Jason Persoff, Hemali Patel, Sarguni Singh, Cathy Ehrenfeucht, J. Kutner, Charlie Little, S. Tevis
The SARS-CoV-2 (COVID-19) pandemic is the largest mass effect incident in a century, requiring hospitals to consider how best to adapt the Hospital Incident Command System for a sustained pandemic. Given the scope of the pandemic a central position is required to improve the flow of information to providers, the flow from providers to the Incident Commander, and the overall coordination between diverse service lines and specialties. We describe a novel position, the Physician Clinical Support Supervisor, a position that has three primary functions during disaster operations: liaison, coordinator, and advocate. This role proved critical in day-to-day operations and facilitated highly effective communication up and down the chain of command, created a single point-person to coordinate multiple service lines and specialties, and served as a primary advocate for front-line workers and command.
{"title":"Expanding the hospital incident command system with a physician-centric role during a pandemic: The role of the physician clinical support supervisor","authors":"Jason Persoff, Hemali Patel, Sarguni Singh, Cathy Ehrenfeucht, J. Kutner, Charlie Little, S. Tevis","doi":"10.5430/jha.v9n3p7","DOIUrl":"https://doi.org/10.5430/jha.v9n3p7","url":null,"abstract":"The SARS-CoV-2 (COVID-19) pandemic is the largest mass effect incident in a century, requiring hospitals to consider how best to adapt the Hospital Incident Command System for a sustained pandemic. Given the scope of the pandemic a central position is required to improve the flow of information to providers, the flow from providers to the Incident Commander, and the overall coordination between diverse service lines and specialties. We describe a novel position, the Physician Clinical Support Supervisor, a position that has three primary functions during disaster operations: liaison, coordinator, and advocate. This role proved critical in day-to-day operations and facilitated highly effective communication up and down the chain of command, created a single point-person to coordinate multiple service lines and specialties, and served as a primary advocate for front-line workers and command.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"25 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2020-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73528908","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 Extension for Community Health Outcomes (ECHO) project uses teleconferencing to improve access to care for patients who are unable to access academic medical centers. The model can also be used to address key operational issues facing academic medical centers today. Furthermore, the current healthcare landscape is well primed to accept this innovation. We propose application of this model to solve current challenges in healthcare, including: inpatient capacity, network development and access. Applied in these ways, this program has the potential to alleviate stress on hospital systems, ultimately improving patient care and the patient and provider experience.
{"title":"ECHO’s ECHO: Overcoming modern healthcare operational challenges with provider-to-provider video communication","authors":"Amber B. Moore, L. Lipsitz","doi":"10.5430/jha.v9n2p48","DOIUrl":"https://doi.org/10.5430/jha.v9n2p48","url":null,"abstract":"The Extension for Community Health Outcomes (ECHO) project uses teleconferencing to improve access to care for patients who are unable to access academic medical centers. The model can also be used to address key operational issues facing academic medical centers today. Furthermore, the current healthcare landscape is well primed to accept this innovation. We propose application of this model to solve current challenges in healthcare, including: inpatient capacity, network development and access. Applied in these ways, this program has the potential to alleviate stress on hospital systems, ultimately improving patient care and the patient and provider experience.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"65 1","pages":"48"},"PeriodicalIF":0.0,"publicationDate":"2020-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86887004","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}
L. Leontieva, S. Safadi, Pratik Jain, S. Tabi, C. Roe, Derek Empey
Background: Agitation is a significant challenge to mental healthcare. This project aims to examine the effects of implementing an interactive mental flexibility group to decrease incidences of agitation in the inpatient psychiatric population during nursing shift change. Methods: This observational study, conducted on the acute inpatient psychiatric unit of an academic hospital in Central NY, USA. This 23-bed unit admits psychiatric patients from the E.D. and local hospitals. The art-based interactive group was implemented during the critical period of nursing shift change, which is known for having an increased agitation due to caregiver changes. We tracked group attendance, incidences of agitation, and as-needed medication administration for agitation. We administered a Likert-type scale to rate emotions before and after each session. Results: We observed a dramatic decrease in as needed medications for agitation 1 month prior to group (n = 576) compared to 3 months during group (n = 120). The new group constitutes a significant decrease in agitation incidents. Patients indicated an increase in happiness (mean = 0.46, SD = 0.978), decrease in sadness (mean = 0.44, SD = 1.078), and decrease in anger (mean = 1.15, SD = 1.984). Conclusions: Our project indicates that the patients and staff well receive interactive group sessions in an acute psychiatric unit. The group sessions helped to decrease agitation and medication administration. Future directions: We recommend the utilization of interactive mental flexibility groups on acute psychiatric units to promote emotional regulation, especially during nursing shift change.
