Patient Care Capacity Research Articles

Innovations in Emergency Nursing: Adapting Patient Flow Management to Emergency Department Overcrowding

IntroductionThe coronavirus disease-2019 pandemic brought greater attention to nurses’ innovation and adaptability. Emergency nurses continue to adjust their patient flow management strategies in response to high levels of overcrowding, but this work has been poorly described. MethodsThis paper describes findings from a grounded theory study that included 29 focus groups and interviews with emergency nurses. Data was also collected through 64 hours of participant observation across 4 emergency departments. ResultsTwo themes emerged to capture how emergency nurses manage patient flow in overcrowded departments. First, emergency nurses creatively adapt their resource use, staffing roles, and patient care processes to expand patient care capacity and expedite throughput. Second, nurses demonstrate cognitive adaptability by modifying their attention and focus. As crowding increases, nurses become more highly engaged in the work of patient flow management until excessive overcrowding may lead to disengagement. Nurses also shift their focus away from proactive and retrospective patient flow management strategies to become more attentive to meeting current patient care needs. DiscussionThe ability of emergency departments to care for high patient volumes depends upon nurses' cognitive and organizational labor. Innovation and adaptability are essential components of emergency nursing work. Although emergency nurses have demonstrated great ingenuity, more work is needed to ensure that emergency patient flow management strategies are evidence-based.

Nationwide status of aeromedical pre-hospital and retrieval medicine in Australia.

To survey the current structure, capability and operational scope of pre-hospital and retrieval aeromedical teams across Australia. The medical directors of all Australian civilian adult aeromedical retrieval organisations with pre-hospital teams and/or doctors for inter-hospital critical care patient transport were contacted in a survey to qualitatively assess capacity and team structure. All 17 organisations contacted completed the survey. While there is diversity in team structure with the pairing of doctors, paramedics and nurses, capacity for patient care is generally homogenous. A doctor/paramedic model is the more common team structure for rotary-wing missions, and doctor/nurse for fixed-wing. Differences are mostly due to state government controlled aspects of their health services. An advanced degree of intensive patient care occurs outside of the hospital. Land and sea rescue is an important aspect of Australian aeromedical work. Aeromedicine in Australia has many consistent elements, but variable contexts have resulted in a diversity of operational models.

Paediatric oncology in the Eastern Mediterranean region (EMR): the current state and challenges.

The WHO Eastern Mediterranean region (EMR) is characterised by highly economically diverse countries, with healthcare systems in various phases of development. Childhood cancer care provision also ranges from that provided in centres able to deliver sophisticated therapy resulting in outcomes comparable to those seen in highly developed nations, to countries with no provision for care of children with cancer. At 10·1 per 100,000 children at risk, the age standardised incidence-rate for cancer in children below 14 years of age is relatively low but may be consequent to poor registration. Shortages in trained care providers were identified in many regional countries, particularly in low and lower-middle income countries, however, implementation of training programs are beginning to counter this deficit. Significant diversity in patient care capacity exists in the region, leading to inequitable access to quality paediatric oncology care. There is strong potential for regional collaboration towards infrastructure and capacity improvement, with facilities available within the EMR for twinning and educational support to those centres and countries that need them. While cancer care coverage is available to citizens of high-income countries, in the lower-income countries out-of-pocket health expenditure can reach 75%. Some relief is achieved through the contribution of multiple charitable foundations working to support childhood cancer care in the region, as well as the provision of care in, often overburdened, public sector hospitals. War and other geo-political turmoil, as well as natural disasters, have negatively impacted healthcare capacity, including childhood cancer care, in several regional countries. Despite all this, the trajectory for change is upward and initiatives such as the WHO Global Initiative for Childhood Cancer are igniting positive change.

