With Disease-Based Epidemiologic Indices May Reduce Shortage of Intensive Care Unit Staff During the COVID-19 Pandemic. Anesth Analg 2020; 131:24-30. [PMID: 32343514 PMCID: PMC7173088 DOI: 10.1213/ane.0000000000004849] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Health care worker (HCW) safety is of pivotal importance during a pandemic such as coronavirus disease 2019 (COVID-19), and employee health and well-being ensure functionality of health care institutions. This is particularly true for an intensive care unit (ICU), where highly specialized staff cannot be readily replaced. In the light of lacking evidence for optimal staffing models in a pandemic, we hypothesized that staff shortage can be reduced when staff scheduling takes the epidemiology of a disease into account. METHODS Various staffing models were constructed, and comprehensive statistical modeling was performed. A typical routine staffing model was defined that assumed full-time employment (40 h/wk) in a 40-bed ICU with a 2:1 patient-to-staff ratio. A pandemic model assumed that staff worked 12-hour shifts for 7 days every other week. Potential in-hospital staff infections were simulated for a total period of 120 days, with a probability of 10%, 25%, and 40% being infected per week when at work. Simulations included the probability of infection at work for a given week, of fatality after infection, and the quarantine time, if infected. RESULTS Pandemic-adjusted staffing significantly reduced workforce shortage, and the effect progressively increased as the probability of infection increased. Maximum effects were observed at week 4 for each infection probability with a 17%, 32%, and 38% staffing reduction for an infection probability of 0.10, 0.25, and 0.40, respectively. CONCLUSIONS Staffing along epidemiologic considerations may reduce HCW shortage by leveling the nadir of affected workforce. Although this requires considerable efforts and commitment of staff, it may be essential in an effort to best maintain staff health and operational functionality of health care facilities and systems.
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Affiliation(s)
- Edward J. Mascha
- From the Departments of Quantitative Health Sciences and Outcomes Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Schober
- Department of Anaesthesiology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frank Stueber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Dunn M, Sheehan M, Hordern J, Turnham HL, Wilkinson D. 'Your country needs you': the ethics of allocating staff to high-risk clinical roles in the management of patients with COVID-19. J Med Ethics 2020; 46:436-440. [PMID: 32409625 PMCID: PMC7246092 DOI: 10.1136/medethics-2020-106284] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 05/30/2023]
Abstract
As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to themselves, and new policies for staff reallocation are causing distress and uncertainty to the professionals concerned. In this paper, we analyse a range of ethical issues associated with changes to staff allocation processes in the face of COVID-19. In line with a dominant view in the medical ethics literature, we claim, first, that no individual health professional has a specific, positive obligation to treat a patient when doing so places that professional at risk of harm, and so there is a clear ethical tension in any reallocation process in this context. Next, we argue that the changing asymmetries of health needs in hospitals means that careful consideration needs to be given to a stepwise process for deallocating staff from their usual duties. We conclude by considering how a justifiable process of reallocating professionals to high-risk clinical roles should be configured once those who are 'fit for reallocation' have been identified. We claim that this process needs to attend to three questions that we consider in detail: (1) how the choice to make reallocation decisions is made, (2) what justifiable models for reallocation might look like and (3) what is owed to those who are reallocated.
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Affiliation(s)
- Michael Dunn
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Mark Sheehan
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Joshua Hordern
- Faculty of Theology and Religion, University of Oxford, Oxford, UK
| | - Helen Lynne Turnham
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Dominic Wilkinson
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, South Australia, Australia
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26
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O'Connor D, Wilderman M, Cao L, Cook K, Ratnathicam A, Simonian G, Napolitano M. Creation of a dedicated line service in the New Jersey epicenter of COVID-19. J Vasc Surg 2020; 72:1159-1160. [PMID: 32603816 PMCID: PMC7320849 DOI: 10.1016/j.jvs.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Affiliation(s)
- David O'Connor
- Division of Vascular and Endovascular Surgery, Department of Surgery, Hackensack University Medical Center, Hackensack, NJ.
