Increased Staffing Levels Research Articles

A needs assessment of lymphoedema services in Fife and resulting recommendations

Lymphoedema is a chronic condition that leads to reduced quality of life through its negative impacts on physical, psychological, and social aspects of health. Limb swelling leads to discomfort and pain, reduced movement and function, and acute inflammatory episodes. Individuals experience altered body image and self-esteem impacting on social interaction. There is evidence that specialist management of the condition leads to improved quality of life. Concern regarding the adequacy of lymphoedema services led to the commissioning of a needs assessment by the Core Cancer Review Group in Fife, Scotland. The needs assessment used a variety of methods. Current services were located through consultation of known providers and databases. Existing databases were analysed to find out the number of people requiring the service: hospital admissions and diagnoses were analysed alongside a survey of primary practices in Fife. Access to existing services was explored through a telephone survey of referrers (n = 44), and qualitative interviews with five service providers and five clients. At the time of the study, non-palliative National Health Service (NHS) provision consisted of one part-time clinician; the service provided was under pressure from rapidly increasing referrals. However, consensus from referrers, providers, and clients indicated that there were obstacles to achieving diagnosis and referral, especially for those with non-cancer-related lymphoedema. This was primarily due to poor referrer awareness of the condition, its management, and existing services, for example, only seven per cent of those surveyed would refer to existing specialist services. Delayed referral is a significant issue, as prompt intervention leads to more positive treatment outcomes. As a result of the needs assessment, recommendations were made to increase staffing levels, promote awareness of the condition and related services, and improve geographical and multidisciplinary coordination of the service.

Do staffing levels determine outcome in psychiatric inpatient care? – Factors related to the ratio of period hospitalized in Japan

The aim of this study was to determine the factors related to outcome, as measured by the cumulative number of days hospitalized, of a cohort group of inpatients with a diagnosis of schizophrenia followed up for 6 years. Comprehensive data were obtained from 18 psychiatric hospitals from two surveys conducted in 1993 and 1999. Outcome was evaluated by calculating the cumulative number of days between the two surveys that the cohort group was hospitalized. Tree-based models analysis was used to explore the factors related to outcome. Patient characteristics at the time of the first survey that were related to outcome were the number of days hospitalized, cumulative number of years hospitalized, age, Global Assessment of Functioning score and relationship to the main visitor. The number of beds in each hospital and changes in their number were also related. Increasing staffing levels is not likely to impact on deinstitutionalization since their levels were not related to outcome.

The NHS is responsible to patients, nurses and itself

Nurses are the central force in the NHS; the largest sector of workers and certainly the most affected when the government make changes. Why, it was only 4 years ago that the NHS was importing overseas nurses by the thousands to increase staffing levels. Today, nursing students are unable to find placements, bulk (and seemingly indiscriminate) redundancies are rampant and even high grade jobs are being cut. Job reductions and staff cuts will affect patients. Full stop. As nurses, we're taught to care and to help, yet we are not even given the time to help feed our patients, let alone give the holistic care they deserve.

Nurse staffing levels and Medicaid reimbursement rates in nursing facilities.

To examine the relationship between nursing staffing levels in U.S. nursing homes and state Medicaid reimbursement rates. Facility staffing, characteristics, and case-mix data were from the federal On-Line Survey Certification and Reporting (OSCAR) system and other data were from public sources. Ordinary least squares and two-stage least squares regression analyses were used to separately examine the relationship between registered nurse (RN) and total nursing hours in all U.S. nursing homes in 2002, with two endogenous variables: Medicaid reimbursement rates and resident case mix. RN hours and total nursing hours were endogenous with Medicaid reimbursement rates and resident case mix. As expected, Medicaid nursing home reimbursement rates were positively related to both RN and total nursing hours. Resident case mix was a positive predictor of RN hours and a negative predictor of total nursing hours. Higher state minimum RN staffing standards was a positive predictor of RN and total nursing hours while for-profit facilities and the percent of Medicaid residents were negative predictors. To increase staffing levels, average Medicaid reimbursement rates would need to be substantially increased while higher state minimum RN staffing standards is a stronger positive predictor of RN and total nursing hours.

Workload as a Determinant of Staff Injury in Intermediate Care

Care aides (CAs) and licensed practical nurses (LPNs) in intermediate care (IC) facilities experience high risks of injury. Workload measures were examined in eight IC facilities to ascertain their relationships with musculoskeletal injury rates, pain, burnout, and self-reported health. Workload was measured using (1) focus groups and telephone interviews to obtain CA/LPN perceptions; (2) systematic observation (numbers of tasks performed in shift); and (3) CA-to-resident staffing ratios. Controlling for resident dependency and facility funding, all workload measures were correlated with staff injury rates and burnout. Facilities with low injury rates had better CA/LPN-to-resident staffing ratios and fewer tasks. The differences in staffing reflected differences in how organizations prioritized and allocated resources. Thus, workload is an important determinant of injuries and increased staffing levels correlate with decreased injuries.

