Hospital In Northern Italy Research Articles

A qualitative content analysis of HIV consultation: when conversation is about aother than disease

In recent decades the literature has paid growing attention to the communicative and relational aspects of the medical consultation, showing a consistent presence - besides contents related to the disease and the patient's agenda - of friendly conversations or "chitchat", i.e. interventions related to social, relational and personal aspects made by the physician or by the patient. The aim of the study is to analyze the content, frequency and who between the doctor and the patient introduce the "chitchat" during the check-up visits with HIV+ patients and assess the patient satisfaction at the end of the visit. 52 visits at the clinic of Infectious Diseases in a hospital in Northern Italy were videotaped and transcribed. All patients filled out a satisfaction questionnaire at the end of the visit. The friendly conversations were extrapolated, and analyzed qualitatively with a content thematic analysis, and quantitatively using descriptive statistics. The following thematic areas were identified: patient's medical issue not related to HIV; medical condition of a family member or others; labour issues of the patient; patient's relational/emotional issues; relational/working issues work of others; social conversations; physician's self-disclosure. "Chitchat" accounted for 26.5% of the time of the visit and in 63% of cases was introduced by doctors. The 91.4% of the patients was highly satisfied. The presence of friendly conversations during the doctor-patient exchanges in the field of HIV infection seems to have a role of consolidation of the therapeutic relationship and seems to reflect an authentic interest of the physician towards the patient as a person.

A Randomized Controlled Trial of Listening to Recorded Music for Heart Failure Patients

To describe a conceptual framework and to test the effectiveness of a recorded music-listening protocol on symptom burden and quality of life in heart failure (HF) patients. Heart failure is an important public health problem. Many HF patients experience symptoms burden and poor quality of life, even with current improvements in pharmacological treatments. Recorded music listening has been shown to improve outcomes in cardiovascular patients, but it has never been tested on HF patients and with a specific music protocol and a randomized controlled trial methodology. This study is a multicenter blinded randomized controlled trial that will involve 150 patients. Eligible patients will have a diagnosis of HF, in New York Heart Association functional classification of I to III, and will be recruited from 3 large hospitals in Northern Italy. Patients will be randomly allocated in a 1:1 ratio to receive recorded music-listening intervention with or without standard care for 3 months. Data will be collected at baseline and at the end of the first, second, and third month during the intervention, and at 6 months for follow-up. The following variables will be collected from HF patients with validated protocols: quality of life (primary endpoint), use of emergency services, rehospitalization rates, all cause mortality, self-care, somatic symptoms, quality of sleep, anxiety and depression symptoms, and cognitive function. This study will examine the effect of recorded music listening on HF patients and will inform clinical practice. If the findings are found to be positive, the protocol could be used as a tool for evidence-based applications of recorded music in HF patients. The framework developed in this study may be helpful for future research focused on the effects of music in HF patients.

Exploring Identity Dynamics from a Combined Social Exchange and Social Identity Perspective

ABSTRACTThe aim of this article is to explore identity dynamics of unit and department leaders in a healthcare setting using both social identity and social exchange theories. In particular, we developed a mediational moderated model in which supervisor trust indirectly influences identification with a subordinate level (i.e., the clinical unit) through its effect on identification with a superordinate level (i.e., the organization as a whole). Furthermore, we predicted and found that this relation is moderated by organizational tenure, contract breach, and the clinical-manager's role (heads of clinical units vs. chairs of departments). We tested our hypotheses with doctors of a large public hospital in northern Italy. A total of 370 doctors completed questionnaires measuring organizational and unit identification, supervisor trust, and contract breach. Results supported our hypotheses: supervisor trust was related to unit identification through its effect on organizational identification. As expected, this relation was stronger for more tenured department chairs, and for those doctors who perceived less contract breach.