Văn hóa an toàn người bệnh và một số yếu tố ảnh hưởng tại bệnh viện đa khoa Tâm Trí Nha Trang năm 2023

The study is to describe the patient safety culture awareness of healthcare staff and to analyze factors affecting the culture of patient safety at Tam Tri Nha Trang General Hospital in 2023. This is a cross-sectional study, combining quantitative method using the tool of HSOPSC - VN 2015 and qualitative method using in-depth interview guide from 10/2022 to 06/2023. Results of the research were as follows: The rate of healthcare employees responding positively to patient safety culture was 77.6%; 7 aspects achieved positive feedback rate > 75%, 3 aspects had low positive feedback. Positive impact factors were leaders’ encouragement for healthcare employees to report errors, clear reward and recognition mechanisms for efforts, relationships and communication and work environment. Negative impact factors were lack of clear understanding of healthcare employees about report regulations, lack of behavioral experience, deteriorating infrastructure, lack and non-consistency of equipment, ineffective problem solving, lack of separate budget for internal safety activities, and human resource shortage. The Hospital's board of directors should improve infrastructure, finance, policies, medical error report processes, and recruitment of healthcare employees with sufficient professional capacity and patient care capacity.

임상간호사의 호흡기계 환자 간호 경험

Purpose : This study aimed to explore nurses’ caring experience for inpatients with respiratory tract diseases in hospital settings.
 Methods : This qualitative research employed focus group interviews to collect data. Two focus groups comprising of 11 nurses were interviewed from January 11 to 18, 2022.
 Results : The data analysis derived two theme clusters and six sub-themes. The two main themes from the analysis were ‘Pay close attention and deal with sensitively to changes in the patient's condition’ and ‘Continuous efforts to enhance respiratory patient care capacity’.
 Conclusion : This study provides valuable insights that can contribute to the development of education programs and policies aimed at enhancing the competency of clinical nurses and nursing students in caring for respiratory patients.

Enhancing Nursing Capacity to Provide Patient Care in a Pandemic.

At the onset of the COVID-19 pandemic, an immediate priority for nurse leaders was to develop a care delivery plan to address anticipated surges in patient volumes and potential staff shortages. This article describes actions taken to enhance patient care capacity. Strategies included reviewing the competencies of nurses and other health professionals, mapping out redeployment pathways, preparing nurses and other health professionals for redeployment as needed and creating a collaborative care team model. This article includes an in-depth focus on the design, implementation and outcomes of an innovative role for fourth-year nursing students in the collaborative care team model.

Making Data Reports Useful During the COVID-19 Pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, anxiety regarding hospitals resulted in patients risking their lives and not seeking emergency medical care when needed. Early into the pandemic, hospital emergency room utilization plummeted more than 40% in some hospitals, according to the Centers for Disease Control and Prevention. As COVID-19 outbreaks intensified in the Western regions of the country, emergency room census began to increase significantly in the middle of June. Local safety net health care resources were struggling with the increase in emergency room utilization and scrambled to increase patient care capacity, especially their emergency rooms and intensive care units. The data collected during this time is of great value. Unfortunately, it is often poorly reported, overlooked, and ignored when it should be used to make better decisions and allocations. During the pandemic, underserved populations were especially impacted, overwhelming safety net health organizations. The findings from a simple data analysis provide a template for resource acuity among communities and depict the importance of health equity.

Impact of health information technology optimization on clinical quality performance in health centers: A national cross-sectional study.

Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization's health information technology (IT) optimization and clinical quality performance. Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs. Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health record (EHR) and to undertake PCMH transformation are found more commonly among larger HCs practices. Smaller practices may lack the financial, human and educational assets to implement and to maintain EHR technology. Accordingly, targeted approaches to support small HCs practices in leveraging economies of scale for health IT optimization, clinical decision support, and clinical workflow enhancements are critical for practices to thrive in the dynamic value-based payment environment.

Public Health Academic Alliance for COVID-19 Response: The Role of a National Medical Task Force in Puerto Rico.

