Acute Care Hospital Units Research Articles

Licensed caregiver characteristics and staffing in California acute care hospital units.

Concerns about declining quality of care and nurse staffing shortages led to legislation mandating minimum nurse-to-patient ratios in the state of California. Although research finds that better registered nurse (RN) staffing results in higher quality of care, little evidence exists on which to base specific nurse-patient ratios. The authors describe the results of a California survey characterizing licensed caregivers, identifying staffing levels by unit type, and describing how staffing levels vary across hospital types. A stratified random sample of general acute care hospitals was surveyed to collect cross-sectional data on hospitals' nursing workforce and staffing practices and to assess the impact of potential patient-to-nurse staffing ratios. All academic medical centers; rural, private, and city/county hospitals; and hospitals affiliated with a large group-model health maintenance organization (HMO) were eligible for inclusion. Eighty hospitals were surveyed, representing all major metropolitan areas in the state. Acute care hospitals in California have diverse nursing staffs with variations in education, experience, and employment status. Considerable variations in skill mix were identified, with the proportion of RNs ranging from 30% to 84%, depending on the unit type surveyed. As states struggle with an anticipated critical shortage of RNs, these results have several implications for health and education policy. Future studies of this type will be needed to evaluate the impact of anticipated changes in the regulation of nurse staffing.

Nurse staffing and patient falls on acute care hospital units

Changes in health care financing, beginning in the 1980's, resulted in reduced nurse staffing and skill levels in acute care hospitals. Research has shown that reduced nurse staffing has endangered some aspects of patient safety. This study estimated the relationship between three aspects of nurse staffing and the patient fall rate for four types of acute care units. The association was estimated using a generalized linear mixed model with data for 2002 from 1751 hospital units in the National Database of Nursing Quality Indicators. Higher fall rates were associated with fewer nursing hours per patient day and a lower percentage of registered nurses, although the relationship varied by unit type. Smaller hospitals also had higher fall rates. Information on unit type and different aspects of nurse staffing, with advanced statistical modeling, resulted in a more precise understanding of the relationship between nurse staffing and falls.

After a Long Journey Psychiatrist Helps at Home

After a Long Journey Psychiatrist Helps at Home

The pouch acting as a mediator between “Being a Person With an Ostomy” and “Being a Professional”: Analysis of a pedagogical strategy

Objective: This study analyzes the process of constructing and reconstructing the meanings of the concepts ostomy, ostomy patient, and the nurse's role in managing an ostomy after the experience of wearing a pouch. Subjects and setting: Thirty nurses who were students in the Enterostomal Therapy Nursing Education Program in 1992 and 1993 participated in this study. All of the participants were female, ages 20 to 55 years, had graduated from nursing at least 6 years previously, and had been working at acute care hospital units or at outpatient care centers. The research was completed at the Enterostomal Therapy Nursing Education Program in the Nursing College of the University of São Paulo. Methods: All participants wore a pouch and lived as an ostomy patient for a 24-hour period and then were interviewed about their experience. Two major themes were identified after analysis: “being a person with an ostomy” and “being a professional.” Results: The experience of wearing a pouch promoted changes in perceived role, self-esteem, body image, sexuality, and social relations. These changes were sometimes perceived as stigmatization and sometimes as enhancing social support. The perceptions caused a crisis that provoked the use of coping and social defense mechanisms that ultimately altered the participants' perceptions of the meaning of “being a nurse.” Prior to this learning experience, the participants' management of patients with ostomies was fragmented and marked by a dissociation among activity, thinking, and feeling. Before the experiences, participants defined their management of patients with ostomies as mostly technical, focusing on the ostomy and the pouch. Following the experience, participants proposed changes in practice designed to care for the whole human being, revealing an incorporation of the affective, symbolic, and relational dimensions critical to managing the care of patients with an ostomy. Conclusion: The results showed that having subjects wear a pouch as a pedagogic strategy was successful in directing the participants' thinking about new meanings concerning “being a professional,” resulting in some potential profound changes in the future nursing care of their patients. (J WOCN 2001;28:206-14.)

Measuring Judgments of Professionals: Using Vignettes in a Social Survey About Patient Confusion

The use of a factorial survey to measure the clinical judgments of professionals is described. This design allows the researcher to partial out the effects of variables on clinical decision making while using probability sampling. Methods frequently used to study judgments are reviewed and a study of nurses' judgments about patients' confusional episodes are used to illustrate the application of the factorial survey. Acute confusion in patients is a common clinical problem for nurses working in medical-surgical units in acute care hospitals. Using the factorial survey to study a real-life problem such as confusion demonstrates how this design can be used to test judgments in complex clinical situations, to aid in concept development, and to identify consensus among professionals.

The Evolution of an Acute Care Hospital Unit to a DRG-exempt Rehabilitation Unit

The Health Care Financing Administration's decision to adopt a prospective based payment system has caused many institutions to implement new policies and practices. A recent area of interest for many hospitals has been the creation of diagnosis-related group (DRG) exempt units to maximize reimbursement practices. We analyzed changes which occurred when an eight bed acute care stroke unit (SU) was converted to a DRG exempt eight bed rehabilitation unit (RU). The time period involved was 1 1/2 months before and 1 1/2 months after the transition occurred. Analysis of data from the pre- and posttransition periods revealed that: (1) length of stay increased significantly from 11.7 to 15.3 days (P less than 0.001); (2) functional independence measure (FIM) score improvement was significantly greater (P less than 0.05) for RU patients (0.84/day) than for SU patients (0.39/day); (3) disposition to home v other facilities increased significantly from 50 to 81% (P less than 0.05); (4) the overall occupancy increased from 94 to 100% and all beds were filled with rehabilitation patients; (5) the proportion of patients with Medicare as their primary insurer was comparable before (64%) and after (67%) unit conversion; (6) gross income from rehabilitation patients increased by 43%. Indirect savings via reduction of acute hospital length of stay for Medicare patients increased total income from operation of this unit. We conclude that patients on the RU stayed longer, had greater daily improvements in functional status, and were more likely to be discharged to home. This appears to be due to a more efficient use of rehabilitation beds and a concomitant overall improvement in reimbursement to the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

The observable patient in the DRG era

We examined financial differences of observing patients in the acute care hospital versus an emergency department observation unit. We identified 193 patients who could have been treated in either the acute care hospital or observation unit. Under a cost reimbursement system, the charge per patient was $197 greater, the reimbursement per patient was $254 greater, and the profit per patient was $140 greater for observing patients in the hospital rather than in the observation unit ( p < 0.001). Under a prospective payment system, the charge per patient was $1187 greater, the reimbursement per patient was $1137 greater, and the profit per patient was $1063 greater for observing patients in the hospital rather than in the observation unit ( p < 0.001). This difference in reimbursement can be a great financial incentive for hospitals to admit patients rather than to observe them in the emergency department. Significant savings might be realized for the health care payer by optimal use of observation units under a prospective payment or cost reimbursement system.