First-time mothers’ experiences of early labour in Italian maternity care services

ObjectiveThe aim of this study is to explore first-time mothers’ experiences of early labour in Italian maternity care services when admitted to hospital or advised to return home after maternity triage assessment. SettingThe study was conducted in a second-level maternity hospital in northern Italy with an obstetric unit for both low- and high-risk women. ParticipantsThe participants included 15 first-time mothers in good general health with spontaneous labour at term of a low-risk pregnancy who accessed maternity triage during early labour, and were either admitted to hospital or advised to return home. DesignA qualitative interpretive phenomenological study was conducted. A face-to-face recorded semi-structured interview was conducted with each participant 48–72h after birth. FindingsFour key themes emerged from the interviews: (a) recognising signs of early labour; (b) coping with pain at home; (c) seeking reassurance from healthcare professionals; and (d) being admitted to hospital versus returning home. Uncertainty about the progression of labour and the need for reassurance were cited by women as the main reasons for hospital visit in early labour. An ambivalent feeling was reported by the participants when admitted to hospital in early labour. In fact, while the women felt reassured in the first instance, some women subsequently felt dissatisfied due to the absence of one-to-one dedicated care during early labour. When advised to return home, a number of women reported feelings of disappointment, anger, fear, discouragement and anxiety about not being admitted to hospital; however, some of these women reported a subsequent feeling of comfort due to being at home and putting in place the suggestions made by the midwives during the maternity triage assessment. The guidance provided by midwives during triage assessment seemed to be the key factor influencing women׳s satisfaction when advised either to return home or to stay at the hospital during early labour. Conclusions and implications for practiceDuring antenatal classes and clinics, midwives should provide clear information and advice about early labour in order to increase women׳s confidence and self-efficacy, and decrease their anxiety and fear. During early labour, appropriate maternity care services should be offered according to individual needs. When home visits are not provided by midwives, a telephone triage run by midwives should be considered as a routine service for the first point of contact with women during early labour.

The Effect of an Impaired Arousal on Short- and Long-Term Mortality of Elderly Patients Admitted to an Acute Geriatric Unit

ObjectiveImpaired arousal is associated with negative outcomes in intensive care units, but studies in acute medical wards are scanty. The study aim was to evaluate the association between impaired arousal, as measured using an ultrabrief screen, and risk of both 1- and 6-month mortality and discharge to nursing home (NH) or hospice. DesignProspective cohort study with 6-month follow-up. SettingAn acute geriatric unit (AGU) of a university-based hospital in Northern Italy. ParticipantsAll patients aged 65 years or older, admitted to the AGU between September 2012 and February 2015. MeasurementsThe modified Richmond Agitation Sedation Scale (m-RASS) was used to assess patients' arousal; a score of 0 denotes normal arousal, scores ranging from +1 to +4 denote increased arousal, and scores ranging from −1 to −5 denote decreased levels. The association of m-RASS scores with 6-month mortality was assessed by a Kaplan-Meier analysis. The impact of impaired arousal, defined by the m-RASS as anything other than “awake and alert,” was determined using Cox proportional hazard regression for 1- and 6-month mortality after admission and logistic regressions were used for discharge to NH or hospice. The models were adjusted for age, sex, dementia, Sequential Organ Failure Assessment score, and disability. ResultsPatients (n = 2477) had a mean age of 84 years, and were predominantly women (59.8%). Impaired arousal on admission was present in 644 (25.9%) patients: 33 (1.3%) were comatose (m-RASS = −5), 56 (2.3%) awakened to pain only (m-RASS = −4), 43 (1.7%) were very drowsy (m-RASS = −3), 93 (3.8%) drowsy (m-RASS = −2), and 212 (8.6%) were slightly drowsy (m-RASS = −1), but there were also 110 (4.4%) patients with restlessness, 75 (3.0%) with agitation, 17 (0.7%) with severe agitation, and 3 (0.1%) with combative behavior. Globally, 337 patients died within 1 month and 689 patients within 6 months. After adjustment for covariates, patients with impaired arousal had a significantly higher chance of having died at 1-month (adjusted hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.22–2.03) and 6-month follow-up (adjusted HR 1.31, 95% CI 1.10–1.57). Those with impaired arousal were more likely to be discharged to a new NH (odds ratio [OR] 1.75, 95% CI 1.19–2.57) or to hospice (OR 1.96, 95% CI 1.18–3.23) than those without impaired arousal. ConclusionsAn abnormal arousal level is an independent predictor of increased risk of 1- and 6-month mortality and of discharge to a new NH or hospice. The assessment of arousal with m-RASS should be routinely performed on all older patients on admission to acute hospital wards to screen potentially critical conditions.

Trends in the annual incidence of carbapenem-resistant Klebsiella pneumoniae bloodstream infections: a 8-year retrospective study in a large teaching hospital in northern Italy.