Alliances between the government and academic communities can be a key component of the public health response to an emergency such as the coronavirus disease 2019 (COVID-19) pandemic. The Governor of Puerto Rico designated the Puerto Rico Medical Task Force (MTF) COVID-19 to provide direct guidance and evaluation of the government response to the epidemic in Puerto Rico. Several work groups were formed within the MTF to create protocols and provide evidence-based recommendations on different public health aspects. The collaboration between the academia and the government enhanced the Puerto Rican public health response and contributed to the reduction seen in the contagion curve. Healthcare services and hospitals have not reached their maximum patient care capacity and the death toll has been controlled. Incorporating a national MTF with members of the academia into the government structure was beneficial during the COVID-19 response in Puerto Rico. A similar strategy could serve as a model for other states or territories and countries in similar scenarios.

The Role of the National Health Service Corps Clinicians in Enhancing Staffing and Patient Care Capacity in Community Health Centers.

The National Health Service Corps (NHSC) is a federal program to increase the supply of health professionals in underserved communities, but its role in enhancing the capacity of community health centers (CHCs) has not been investigated. This study examined the role of NHSC clinicians in improving staffing and patient care capacity in primary, dental, and mental health care in CHCs. Using 2013-2016 administrative data from CHCs and the NHSC, we used a generalized estimating equation approach to examine whether NHSC clinicians [staff full-time equivalents (FTEs)] complement non-NHSC clinicians in CHCs and whether their productivity (patient visits per staff FTE) was greater than that of non-NHSC clinicians in primary, dental, and mental health care. Each additional NHSC clinician FTE was associated with a significant gain of 0.72 non-NHSC clinician FTEs in mental health care in CHCs and an increase of 0.04 non-NHSC FTEs in primary care in CHCs with more severe staffing shortages. On average, every additional NHSC clinician was associated with an increase of 2216 primary care visits, 2802 dental care visits, and 1296 mental health care visits per center-year. The adjusted visits per additional staff for NHSC clinicians were significantly greater in dental (difference=992) and mental health (difference=423) care, compared with non-NHSC clinicians. The NHSC clinicians complement non-NHSC clinicians in primary care and mental health care. They help enhance the provision of patient care in CHCs, particularly in dental and mental health services, the 2 major areas of service gaps.

How elimination of lymphatic filariasis as a public health problem in the Kingdom of Cambodia was achieved

BackgroundEndemicity of lymphatic filariasis (LF) in Cambodia was proven in 1956 when microfilariae were detected in mosquitos in the Kratié province. In 2001, an extensive study confirmed the presence of both Brugia malayi and Wuchereria bancrofti microfilariae. In 2003, the Ministry of Health established a national task force to develop policies and strategies for controlling and eliminating neglected tropical diseases (NTDs), with the goal of eliminating LF by 2015. This article summarizes the work accomplished to eliminate LF as a public health problem in Cambodia.MethodsThe National Program to Eliminate Lymphatic Filariasis made excellent progress in the goal towards elimination due to strong collaboration between ministries, intensive supervision by national staff, and advocacy for mobilization of internal and external resources. Mass drug administration (MDA) with diethylcarbamazine citrate and albendazole was conducted in six implementation units, achieving > 70% epidemiological coverage for five consecutive rounds, from 2005 to 2009. In 2006, in 14 provinces, healthcare workers developed a line list of lymphedema and hydrocele patients, many of whom were > 40 years old and had been affected by LF for many years. The national program also trained healthcare workers and provincial and district staff in morbidity management and disability prevention, and designated health centers to provide care for lymphedema and acute attack. Two reference hospitals were designated to administer hydrocele surgery.ResultsEffectiveness of MDA was proven with transmission assessment surveys. These found that less than 1% of school children had antigenemia in 2010, which fell to 0% in both 2013 and 2015. A separate survey in one province in 2015 using Brugia Rapid tests to test for LF antibody found one child positive among 1677 children. The list of chronic LF patients was most recently updated and confirmed in 2011–2012, with 32 lymphoedema patients and 17 hydrocele patients listed. All lymphedema patients had been trained on self-management and all hydrocele patients had been offered free surgery.ConclusionsDue to the success of the MDA and the development of health center capacity for patient care, along with benefits gained from socioeconomic improvements and other interventions against vector-borne diseases and NTDs, Cambodia was validated by the World Health Organization as achieving LF elimination as a public health problem in 2016.

