B. X. Lum, Hubert M. Tay, Rachel X. Phang, Steven B. Tan, E. H. Liu
Background: Healthcare systems have to prepare for climate change’s health impact, while reducing healthcare’s contribution to global warming. Most evaluations of healthcare’s greenhouse gas emissions involve national level methodologies.Objective: As sustainability metrics become a key factor in hospital management, the paper describes a method for quantifying emissions at a large tertiary care hospital in Singapore.Methods: Hospital operational and financial data was used to determine the greenhouse gas effect of the hospital. Emission factors from government and academic sources were used for on-site and purchased energy emissions. Spend based emission factors from the environmentally-extended multiregional input-output (EE-MRIO) Eora database were used for other indirect emissions. This provided the total carbon footprint across the various scopes.Results:The hospital had an annual carbon footprint of 245,962 tonnes of carbon dioxide equivalents (CO2e). Scope 1 emissions accounted for 4,223 tonnes of CO2e, scope 2 for 38,380 tonnes of CO2e and scope 3 for 165,190 tonnes of CO2e. Operating carbon totalled 207,793 tonnes of CO2e, and 38,169 tonnes of scope 3 CO2e was attributed to capital expenditure projects. Medical equipment, pharmaceutical supplies and electricity were the largest contributors to the hospital’s carbon footprint.Conclusions: Identifying key areas contributing to emissions can enable targeted approaches in reducing a hospital’s carbon footprint, better preparing the hospital as the carbon economy evolves to include the healthcare sector.
{"title":"Evaluating a hospital’s carbon footprint – A method using energy, materials and financial data","authors":"B. X. Lum, Hubert M. Tay, Rachel X. Phang, Steven B. Tan, E. H. Liu","doi":"10.5430/jha.v11n2p33","DOIUrl":"https://doi.org/10.5430/jha.v11n2p33","url":null,"abstract":"Background: Healthcare systems have to prepare for climate change’s health impact, while reducing healthcare’s contribution to global warming. Most evaluations of healthcare’s greenhouse gas emissions involve national level methodologies.Objective: As sustainability metrics become a key factor in hospital management, the paper describes a method for quantifying emissions at a large tertiary care hospital in Singapore.Methods: Hospital operational and financial data was used to determine the greenhouse gas effect of the hospital. Emission factors from government and academic sources were used for on-site and purchased energy emissions. Spend based emission factors from the environmentally-extended multiregional input-output (EE-MRIO) Eora database were used for other indirect emissions. This provided the total carbon footprint across the various scopes.Results:The hospital had an annual carbon footprint of 245,962 tonnes of carbon dioxide equivalents (CO2e). Scope 1 emissions accounted for 4,223 tonnes of CO2e, scope 2 for 38,380 tonnes of CO2e and scope 3 for 165,190 tonnes of CO2e. Operating carbon totalled 207,793 tonnes of CO2e, and 38,169 tonnes of scope 3 CO2e was attributed to capital expenditure projects. Medical equipment, pharmaceutical supplies and electricity were the largest contributors to the hospital’s carbon footprint.Conclusions: Identifying key areas contributing to emissions can enable targeted approaches in reducing a hospital’s carbon footprint, better preparing the hospital as the carbon economy evolves to include the healthcare sector.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85499588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. P. Makoutodé, T. Nougbode, C. Sossa-Jérôme, G. Sopoh
Objective: Constant availability of inpatient beds in an intensive care unit (ICU) is part of the resilience of health systems, especially in an emergency context, namely in public health. This study aims to appraise the management of inpatient waiting lines in the ICU of Hubert Koutoukou Maga National Hospital and University Center (CNHU-HKM) in Benin, in March-April 2022.Methods: This was an analytic cross-sectional study of inpatients or their relatives and staff, selected by convenience and reasoned choice, respectively, carried out from March 21 to April 15, 2022. Logistic regression was used to identify associated factors with queues management.Results: Altogether 55 patients were surveyed. On a daily basis, 13 ± 1 patients were hospitalized in 18 functional beds for 3 ± 1 admissions and 3 ± 1 discharges. The average bed occupancy rate was 89.8% ± 3.8%; the average waiting time before patient care was 3.6 ± 1.2 minutes and the traffic intensity were 0.03. Per hour, the odds of having a patient were 33.29%, with a 97% chance of a bed being occupied. The probability that an admitted patient would spend a whole week there was 37%. Only patient arrival flow was significantly associated with insufficient queuing management. There was also a lack of inpatient beds and technical boards. The construction of two wards and the installation of seven additional beds could improve queues management.Conclusions: The management of AF in our study site depends mainly on the daily flow of arriving patients, but also on the number of available hospital beds, the working organization and the existing technical and structural measures. Addressing these parameters will significantly improve the situation.