| | - Michael Wilderman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Hackensack University Medical Center, Hackensack, NJ
| | - Lifen Cao
- Division of Vascular and Endovascular Surgery, Department of Surgery, Hackensack University Medical Center, Hackensack, NJ
| | - Kristin Cook
- Division of Vascular and Endovascular Surgery, Department of Surgery, Hackensack University Medical Center, Hackensack, NJ
| | - Anjali Ratnathicam
- Division of Vascular and Endovascular Surgery, Department of Surgery, Hackensack University Medical Center, Hackensack, NJ
| | - Gregory Simonian
- Division of Vascular and Endovascular Surgery, Department of Surgery, Hackensack University Medical Center, Hackensack, NJ
| | - Massimo Napolitano
- Division of Vascular and Endovascular Surgery, Department of Surgery, Hackensack University Medical Center, Hackensack, NJ
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27
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Fukuda T, Sakurai H, Kashiwagi M. Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists. PLoS One 2020; 15:e0234879. [PMID: 32542030 PMCID: PMC7295221 DOI: 10.1371/journal.pone.0234879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/03/2020] [Indexed: 11/18/2022] Open
Abstract
Certified Nurse Specialists (CNS) are advanced practice nurses that often play a role in management. This study aims to investigate whether cooperation between CNSs in the position of Intensive Care Unit (ICU) head nurse and intensivists change the length of stay for ICU patients. A single centered retrospective cohort study design was followed. A multivariable regression analysis was performed to determine whether there is a difference in patients’ length of ICU stay for two years before and after CNS as ICU head nurse and an intensivist started collaborating. The patients’ diagnosis, age, gender, scheduled/emergency admission, surgical history, length of ICU stay, usage of ventilator, and details of ICU treatment were collected from the institution’s electronic medical records. During the study period (April 2015 to March 2019), 3,135 patients were admitted to ICU, with 1,471 in the before collaboration group and 1,664 in the after-collaboration group. Collaboration between the CNS as head nurse and intensivists was significantly associated with shorter length of ICU stay (coefficient -0.03 [95% CI, -0.05–0.01], p < 0.001, t-statistic -3.29). Our main finding illustrates that in low-intensity ICUs, collaboration between CNSs as head nurses and intensivists may reduce patients’ length of ICU stay.
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Affiliation(s)
- Tomohide Fukuda
- Faculty of Nursing, Kyoritsu Women’s University, Tokyo, Japan
- * E-mail:
| | - Hironori Sakurai
- Department of Anesthesiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masanori Kashiwagi
- Department of Anesthesiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
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28
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Kester KM. A multifaceted approach to tackling nurse turnover. Nurs Manag (Harrow) 2020; 51:22-28. [PMID: 32472856 DOI: 10.1097/01.numa.0000662652.32499.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Kelly M Kester
- Kelly M. Kester is the heart services clinical operations director at Duke University Hospital in Durham, N.C
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30
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Buchan J, Campbell J, McCarthy C. Research to support evidence-informed decisions on optimizing the contributions of nursing and midwifery workforces. Hum Resour Health 2020; 18:23. [PMID: 32197652 PMCID: PMC7082898 DOI: 10.1186/s12960-020-0459-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- James Buchan
- Human Resources for Health, BMC, London, United Kingdom
- University of Technology, Sydney, Australia
| | - James Campbell
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Carey McCarthy
- Health Workforce Department, World Health Organization, Geneva, Switzerland
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31
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Bates RE, Kesselring GM, Breunig MJ, Rieck KM. Overnight cross-coverage on hospital medicine services: perceived workload based on patient census, pager volumes, and patient acuity. Hosp Pract (1995) 2020; 48:108-112. [PMID: 32160480 DOI: 10.1080/21548331.2020.1741951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/10/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Little is understood about what contributes to perceived workload for those providing overnight coverage to hospitalized patients overnight, which limits the ability to modify these factors or to proactively identify appropriate staffing levels. The objective of this study is to understand the major contributors to perceived overnight cross-coverage workload. METHODS Cross-covering advanced practice providers (APPs) in a large academic hospitalist group completed the National Aeronautics and Space Administration Task Load Index (NASA-TLX) at the end of each night shift. Other shift characteristics were collected, including patient load, assigned action items, watcher/unstable patients, newly admitted patients, number of units covered, total pages, peak pager density, rapid response team (RRT) activations, and intensive care unit (ICU) transfers. RESULTS For 14 APP participants, who completed 271 post-shift surveys, the mean (SD) patient load was 49.9 (6.4) patients per night, and providers received a mean (SD) of 40.8 (13.7) total pages per shift. Mean (SD) NASA-TLX score was 35.1 (19.0). In multivariate modeling, total pages, action items, and any RRT or ICU transfer were associated with significant increases in the mean NASA-TLX score, with estimated effect sizes of 0.5, 0.8, and 14.3, respectively, per 1-unit increase in each shift characteristic. The greatest cumulative contributor to perceived workload was total number of pages, followed by the presence of any RRT activation/ICU transfer, with estimated effect sizes of 20.4 and 14.9, respectively. CONCLUSIONS Total number of pages was the greatest contributor to perceived workload. This study suggests that quality improvement initiatives designed to improve pager communication may considerably improve provider-perceived workload.
