Conflicts and friction are part and parcel of healthcare environments. Associated complexity and multilayered intricacies that exist, leads to unsettling and unresolved circumstances. Issues and problems may occur at all levels in the hierarchical set up universally in healthcare institutions. Resolution of these conflictual experiences has to occur with a pervasive and streamlined methodology that fully dissects out the issues, in order to gain understanding as a preemptive strategy. Through a collaborative framework and mediation, success can be achieved.
{"title":"Mediation in a healthcare setting: Strategies and implementation","authors":"A. Nager","doi":"10.5430/jha.v9n4p34","DOIUrl":"https://doi.org/10.5430/jha.v9n4p34","url":null,"abstract":"Conflicts and friction are part and parcel of healthcare environments. Associated complexity and multilayered intricacies that exist, leads to unsettling and unresolved circumstances. Issues and problems may occur at all levels in the hierarchical set up universally in healthcare institutions. Resolution of these conflictual experiences has to occur with a pervasive and streamlined methodology that fully dissects out the issues, in order to gain understanding as a preemptive strategy. Through a collaborative framework and mediation, success can be achieved.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"38 1","pages":"34"},"PeriodicalIF":0.0,"publicationDate":"2020-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84271468","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}
Gregory D. Kearney, P. Cowin, T. Hickey, Bennett Wall, Jeffrey Shovelin, Michael R. Waldrum, D. Thompson
Background: Incessant, COVID-19 outbreaks occurring in nursing and adult care homes are a serious public health concern that continues to create significant healthcare crisis management challenges. Adult care facilities often lack in-house capacity and capability to safely treat its ill residents, while hospitals are strained to balance the influx of patients, allocate scarce resources and protect healthcare workers.Objectives: This project sought to implement a regional, community engaged, intervention model to assist nursing and adult care homes in reducing or preventing outbreaks and risks associated with COVID-19 in rural eastern North Carolina (N.C.).Methods: Design/Setting: Through collaborations between Vidant Health (VH), health departments and a network of community partners, a shared intervention plan was created and implemented to monitor nursing and adult care homes for COVID-19-related outbreaks across 29 counties in rural eastern N.C. A “Strike” team or “Swarm (SWARM) approach was developed as an operationalized concept for rapidly responding to nursing and adult care home outbreaks while providing an array of services and interventions to help prevent the spread of COVID-19. Comparative analysis was conducted between the mean number of COVID-19-related cases, deaths and length of outbreak time in VH service contracted, SWARM facilities (n = 12) and all other non-service contracted, or non-SWARM facilities (n = 155) in N.C.Results: Nursing and adult care homes under service contract using our SWARM approach experienced fewer average number of COVID-19-related resident ill cases (24.4 vs 29.0), and deaths (1.2 vs. 3.9). The length of outbreak recovery time was far less among SWARM facilities than non-participating, non-SWARM facilities (17.1 vs. 25.4; p < .034).Conclusions: By actively monitoring key indicators, engaging in daily communication with local partners and providing rapid response, VH’s SWARM approach provides a proactive method for preventing further spread of COVID-19 in adult care facilities and communities.