{"title":"Queuing management study at the Multidisciplinary Anesthesia and Intensive Care Clinic of CNHU-HKM in April 2022","authors":"C. P. Makoutodé, T. Nougbode, C. Sossa-Jérôme, G. Sopoh","doi":"10.5430/jha.v11n2p25","DOIUrl":"https://doi.org/10.5430/jha.v11n2p25","url":null,"abstract":"Objective: Constant availability of inpatient beds in an intensive care unit (ICU) is part of the resilience of health systems, especially in an emergency context, namely in public health. This study aims to appraise the management of inpatient waiting lines in the ICU of Hubert Koutoukou Maga National Hospital and University Center (CNHU-HKM) in Benin, in March-April 2022.Methods: This was an analytic cross-sectional study of inpatients or their relatives and staff, selected by convenience and reasoned choice, respectively, carried out from March 21 to April 15, 2022. Logistic regression was used to identify associated factors with queues management.Results: Altogether 55 patients were surveyed. On a daily basis, 13 ± 1 patients were hospitalized in 18 functional beds for 3 ± 1 admissions and 3 ± 1 discharges. The average bed occupancy rate was 89.8% ± 3.8%; the average waiting time before patient care was 3.6 ± 1.2 minutes and the traffic intensity were 0.03. Per hour, the odds of having a patient were 33.29%, with a 97% chance of a bed being occupied. The probability that an admitted patient would spend a whole week there was 37%. Only patient arrival flow was significantly associated with insufficient queuing management. There was also a lack of inpatient beds and technical boards. The construction of two wards and the installation of seven additional beds could improve queues management.Conclusions: The management of AF in our study site depends mainly on the daily flow of arriving patients, but also on the number of available hospital beds, the working organization and the existing technical and structural measures. Addressing these parameters will significantly improve the situation.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75483307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Malcolm Su, L. Leonard, David Marchant, Jeniann A. Yi, E. Cumbler, R. Meguid, J. Kutner, K. Colborn, Brent Rikhoff, S. Tevis
Objective: Inaccuracies in Current Procedural Terminology (CPT) coding entries for surgical procedures have a profound impact on hospital systems and surgeon compensation for services. We sought to characterize the variations of surgical CPT entry at a multi-site academic medical center and estimate the financial burden implicated by improper code entry.Methods: A mixed methods study was conducted to evaluate variations in CPT entry across an academic center. Semi-structured interviews with 8 surgical schedulers were conducted and analyzed to understand the current scheduling process. Coding data for surgical procedures performed within a 31-day period during September and October 2020 within the large healthcare system were assessed for appropriate CPT code entry. Reimbursement for the 2020 fiscal year was then analyzed to determine the impact of pre-operative CPT code accuracy on reimbursements and denials.Results: Interviews revealed a lack of standardization in the surgical scheduling process across the hospital system. Lack of standardized onboarding and variations in workflow contributed to difficult cross coverage for schedulers and errors in CPT entry. On quantitative analysis, the accuracy of pre-operative CPT code entry was poor with only 59.3% of pre-operative CPT code entries being correct. In the 2020 fiscal year, $5.4 million was lost due to problems related to CPT code entry.Conclusions: Variations and lack of standardization in CPT code entry can greatly contribute to financial losses and disrupt surgical scheduling. Standardization of workflow and CPT entry schemes can help minimize scheduling complications and enhance the quality of care provided to patients.