{"title":"On importance of new group therapy for decrease of agitation during the critical period of nursing shift changes on an acute psychiatric inpatient floor","authors":"L. Leontieva, S. Safadi, Pratik Jain, S. Tabi, C. Roe, Derek Empey","doi":"10.5430/jha.v9n2p41","DOIUrl":"https://doi.org/10.5430/jha.v9n2p41","url":null,"abstract":"Background: Agitation is a significant challenge to mental healthcare. This project aims to examine the effects of implementing an interactive mental flexibility group to decrease incidences of agitation in the inpatient psychiatric population during nursing shift change. Methods: This observational study, conducted on the acute inpatient psychiatric unit of an academic hospital in Central NY, USA. This 23-bed unit admits psychiatric patients from the E.D. and local hospitals. The art-based interactive group was implemented during the critical period of nursing shift change, which is known for having an increased agitation due to caregiver changes. We tracked group attendance, incidences of agitation, and as-needed medication administration for agitation. We administered a Likert-type scale to rate emotions before and after each session. Results: We observed a dramatic decrease in as needed medications for agitation 1 month prior to group (n = 576) compared to 3 months during group (n = 120). The new group constitutes a significant decrease in agitation incidents. Patients indicated an increase in happiness (mean = 0.46, SD = 0.978), decrease in sadness (mean = 0.44, SD = 1.078), and decrease in anger (mean = 1.15, SD = 1.984). Conclusions: Our project indicates that the patients and staff well receive interactive group sessions in an acute psychiatric unit. The group sessions helped to decrease agitation and medication administration. Future directions: We recommend the utilization of interactive mental flexibility groups on acute psychiatric units to promote emotional regulation, especially during nursing shift change.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"17 1","pages":"41"},"PeriodicalIF":0.0,"publicationDate":"2020-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79377691","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}
E. Platonova, Kailas Venkitasubramanian, Michael E. Thompson
High quality health care requires competent, motivated, and satisfied health care employees. This research examines whether employee job satisfaction differs at for-profit (FP) and not-for-profit (NFP) hospitals and how other organizational characteristics mediate this relationship. In this cross-sectional study, Press Ganey Employee Partnership Survey data from 35 Florida hospitals were used to understand the relationship between hospital ownership (primary independent variable) and employee job satisfaction (outcome). A flexible structural equation model was used to examine the relationship. The sample included 32,892 valid responses (approximately 23% from FP hospitals). Employees in FP hospitals were found to less satisfied with their jobs than their NFP counterparts. This trend was strongly associated with an inverse relationship between job satisfaction and assessment of immediate supervisors. The resulting job satisfaction model had an R2 of 0.524, indicating good fit. Further analyses revealed a positive association between perceived staffing levels and supervisor satisfaction, suggesting that the relative leanness of FP institutions might explain the observed difference in supervisor satisfaction. Employee job satisfaction is a complex multifaceted construct. Four main organizational factors affect employee job satisfaction: the organization’s ownership type (FP or NFP), employee relationships with supervisors, work schedule, and length of employment. Leaders need to provide front line supervisors with adequate resources and support. Training immediate supervisors how to approach and be supportive of their workers provides an immediate solution toward increasing employee job satisfaction.