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Affiliation(s)
- Ruth E Bates
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
| | - Gina M Kesselring
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
| | - Michael J Breunig
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
| | - Katie M Rieck
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
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Stone PW, Agarwal M, Pogorzelska-Maziarz M. Infection preventionist staffing in nursing homes. Am J Infect Control 2020; 48:330-332. [PMID: 31911068 DOI: 10.1016/j.ajic.2019.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/16/2022]
Abstract
Infection preventionist (IP) staffing in nursing homes (NHs) is now required as part of new federal regulations. In this study, we examined IP staffing changes from 2014 to 2018 and found relatively few changes over time. IP staffing in NHs remains low but does vary between for profit and non-profit facilities.
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Affiliation(s)
| | - Mansi Agarwal
- Columbia University School of Nursing, New York, NY.
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33
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Babapour Chafi M, Harder M, Bodin Danielsson C. Workspace preferences and non-preferences in Activity-based Flexible Offices: Two case studies. Appl Ergon 2020; 83:102971. [PMID: 31778864 DOI: 10.1016/j.apergo.2019.102971] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/22/2019] [Accepted: 10/01/2019] [Indexed: 06/10/2023]
Abstract
Activity-based Flexible Offices (AFOs) are innovations in workspace design that are being increasingly implemented in organisations. While most studies investigate satisfaction and perceived work support in AFOs, employees' workspace preferences are not addressed in the literature. The aims of this study were to (i) identify workspace preferences and non-preferences in AFOs, and (ii) investigate whether employees' workstation choices support their activities and align with their preferences. Two Swedish municipalities participated in the study. Data collection involved 27 semi-structured interviews and annotations on architectural drawings. The results showed that the interviewees preferred workstations that were both desirable and functional, and avoided workstations that were undesirable. This was due to functional, social, emotional and symbolic aspects of the workspaces as well as their physical structure and stimuli. The approach used in this paper can be adopted for improving the design of AFOs, thereby mitigating the stress of finding a suitable workstation.
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Affiliation(s)
- Maral Babapour Chafi
- Division Design & Human Factors, Chalmers University of Technology, Hörsalsvägen 5-7, SE-412 96, Gothenburg, Sweden.
| | - Mette Harder
- Umeå School of Architecture, Arkitekhögskolan, Umeå Universitet, Östra Strandgatan 30c, SE-90187, Umeå, Sweden.
| | - Christina Bodin Danielsson
- KTH School of Architecture, The Royal Institute of Technology (KTH), Osquars backe 9, SE-100 44, Stockholm, Sweden.