Child and adolescent mental health: a new pathway of care to improve access to services

AbstractThe present paper considers the development of a new integrated model of care to improve services aimed at addressing the mental health needs of children and young people after increased staffing levels and other initiatives had failed to bring about the necessary improvements in the service. A different approach, focused on a radical redesign of the pathway for referral and treatment, appears to have been successful in ensuring that children and young people receive a more timely and acceptable service. Copyright © 2003 Whurr Publishers Ltd.

Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units: a prospective evaluation

UK recommendations suggest that large neonatal intensive-care units (NICUs) have better outcomes than small units, although this suggestion remains unproven. We assessed whether patient volume, staffing levels, and workload are associated with risk-adjusted outcomes, and with costs or staff wellbeing. 186 UK NICUs were stratified according to volume of patients, nursing provision, and neonatal consultant provision. Primary outcomes were hospital mortality, mortality or cerebral damage, and nosocomial bacteraemia. We studied 13515 infants of all birthweights consecutively admitted to 54 randomly selected NICUs. Multiple logistic regression analyses were done with every primary outcome as the dependent variable. Staff wellbeing and stress were assessed by anonymous mental health index (MHI)-5 questionnaires. Data were available for 13334 (99%) infants. High-volume NICUs treated the sickest infants and had highest crude mortality. Risk-adjusted mortality and mortality or cerebral damage were unrelated to patient volume or staffing provision; however, nosocomial bacteraemia was less frequent in NICUs with low neonatal consultant provision (odds ratio 0.65, 95% CI 0.43-0.98). Mortality was raised with increasing workload in all types of NICUs. Infants admitted at full capacity versus half capacity were about 50% more likely to die, but there was wide uncertainty around this estimate. Most staff had MHI-5 scores that suggested good mental health. The implications of this report for staffing policy, medicolegal risk management, and ethical practice remain to be tested. Centralisation of only the sickest infants could improve efficiency, provided that this does not create excessive workload for staff. Assessment of increased staffing levels that are closer to those in adult intensive care might be appropriate.

Improving food intake in nursing home residents with feeding assistance: a staffing analysis.

Recommendations have been made to increase the number of nursing home (NH) staff available to provide feeding assistance during mealtime. There are, however, no specific data related to two critical variables necessary to estimate mealtime staffing needs: (1) How many residents are responsive to feeding assistance? (2) How much staff time is required to provide feeding assistance to these residents? The purpose of this study was to collect preliminary data relevant to these two issues. Seventy-four residents in three NHs received a 2-day, or six-meal, trial of one-on-one feeding assistance. Total percentage (0% to 100%) of food and fluid consumed during mealtime was estimated across 3 days during usual NH care and 2 days during the intervention. The amount of time that staff spent providing assistance and type of assistance (i.e., frequency of verbal and physical prompts) was measured under each condition. One half (50%) of the participants significantly increased their oral food and fluid intake during mealtime. The intervention required significantly more staff time to implement (average of 38 minutes per resident/meal vs 9 minutes rendered by NH staff). The time required to implement the feeding assistance intervention greatly exceeded the time the nursing staff spent assisting residents in usual mealtime care conditions. These data suggest that it will almost certainly be necessary to both increase staffing levels and to organize staff better to produce higher quality feeding assistance during mealtimes.

Clinical pharmacy services, pharmacy staffing, and the total cost of care in United States hospitals.