BackgroundBloodstream infections (BSI) due to carbapenem-resistant (C-R) Klebsiella pneumoniae (Kp) are of global concern from both clinical and public health standpoints. This retrospective study aimed to describe C-R Kp BSI epidemiology in a large teaching hospital in northern Italy.MethodsBetween 1 January 2007 and 31 December 2014, annual incidences both of C-R Kp BSI and of carbapenem-susceptible (C-S) Kp BSI were calculated as the number of events per 10,000 patient-days. A Chi square test for linear trend was used to assess the change in the incidence of C-R Kp BSI and C-S Kp BSI over the study period. Crude 30-day mortality rates were provided both for C-R Kp BSI and for C-S Kp BSI.ResultsFrom 2007 to 2014, we observed 511 episodes of Kp BSI, 349 of which were caused by C-R Kp (68.3 %). The incidence of C-R Kp BSI considerably increased from 0.04/10,000 patient-days in 2007 to 1.77/10,000 patient-days in 2014 (Chi square for trend p < 0.001). The highest incidence of C-R Kp BSI was observed in intensive care units (ICUs), with a peak of 22.01 C-R Kp BSI/10,000 patient-days in 2012. A less marked but significant increase of C-S Kp BSI was also observed (Chi square for trend p = 0.004). Crude 30-day mortality was 36.1 % in patients with C-R Kp BSI and 23.5 % in those with C-S Kp BSI.ConclusionsDuring the study period, we observed a dramatic increase in the incidence of C-R Kp BSI in our hospital. More concerted infection-control efforts are needed to contain this alarming C-R Kp diffusion.

Epidemiology of bloodstream infections sustained by carbapenem-resistant Klebsiella pneumonia in a large teaching hospital in northern Italy

The rapid diffusion of carbapenem-resistant (C-R) Klebsiella pneumoniae (Kp) represents a global concern from both clinical and public health standpoints. In particular, bloodstream infections sustained by C-R Kp are associated with high mortality rates and the treatment of these clinical picture is a major challenge for clinicians.

Epidemiology and mortality of Clostridium difficile infection: a 5-year retrospective laboratory-based study in a large teaching hospital in Northern Italy

Clostridium difficile represents the major infective causes of hospital-acquired infectious diarrhoea and one of the most common microorganisms responsible for health-care associated infection.

Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy

We performed a quasi-experimental study of a multifaceted infection control programme for reducing carbapenem-resistant Enterobacteriaceae (CRE) transmission and bloodstream infections (BSIs) in a 1420-bed university-affiliated teaching hospital during 2010–2014, with 30 months of follow-up. The programme consisted of the following: (a) rectal swab cultures were performed in all patients admitted to high-risk units (intensive-care units, transplantation, and haematology) to screen for CRE carriage, or for any room-mates of CRE-positive patients in other units; (b) cohorting of carriers, managed with strict contact precautions; (c) intensification of education, cleaning and hand-washing programmes; and (d) promotion of an antibiotic stewardship programme carbapenem-sparing regimen. The 30-month incidence rates of CRE-positive rectal cultures and BSIs were analysed with Poisson regression. Following the intervention, the incidence rate of CRE BSI (risk reduction 0.96, 95% CI 0.92–0.99, p 0.03) and CRE colonization (risk reduction 0.96, 95% CI 0.95–0.97, p <0.0001) significantly decreased over a period of 30 months. After accounting for changes in monthly census and percentage of externally acquired cases (positive at ≤72 h), the average institutional monthly rate of compliance with CRE screening procedures was the only independent variable associated with a declining monthly incidence of CRE colonization (p 0.002). The monthly incidence of CRE carriage was predictive of BSI (p 0.01). Targeted screening and cohorting of CRE carriers and infections, combined with cleaning, education, and antimicrobial stewardship measures, significantly decreased the institutional incidence of CRE BSI and colonization, despite endemically high CRE carriage rates in the region.