{"title":"Implications of Current Procedural Terminology code accuracy on surgical workflow and financial reimbursement","authors":"Malcolm Su, L. Leonard, David Marchant, Jeniann A. Yi, E. Cumbler, R. Meguid, J. Kutner, K. Colborn, Brent Rikhoff, S. Tevis","doi":"10.5430/jha.v11n2p18","DOIUrl":"https://doi.org/10.5430/jha.v11n2p18","url":null,"abstract":"Objective: Inaccuracies in Current Procedural Terminology (CPT) coding entries for surgical procedures have a profound impact on hospital systems and surgeon compensation for services. We sought to characterize the variations of surgical CPT entry at a multi-site academic medical center and estimate the financial burden implicated by improper code entry.Methods: A mixed methods study was conducted to evaluate variations in CPT entry across an academic center. Semi-structured interviews with 8 surgical schedulers were conducted and analyzed to understand the current scheduling process. Coding data for surgical procedures performed within a 31-day period during September and October 2020 within the large healthcare system were assessed for appropriate CPT code entry. Reimbursement for the 2020 fiscal year was then analyzed to determine the impact of pre-operative CPT code accuracy on reimbursements and denials.Results: Interviews revealed a lack of standardization in the surgical scheduling process across the hospital system. Lack of standardized onboarding and variations in workflow contributed to difficult cross coverage for schedulers and errors in CPT entry. On quantitative analysis, the accuracy of pre-operative CPT code entry was poor with only 59.3% of pre-operative CPT code entries being correct. In the 2020 fiscal year, $5.4 million was lost due to problems related to CPT code entry.Conclusions: Variations and lack of standardization in CPT code entry can greatly contribute to financial losses and disrupt surgical scheduling. Standardization of workflow and CPT entry schemes can help minimize scheduling complications and enhance the quality of care provided to patients.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90673644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Turner, Jerneja Sveticic, D. Grice, M. Welch, Catherine King, Jennifer L. Panther, Claire Strivens, Brad Whitfield, Geoffrey Norman, A. Almeida-Crasto, Tamirin Darch, Nicolas J. C. Stapelberg, S. Dekker
Objective: Matching safety and quality improvements to the complexity of healthcare, Gold Coast Mental Health and Specialist Services implemented a new response to clinical incidents: the Gold Coast Clinical Incident Response Framework (GC-CIRF). It utilises a Restorative Just Culture (RJC) framework and Safety II principles. This paper evaluates its impact.Methods: Staff surveys measured perceptions of just culture and second victim experiences. Quality of recommendations were compared before and after implementation. For the 19 incidents that occurred after the implementation of GC-CIRF, audits of the review processes were undertaken, measuring several components.Results: Results show significant improvement in staff perceptions of just culture and second victim experiences. Review of incident review data showed several shifts in line with Safety II and RJC. The process audit demonstrated inclusion of a broad range of stakeholders, and significant improvements in the quality and strength of recommendations.Conclusions: Embedding RJC and Safety II concepts into the incident review process is associated with improved measures of culture and review outputs. The integration of Safety II concepts and support of cultural shifts will require further work and committed leadership at all levels.
{"title":"Restorative just culture significantly improves stakeholder inclusion, second victim experiences and quality of recommendations in incident responses","authors":"K. Turner, Jerneja Sveticic, D. Grice, M. Welch, Catherine King, Jennifer L. Panther, Claire Strivens, Brad Whitfield, Geoffrey Norman, A. Almeida-Crasto, Tamirin Darch, Nicolas J. C. Stapelberg, S. Dekker","doi":"10.5430/jha.v11n2p8","DOIUrl":"https://doi.org/10.5430/jha.v11n2p8","url":null,"abstract":"Objective: Matching safety and quality improvements to the complexity of healthcare, Gold Coast Mental Health and Specialist Services implemented a new response to clinical incidents: the Gold Coast Clinical Incident Response Framework (GC-CIRF). It utilises a Restorative Just Culture (RJC) framework and Safety II principles. This paper evaluates its impact.Methods: Staff surveys measured perceptions of just culture and second victim experiences. Quality of recommendations were compared before and after implementation. For the 19 incidents that occurred after the implementation of GC-CIRF, audits of the review processes were undertaken, measuring several components.Results: Results show significant improvement in staff perceptions of just culture and second victim experiences. Review of incident review data showed several shifts in line with Safety II and RJC. The process audit demonstrated inclusion of a broad range of stakeholders, and significant improvements in the quality and strength of recommendations.Conclusions: Embedding RJC and Safety II concepts into the incident review process is associated with improved measures of culture and review outputs. The integration of Safety II concepts and support of cultural shifts will require further work and committed leadership at all levels.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"142 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76750115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kennedy, Gregory N Orewa, A. G. Hall, Sue S. Feldman, F. Zengul, T. Peters, Kristine R. Hearld
Background: The COVID-19 pandemic created pressure on healthcare systems worldwide. Hospitals have developed strategies to efficiently address the demand for inpatient beds.Objective: This paper examines changes in length of stay at a southern academic medical center and documents the intervention efforts aimed at providing high quality care and reduced lengths of stay.Methods: Data include 3,279 patients receiving inpatient treatment for COVID-19 between March 29, 2020, and October 31, 2021. The study data mirrors the three major waves of COVID-19 pandemic in Alabama as reported in Johns Hopkins’ coronavirus resource center. To account for the chronological change in care processes, we interviewed Hospitalists and categorized the interventions by month, June 2020-February 2021. We examined changes in average length of stay and differences in sociodemographic characteristics among the three waves using ANOVA and chi-square tests. Socio demographic factors analyzed include age, gender, race/ethnicity, marital status, and insurance.Results: The average length of stay, ICU admissions, and 30-day readmissions each decreased in the second and third waves compared to the first wave. Statistically significant differences were found for ICU admission, age, and insurance for hospitalized patients among waves.Conclusions: This study contributes to the COVID-19 literature by providing the chronological evolution of ALOS and interventions during the pandemic by highlighting the case of a southern academic medical center.