Qualifications, Demographics, Satisfaction, and Future Capacity of the HIV Care Provider Workforce in the United States, 2013-2014.

The human immunodeficiency virus (HIV)-infected population in the United States is increasing by about 30 000 annually (new infections minus deaths). With improvements in diagnosis and engagement in care, additional qualified HIV care providers may be needed. We surveyed a probability sample of 2023 US HIV care providers in 2013-2014, including those at Ryan White HIV/AIDS Program (RWHAP)-funded facilities and in private practices. We estimated future patient care capacity by comparing counts of providers entering and planning to leave practice within 5 years, and the number of patients under their care. Of surveyed providers, 1234 responded (adjusted response rate, 64%): 63% were white, 11% black, 11% Hispanic, and 16% other race/ethnicity; 37% were satisfied/very satisfied with salary/reimbursement, and 33% were satisfied/very satisfied with administrative time. Compared with providers in private practice, more providers at RWHAP-funded facilities were HIV specialists (71% vs 43%; P < .0001) and planned to leave HIV practice within 5 years (11% vs 4%; P = .0004). An estimated 190 more full-time equivalent providers (defined as 40 HIV clinical care hours per week) entered practice in the past 5 years than are expected to leave in the next 5 years. If these rates continue, by 2019 patient care capacity will increase by 65 000, compared with an increased requirement of at least 100 000. Projected workforce growth by 2019 will not accommodate the increased number of HIV-infected persons requiring care. RWHAP-funded facilities may face attrition of highly qualified providers. Dissatisfaction with salary/reimbursement and administrative burden is substantial, and black and Hispanic providers are underrepresented relative to HIV patients.

Successful Control of Ebola Virus Disease: Analysis of Service Based Data from Rural Sierra Leone

IntroductionThe scale and geographical distribution of the current outbreak in West Africa raised doubts as to the effectiveness of established methods of control. Ebola Virus Disease (EVD) was first detected in Sierra Leone in May 2014 in Kailahun district. Despite high case numbers elsewhere in the country, transmission was eliminated in the district by December 2014. We describe interventions underpinning successful EVD control in Kailahun and implications for EVD control in other areas.MethodsInternal service data and published reports from response agencies were analysed to describe the structure and type of response activities, EVD case numbers and epidemic characteristics. This included daily national situation reports and District-level data and reports of the Sierra Leone Ministry of Health and Sanitation, and Médecins Sans Frontières (MSF) patient data and internal epidemiological reports. We used EVD case definitions provided by the World Health Organisation over the course of the outbreak. Characteristics assessed included level of response activities and epidemiological features such as reported exposure (funeral-related or not), time interval between onset of illness and admission to the EVD Management Centre (EMC), work-related exposures (health worker or not) and mortality. We compared these characteristics between two time periods—June to July (the early period of response), and August to December (when coverage and quality of response had improved). A stochastic model was used to predict case numbers per generation with different numbers of beds and a varying percentage of community cases detected.ResultsThere were 652 probable/confirmed EVD cases from June-December 2014 in Kailahun. An EMC providing patient care opened in June. By August 2014 an integrated detection, treatment, and prevention strategy was in place across the district catchment zone. From June-July to August-December 2014 surveillance and contact tracing staff increased from 1.0 to 8.8 per confirmed EVD case, EMC capacity increased from 32 to 100 beds, the number of burial teams doubled, and health promotion activities increased in coverage. These improvements in response were associated with the following changes between the same periods: the proportion of confirmed/probable cases admitted to the EMC increased from 35% to 83% (χ2 p-value<0·001), the proportion of confirmed patients admitted to the EMC <3 days of symptom onset increased from 19% to 37% (χ2 p-value <0·001), and reported funeral contact in those admitted decreased from 33% to 16% (χ2 p-value <0·001). Mathematical modelling confirmed the importance of both patient management capacity and surveillance and contact tracing for EVD control.DiscussionOur findings demonstrate that control of EVD can be achieved using established interventions based on identification and appropriate management of those who are at risk of and develop EVD, including in the context of ongoing transmission in surrounding regions. Key attributes in achieving control were sufficient patient care capacity (including admission to specialist facilities of suspect and probable cases for assessment), integrated with adequate staffing and resourcing of community-based case detection and prevention activities. The response structure and coverage targets we present are of value in informing effective control in current and future EVD outbreaks.