Effects of combined hormonal contraception on health and wellbeing: Women's knowledge in northern Italy

Objectives We investigated levels of knowledge of the effects of combined hormonal contraceptives (CHCs) on general/reproductive health and physical/psychosexual wellbeing.Methods A cross-sectional study was conducted in two university hospitals in northern Italy. Healthy current-, past- and never CHC users (n = 545; age 18–44 years) completed a self-administered questionnaire.Results Ninety-three percent of current-, 74% of past-, and 56% of never users believed they were sufficiently informed (χ2: 67.1; p = 0.001) about the benefits and risks of CHCs. Respondents mentioned: (i) a reduced risk of ovarian (67%) and endometrial (53%) cancer; (ii) an increased risk of thrombosis (82%); (iii) an increased risk of breast cancer (45%); (iv) a decreased fertility (19%) and no influence on risk of sexually transmitted infections (48%); (v) a reduced risk of menstrual abnormalities (77%) and acne (79%); (vi) less dysmenorrhoea (83%) and more headache (56%), weight gain (74%), increased appetite (51%), leg cramps (77%), mood swings (45%), vaginal dryness (47%), and low sex drive (48%). Beliefs about diseases/conditions and symptoms were influenced by CHC use.Conclusions CHC use is linked to good knowledge of risks and benefits. Our data suggest HCPs must be proactive in providing relevant information so that women can choose their contraception with a balanced insight of side effects.Chinese 摘要：目的我们调查复方激素避孕药（CHCs）对全身/生殖健康以及身体/心理健康影响的知识水平。方法一项横断面研究在意大利北部的两所大学医院进行。目前使用、过去使用和从没使用CHC的受访者（N =545；年龄18–44岁）完成自填问卷。结果93%目前使用CHC、74%过去使用CHC和56%从没使用CHC的受访者认为他们被充分告知了CHC的好处和风险（χ2: 67.1；p =0.001）。受访者提到：（i）卵巢癌的风险降低（67%）和子宫内膜癌的风险降低（53%）；（ii）血栓形成的风险增加（82%）；（iii）乳腺癌的风险增加（45%）；（iv）生育率降低（19%），对性传播疾病的风险没有影响（48%）；（v）月经异常的风险降低（77%）、痤疮的风险降低（79%）；（vi）痛经减少（83%）、头痛增加（56%），体重增加（74%），食欲增加（51%），小腿抽筋（77%），情绪波动（45%），阴道干涩（47%），和性欲降低（48%）。使用CHC使其对疾病/健康状况和症状的观念受到了影响。结论CHC使用与良好的风险和受益的知识相关。我们的数据表明，医疗专业人员必须主动提供相关信息，从而使女性能平衡各种副作用后选择他们的避孕方法。

Klebsiella pneumoniae bloodstream infection: epidemiology and impact of inappropriate empirical therapy.

Multidrug resistance associated with extended-spectrum beta-lactamase (ESBL) and Klebsiella pneumoniae carbapenemase (KPC) among K. pneumoniae is endemic in southern Europe. We retrospectively analyzed the impact of resistance on the appropriateness of empirical therapy and treatment outcomes of K. pneumoniae bloodstream infections (BSIs) during a 2-year period at a 1420-bed tertiary-care teaching hospital in northern Italy. We identified 217 unique patient BSIs, including 92 (42%) KPC-positive, 49 (23%) ESBL-positive, and 1 (0.5%) metallo-beta-lactamase-positive isolates. Adequate empirical therapy was administered in 74% of infections caused by non-ESBL non-KPC strains, versus 33% of ESBL and 23% of KPC cases (p < 0.0001). To clarify the impact of resistance on BSI treatment outcomes, we compared several different models comprised of non-antibiotic treatment-related factors predictive of patients’ 30-day survival status. Acute Physiology and Chronic Health Evaluation (APACHE) II score determined at the time of positive blood culture was superior to other investigated models, correctly predicting survival status in 83% of the study cohort. In multivariate analysis accounting for APACHE II, receipt of inadequate empirical therapy was associated with nearly a twofold higher rate of death (adjusted hazard ratio 1.9, 95% confidence interval 1.1–3.4; p = 0.02). Multidrug-resistant K. pneumoniae accounted for two-thirds of all K. pneumoniae BSIs, high rates of inappropriate empirical therapy, and twofold higher rates of patient death irrespective of underlying illness.

Candidaemia observed at a university hospital in Milan (northern Italy) and review of published studies from 2010 to 2014.