{"title":"From pandemic to endemic: A comparison of first, second, and third waves of COVID-19 for applicability in communicable disease management","authors":"K. Kennedy, Gregory N Orewa, A. G. Hall, Sue S. Feldman, F. Zengul, T. Peters, Kristine R. Hearld","doi":"10.5430/jha.v11n2p1","DOIUrl":"https://doi.org/10.5430/jha.v11n2p1","url":null,"abstract":"Background: The COVID-19 pandemic created pressure on healthcare systems worldwide. Hospitals have developed strategies to efficiently address the demand for inpatient beds.Objective: This paper examines changes in length of stay at a southern academic medical center and documents the intervention efforts aimed at providing high quality care and reduced lengths of stay.Methods: Data include 3,279 patients receiving inpatient treatment for COVID-19 between March 29, 2020, and October 31, 2021. The study data mirrors the three major waves of COVID-19 pandemic in Alabama as reported in Johns Hopkins’ coronavirus resource center. To account for the chronological change in care processes, we interviewed Hospitalists and categorized the interventions by month, June 2020-February 2021. We examined changes in average length of stay and differences in sociodemographic characteristics among the three waves using ANOVA and chi-square tests. Socio demographic factors analyzed include age, gender, race/ethnicity, marital status, and insurance.Results: The average length of stay, ICU admissions, and 30-day readmissions each decreased in the second and third waves compared to the first wave. Statistically significant differences were found for ICU admission, age, and insurance for hospitalized patients among waves.Conclusions: This study contributes to the COVID-19 literature by providing the chronological evolution of ALOS and interventions during the pandemic by highlighting the case of a southern academic medical center.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79308459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea Blome, S. Anderson, Mandy Middlebrook-Lovett, Jon Michael Cuba, Jeffrey Kuo, NICHOLAS P. Gorham, Lauren Defrates, N. McCoin
Objective: Emergency Departments (EDs) experience throughput constraints for various reasons, such as space, resources, staffing, and bed placement. These throughput constraints are known to increase the volume of patients who leave without being evaluated. TeleTriage is a method implemented shortly after the arrival of the patient to the ED, as a means to expedite evaluation of patients. The project aimed to implement a TeleTriage program and analyze any impact on Left Without Being Seen (LWBS) rates and cost.Methods: A TeleTriage program was developed within a large, nonprofit, academic health care delivery system. The program was piloted at several campuses and subsequently implemented at multiple sites within the health system. Data on LWBS rates were collected for patients evaluated by the TeleTriage process and those who were not. An analysis of staffing utilization and cost-savings was also performed.Results: The TeleTriage program resulted in an average LWBS rate of 0.12% post-implementation, versus 0.79% for patients who were not in the TeleTriage group. In addition, the staffing consolidation resulted in cost-savings.Conclusions: The use of a TeleTriage program results in decreased LWBS rates, as well as cost-savings.