背景:在护理和成人疗养院中不断发生的COVID-19疫情是一个严重的公共卫生问题，继续给医疗危机管理带来重大挑战。成人护理设施往往缺乏安全治疗病人的内部能力和能力，而医院在平衡涌入的病人、分配稀缺资源和保护医护人员方面也面临压力。目标:本项目旨在实施一种区域、社区参与的干预模式，以帮助护理和成人疗养院减少或预防北卡罗来纳州东部农村地区与COVID-19相关的疫情和风险。方法:设计/设置:通过维丹特健康(VH)、卫生部门和社区伙伴网络之间的合作，制定并实施了一项共享干预计划，以监测北卡罗来纳州东部农村29个县的疗养院和成人疗养院与COVID-19相关的疫情。制定了“打击”团队或“蜂群(Swarm)方法，作为一种可操作的概念，用于快速响应疗养院和成人疗养院的疫情，同时提供一系列服务和干预措施，以帮助防止COVID-19的传播。对比分析了北卡罗来纳州VH服务合同、SWARM设施(n = 12)与所有其他非服务合同或非SWARM设施(n = 155)中与covid -19相关的平均病例数、死亡人数和爆发时间长度。结果:使用我们的SWARM方法签订服务合同的护理和成人护理之家的平均covid -19相关住院病例数(24.4 vs 29.0)和死亡人数(1.2 vs 3.9)较少。在SWARM设施中，爆发恢复时间的长度远小于未参与的非SWARM设施(17.1 vs. 25.4;P < 0.034)。结论:通过积极监测关键指标，与当地合作伙伴进行日常沟通，并提供快速响应，VH的SWARM方法为预防COVID-19在成人护理机构和社区进一步传播提供了主动方法。
{"title":"SWARM: A regional health system’s intervention approach to COVID-19 outbreaks in nursing and adult care homes in rural eastern North Carolina","authors":"Gregory D. Kearney, P. Cowin, T. Hickey, Bennett Wall, Jeffrey Shovelin, Michael R. Waldrum, D. Thompson","doi":"10.5430/jha.v9n4p27","DOIUrl":"https://doi.org/10.5430/jha.v9n4p27","url":null,"abstract":"Background: Incessant, COVID-19 outbreaks occurring in nursing and adult care homes are a serious public health concern that continues to create significant healthcare crisis management challenges. Adult care facilities often lack in-house capacity and capability to safely treat its ill residents, while hospitals are strained to balance the influx of patients, allocate scarce resources and protect healthcare workers.Objectives: This project sought to implement a regional, community engaged, intervention model to assist nursing and adult care homes in reducing or preventing outbreaks and risks associated with COVID-19 in rural eastern North Carolina (N.C.).Methods: Design/Setting: Through collaborations between Vidant Health (VH), health departments and a network of community partners, a shared intervention plan was created and implemented to monitor nursing and adult care homes for COVID-19-related outbreaks across 29 counties in rural eastern N.C. A “Strike” team or “Swarm (SWARM) approach was developed as an operationalized concept for rapidly responding to nursing and adult care home outbreaks while providing an array of services and interventions to help prevent the spread of COVID-19. Comparative analysis was conducted between the mean number of COVID-19-related cases, deaths and length of outbreak time in VH service contracted, SWARM facilities (n = 12) and all other non-service contracted, or non-SWARM facilities (n = 155) in N.C.Results: Nursing and adult care homes under service contract using our SWARM approach experienced fewer average number of COVID-19-related resident ill cases (24.4 vs 29.0), and deaths (1.2 vs. 3.9). The length of outbreak recovery time was far less among SWARM facilities than non-participating, non-SWARM facilities (17.1 vs. 25.4; p < .034).Conclusions: By actively monitoring key indicators, engaging in daily communication with local partners and providing rapid response, VH’s SWARM approach provides a proactive method for preventing further spread of COVID-19 in adult care facilities and communities.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75047195","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}
I. Córdova, Carlos Francisco Albornoz-Jiménez, Tranquilina Gutiérrez-Gómez, R. León-Hernández, David de Jesús Malibrán-Luque, Ricardo Colmenares-Diaz
The Partners and Health Scale Instrument has been validated in several countries, however, it has just been applied in Spanishspeaking countries to people with chronic conditions, allowing a self-management evaluation with wide clinical application and research. It is the first time it has been applied in elderly patients (60 or older) in Spanish-speaking countries. This study shows the instrument validity in this population - users of health services of the Ministry of Health in Lima-Peru. An intentional non-probabilistic sample of 152 subjects with Construction Validity was performed: 1) Factor Analysis and 2) Confirmatory with structural equations and Reliability: Cronbach’s Alpha presents construct validity in three factors with an explained variance of 0.597. From the results of the goodness of fit model measures obtained by AMOS 24.0 and FACTOR 10.10, it can be seen that 6 of the 7 measures obtained are acceptable. The reliability with the Cronbach Alpha coefficient was 0.845. Although the model may have high-quality goodness of fit, the possibility of another alternative model that meets a better fit cannot be rejected; the results allow us to conclude that this Instrument presents validity and reliability in the evaluation of self-management within three factors.