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Shen Y, Jian W, Zhu Q, Li W, Shang W, Yao L. Nurse staffing in large general hospitals in China: an observational study. Hum Resour Health 2020; 18:3. [PMID: 31952532 PMCID: PMC6969396 DOI: 10.1186/s12960-020-0446-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 01/09/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND The appropriate staffing of nurses not only reflects the situation of nursing management of human resource, but also is related to the nursing quality in hospitals. This study investigated the staffing of nurses in large general hospitals in China. METHODS In this study, a database established by the National Centre for Nursing Care Quality Control, which conducted a national survey of the staffing of nurses in China mainland in 2017, was analysed. The time-point survey data of 20 375 departments in 668 large general hospitals in China were obtained, including the information of nurses and patients during the day (10:00 am) and at night (10:00 pm). Then, the staffing of nurses was evaluated by calculating the nurse to patient ratio (the average number of patients assigned to a nurse, NTP ratio). The Kruskal-Wallis test was performed to compare the NTP ratios during the day and at night among different regions and departments. RESULTS In large general hospitals, a nurse takes care of eight patients (NTP ratio = 1:8.0) during the day and 23 patients at night (NTP ratio = 1:23) on average. There were significant differences between day and night. In terms of different regions, a nurse in the hospitals in the western region takes care of 7.8 patients during the day (NTP ratio = 1:7.8) on average, and the nursing resource in the western region is more adequate than that in the eastern (1:8.0) and central (1:8.0) regions. At night, the eastern region has a higher level of NTP (1:23.0). In terms of departments, a nurse working in the ICU takes care of two patients during the day (NTP ratio = 1:2.0) and 2.9 patients at night (NTP ratio = 1:2.9). The level of NTP in the oncology department is relatively higher: 9.3 during the day and 34.0 at night. Other departments including internal medicine, surgery, obstetrics and gynaecology, paediatrics, and geriatrics have NTP ratios of 1:7-8 during the day and 1:18-25 at night. CONCLUSIONS In China, the nurse staffing of large general hospitals has some regional and departmental patterns. The low level of nurse staffing at night may be a problem worthy of attention; the Chinese government needs to establish standards for different periods and departments to improve efficiency and quality of nursing.
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Affiliation(s)
- Yuchi Shen
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Weiyan Jian
- School of Public Health, Peking University Health Science Center, Beijing, China
- Center for Health Policy and Technology Evaluation, Peking University Health Science Center, Beijing, China
| | - Qiufen Zhu
- ZhongWei Institute of Nursing Information, Beijing, China
| | - Wei Li
- Nursing Center, National Institute of Hospital Administration, Beijing, China
| | - Wenhan Shang
- Nursing Center, National Institute of Hospital Administration, Beijing, China
| | - Li Yao
- Nursing Center, National Institute of Hospital Administration, Beijing, China
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Pearce AP, Marsden MER, Newell N, Hancorn K, Lecky F, Brohi K, Tai N. Trends in admission timing and mechanism of injury can be used to improve general surgical trauma training. Ann R Coll Surg Engl 2020; 102:36-42. [PMID: 31660752 PMCID: PMC6937604 DOI: 10.1308/rcsann.2019.0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The temporal patterns and unit-based distributions of trauma patients requiring surgical intervention are poorly described in the UK. We describe the distribution of trauma patients in the UK and assess whether changes in working patterns could provide greater exposure for operative trauma training. METHODS We searched the Trauma Audit and Research Network database to identify all patients between 1 January 2014 to 31 December 2016. Operative cases were defined as all patients who underwent laparotomy, thoracotomy or open vascular intervention. We assessed time of arrival, correlations between mechanism of injury and surgery, and the effect of changing shift patterns on exposure to trauma patients by reference to a standard 10-hour shift assuming a dedicated trauma rotation or fellowship. RESULTS There were 159,719 patients from 194 hospitals submitted to the Network between 2014 and 2016. The busiest 20 centres accounted for 57,568 (36.0%) of cases in total. Of these 2147/57,568 patients (3.7%) required a general surgical operation; 43% of penetrating admissions (925 cases) and 2.2% of blunt admissions (1222 cases). The number of operations correlated more closely with the number of penetrating rather than blunt admissions (r = 0.89 vs r = 0.51). A diurnal pattern in trauma admissions enabled significant increases in trauma exposure with later start times. CONCLUSIONS Centres with high volume and high penetrating rates are likely to require more general surgical input and should be identified as locations for operative trauma training. It is possible to improve the number of trauma patients seen in a shift by optimising shift start time.