Candida species represent the fourth leading cause of nosocomial bloodstream infections (BSI) worldwide. However, candidaemia rates and species involved vary geographically. To evaluate the epidemiological pattern, risk factors for mortality and antifungal therapy of Candida BSI over a 5-year period (2008-2012) in a university hospital in northern Italy together with a review of the recent literature concerning candidaemia. A retrospective cohort study cross-linked with microbiology database was performed. A total of 89 Candida BSI were identified in 42 males (47 %) and 47 females (52.8 %). The median age was 69 years (interquartile range 55-78) with 61.8 % of patients being older than 65 years. Considering all hospitalized patients, the overall incidence rate of candidaemia increased significantly from 2008 to 2012 (from 0.4 to 1.68 episodes per 10,000 patient/days) (p = 0.0001) with a mean linear increase in 5 new cases per year. Candida albicans was the predominant species isolated (64 %) followed by C. glabrata (19.1 %). The latter species was observed with significantly higher frequency in Internal Medicine and Intensive Care Units (ICU). In-hospital crude mortality was 41.6 %. Candidaemia is an increasing BSI in our university hospital, in accordance with that observed in northern Italy, and it is still associated with high in-hospital crude mortality.

Efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis (CORP-2): a multicentre, double-blind, placebo-controlled, randomised trial

Colchicine is effective for the treatment of acute pericarditis and first recurrences. However, conclusive data are lacking for the efficacy and safety of colchicine for treatment of multiple recurrences of pericarditis. We did this multicentre, double-blind trial at four general hospitals in northern Italy. Adult patients with multiple recurrences of pericarditis (≥two) were randomly assigned (1:1) to placebo or colchicine (0·5 mg twice daily for 6 months for patients weighing more than 70 kg or 0·5 mg once daily for patients weighing 70 kg or less) in addition to conventional anti-inflammatory treatment with aspirin, ibuprofen, or indometacin. Permuted block randomisation (size four) was done with a central computer-based automated sequence. Patients and all investigators were masked to treatment allocation. The primary outcome was recurrent pericarditis in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT00235079. 240 patients were enrolled and 120 were assigned to each group. The proportion of patients who had recurrent pericarditis was 26 (21·6%) of 120 in the colchicine group and 51 (42·5%) of 120 in the placebo group (relative risk 0·49; 95% CI 0·24-0·65; p=0·0009; number needed to treat 5). Adverse effects and discontinuation of study drug occurred in much the same proportions in each group. The most common adverse events were gastrointestinal intolerance (nine patients in the colchicine group vs nine in the placebo group) and hepatotoxicity (three vs one). No serious adverse events were reported. Colchicine added to conventional anti-inflammatory treatment significantly reduced the rate of subsequent recurrences of pericarditis in patients with multiple recurrences. Taken together with results from other randomised controlled trials, these findings suggest that colchicine should be probably regarded as a first-line treatment for either acute or recurrent pericarditis in the absence of contraindications or specific indications. Azienda Sanitaria 3 of Torino (now ASLTO2).

Profile of infective endocarditis observed from 2003 - 2010 in a single center in Italy

BackgroundThis study aimed to provide a contemporary picture of the epidemiologic, clinical, microbiologic characteristics and in-hospital outcome of infective endocarditis (IE) observed in a single center in Italy.MethodsWe performed a retrospective study of patients with definite or probable IE observed at the “L. Sacco” Hospital in Milan, Italy, from January 1, 2003 through December 31, 2010.Results189 episodes of IE in 166 patients were included. The mean number of incident IE in the study period was of 1.27 (range 0.59-1.76) cases per 1000 patients admitted. The median age of the cohort was 57 (interquartile range, 43-72) years, 63% were male and 62.5% had native valve IE. Twenty-six percent were active intravenous drug users (IVDU), 29% had a health care-associated IE and 5% chronic rheumatic disease. Twenty-nine percent of the cases occurred in patients affected by chronic liver disease and 19% in HIV positive subjects. Staphylococcus aureus was the most common pathogen (30%), followed by streptococci. The mitral (34%) and aortic (31%) valves were involved most frequently. The following complications were common: stroke (19%), non-stroke embolizations (25%), heart failure (26%) and intracardiac abscess (9%). Surgical treatment was frequently employed (52%) but in hospital mortality remained high (17%). Health care-associated IE and complications were independently associated with an increased risk of in-hospital death, while surgery was associated with decreased mortality.ConclusionS. aureus emerged as the leading causative organism of IE in a University hospital in northern Italy. Our study confirmed the high in-hospital mortality of IE, particularly if health care associated, and the protective role of surgery.