{"title":"A self-management measurement: Validity of the Partners in Health Scale (PHS) instrument in Peruvian elderly population","authors":"I. Córdova, Carlos Francisco Albornoz-Jiménez, Tranquilina Gutiérrez-Gómez, R. León-Hernández, David de Jesús Malibrán-Luque, Ricardo Colmenares-Diaz","doi":"10.5430/jha.v9n4p20","DOIUrl":"https://doi.org/10.5430/jha.v9n4p20","url":null,"abstract":"The Partners and Health Scale Instrument has been validated in several countries, however, it has just been applied in Spanishspeaking countries to people with chronic conditions, allowing a self-management evaluation with wide clinical application and research. It is the first time it has been applied in elderly patients (60 or older) in Spanish-speaking countries. This study shows the instrument validity in this population - users of health services of the Ministry of Health in Lima-Peru. An intentional non-probabilistic sample of 152 subjects with Construction Validity was performed: 1) Factor Analysis and 2) Confirmatory with structural equations and Reliability: Cronbach’s Alpha presents construct validity in three factors with an explained variance of 0.597. From the results of the goodness of fit model measures obtained by AMOS 24.0 and FACTOR 10.10, it can be seen that 6 of the 7 measures obtained are acceptable. The reliability with the Cronbach Alpha coefficient was 0.845. Although the model may have high-quality goodness of fit, the possibility of another alternative model that meets a better fit cannot be rejected; the results allow us to conclude that this Instrument presents validity and reliability in the evaluation of self-management within three factors.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"22 1","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2020-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78449492","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}
A. Parnell, Krzysztof Goniewicz, A. Khorram‐Manesh, Fredrick M. Burkle, Ahmed M. Al-Wathinani, A. Hertelendy
The United States has continued to face severe health coverage and spending challenges that have been attributed to a fragmented multi-payer and fee-for-service delivery system which has become even more exposed by the COVID-19 pandemic. Legislators and healthcare professionals have tried to answer the challenges faced by the U.S. health system through the introduction of several state and federal proposals for a “Medicare-for-all” like system, which have failed to be adopted likely due to the lack of consideration for free-market economic values. Looking to existing models abroad can provide the U.S. with different ways to understand how to achieve the benefits of single-payer models with universal coverage while maintaining the integrity of free-market values. The health systems in wealthy, industrialized countries are closely referenced in this article because of the variation of methods in which each achieves a single-payer/universal coverage model as well as the contrast in their health outcomes compared to that of the U.S. The biggest considerations for any reform effort to achieve an efficient single-payer system with universal coverage is the maintenance of private health insurers and the degree to which expanded government influence would be accepted. The future state of health care remains uncertain and unstable as a result of the COVID-19 pandemic, therefore a window of opportunity exists now for leveraging this uncertainty to achieve reform.