{"title":"Employee job satisfaction at Florida for-profit and not-for-profit hospitals","authors":"E. Platonova, Kailas Venkitasubramanian, Michael E. Thompson","doi":"10.5430/jha.v9n2p33","DOIUrl":"https://doi.org/10.5430/jha.v9n2p33","url":null,"abstract":"High quality health care requires competent, motivated, and satisfied health care employees. This research examines whether employee job satisfaction differs at for-profit (FP) and not-for-profit (NFP) hospitals and how other organizational characteristics mediate this relationship. In this cross-sectional study, Press Ganey Employee Partnership Survey data from 35 Florida hospitals were used to understand the relationship between hospital ownership (primary independent variable) and employee job satisfaction (outcome). A flexible structural equation model was used to examine the relationship. The sample included 32,892 valid responses (approximately 23% from FP hospitals). Employees in FP hospitals were found to less satisfied with their jobs than their NFP counterparts. This trend was strongly associated with an inverse relationship between job satisfaction and assessment of immediate supervisors. The resulting job satisfaction model had an R2 of 0.524, indicating good fit. Further analyses revealed a positive association between perceived staffing levels and supervisor satisfaction, suggesting that the relative leanness of FP institutions might explain the observed difference in supervisor satisfaction. Employee job satisfaction is a complex multifaceted construct. Four main organizational factors affect employee job satisfaction: the organization’s ownership type (FP or NFP), employee relationships with supervisors, work schedule, and length of employment. Leaders need to provide front line supervisors with adequate resources and support. Training immediate supervisors how to approach and be supportive of their workers provides an immediate solution toward increasing employee job satisfaction.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"1 1","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2020-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88623081","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}
Ere Uibu, Kaja Põlluste, M. Lember, M. Kangasniemi
Objective: This review summarizes and synthesizes the evidence on follow-up activities regarding patient safety incidents reported in hospitals. Methods: Peer-reviewed papers were retrieved with electronic searches from CINAHL, Web of Science, PubMed and Scopus databases and with manual searches in most relevant journals and in the reference lists of included studies, limiting searches to papers published in English between 2014 and 2018. A systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two authors extracted the data following a predefined extraction form. Results: All together 16 studies were selected for analysis. All studies described incidents and gave insight into problems, risks and unsafe situations which were responded to with recommended improvements. Recommended improvements in response to incidents involved guidelines, staff training, technical improvements and general safety improvements. Only five studies reported feedback and knowledge dissemination activities, referring to meetings, written support and visual support. Conclusions: Limited research has described the systematic use of report outcomes for knowledge application in organizations. However, the development of patient safety requires that reported incidents are responded to by knowledge application within feedback and knowledge dissemination activities. Therefore, healthcare professionals need to have sufficient competences in patient safety, and more research is needed on the content and effectiveness of the responding activities.
目的:总结和综合医院报告的患者安全事件后续活动的证据。方法:通过电子检索从CINAHL、Web of Science、PubMed和Scopus数据库检索同行评议论文，并在大多数相关期刊和纳入研究的参考文献列表中进行人工检索，将检索限制在2014年至2018年期间以英文发表的论文。根据系统评价和荟萃分析声明的首选报告项目进行了系统评价。两位作者按照预定义的提取表单提取数据。结果:共选择16项研究进行分析。所有研究都描述了事件，并对问题、风险和不安全情况进行了深入分析，并提出了改进建议。针对事故提出的改进建议包括指导方针、员工培训、技术改进和一般安全改进。只有五项研究报告了反馈和知识传播活动，涉及会议、书面支持和视觉支持。结论:有限的研究描述了在组织中系统地使用报告结果来应用知识。然而，患者安全的发展需要通过反馈和知识传播活动中的知识应用来响应报告的事件。因此，医疗保健专业人员需要在患者安全方面具备足够的能力，并且需要对响应活动的内容和有效性进行更多的研究。
{"title":"Reporting and responding to patient safety incidents based on data from hospitals’ reporting systems: A systematic review","authors":"Ere Uibu, Kaja Põlluste, M. Lember, M. Kangasniemi","doi":"10.5430/jha.v9n2p22","DOIUrl":"https://doi.org/10.5430/jha.v9n2p22","url":null,"abstract":"Objective: This review summarizes and synthesizes the evidence on follow-up activities regarding patient safety incidents reported in hospitals. Methods: Peer-reviewed papers were retrieved with electronic searches from CINAHL, Web of Science, PubMed and Scopus databases and with manual searches in most relevant journals and in the reference lists of included studies, limiting searches to papers published in English between 2014 and 2018. A systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two authors extracted the data following a predefined extraction form. Results: All together 16 studies were selected for analysis. All studies described incidents and gave insight into problems, risks and unsafe situations which were responded to with recommended improvements. Recommended improvements in response to incidents involved guidelines, staff training, technical improvements and general safety improvements. Only five studies reported feedback and knowledge dissemination activities, referring to meetings, written support and visual support. Conclusions: Limited research has described the systematic use of report outcomes for knowledge application in organizations. However, the development of patient safety requires that reported incidents are responded to by knowledge application within feedback and knowledge dissemination activities. Therefore, healthcare professionals need to have sufficient competences in patient safety, and more research is needed on the content and effectiveness of the responding activities.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"9 1","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2020-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82862140","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}
M. Karagic, Justin Chin, Jun Lin, N. Silverberg, M. Lee-Wong