{"title":"Impact of a Teletriage program on left without being seen rates and cost","authors":"Andrea Blome, S. Anderson, Mandy Middlebrook-Lovett, Jon Michael Cuba, Jeffrey Kuo, NICHOLAS P. Gorham, Lauren Defrates, N. McCoin","doi":"10.5430/jha.v11n1p35","DOIUrl":"https://doi.org/10.5430/jha.v11n1p35","url":null,"abstract":"Objective: Emergency Departments (EDs) experience throughput constraints for various reasons, such as space, resources, staffing, and bed placement. These throughput constraints are known to increase the volume of patients who leave without being evaluated. TeleTriage is a method implemented shortly after the arrival of the patient to the ED, as a means to expedite evaluation of patients. The project aimed to implement a TeleTriage program and analyze any impact on Left Without Being Seen (LWBS) rates and cost.Methods: A TeleTriage program was developed within a large, nonprofit, academic health care delivery system. The program was piloted at several campuses and subsequently implemented at multiple sites within the health system. Data on LWBS rates were collected for patients evaluated by the TeleTriage process and those who were not. An analysis of staffing utilization and cost-savings was also performed.Results: The TeleTriage program resulted in an average LWBS rate of 0.12% post-implementation, versus 0.79% for patients who were not in the TeleTriage group. In addition, the staffing consolidation resulted in cost-savings.Conclusions: The use of a TeleTriage program results in decreased LWBS rates, as well as cost-savings.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85443358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashwani Kumar, B. Abbenbroek, N. Hammond, B. Vijayaraghavan, Lowell Ling, L. Thwaites, S. Myatra, S. Finfer
There is paucity of data on critical care resources, disaster preparedness, and sepsis management in countries within the Asia Pacific region. An online survey was conducted from 15 April to 17 July 2020. Snowball sampling through the Asia Pacific Sepsis Alliance and network contacts was used to recruit respondents. Countries were grouped according to the World Bank Country Income 2019 classification into lower-middle income (LMIC), upper-middle income (UMIC), and high-income (HIC). Survey questions addressed to hospital characteristics, critical care resources, disaster preparedness, and sepsis management. In total, 59 hospitals from 15 countries responded (33 LMICs, 8 UMICs, 18 HICs) with most responses from the Philippines (10; 16.9%). Median [Inter-quartile range (IQR)] hospital and Intensive Care Unit (ICU) bed capacity was 798 (500–1,001) and 37 (19–59), respectively. Median (IQR) doctor-to-patient and nurse-to-patient day ratios were 1:5 (1:3–1:8) and 1:2 (1:1–1:2), respectively. Availability of 24/7 physiotherapy services, 24/7 Medical resonance Imaging (MRI), point-of-care lactate, and “reserve” antibiotics was limited. Most ICUs had a disaster management plan (88%) and access to Personal Protective Equipment (96%). The most commonly adopted sepsis guideline was the Surviving Sepsis Campaign guidelines (77%). LMIC/UMIC ICUs had lower nurse-to patient ratio and surge capacity along with limited access to 24/7 physiotherapy and MRI services, and interventions like Extra Corporeal Membrane Oxygenation, and Continuous Renal Replacement Therapy. Self-reported adoption and adherence to sepsis guidelines was higher in LMICs/UMICs than HICs. In the Asia Pacific region, critical care resources, disaster preparedness and management of sepsis vary considerably between countries across different income categories. In particular, low surge and isolation capacity in LMICs highlights the need for better health service planning and preparation.