{"title":"COVID-19 a health reform catalyst? —Analyzing single-payer options in the U.S.: Considering economic values, recent proposals, and existing models from abroad","authors":"A. Parnell, Krzysztof Goniewicz, A. Khorram‐Manesh, Fredrick M. Burkle, Ahmed M. Al-Wathinani, A. Hertelendy","doi":"10.5430/jha.v9n4p10","DOIUrl":"https://doi.org/10.5430/jha.v9n4p10","url":null,"abstract":"The United States has continued to face severe health coverage and spending challenges that have been attributed to a fragmented multi-payer and fee-for-service delivery system which has become even more exposed by the COVID-19 pandemic. Legislators and healthcare professionals have tried to answer the challenges faced by the U.S. health system through the introduction of several state and federal proposals for a “Medicare-for-all” like system, which have failed to be adopted likely due to the lack of consideration for free-market economic values. Looking to existing models abroad can provide the U.S. with different ways to understand how to achieve the benefits of single-payer models with universal coverage while maintaining the integrity of free-market values. The health systems in wealthy, industrialized countries are closely referenced in this article because of the variation of methods in which each achieves a single-payer/universal coverage model as well as the contrast in their health outcomes compared to that of the U.S. The biggest considerations for any reform effort to achieve an efficient single-payer system with universal coverage is the maintenance of private health insurers and the degree to which expanded government influence would be accepted. The future state of health care remains uncertain and unstable as a result of the COVID-19 pandemic, therefore a window of opportunity exists now for leveraging this uncertainty to achieve reform.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"60 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2020-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88756115","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}
Umar Y. Kabir, Angela L. Askew, Yu Jiang, S. Bhuyan, E. Ezekekwu, A. Dobalian
Objective: To examine the relationship between Breast Cancer Screening (BCS) and Moderate Psychological Distress (MPD). Also, to assess the effect of aggregating women with No Psychological Distress (NPD) and MPD into one group, as done in prior studies when evaluating the relationship between BCS and Psychological Distress (PD). Methods: The study population comprised of 34,565 women aged 50-74 years who participated in the National Health Interview Survey from 2013 to 2017. The Kessler-6 PD index score (0-24) was dichotomized (0-12: NPD; > 13: Severe Psychological Distress SPD) and trichotomized (0-5: NPD; 5-12: MPD; > 13 SPD). Two multivariate logistic regressions were conducted for the dichotomous and trichotomous PD categories. Andersen’s Behavioral Model of Health Services Use guided the choice of covariates. Data analysis was conducted using SAS version 9.4. Results: Our study showed 4.6% had SPD, and 17.9% had MPD. The latter group (MPD) was included in the NPD group in the dichotomous analysis. In the dichotomous analysis, women with SPD (adjusted Odds Ratio (aOR) = 0.71, 95% CI = 0.63, 0.81, p < .00001) were less likely to have received a mammogram than those with NPD. In the trichotomous model, women with SPD (aOR = 0.76, 95% CI = 0.67, 0.87, p = .0001) and MPD (aOR = 0.84, 95% CI = 0.78, 0.91, p <.00001) were both less likely to have had a mammogram than those with NPD. Conclusions: Prior studies that included individuals with MPD among those with NPD overestimated the effect of SPD on mammography and minimized the importance of targeting women with MPD along with those that have SPD to enhance the uptake of mammography.
目的:探讨乳腺癌筛查(BCS)与中度心理困扰(MPD)的关系。此外，为了评估将无心理困扰(NPD)和MPD女性合并为一组的效果，就像之前评估BCS和心理困扰(PD)之间关系的研究一样。方法:研究人群包括2013 - 2017年参加全国健康访谈调查的34565名年龄在50-74岁之间的女性。将Kessler-6 PD指数评分(0-24分)进行二分类(0-12分:NPD;> 13:重度心理困扰SPD)和三分型(0-5:NPD;5 - 12: MPD;> 13 spd)。对二分型和三分型PD进行了两次多变量logistic回归。Andersen的卫生服务使用行为模型指导协变量的选择。数据分析采用SAS 9.4版本。结果:我们的研究显示4.6%的人患有SPD, 17.9%的人患有MPD。后一组(MPD)在二分类分析中被纳入NPD组。在二分类分析中，SPD患者(校正优势比(aOR) = 0.71, 95% CI = 0.63, 0.81, p < 0.00001)接受乳房x光检查的可能性低于NPD患者。在三分型模型中，SPD (aOR = 0.76, 95% CI = 0.67, 0.87, p = 0.0001)和MPD (aOR = 0.84, 95% CI = 0.78, 0.91, p < 0.00001)的女性接受乳房x光检查的可能性都低于NPD患者。结论:先前的研究在NPD患者中纳入了MPD患者，高估了SPD对乳房x光检查的影响，并最小化了针对MPD患者和SPD患者的重要性，以提高乳房x光检查的吸收。