Background: Research subjects may receive payment for their participation. Multiple models for payment have been proposed, however, the most ethical model is not completely clear. Objective: The purpose of the present study is to evaluate and quantify the public’s perception and to identify demographic determinants influencing said perceptions. Methods: Patients from a New York City medical clinic were queried using an adapted survey on medical research compensation consisting of 6 opinion-style questions pertaining to the payment of subjects enrolling in clinical trials and 9 demographic questions. Pearson’s chi-squared tests of independence with two-tailed alpha of 0.05 and correction for multiple testing were performed to determine statistical significance. Results: 440 respondents were recruited for participation, with broad distribution across age, race, and socioeconomic levels. For research payment, surveyed respondents preferred the market model (n = 265, 62%) compared to the reimbursement model (n = 72, 16.8%) or wage payment model (n = 64, 15%) and no payment (n = 27, 6.3%). Patients under the age of 60 were more likely to choose the market model ( p = .01) compared to those over 60 selecting the reimbursement model ( p = .001). 88.7% (n = 377) of respondents indicated they did not perceive clinical trial payment to be a bribe, with non-white patients being more likely to identify payment as a bribe ( p = .025). 73.2% of respondents (n = 344) believed that poorer individuals were more likely to enroll. Patients without high school education and patients 60 years of age or older were more likely to believe that payment ( p = .006 and p < .001, respectively) would have no influence on enrollment than those with high school education. Conclusions: Differences in mind-set towards clinical trials demonstrate older patients and individuals without a high school education may have differing opinions with regards to financial incentives in clinical trials. Sensitivity towards these attitudes may require alternative models of payment for future clinical trials.
{"title":"A cross-sectional survey on patient perception of subject payment for research","authors":"M. Karagic, Justin Chin, Jun Lin, N. Silverberg, M. Lee-Wong","doi":"10.5430/jha.v9n2p14","DOIUrl":"https://doi.org/10.5430/jha.v9n2p14","url":null,"abstract":"Background: Research subjects may receive payment for their participation. Multiple models for payment have been proposed, however, the most ethical model is not completely clear. Objective: The purpose of the present study is to evaluate and quantify the public’s perception and to identify demographic determinants influencing said perceptions. Methods: Patients from a New York City medical clinic were queried using an adapted survey on medical research compensation consisting of 6 opinion-style questions pertaining to the payment of subjects enrolling in clinical trials and 9 demographic questions. Pearson’s chi-squared tests of independence with two-tailed alpha of 0.05 and correction for multiple testing were performed to determine statistical significance. Results: 440 respondents were recruited for participation, with broad distribution across age, race, and socioeconomic levels. For research payment, surveyed respondents preferred the market model (n = 265, 62%) compared to the reimbursement model (n = 72, 16.8%) or wage payment model (n = 64, 15%) and no payment (n = 27, 6.3%). Patients under the age of 60 were more likely to choose the market model ( p = .01) compared to those over 60 selecting the reimbursement model ( p = .001). 88.7% (n = 377) of respondents indicated they did not perceive clinical trial payment to be a bribe, with non-white patients being more likely to identify payment as a bribe ( p = .025). 73.2% of respondents (n = 344) believed that poorer individuals were more likely to enroll. Patients without high school education and patients 60 years of age or older were more likely to believe that payment ( p = .006 and p < .001, respectively) would have no influence on enrollment than those with high school education. Conclusions: Differences in mind-set towards clinical trials demonstrate older patients and individuals without a high school education may have differing opinions with regards to financial incentives in clinical trials. Sensitivity towards these attitudes may require alternative models of payment for future clinical trials.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"53 1","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2020-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85717774","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}
Background: Many organizations have adopted Lean tools to improve healthcare, but few studies adequately evaluate the effectiveness of Lean tools, such as Rapid Process Improvement Workshops (RPIWs). Objective: To evaluate the effectiveness of RPIWs conducted in surgical services at two hospital sites from economic and statistical perspectives. Methods: Retrospective data over three years from the two interventions sites were used for a cost-benefit analysis in the form of Return on Investment (ROI). The Interrupted Time Series (ITS) method was used to analyze the trends of selected process measures such as surgical volumes, overtime, and sick time hours during intervention and post-intervention periods at the two sites. Also, comparable data from two control sites were used to statistically compare the trends of some of the process measures between the intervention and control sites. Results: The cumulative effects of the six RPIWs performed at each site were examined. The results did not produce any evidence to indicate that the outcomes justify the investments. The ITS analysis revealed no indication of systematic and sustained change in the pattern of process measures at the intervention sites as a result of RPIWs. Nor did they provide significant or conclusive evidence when comparing the process measures between the intervention and control sites. Conclusions: This study identifies some of the difficulties of empirically calculating the ROI of RPIWs, and provides evidence that any realized benefits due to RPIWs implemented in two hospitals were not worth the investment. Such a result may lead us to challenge any unfounded claims of high monetary benefits from Lean tools or similar quality improvement initiatives.