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Affiliation(s)
- AP Pearce
- Department of General Surgery, Royal London Hospital, Barts’ Health NHS Trust, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - MER Marsden
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Centre for Trauma Sciences, Queen Mary University of London, UK
| | - N Newell
- Department of Mechanical Engineering, Imperial College, London, UK
| | - K Hancorn
- Department of General Surgery, Royal London Hospital, Barts’ Health NHS Trust, London, UK
| | - F Lecky
- Trauma and Audit Research Network, University of Manchester, UK
| | - K Brohi
- Department of General Surgery, Royal London Hospital, Barts’ Health NHS Trust, London, UK
- Centre for Trauma Sciences, Queen Mary University of London, UK
| | - N Tai
- Department of General Surgery, Royal London Hospital, Barts’ Health NHS Trust, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
- Centre for Trauma Sciences, Queen Mary University of London, UK
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Schwartz LS. Addressing Home Healthcare Staffing Challenges Through Geo-Intelligent Scheduling. Home Healthc Now 2020; 38:307-310. [PMID: 33165100 DOI: 10.1097/nhh.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Industries that face challenges in staffing and scheduling have successfully addressed these issues through the implementation of intraday staffing automation. Home healthcare, however, introduces an additional dimension: location-specifically, efficiently scheduling the appropriate healthcare worker based on their projected location at a given time with the location of a patient who needs care. Geo-Intelligent Scheduling has the potential to effectively address the unique staffing/scheduling challenges in home healthcare: the ability to get the right clinician to the right patient at the right location at the right time by taking into account the real-time location of the patient and clinician throughout the day. Geo-Intelligent Scheduling also has the potential to automatically create route-optimized intraday schedules for clinicians and increase effective staffing capacity by over 16% with no additional labor cost. Finally, Geo-Intelligent Scheduling can potentially improve appointment-time adherence, automate Electronic Visit Verification compliance, enhance patient/clinician communication, and improve employee retention through self-scheduling empowerment.
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Albrecht SC, Leineweber C, Ojajärvi A, Oksanen T, Kecklund G, Härmä M. Association of work-time control with sickness absence due to musculoskeletal and mental disorders: An occupational cohort study. J Occup Health 2020; 62:e12181. [PMID: 33314546 PMCID: PMC7733664 DOI: 10.1002/1348-9585.12181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 09/28/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Work-time control is associated with lower sickness absence rates, but it remains unclear whether this association differs by type of diagnosis and sub-dimension of work-time control (control over daily hours and control over time off) and whether certain vulnerable groups benefit more from higher levels of work-time control. METHODS Survey data from the Finnish 10-town study in 2004 were used to examine if baseline levels of work-time control were associated with register data on diagnose-specific sickness absence for 7 consecutive years (n = 22 599). Cox proportional hazard models were conducted, adjusted for age, sex, education, occupational status, shift work including nights, and physical/mental workload. RESULTS During follow-up, 2,818 individuals were on sick leave (≥10 days) due to musculoskeletal disorders and 1724 due to mental disorders. Employees with high (HR = 0.80, 95% CI 0.74-0.87; HR = 0.76, 95% CI 0.70-0.82, respectively) and moderate (HR = 0.83, 95% CI 0.77-0.90; HR = 0.85, 95% CI 0.79-0.91, respectively) levels of control over daily hours/control over time off had a decreased risk of sickness absence due to musculoskeletal disorders. Sub-group analyses revealed that especially workers who were older benefitted the most from higher levels of work-time control. Neither sub-dimension of work-time control was related to sickness absence due to mental disorders. CONCLUSIONS Over a 7-year period of follow-up, high and moderate levels of work-time control were related to lower rates of sickness absence due to musculoskeletal disorders, but not due to mental disorders.
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Affiliation(s)
| | - Constanze Leineweber
- Stress Research InstituteDepartment of PsychologyStockholm UniversityStockholmSweden
| | | | - Tuula Oksanen
- Finnish Institute of Occupational HealthHelsinkiFinland
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
| | - Goran Kecklund
- Stress Research InstituteDepartment of PsychologyStockholm UniversityStockholmSweden
| | - Mikko Härmä
- Finnish Institute of Occupational HealthHelsinkiFinland
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Ibáñez-Romaguera JM, Estrada-Cuxart O. [Strategic alliances: Make the need virtue]. J Healthc Qual Res 2019; 34:337-338. [PMID: 31787221 DOI: 10.1016/j.jhqr.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/26/2019] [Indexed: 06/10/2023]
Affiliation(s)
| | - O Estrada-Cuxart
- Gerencia Territorial Metropolitana Norte, Institut Català de la Salut, Badalona, España
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Boerger JA, LaCross E, Custer H, Powers J. The Emeritus Nurse: Retired, Rehired, and Revolutionary. J Nurs Adm 2019; 49:538-542. [PMID: 31651613 DOI: 10.1097/nna.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A strong culture rooted in excellent nursing practice is essential to the future success of healthcare organizations. Nursing leaders face the challenge of establishing and retaining this culture with the exodus of nursing knowledge and clinical reasoning expertise from retirements of experienced nurses. This article presents a novel plan to mitigate this looming problem by rehiring and reengaging recently retired nurses to return to practice for an emeritus RN program.