{"title":"Moderate psychological distress as a barrier to breast cancer screening among women","authors":"Umar Y. Kabir, Angela L. Askew, Yu Jiang, S. Bhuyan, E. Ezekekwu, A. Dobalian","doi":"10.5430/jha.v9n4p1","DOIUrl":"https://doi.org/10.5430/jha.v9n4p1","url":null,"abstract":"Objective: To examine the relationship between Breast Cancer Screening (BCS) and Moderate Psychological Distress (MPD). Also, to assess the effect of aggregating women with No Psychological Distress (NPD) and MPD into one group, as done in prior studies when evaluating the relationship between BCS and Psychological Distress (PD). Methods: The study population comprised of 34,565 women aged 50-74 years who participated in the National Health Interview Survey from 2013 to 2017. The Kessler-6 PD index score (0-24) was dichotomized (0-12: NPD; > 13: Severe Psychological Distress SPD) and trichotomized (0-5: NPD; 5-12: MPD; > 13 SPD). Two multivariate logistic regressions were conducted for the dichotomous and trichotomous PD categories. Andersen’s Behavioral Model of Health Services Use guided the choice of covariates. Data analysis was conducted using SAS version 9.4. Results: Our study showed 4.6% had SPD, and 17.9% had MPD. The latter group (MPD) was included in the NPD group in the dichotomous analysis. In the dichotomous analysis, women with SPD (adjusted Odds Ratio (aOR) = 0.71, 95% CI = 0.63, 0.81, p < .00001) were less likely to have received a mammogram than those with NPD. In the trichotomous model, women with SPD (aOR = 0.76, 95% CI = 0.67, 0.87, p = .0001) and MPD (aOR = 0.84, 95% CI = 0.78, 0.91, p <.00001) were both less likely to have had a mammogram than those with NPD. Conclusions: Prior studies that included individuals with MPD among those with NPD overestimated the effect of SPD on mammography and minimized the importance of targeting women with MPD along with those that have SPD to enhance the uptake of mammography.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"14 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2020-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77751506","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}
The COVID-19 pandemic has shaken the foundation of our healthcare system. One of the most dramatic consequences is the postponement of elective surgical procedures, which has led to significant financial stress. As institutions plan to reintegrate their surgical case backlog back into the operating room, there are many factors to consider. Now, more than ever, efficiency and cost-savings must be considered, but these factors must not overshadow the commitment to caring for our patients and communities.
{"title":"The ethics of rebuilding our country’s surgical platform after a pandemic","authors":"E. Robinson, B. Brost, J. Moulder","doi":"10.5430/jha.v9n3p30","DOIUrl":"https://doi.org/10.5430/jha.v9n3p30","url":null,"abstract":"The COVID-19 pandemic has shaken the foundation of our healthcare system. One of the most dramatic consequences is the postponement of elective surgical procedures, which has led to significant financial stress. As institutions plan to reintegrate their surgical case backlog back into the operating room, there are many factors to consider. Now, more than ever, efficiency and cost-savings must be considered, but these factors must not overshadow the commitment to caring for our patients and communities.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"2012 1","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2020-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82603984","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}
G. Gellert, Crystal Delacerda, L. Patel, Gabriel Maciaz
Background: Computer workstation single sign-on (SSO) was implemented in 19 hospitals to reduce manual keyboard login and expedite access to the electronic health record (EHR) and clinical applications. Objective: To quantify hospitalists time liberated from EHR keyboard to focus on patient care, and estimate financial value of this time for hospitalists. Methods: Login duration prior to and after SSO implementation were compared in eight hospitals. Using national estimates of hospitalist hourly wage, dollar values of time liberated from keyboard were calculated, stratified by different levels of total EHR use. Results: Following SSO implementation, first of shift login decreased 5.3 seconds (15.3%), and reconnect duration decreased 20.4 seconds (69.9%). The volume of hospitalist EHR use among all physician end users comprises 70%-90% of all electronic documentation and clinical orders issued, yielding an annual range of 10,302 hours (or 858.5 12-hour shifts) to 13,245 hours (or 1,103.8 12-hour shifts) in hospitalist time liberated from keyboard for patient care, with recurrent annual value of $1,164,126 to $1,496,685. Conclusions: Hospitalists gained meaningful amounts of time for patient care from SSO implementation. This time accrued to substantial financial value. SSO eases the EHR burden of hospitalists, and facilities using hospitalists extensively should consider SSO implementation.