{"title":"Are the benefits of lean rapid process improvement workshops in healthcare worth the investment?","authors":"James G. Chan, J. Safaei, T. Rotter","doi":"10.5430/jha.v9n2p1","DOIUrl":"https://doi.org/10.5430/jha.v9n2p1","url":null,"abstract":"Background: Many organizations have adopted Lean tools to improve healthcare, but few studies adequately evaluate the effectiveness of Lean tools, such as Rapid Process Improvement Workshops (RPIWs). Objective: To evaluate the effectiveness of RPIWs conducted in surgical services at two hospital sites from economic and statistical perspectives. Methods: Retrospective data over three years from the two interventions sites were used for a cost-benefit analysis in the form of Return on Investment (ROI). The Interrupted Time Series (ITS) method was used to analyze the trends of selected process measures such as surgical volumes, overtime, and sick time hours during intervention and post-intervention periods at the two sites. Also, comparable data from two control sites were used to statistically compare the trends of some of the process measures between the intervention and control sites. Results: The cumulative effects of the six RPIWs performed at each site were examined. The results did not produce any evidence to indicate that the outcomes justify the investments. The ITS analysis revealed no indication of systematic and sustained change in the pattern of process measures at the intervention sites as a result of RPIWs. Nor did they provide significant or conclusive evidence when comparing the process measures between the intervention and control sites. Conclusions: This study identifies some of the difficulties of empirically calculating the ROI of RPIWs, and provides evidence that any realized benefits due to RPIWs implemented in two hospitals were not worth the investment. Such a result may lead us to challenge any unfounded claims of high monetary benefits from Lean tools or similar quality improvement initiatives.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"34 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2020-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82396340","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}
Patient movements following hospitalization are difficult to track. In a large Midwestern academic institution, we analyzed data using network statistics for patients discharged by the hospitalist service between June 2016-June 2018. We retrieved all major patient movements logged in the patient throughput management system following admission. The 4,869 patients discharged by the hospitalist service during the study period experienced 6,832 movements. The mean was 1.4 movements per patient while the maximum was 8. Most patients (72.3%) moved once following hospitalization while 27.7% moved more than once. The predominant movement type was downgrades which comprised 51.8% (n = 3,543) of all movements. Lateral movements were the next most common (25.9%, n = 1,771). Network statistics revealed progressive care units to be central to patient flow across the system. Transfers following hospitalization are common. Visualizing these transfers using network statistics may provide valuable insights to enhance patient safety.