Greening Cardiology: Exploring the Sustainability Practices of Healthcare Workers in the Cardiac Catheterization Laboratory

Background: Hospitals produce a substantial amounts of waste. To understand the potential role of employees in reducing waste, we surveyed healthcare workers in the cardiac catheterization laboratory-a resource-intensive hospital area – about their personal practices regarding sustainability at work and at home. Methods and results: We surveyed 52 full-time employees of the University of Michigan Cardiac Catheterization Laboratories using an anonymous online survey. Employees included all individuals working in a patient care capacity, such as physicians, nurses, technicians, medical assistants and administrators. Paired t-tests compared responses to parallel questions about recycling and energy saving habits between work and home. A total of 42 of 52 (80.8%) respondents completed the survey with 12 (28.6%) physicians and 30 (71.4%) non-physicians. Recycling and energy saving habits were more evident on average at home than in the workplace across the majority of areas examined. Comparing sustainability habits between subpopulations, physicians were found to engage in energy saving habits at home significantly less often than non-physician employees (mean score, 2.3 versus 2.9; p=0.0014) and employees under 40 years of age engaged in energy saving habits significantly less at work than employees over 40 years of age (mean score, 1.7 versus 2.1; p=0.0322).

Use of Patient Flow Analysis to Improve Patient Access and Clinical Efficiency by Decreasing Patient Wait Time in a Tertiary Community Hospital Ob/Gyn Ambulatory Women’s Clinic: A Quality Improvement (QI) Project

Use of Patient Flow Analysis to Improve Patient Access and Clinical Efficiency by Decreasing Patient Wait Time in a Tertiary Community Hospital Ob/Gyn Ambulatory Women’s Clinic: A Quality Improvement (QI) Project

Disaster: Are We Prepared?

In the last issue of Nursing and Midwifery Studies Journal, there was an interesting article about the experiences of nurses in Bam earthquakes in December 2003 that left 25000 dead and put the whole nation into the shock and grief (1). In summary, nurses reported that there was such a mental stress that many of them could not perform their usual simple tasks efficiently. There was a shortage of essential equipment and weak management that led to chaos. As a whole, the health system and nurses were not prepared for that disaster (1). The question is “are we prepared for the next disaster?” Iran is the tenth disaster-prone country in the world and the fourth in Asia (2) and unfortunately, the next disaster will happen sooner or later. Large-scale disaster events such as earthquake, causes social and psychological distortion of the community, infrastructures, and service levels; in this situation, delivering the best healthcare services is a challenging task (3). Therefore, the health system especially nurses should be completely prepared for such events. Although some national efforts have been made, we cannot see the complete preparedness in our health system, as in the recent earthquake in Azerbaijan, the relief operation was far from satisfactory level. There are some lessons that we can learn from our past as well as from the experiences in other countries: Hospitals can act as a source of support and management during disasters. The hospital disaster resilience, especially the focus of community-wide disaster cooperation, on-site medical rescue, and hospital patient care capacity must be improved. Hospitals need to take a more cohesive approach to be resilient and to cope efficiently in a potential disaster (4). Nurses should be equipped through education and training with the necessary knowledge and abilities to work in a disaster. The International Council of Nurses (ICN) framework of nursing disaster competencies for general nurses can be used as a guideline for nursing preparedness (4). The emergency drills are essential part of nursing preparedness. The especial well-trained and well-equipped nursing teams should be available to move to the scene in the first hours after disaster. There should be written disaster-specific plans for different situations such as pandemic influenza, earthquakes, floods, and landslides (5). Nongovernmental organizations (NGOs) should be developed to organize the volunteers during the disasters. In Bam earthquake, the crowds of volunteers who rushed to offer help caused a lot of chaos and along with weak management, led to the misuse of human resources (1). As a largest healthcare workgroup, nurses will be called upon during disasters to provide aid and care utilizing their unique skills, abilities, and understanding of the community. Fortunately there are a huge scientific and research-based materials concerning disaster, its management, and nursing in disaster that can be used for the preparedness. To be effective, nurses must be prepared; this preparation has different dimensions including education and training, leadership, and having disaster-specific plans. The health organizations should take essential steps to manage future disasters more efficiently.