{"title":"Easing hospitalist electronic health record burden through clinical workstation single sign-on","authors":"G. Gellert, Crystal Delacerda, L. Patel, Gabriel Maciaz","doi":"10.5430/jha.v9n3p24","DOIUrl":"https://doi.org/10.5430/jha.v9n3p24","url":null,"abstract":"Background: Computer workstation single sign-on (SSO) was implemented in 19 hospitals to reduce manual keyboard login and expedite access to the electronic health record (EHR) and clinical applications. Objective: To quantify hospitalists time liberated from EHR keyboard to focus on patient care, and estimate financial value of this time for hospitalists. Methods: Login duration prior to and after SSO implementation were compared in eight hospitals. Using national estimates of hospitalist hourly wage, dollar values of time liberated from keyboard were calculated, stratified by different levels of total EHR use. Results: Following SSO implementation, first of shift login decreased 5.3 seconds (15.3%), and reconnect duration decreased 20.4 seconds (69.9%). The volume of hospitalist EHR use among all physician end users comprises 70%-90% of all electronic documentation and clinical orders issued, yielding an annual range of 10,302 hours (or 858.5 12-hour shifts) to 13,245 hours (or 1,103.8 12-hour shifts) in hospitalist time liberated from keyboard for patient care, with recurrent annual value of $1,164,126 to $1,496,685. Conclusions: Hospitalists gained meaningful amounts of time for patient care from SSO implementation. This time accrued to substantial financial value. SSO eases the EHR burden of hospitalists, and facilities using hospitalists extensively should consider SSO implementation.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"21 1","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2020-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86894240","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}
Y. Weiss, I. Buda, Rechel Alon, Y. Adar, B. Lavi, Zeev Rothstein
In December 2019, a novel pneumonia caused by a previously unknown pathogen emerged in Wuhan, China. Whereas, thus far, the large majority of people infected by SARS-CoV-2 develop mild inconsequential respiratory symptoms, a minority of mostly fragile, immunecompromised, often aged individuals with chronic medical conditions, develop a severe form of acute respiratory distress syndrome (ARDS) and shock leading to death. Thanks to the early implementation of a social distancing strategy, some regions have seen only a moderate but significant increase in the number of SARS-CoV-2 infection. Although, a significant increase in severe and critical COVID-19 patients was noted, requiring significant investment in dedicated personnel and allocation of specific hospitalization and intensive care unit (ICU) infrastructure and resources, but the medical systems’ functioning was not completely disrupted. As the development of a readily available vaccine against the new coronavirus is expected to take about 1.5 - 2 years, most hospitals will have to address the problems and challenges of caring for regular patients, some of them high-risk patients for SARS-CoV-2 infection, while caring in parallel for a low to moderate number of COVID-19 infected patients. This report presents an outline for a plan of action of a hospital system to deal with such an eventuality. We review the key changes that must be implemented in hospital management and activity to prevent disruption of key services due to the COVID-19 outbreak and the maintenance of high quality of care to all patients while ensuring the highest standards of staff and patient safety.