A Longitudinal Study on Motherhood and Well-Being: Developmental and Clinical Implications

Pregnancy and puerperium are crucial periods at both the biological and psychological levels. The aim of this longitudinal study was to investigate women’s perceived health and illness during pregnancy and puerperium through the assessment of hedonic and eudaimonic components of well-being, symptoms of peripartum depression, and their relationship. Nineteen women recruited at the Unit of Obstetrics and Gynecology of a university hospital in Northern Italy were enrolled and answered a set of questionnaires at two time points: 20-22 weeks of gestation and 6 months after childbirth. Results showed a substantial lack of correlation between the dimensions of mental illness and mental health. The analysis of the well- and ill-being components showed low levels of depression as well as good levels of mental health, especially concerning the eudaimonic components of well-being, both during and after pregnancy. Overall, findings attested to a general stability of well-being over pregnancy and puerperium.

HBV Infection in Italian and Non-Italian Patients in Northern Italy

Aims: The introduction of HBV vaccination in Italy has reduced the incidence and prevalence of HBV infection. However, increasing immigration from countries in which HBV is endemic has led to a wave of new HBsAg-positive subjects and their clinical impact needs evaluation. We compared the serological, clinical and epidemiological data relating to Italian and non-Italian subjects referred to a hospital in Northern Italy. Study Design: We retrospectively analysed the laboratory and clinical records of 488 subjects, including 107 (21.9%) non-Italians, in order to find data concerning clinical diagnoses, possible routes of infection, anti-HCV and anti-HDV antibodies. Results: The differences in gender distribution and mean age between the non-Italian Research Article British Journal of Medicine & Medical Research, 3(1): 1-12, 2013 2 and Italian patients were statistically significant (p<.001). There were no significant differences in the prevalence of anti-HCV (2.9% vs 4.9%, p=.86) or anti-HDV (4.7% vs 5.0%, p=.89) co-infection, or the presence of HBeAg in chronic infection. There were no differences in the rates of acute (3.3% vs 5.1%; p=.68) or chronic infections (96.7% vs 94.9%; p=.68) infections, but there were statistically significant differences (p<.001) in the rates of prevalent (54.5% vs 85.3%) and incident cases (45.5% vs 14.7%). The differences in the rates of asymptomatic (70.6% vs 34.9%) and symptomatic patients (29.4% vs 65.1%) were also statistically significant (p<.001). The only significant differences in terms of risk factors related to transfusions (0% vs 6.8%; p=.04), and vertical/perinatal transmission (44.1% vs 6.8%; p<.001). Conclusion: The non-Italian HBsAg-positive subjects were mainly women and younger than their Italian counterparts, and had a recent diagnosis. They were predominantly asymptomatic and probably considered themselves healthy and fit to emigrate. Perinatal transmission among non-Italians is still an important risk factor that reflects the epidemiological situation of their countries of origin.

Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial

BackgroundOver 20% of hospital bed use is inappropriate, implying a waste of resources and the increase of patient iatrogenic risk.MethodsThis is a cluster, pragmatic, randomised controlled trial, carried out in a large University Hospital of Northern Italy, aiming to evaluate the effect of a strategy to reduce unnecessary hospital days. The primary outcome was the percentage of patient-days compatible with discharge. Among secondary objectives, to describe the strategy’s effect in the long-term, as well as on hospital readmissions, considered to be a marker of the quality of hospital care. The 12 medical wards with the longest length of stay participated. Effectiveness was measured at the individual level on 3498 eligible patients during monthly index days. Patients admitted or discharged on index days, or with stay >90 days, were excluded. All ward staff was blinded to the index days, while staff in the control arm and data analysts were blinded to the trial’s objectives and interventions. The strategy comprised the distribution to physicians of the list of their patients whose hospital stay was compatible with discharge according to a validated Delay Tool, and of physician length of stay profiles, followed by audits managed autonomously by the physicians of the ward.ResultsDuring the 12 months of data collection, over 50% of patient-days were judged to be compatible with discharge. Delays were mainly due to problems with activities under medical staff control. Multivariate analysis considering clustering showed that the strategy reduced patient-days compatible with discharge by 16% in the intervention vs control group, (OR=0.841; 95% CI, 0.735 to 0.963; P=0.012). Follow-up at 1 year did not yield a statistically significant difference between the percentages of patient-days judged to be compatible with discharge between the two arms (OR=0.818; 95% CI, 0.476 to 1.405; P=0.47). There was no significant difference in 30-day readmission and mortality rates for all eligible patients (N=3498) between the two arms.ConclusionsResults indicate that a strategy, involving physician direct accountability, can reduce unnecessary hospital days. Relatively simple interventions, like the one assessed in this study, should be implemented in all hospitals with excessive lengths of stay, since unnecessary prolongation may be harmful to patients.Trial registrationClinicalTrials.gov, identifier NCT01422811.