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Affiliation(s)
- Judith A Boerger
- Author Affiliations: Senior Vice President and Chief Nursing Executive (Ms Boerger), Chief Nursing Officer (Dr LaCross), Human Resources Director (Ms Custer), and Director of Nursing Research and Professional Practice (Dr Powers), Parkview Health System, Fort Wayne, Indiana
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Duffield C, Twigg D, Roche M, Williams A, Wise S. Uncovering the Disconnect Between Nursing Workforce Policy Intentions, Implementation, and Outcomes: Lessons Learned From the Addition of a Nursing Assistant Role. Policy Polit Nurs Pract 2019; 20:228-238. [PMID: 31615328 DOI: 10.1177/1527154419877571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The use of nursing assistants has increased across health systems in the past 20 years, to alleviate licensed nurses' workload and to meet rising health care demands at lower costs. Evidence suggests that, when used as a substitute for licensed nurses, assistants are associated with poorer patient and nurse outcomes. Our multimethods study evaluated the impact of a policy to add nursing assistants to existing nurse staffing in Western Australia's public hospitals, on a range of outcomes. In this article, we draw the metainferences from previously published quantitative data and unpublished qualitative interview data. A longitudinal analysis of patient records found significantly higher rates adverse patient outcomes on wards that introduced nursing assistants compared with wards that did not. These findings are explained with ward-level data that show nursing assistants were added to wards with preexisting workload and staffing problems and that those problems persisted despite the additional resources. There were also problems integrating assistants into the nursing team, due to ad hoc role assignments and variability in assistants' knowledge and skills. The disconnect between policy intention and outcomes reflects a top-down approach to role implementation where assistants were presented as a solution to nurses' workload problems, without an understanding of the causes of those problems. We conclude that policy makers and managers must better understand individual care environments to ensure any new roles are properly tailored to patient and staff needs. Further, standardized training and accreditation for nursing assistant roles would reduce the supervisory burden on licensed nurses.
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Affiliation(s)
- Christine Duffield
- Nursing and Health Services Management, Faculty of Health, University of Technology Sydney, Australia
- School of Nursing and Midwifery, Edith Cowan University, Australia
| | - Di Twigg
- School of Nursing and Midwifery, Edith Cowan University, Australia
| | - Michael Roche
- Health Services Management and Mental Health Nursing, Faculty of Health, University of Technology Sydney, Australia
| | - Anne Williams
- College of Science, Health, Engineering and Education, Murdoch University, Western Australia
| | - Sarah Wise
- Centre for Health Economics Research and Evaluation, UTS Business School, University of Technology Sydney, Australia
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41
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Lee M. Learning by Doing: Preserving the Quality of Graduate Medical Education in an Era of Work Hour Restrictions. J Grad Med Educ 2019; 11:507-508. [PMID: 31636816 PMCID: PMC6795321 DOI: 10.4300/jgme-d-19-00132.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Morgan AB. Using Contingent Medical Librarians to Address Workforce Staffing Dilemmas. Med Ref Serv Q 2019; 38:376-386. [PMID: 31687906 DOI: 10.1080/02763869.2019.1657732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Experienced medical librarians have been recruited by Mayo Clinic to provide contingency staffing. Functioning as just-in-time librarians, a nontraditional staffing plan was introduced in 2016 to affordably lessen stressors caused by fluctuating demands for library services such as literature searching. Contingent medical librarians were also needed to provide staffing coverage during the absences of existing full-time librarians, particularly Mayo's librarians employed as solo librarians working in hospital and smaller academic libraries. A four-year, nontraditional staffing plan which incorporates contingent medical librarians has proved to be a helpful, affordable, and sustainable staffing alternative for the libraries at Mayo Clinic.