{"title":"Long-term hospital management in the presence of COVID-19: A practical perspective","authors":"Y. Weiss, I. Buda, Rechel Alon, Y. Adar, B. Lavi, Zeev Rothstein","doi":"10.5430/jha.v9n3p18","DOIUrl":"https://doi.org/10.5430/jha.v9n3p18","url":null,"abstract":"In December 2019, a novel pneumonia caused by a previously unknown pathogen emerged in Wuhan, China. Whereas, thus far, the large majority of people infected by SARS-CoV-2 develop mild inconsequential respiratory symptoms, a minority of mostly fragile, immunecompromised, often aged individuals with chronic medical conditions, develop a severe form of acute respiratory distress syndrome (ARDS) and shock leading to death. Thanks to the early implementation of a social distancing strategy, some regions have seen only a moderate but significant increase in the number of SARS-CoV-2 infection. Although, a significant increase in severe and critical COVID-19 patients was noted, requiring significant investment in dedicated personnel and allocation of specific hospitalization and intensive care unit (ICU) infrastructure and resources, but the medical systems’ functioning was not completely disrupted. As the development of a readily available vaccine against the new coronavirus is expected to take about 1.5 - 2 years, most hospitals will have to address the problems and challenges of caring for regular patients, some of them high-risk patients for SARS-CoV-2 infection, while caring in parallel for a low to moderate number of COVID-19 infected patients. This report presents an outline for a plan of action of a hospital system to deal with such an eventuality. We review the key changes that must be implemented in hospital management and activity to prevent disruption of key services due to the COVID-19 outbreak and the maintenance of high quality of care to all patients while ensuring the highest standards of staff and patient safety.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"156 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79854401","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: Quality indicators, based on administrative data, are being increasingly used to assess avoidable hospital readmission rates. Their potential to identify areas for improvement at low cost is attractive, but their performance in emergency departments (EDs) has been criticised. Methods: Hospital readmissions were categorised as potentially avoidable or non-avoidable, by a computerised algorithm (SQLape®, version 2016 - Striving for Quality Level and analysing of patient expenditures). Half-yearly rates were reported between July 2015 and June 2016. Two senior physicians conducted a medical record review on 100 randomly selected cases from an ED, flagged as potentially avoidable readmissions (PAR). Results were then discussed with the algorithm’s designer. Results: The algorithm screened 2,182 eligible emergency visits - 105 cases (4.8%), were deemed potentially avoidable by the algorithm. Among 100 randomly selected cases, nine exclusions were due to coding issues and four due to false positives. Overall (N = 87), 20/87 (23%) of readmissions were directly related to sole emergency care, 31/87 (36%) related to healthcare providers other than the ED, and 23/87 (26%) were of mixed provision, while 13/87 (15%) were attributed to the course of the disease. Conclusions: The study confirms the need for a better understanding of the algorithm’s measurement and of its reported results. Careful interpretation is required before a sound conclusion can be made. Indeed, it is apparent that the 30-day PAR quality indicator rate reflects a wider parameter of care than hospitals alone, who understandably tend to concentrate on their own, direct liability of care. In particular the 30-day PAR quality indicator is not well-suited to evaluate ED performance.