{"title":"Critical care resources, disaster preparedness, and sepsis management: Survey results from the Asia Pacific region","authors":"Ashwani Kumar, B. Abbenbroek, N. Hammond, B. Vijayaraghavan, Lowell Ling, L. Thwaites, S. Myatra, S. Finfer","doi":"10.5430/jha.v11n1p23","DOIUrl":"https://doi.org/10.5430/jha.v11n1p23","url":null,"abstract":"There is paucity of data on critical care resources, disaster preparedness, and sepsis management in countries within the Asia Pacific region. An online survey was conducted from 15 April to 17 July 2020. Snowball sampling through the Asia Pacific Sepsis Alliance and network contacts was used to recruit respondents. Countries were grouped according to the World Bank Country Income 2019 classification into lower-middle income (LMIC), upper-middle income (UMIC), and high-income (HIC). Survey questions addressed to hospital characteristics, critical care resources, disaster preparedness, and sepsis management. In total, 59 hospitals from 15 countries responded (33 LMICs, 8 UMICs, 18 HICs) with most responses from the Philippines (10; 16.9%). Median [Inter-quartile range (IQR)] hospital and Intensive Care Unit (ICU) bed capacity was 798 (500–1,001) and 37 (19–59), respectively. Median (IQR) doctor-to-patient and nurse-to-patient day ratios were 1:5 (1:3–1:8) and 1:2 (1:1–1:2), respectively. Availability of 24/7 physiotherapy services, 24/7 Medical resonance Imaging (MRI), point-of-care lactate, and “reserve” antibiotics was limited. Most ICUs had a disaster management plan (88%) and access to Personal Protective Equipment (96%). The most commonly adopted sepsis guideline was the Surviving Sepsis Campaign guidelines (77%). LMIC/UMIC ICUs had lower nurse-to patient ratio and surge capacity along with limited access to 24/7 physiotherapy and MRI services, and interventions like Extra Corporeal Membrane Oxygenation, and Continuous Renal Replacement Therapy. Self-reported adoption and adherence to sepsis guidelines was higher in LMICs/UMICs than HICs. In the Asia Pacific region, critical care resources, disaster preparedness and management of sepsis vary considerably between countries across different income categories. In particular, low surge and isolation capacity in LMICs highlights the need for better health service planning and preparation.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76062694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Despite an abundance of evidence supporting screening adults for adverse childhood experiences (ACEs), the gap between this knowledge and screening persists. Evidence suggests that screening is warranted, feasible, and desired by patients. This feasibility study aimed to educate and train staff and providers on ACE screening and implement an ACE screening policy and protocol at an outpatient medical psychology practice. The two expected outcomes of this project, provider knowledge after ACE training and provider compliance with the ACE screening protocol, were measured to determine if a clinical practice change occurred.Methods: A quasi-experimental design with a pre-test/post-test was used to determine increases in provider knowledge following an ACEs training intervention. Additionally, post-intervention only data collection was used to determine compliance with ACE screening protocol, to determine practice change and feasibility of continued protocol use.Results: The project results indicated that the implementation of the ACE screening protocol was feasible. Thirty-three adult clients new to the practice completed the ACE screening. Of the 33 clients screened during the 12-week study, 26 clients had an ACE score of three or higher, and 14 (42%) received therapy referrals based on their ACE score after education and discussion by the intake therapist. Weekly chart checks revealed that 100% of clients screened received, at a minimum, the educational packet regarding the impact of ACEs on physical and mental health. The protocol encouraged providers to promote evidence-based interventions to mitigate the potential untoward outcomes associated with ACEs.Conclusions: These findings reflected a change in knowledge based on education and indicated that educational intervention was effective.
{"title":"Implementation of an adverse childhood experiences screening protocol for adults at an outpatient medical psychology practice","authors":"Jennifer Allain, E. Creel, C. Perry","doi":"10.5430/jha.v11n1p8","DOIUrl":"https://doi.org/10.5430/jha.v11n1p8","url":null,"abstract":"Objective: Despite an abundance of evidence supporting screening adults for adverse childhood experiences (ACEs), the gap between this knowledge and screening persists. Evidence suggests that screening is warranted, feasible, and desired by patients. This feasibility study aimed to educate and train staff and providers on ACE screening and implement an ACE screening policy and protocol at an outpatient medical psychology practice. The two expected outcomes of this project, provider knowledge after ACE training and provider compliance with the ACE screening protocol, were measured to determine if a clinical practice change occurred.Methods: A quasi-experimental design with a pre-test/post-test was used to determine increases in provider knowledge following an ACEs training intervention. Additionally, post-intervention only data collection was used to determine compliance with ACE screening protocol, to determine practice change and feasibility of continued protocol use.Results: The project results indicated that the implementation of the ACE screening protocol was feasible. Thirty-three adult clients new to the practice completed the ACE screening. Of the 33 clients screened during the 12-week study, 26 clients had an ACE score of three or higher, and 14 (42%) received therapy referrals based on their ACE score after education and discussion by the intake therapist. Weekly chart checks revealed that 100% of clients screened received, at a minimum, the educational packet regarding the impact of ACEs on physical and mental health. The protocol encouraged providers to promote evidence-based interventions to mitigate the potential untoward outcomes associated with ACEs.Conclusions: These findings reflected a change in knowledge based on education and indicated that educational intervention was effective.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89919195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
All hospitals engage in credentialing to evaluate the qualifications of practitioners who request clinical privileges. Credentialing always includes verifying an applicant’s education, training, licensure and board certification, and evaluating information provided by references who have worked with the applicant. Far fewer hospitals consider whether a practitioner’s volume of cases is sufficient to demonstrate proficiency in a specialty area. This is surprising, given the well-established relationship in the medical literature between volume and proficiency. The authors identified several reasons for hospitals’ reluctance to use volume-based credentialing. These include the fear of lawsuits by physicians and the practical difficulties of satisfying volume requirements in smaller hospitals with fewer patients. The authors conclude that legal challenges to volume-based credentialing are unlikely to be successful and that techniques exist to enable small hospitals to use volume-based credentialing to promote high quality and safe care.