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Affiliation(s)
- Anna Beth Morgan
- Mayo Clinic Libraries and Historical Units, Rochester, Minnesota, USA
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43
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Lamprecht J, Kolisch R, Pförringer D. The impact of medical documentation assistants on process performance measures in a surgical emergency department. Eur J Med Res 2019; 24:31. [PMID: 31492198 PMCID: PMC6729055 DOI: 10.1186/s40001-019-0390-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The administrative work of physicians, particularly documentation effort, consumes considerable time in surgical emergency departments. At the same time, the latter face an ever-growing influx of patients, leading to increasing waiting and flow times and thus patient dissatisfaction as well as overload of physicians and nurses. The deployment of medical documentation assistants, who specialize in and undertake documentation work currently performed by physicians, poses a solution to the problem. The goal of this study is to assess the impact of deploying medical documentation assistants on key performance indicators of a surgical emergency department, i.e. waiting and flow times of patients differentiated according to triage categories, utilization of physicians and time allocation of physicians. METHODS The underlying study has analysed the processes of the surgical emergency department of a major university medical centre and modelled them in a discrete event simulation. Data on patient arrivals as well as processing times in the X-ray department and the laboratory were obtained from the clinical information system, while processing times in the emergency department were recorded using time-motion studies. Though the emergency department currently does not deploy medical documentation assistants, the simulation model includes a variable number of such assistants. RESULTS The deployment of a medical documentation assistant frees up physician working time and decreases the waiting time and consequently the flow time of patients, in particular for standard and non-urgent patients. Adding additional documentation assistants leads to further improvements, however, with diminishing marginal returns. Under the assumption of medical documentation assistants being 35% more efficient than physicians in undertaking documentation work, one of the three physicians can be replaced in the analysed surgical emergency department with an average of 502 patient arrivals per week. CONCLUSIONS Medical documentation assistants are a viable way of improving the performance of surgical emergency departments. Depending on the goals of the hospital, medical documentation assistants can be used for an array of measures such as decreasing patients' waiting and flow times or increasing physicians' time spent on medical treatment.
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Affiliation(s)
- Johannes Lamprecht
- TUM School of Management, Technische Universität München, Arcisstr. 21, 80333 Munich, Germany
| | - Rainer Kolisch
- TUM School of Management, Technische Universität München, Arcisstr. 21, 80333 Munich, Germany
| | - Dominik Pförringer
- Klinikum Rechts der Isar, Technische Universität München, Klinik und Poliklinik für Unfallchirurgie, Ismaningerstr. 22, 81675 Munich, Germany
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Tan BYQ, Ngiam NJ, Chang ZY, Tan SMY, Shen X, Mok SF, Subramanian S, Ooi SBS, Kee ACL. Perceptions of a night float system for intern doctors in an internal medicine program: an Asian perspective. Korean J Med Educ 2019; 31:271-276. [PMID: 31455056 PMCID: PMC6715894 DOI: 10.3946/kjme.2019.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/14/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
Long duty hours have been associated with significant medical errors, adverse events, and physician "burn-out". An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors' perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician "burn-out" (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician "burn-out".
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Affiliation(s)
| | | | - Zi Yun Chang
- Department of Medicine, National University Health System, Singapore
| | | | - Xiayan Shen
- Department of Medicine, National University Health System, Singapore
| | - Shao Feng Mok
- Department of Medicine, National University Health System, Singapore
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45
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Yeung E. How to fix doctors' rotas: vacation policies and mutual respect. BMJ 2019; 366:l5049. [PMID: 31399445 DOI: 10.1136/bmj.l5049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Eugene Yeung
- Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
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Peate I. Staffing: the biggest challenge. Br J Nurs 2019; 28:961. [PMID: 31393773 DOI: 10.12968/bjon.2019.28.15.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Ian Peate
- Editor in Chief, British Journal of Nursing
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47
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Eaton B, O'Meara L, Herrera AV, Tesoriero R, Diaz J, Bruns B. Service-Based Advanced Practice Providers: The Surgeon's Perspective. Am Surg 2019; 85:747-751. [PMID: 31405421 PMCID: PMC6995346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.