{"title":"Patient transfers during hospitalization: An examination of intra facility patient locations using network analysis","authors":"Josh Sadowski, Mark Luetkemeyer, Areeba Kara","doi":"10.5430/jha.v9n1p43","DOIUrl":"https://doi.org/10.5430/jha.v9n1p43","url":null,"abstract":"Patient movements following hospitalization are difficult to track. In a large Midwestern academic institution, we analyzed data using network statistics for patients discharged by the hospitalist service between June 2016-June 2018. We retrieved all major patient movements logged in the patient throughput management system following admission. The 4,869 patients discharged by the hospitalist service during the study period experienced 6,832 movements. The mean was 1.4 movements per patient while the maximum was 8. Most patients (72.3%) moved once following hospitalization while 27.7% moved more than once. The predominant movement type was downgrades which comprised 51.8% (n = 3,543) of all movements. Lateral movements were the next most common (25.9%, n = 1,771). Network statistics revealed progressive care units to be central to patient flow across the system. Transfers following hospitalization are common. Visualizing these transfers using network statistics may provide valuable insights to enhance patient safety.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"9 1","pages":"43"},"PeriodicalIF":0.0,"publicationDate":"2020-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87186090","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}
Hospital observation is a topic of interest among patients for whom being classified as observation has negative financial ramifications. Similarly, observation rate is monitored by some hospital administrators because of its potential financial impact on the health system. During the creation of an internal physician advisor program, the new health system physician advisor was asked to investigate causes for a higher than average observation rate for WellSpan Summit Health. Using Lean methodology, standard work was established for the physician advisor observation patient review process when inpatient criteria were not met. Key performance indicators were tracked using production boards and a dashboard that interfaces with the electronic health record. The physician advisor program decreased missed inpatient conversion opportunities, but despite fixing process problems, improving level of care determination accuracy, and seeing outcomes that should have decreased the observation rate, the observation rate paradoxically increased. The cause of the rising observation rate is unknown but is likely multifactorial. Possible causes include changing standards concerning what qualifies as inpatient, Affordable Care Act (ACA) expansion of insured patients presenting to the emergency department (ED) with low acuity conditions, and the safety net function of the hospital for patients living with adverse social determinants of health. The safety net theory is most likely true for “high utilizers” using a greater portion of hospital resources than the rest of the population. This study provides evidence that observation rate is not a useful metric in the absence of a process problem. A more meaningful metric concerning observation patients is observation length of stay.
{"title":"Hospital based physician advisor program sheds new light on observation rate","authors":"T. Owolabi","doi":"10.5430/jha.v9n1p35","DOIUrl":"https://doi.org/10.5430/jha.v9n1p35","url":null,"abstract":"Hospital observation is a topic of interest among patients for whom being classified as observation has negative financial ramifications. Similarly, observation rate is monitored by some hospital administrators because of its potential financial impact on the health system. During the creation of an internal physician advisor program, the new health system physician advisor was asked to investigate causes for a higher than average observation rate for WellSpan Summit Health. Using Lean methodology, standard work was established for the physician advisor observation patient review process when inpatient criteria were not met. Key performance indicators were tracked using production boards and a dashboard that interfaces with the electronic health record. The physician advisor program decreased missed inpatient conversion opportunities, but despite fixing process problems, improving level of care determination accuracy, and seeing outcomes that should have decreased the observation rate, the observation rate paradoxically increased. The cause of the rising observation rate is unknown but is likely multifactorial. Possible causes include changing standards concerning what qualifies as inpatient, Affordable Care Act (ACA) expansion of insured patients presenting to the emergency department (ED) with low acuity conditions, and the safety net function of the hospital for patients living with adverse social determinants of health. The safety net theory is most likely true for “high utilizers” using a greater portion of hospital resources than the rest of the population. This study provides evidence that observation rate is not a useful metric in the absence of a process problem. A more meaningful metric concerning observation patients is observation length of stay.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"11 1","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2020-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87073878","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}
Jeong-ah Kim, D. Terry, Sunny Jang, J. Gilbert, M. Cruickshank
Background: Patient safety remains a priority for healthcare organisations globally. There remains little consensus regarding the extent of this issue and the resultant impact on both individuals and communities. Aim: Our study aims to provide healthcare organisations and decision makers with increased information regarding predictive risk factors to enhance patient safety, and develop an organisational culture of safety. Methods: This paper reviews current literature regarding patient safety and presents predictive risk factors and recommendations for healthcare organisations globally to measure and monitor patient safety. Results: Three categories of organisational factors promoting safety culture were identified – Focusing on system/culture, management support and team work and event reporting. Conclusions: This review strove to identify and discuss the predictive risk factors for patient safety and support the importance of a positive organisational culture and strong leadership in monitoring and reducing patient care errors and improving patient care in healthcare setting.
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