{"title":"Volume-based credentialing: Practical steps to promote high quality, safe care","authors":"K. Shute, P. Zarone, Erin McCluan","doi":"10.5430/jha.v11n1p1","DOIUrl":"https://doi.org/10.5430/jha.v11n1p1","url":null,"abstract":"All hospitals engage in credentialing to evaluate the qualifications of practitioners who request clinical privileges. Credentialing always includes verifying an applicant’s education, training, licensure and board certification, and evaluating information provided by references who have worked with the applicant. Far fewer hospitals consider whether a practitioner’s volume of cases is sufficient to demonstrate proficiency in a specialty area. This is surprising, given the well-established relationship in the medical literature between volume and proficiency. The authors identified several reasons for hospitals’ reluctance to use volume-based credentialing. These include the fear of lawsuits by physicians and the practical difficulties of satisfying volume requirements in smaller hospitals with fewer patients. The authors conclude that legal challenges to volume-based credentialing are unlikely to be successful and that techniques exist to enable small hospitals to use volume-based credentialing to promote high quality and safe care.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89665331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Risks associated with drugs and treatments are a key concern in clinical investigations of therapeutics. There is a keen attention to side effects and adverse events included in critical safety documentation presented in regulatory submissions for new drugs. Likewise, Companion Diagnostic (CDx) technology is subject to rigorous regulated research and testing because of the risk associated with a false test result that could affect clinical decisions and treatment. The rigor of testing imposed by the regulatory path to clearance or approval is intended to ensure an assay is reliable when performance criteria are defined by a fixed set of these variables so that there is the least risk of false test results. The clinical validation of these assays is especially important when the test result is used to manage therapeutic decisions for patients. The same patients that expect a clinician to use reliable diagnostics to recommend treatment may also be recruited to participate in CDx clinical investigations. This educational review of CDx product development, regulations, and clinical investigations involving human subjects is important to: (1) Clinicians who rely on the test results to manage patient care; (2) Patients who trust these test results are informing the clinician, and (3) Hospital administrators who oversee human subjects safety and data intergrity for clinical investigations in the personalized medicine space.
{"title":"In vitro diagnostic tests: Ensuring test accuracy and patient safety when used as companion diagnostics","authors":"U. Ifediora, Wendy Schroeder","doi":"10.5430/jha.v10n6p34","DOIUrl":"https://doi.org/10.5430/jha.v10n6p34","url":null,"abstract":"Risks associated with drugs and treatments are a key concern in clinical investigations of therapeutics. There is a keen attention to side effects and adverse events included in critical safety documentation presented in regulatory submissions for new drugs. Likewise, Companion Diagnostic (CDx) technology is subject to rigorous regulated research and testing because of the risk associated with a false test result that could affect clinical decisions and treatment. The rigor of testing imposed by the regulatory path to clearance or approval is intended to ensure an assay is reliable when performance criteria are defined by a fixed set of these variables so that there is the least risk of false test results. The clinical validation of these assays is especially important when the test result is used to manage therapeutic decisions for patients. The same patients that expect a clinician to use reliable diagnostics to recommend treatment may also be recruited to participate in CDx clinical investigations. This educational review of CDx product development, regulations, and clinical investigations involving human subjects is important to: (1) Clinicians who rely on the test results to manage patient care; (2) Patients who trust these test results are informing the clinician, and (3) Hospital administrators who oversee human subjects safety and data intergrity for clinical investigations in the personalized medicine space.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79136005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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