{"title":"Assessing 30-day avoidable readmission rates: Is it an appropriate tool to manage emergency department quality of care?","authors":"Agri Fabio, Eggli Yves, F. Dami","doi":"10.5430/jha.v9n3p11","DOIUrl":"https://doi.org/10.5430/jha.v9n3p11","url":null,"abstract":"Objective: Quality indicators, based on administrative data, are being increasingly used to assess avoidable hospital readmission rates. Their potential to identify areas for improvement at low cost is attractive, but their performance in emergency departments (EDs) has been criticised. Methods: Hospital readmissions were categorised as potentially avoidable or non-avoidable, by a computerised algorithm (SQLape®, version 2016 - Striving for Quality Level and analysing of patient expenditures). Half-yearly rates were reported between July 2015 and June 2016. Two senior physicians conducted a medical record review on 100 randomly selected cases from an ED, flagged as potentially avoidable readmissions (PAR). Results were then discussed with the algorithm’s designer. Results: The algorithm screened 2,182 eligible emergency visits - 105 cases (4.8%), were deemed potentially avoidable by the algorithm. Among 100 randomly selected cases, nine exclusions were due to coding issues and four due to false positives. Overall (N = 87), 20/87 (23%) of readmissions were directly related to sole emergency care, 31/87 (36%) related to healthcare providers other than the ED, and 23/87 (26%) were of mixed provision, while 13/87 (15%) were attributed to the course of the disease. Conclusions: The study confirms the need for a better understanding of the algorithm’s measurement and of its reported results. Careful interpretation is required before a sound conclusion can be made. Indeed, it is apparent that the 30-day PAR quality indicator rate reflects a wider parameter of care than hospitals alone, who understandably tend to concentrate on their own, direct liability of care. In particular the 30-day PAR quality indicator is not well-suited to evaluate ED performance.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"128 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2020-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78965443","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: Transitions of care, including those between the Emergency Department (ED) and Internal Medicine (IM) for hospital admissions are complicated, variable processes that impact efficiency and patient safety. At our institution, a new, standardized admissions process that involved a nurse coordinator intermediary who served a dual role of facilitating admissions and overseeing bed board was implemented in July 2017. We aimed to evaluate the impact of the new process on ED throughput and safety outcomes of admitted patients. Methods: A retrospective analysis of the admissions process for patients at an urban, academic ED was conducted over a 4-month period preceding and following process implementation. ED metrics, including admission decision to ED departure time, were reviewed. In addition, the number of admitted patients upgraded to the intensive care unit (ICU) via a rapid response team (RRT-ICU) within 24 hours of admission and direct physician-physician handoffs were analyzed via surveys of both IM and EM physicians. Results: A total of 1,109 admissions were reviewed. The new admissions process resulted in a statistically significant decrease in boarding times for admitted ED patients ( p = .03). The number of RRT-ICUs within 24 hours of admission did not change as a result of the intervention ( p = .5). Direct physician handoffs increased, but not significantly, according to surveys of IM ( p = .39) and EM physicians ( p = .34). Conclusions: The implementation of a standardized admissions process utilizing a nurse intermediary improved provider communication and ED throughput without negatively impacting patient safety.
{"title":"Impact of a standardized admissions process using a nurse intermediary","authors":"Andrea Blome, Kraftin E Schreyer, D. Pandya","doi":"10.5430/jha.v9n3p1","DOIUrl":"https://doi.org/10.5430/jha.v9n3p1","url":null,"abstract":"Objective: Transitions of care, including those between the Emergency Department (ED) and Internal Medicine (IM) for hospital admissions are complicated, variable processes that impact efficiency and patient safety. At our institution, a new, standardized admissions process that involved a nurse coordinator intermediary who served a dual role of facilitating admissions and overseeing bed board was implemented in July 2017. We aimed to evaluate the impact of the new process on ED throughput and safety outcomes of admitted patients. Methods: A retrospective analysis of the admissions process for patients at an urban, academic ED was conducted over a 4-month period preceding and following process implementation. ED metrics, including admission decision to ED departure time, were reviewed. In addition, the number of admitted patients upgraded to the intensive care unit (ICU) via a rapid response team (RRT-ICU) within 24 hours of admission and direct physician-physician handoffs were analyzed via surveys of both IM and EM physicians. Results: A total of 1,109 admissions were reviewed. The new admissions process resulted in a statistically significant decrease in boarding times for admitted ED patients ( p = .03). The number of RRT-ICUs within 24 hours of admission did not change as a result of the intervention ( p = .5). Direct physician handoffs increased, but not significantly, according to surveys of IM ( p = .39) and EM physicians ( p = .34). Conclusions: The implementation of a standardized admissions process utilizing a nurse intermediary improved provider communication and ED throughput without negatively impacting patient safety.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"72 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2020-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75901545","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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