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Bastien MF, Corbière M. Return-to-Work Following Depression: What Work Accommodations Do Employers and Human Resources Directors Put in Place? J Occup Rehabil 2019; 29:423-432. [PMID: 30039312 DOI: 10.1007/s10926-018-9801-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The magnitude of economic and social costs related to common mental disorders has a profound impact on the workplace. Returning to work following depression is, therefore, a major issue for all stakeholders involved (employee, employer, human resources director, union, physician, etc.). Considering their role in the organization, Human Resources Directors (HRD) and employers have a decisive impact on the return-to-work (RTW) process. Purpose This study aims to determine which RTW accommodations are implemented, following depression, by one of the central stakeholders: HRD and employers. Methods 219 HRD/employers participated in a semi-structured telephone interview about RTW of employees after depression. From that interview, the question related to this article was: Do you put in place work accommodations for employees after a sick leave due to depression (yes or no)? If their response was positive, we asked: If yes, what were the work accommodations? Results 170 HRD/employers specified accommodations. The most common categories identified were related to: work schedule, task modifications, job change and work environment change. Accommodations directly related to the employee or the colleagues were considerably less mentioned and those concerning other RTW stakeholders, including supervisor, were almost absent. Conclusion Our results suggest that accommodations directly related to work aspects seemed to predominate in our sample of HRD/employers when an employee returned-to-work following depression. The relational aspect and the involvement of the different stakeholders are also not prioritized to accommodate the RTW. These results contrast with employer best practice guidelines for the RTW of workers with common mental disorders.
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Affiliation(s)
- Marie-France Bastien
- Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montreal, QC, H3C 3P8, Canada
| | - Marc Corbière
- Education - Career Counselling Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
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Fogerty RL, Cabie M, Doyle D, Brien P, Beley P, Jansen L, Stump L, Gaffney J, Ferencz KW, Lourenco C, Cushing W, Williams E, Marseglia J, Martinello RA, Morris V. Conversion of a Conference Room into a Low-Acuity Inpatient Medical Unit: A Creative Response to Influenza-Related Surge. Jt Comm J Qual Patient Saf 2019; 45:524-529. [PMID: 31164262 DOI: 10.1016/j.jcjq.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/15/2022]
Abstract
The 2017-2018 influenza season was associated with high demand for both emergency department (ED) care and inpatient acute care for influenza-like illness (ILI). This high demand resulted in increased numbers of inpatients and ED patients, including prolonged ED length of stay. A large, urban, academic medical center in a cold-weather region was limited in its ability to expand its footprint to create de novo locations of care, such as temporary outbuildings or tents. As such, a large conference room was rapidly converted and placed in service as a temporary inpatient unit for adults requiring inpatient admission. LOGISTICS AND IMPLEMENTATION: The logistical, infection prevention, safety, information technology, staffing, and other concerns of creating a clinical environment during a high demand scenario is challenging. However, the lessons learned in this study are reproducible despite the complexity of this issue. CONCLUSION: This is believed to be the first published account of successful conversion of a nonclinical area to an operational clinical unit in response to a surge in demand for hospital care and admission. This may be a valid option for hospitals of all sizes as part of a surge or disaster plan.
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Abstract
Public reporting is a tactic that hospitals and other health care facilities use to provide data such as outcomes to clinicians, patients, and payers. Although inadequate registered nurse (RN) staffing has been linked to poor patient outcomes, only eight states in the United States publicly report staffing ratios-five mandated by legislation and the other three electively. We examine nurse staffing trends after the New Jersey (NJ) legislature and governor enacted P.L.1971, c.136 (C.26:2 H-13) on January 24, 2005, mandating that all health care facilities compile, post, and report staffing information. We conduct a secondary analysis of reported data from the State of NJ Department of Health on 73 hospitals in 2008 to 2009 and 72 hospitals in 2010 to 2015. The first aim was to determine if NJ hospitals complied with legislation, and the second was to identify staffing trends postlegislation. On the reports, staffing was operationalized as the number of patients per RN per quarters. We obtained 30 quarterly reports for 2008 through 2015 and cross-checked these reports for data accuracy on the NJ Department of Health website. From these data, we created a longitudinal data set of 13 inpatient units for each hospital (14,158 observations) and merged these data with American Hospital Association Annual Survey data. The number of patients per RN decreased for 10 specialties, and the American Hospital Association data demonstrate a similar trend. Although the number of patients does not account for patient acuity, the decrease in the patients per RN over 7 years indicated the importance of public reporting in improving patient safety.
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Affiliation(s)
- Pamela B. de Cordova
- Rutgers, the State University School of Nursing, Faculty Researcher for the New Jersey Collaborating Center, Newark, NJ, USA
| | - Jeannette Rogowski
- Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, USA
| | - Kathryn A. Riman
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Matthew D. McHugh
- Nursing Education, Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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