Opportunities and Responsibilities for the Academy in the Medical Home

Opportunities and Responsibilities for the Academy in the Medical Home

Building Community Pharmacy Work System Capacity for Medication Therapy Management

Questions within and outside of the pharmacy profession frequently arise about a community pharmacy's capacity to provide patient-care services and maximize contributions to public health. It is surmised that community pharmacy locations must possess specific attributes and have identifiable resources within the location to effectively initiate and optimize their capacity to deliver patient care services in conjunction with medication distribution and other services. The purpose of this paper is to describe three research domains that can help pharmacies make the transition from "traditional" business models to "patient care centered" practices: (1) Work System Design, (2) Entrepreneurial Orientation, and (3) Organizational Flexibility. From these research domains, we identified 21 Work System Design themes, 4 dimensions of Entrepreneurial Orientation, and 4 types of Organizational Flexibility that can be used in combination to assist a practice location in transforming its business model to a "patient care centered" practice. The self-assessment tools we described in this paper could help realign an organization's activities to initiate and optimize capacity for patient care.&#x0D; &#x0D; Type: Idea Paper

Operational and financial impact of physician screening in the ED

BackgroundPhysician screening is one of many front-end interventions being implemented to improve emergency department (ED) efficiency. Study objectiveWe aimed to quantify the operational and financial impact of this intervention at an urban tertiary academic center. MethodsWe conducted a 2-year before-after analysis of a physician screening system at an urban tertiary academic center with 90 000 annual visits. Financial impact consisted of the ED and inpatient revenue generated from the incremental capacity and the reduction in left without being seen (LWBS) rates. The ED and inpatient margin contribution as well as capital expenditure were based on available published data. We summarized the financial impact using net present value of future cash flows performing sensitivity analysis on the assumptions. Operational outcome measures were ED length of stay and percentage of LWBS. ResultsDuring the first year, we estimate the contribution margin of the screening system to be $2.71 million and the incremental operational cost to be $1.86 million. Estimated capital expenditure for the system was $1 200 000. The NPV of this investment was $2.82 million, and time to break even from the initial investment was 13 months. Operationally, despite a 16.7% increase in patient volume and no decrease in boarding hours, there was a 7.4% decrease in ED length of stay and a reduction in LWBS from 3.3% to 1.8%. ConclusionsIn addition to improving operational measures, the implementation of a physician screening program in the ED allowed for an incremental increase in patient care capacity leading to an overall positive financial impact.

Assessing or predicting adoption of telehealth using the diffusion of innovations theory: a practical example from a rural program in New Mexico.

In New Mexico, a large rural state, it was anticipated that telehealth would bring significant value to health care delivery, improve local capacity for patient care, decrease the need for patient travel, diminish professional isolation, provide an avenue for enhanced professional education and information sharing, increase access to care, and ultimately improve health status. During the course of an evaluation of the University of New Mexico Center for Telehealth's rural telemedicine program, we used a grounded theory approach to assess barriers to the adoption of telemedicine and components of successful adoption. We then turned to the diffusion of innovations theory to better understand the dynamic interactions between the characteristics of telehealth and the social system in which it is applied. In doing so, we learned that the type of innovation decision involved in the adoption of telehealth appears to be particularly important in determining adoption. In this article we demonstrate that diffusion theory can be a useful framework for evaluating telehealth programs. We also suggest that the development of a predictive tool for prospective assessment would be useful, and could be applied when new telehealth programs are being planned.