Predictors of intention to leave the nursing profession in two Italian hospitals

Nursing shortage is acknowledged as worldwide issue: understanding the factors that foster nurses' intention to leave the profession (ITL) is therefore essential in lessening its impact. The present study aims at providing insight into the factors influencing nurses' ITL, taking into account personal characteristics, context characteristics and job satisfaction factors. The study was conducted in two hospitals of Northern Italy, by a questionnaire administered to all nurses employed; 746 questionnaires were distributed, of which 525 (70.4%) were returned completed. The questionnaire consisted of four sections: personal characteristics, context characteristics, job satisfaction (44 items of Italian adaptation of Stamps' Index of Work Satisfaction), and ITL (single-item). Descriptive statistics, reliability analysis, univariate analysis and multiple logistic regression model were carried using Pasw18. A higher job satisfaction was registered for Interaction with nurses, Professional status, and Autonomy; on the other hand, a perception of dissatisfaction was registered for Pay and Job requirements; 14.6% of respondents reported ITL. Finally, a low job satisfaction for Professional status, Pay, and Work organization policies, age < 30 years, and part-time schedule are associated to higher ITL. The study allowed to identify various predictors of ITL, enhancing the importance of regular monitoring of ITL. To limit ITL, organizations should: invest on some job satisfaction factors, promote organizational integration of newcomers, and prevent the escalation of work-family and work-life conflict.

Perceived Organizational Stressors and Interpersonal Relationships as Predictors of Job Satisfaction and Well-Being among Hospital Nurses

The purposes of the present study were to examine: a) the most relevant sources of workplace pressure for nurses; b) gender and age differences in occupational stressors; c) which combination of sources of stress, ways of coping, Type A style and locus of control was the best predictor of job satisfaction and both physical and mental health; Data were collected amongst 976 nurses employed in seven public hospital in Northern Italy, who completed the Occupational Stress Indicator (OSI). Results suggested that turnover and amount of work were the most relevant sources of stress. Perceived stressors were higher for female who felt themselves less healthy than their male colleagues, which used non-working time to disperse stress. Statistical analysis produced significant differences in perceived occupational stressors among age ranges. Multivariate analysis for total sample revealed organizational factors and relationships with people the best predictors of job satisfaction and both physical and mental health, respectively. Comparisons with O.S.I. normative Italian data showed several differences in perceived sources of pressure and occupational stress outcomes. Implications of the findings and limitations of the study are discussed in terms of possible targets for action aimed to enhancing quality of the work environment relationships and nurse satisfaction.

Identifying and correcting communication failures among health professionals working in the Emergency Department

ObjectiveThe aim of this study was to identify effective corrective measures to ensure patient safety in the Paediatric Emergency Department (ED). MethodsIn order to outline a clear picture of these risks, we conducted a Failure Mode and Effects Analysis (FMEA) and a Failure Mode, Effects, and Criticality Analysis (FMECA), at a Emergency Department of a Children’s Teaching Hospital in Northern Italy. The Error Modes were categorised according to Vincent’s Taxonomy of Causal Factors and correlated with the Risk Priority Number (RPN) to determine the priority criteria for the implementation of corrective actions. ResultsThe analysis of the process and outlining the risks allowed to identify 22 possible failures of the process. We came up with a mean RPN of 182, and values >100 were considered to have a high impact and therefore entailed a corrective action. ConclusionsMapping the process allowed to identify risks linked to health professionals’ non-technical skills. In particular, we found that the most dangerous Failure Modes for their frequency and harmfulness were those related to communication among health professionals.