This study evaluated direct relationships and associations among clinical pharmacy services, pharmacist staffing, and total cost of care in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services Database. A multiple regression analysis, controlling for severity of illness, was employed to determine the relationships and associations. The study population consisted of 1016 hospitals. Six clinical pharmacy services were associated with lower total cost of care: drug use evaluation (p=0.001), drug information (p=0.003), adverse drug reaction monitoring (p=0.008), drug protocol management (p=0.001), medical rounds participation (p=0.0001), and admission drug histories (p=0.017). Two services were associated with higher total cost of care: total parenteral nutrition (TPN) team participation (p=0.001) and clinical research (p=0.0001). Total costs of care/hospital/year were lower when any of six clinical pharmacy services were present: drug use evaluation $1,119,810.18 (total $1,005,589,541.64 for the 898 hospitals offering the service), drug information $5,226,128.22 (total $1,212,461,747.04 for the 232 hospitals offering the service), adverse drug reporting monitoring $1,610,841.02 (total $1,101,815, 257.68 for the 684 hospitals offering the service), drug protocol management $1,729,608.41 (total $614,010,985.55 for the 355 hospitals offering the service), medical rounds participation $7,979,720.45 (total $1,212,917,508.41 for the 152 hospitals offering the service), and admission drug histories $6,964,145.17 (total $208,924,355.10 for the 30 hospitals offering the service). Clinical research $9,558,788.01 (total $1,013,231,529.06 for the 106 hospitals offering the service) and TPN team participation $3,211,355.12 (total $1,027,633,638.43 for the 320 hospitals offering the service) were associated with higher total costs of care. As staffing increased for hospital pharmacy administrators (p=0.0001) and clinical pharmacists (p=0.007), total cost of care decreased. As staffing increased for dispensing pharmacists, total cost of care increased (p=0.006). Based on this total cost of care model, optimal hospital pharmacy administrator staffing was 2.01/100 occupied beds. Staffing for dispensing pharmacists should be as low as possible, and definitely fewer than 5.11/100 occupied beds. Staffing for clinical pharmacists should be as high as possible, but definitely more than 1.11/100 occupied beds. The results of this study suggest that increased staffing levels of clinical pharmacists and pharmacy administrators, as well as some clinical pharmacy services, were associated with reduced total cost of care in United States hospitals.

Income generation and Facts for Life communication in Vietnam

In1997, UNICEF Vietnam conducted a participatory evaluation, Pathways Forward, to assess the impact of the Income Generation and Facts for Life (FFL) Communication Project, which communicates basic health messages to women who are also participating in a revolving loan scheme. Twenty-five people from UNICEF and the Vietnam Womens Union participated in the month-long evaluation. They used a combination of case studies, interviews, surveys, and social indicators to determine the projects impact on women finishing their final loan cycle in two project communes. A second group studied the projects microcredit component in order to recommend a financial strategy for the future.Evaluators found that while the project had successfully met many of its objectives, the degree of its success varied dramatically between the two communes studied. Further, the evaluation found the projects operational capacity needed to be strengthened so as to support existing microcredit activities.Based on these findings, the Pathways evaluation recommended that UNICEF postpone any future loan disbursements and focus instead on building the projects capacity through increased staffing levels and additional training. It also recommended a number of measures be taken to strengthen FFL communication activities, including training for group leaders and simpler, locally-produced FFL materials.

Assessing statistics for the measurement of workload at a genitourinary medicine clinic.

Since January 1985 James Pringle House, the genitourinary medicine (GUM) clinic at London's Middlesex Hospital, has built up an extensive computerized patient database. Yearly statistics relating to 1) individual patients, 2) diagnoses, 3) attendances, and 4) an activity estimator (combining features of attendances and their corresponding diagnoses) are extracted. Each is assessed as a potential tool for quantifying the rising workload associated with the clinic's increased staffing levels and expanded services. Only the activity estimator identifies an upward trend, rising 26.3% from 1985-86 to 1991-92, caused largely by human immunodeficiency virus (HIV) and hepatitis B related attendances. This activity estimator could provide the basis for a workload reporting facility on all GUM computer systems. The 4 statistics exhibit other useful information, including a 21.0% rate of non-attendance (a substantial hidden addition to workload) and a strong allegiance to the clinic from patients residing outside of the local Health Authority region.

Auditing the community team

An audit by members of a community team of hospital admissions of patients seen by the team in one year suggested that 31% of admissions would have been avoided if staff were available for continuous day-time supervision of patients at home, and if it were possible to insist that these patients took prescribed medication. Fourteen percent of admissions resulted from a breakdown in communication, as did some of what were occasionally seen as unnecessarily prolonged hospital stays. However, more than half of admitted patients were thought to have required the intensity of observation and treatment that can best be provided in hospital. The exercise provided useful information to the team, and suggested that a substantial reduction of admissions could only be achieved by increasing staffing levels to enable patients to be supervised during emergencies. Even then a hospital or some other facility offering medical supervision and physical containment would be required for a substantial proportion of the patients who are currently admitted to hospital.

Extra HV posts spell Victory' in Greenwich.

Health visitors are claiming a 'tremendous victory' after managers in Greenwich agreed to increase staffing levels in , line with their proposals last week.

A quantitative study of nursing staff interactions in psychiatric wards

Data from 2 studies investigating staff-patient and staff-staff interaction rates are presented. In the first the staff-patient ratio was varied by holding patient numbers constant and systematically varying staffing levels. The results showed that although the percentage of time nurses spent interacting with patients did not change, staff-staff interaction increased as a function of increased staffing levels. In the second study the interaction rates from 4 wards were combined. These data showed that, as in the first study, staff-patient interaction remained constant, as staff numbers increased, whilst staff-staff interaction increased. However, unlike the first study, when analysed in terms of the staff-patient ratio, both categories of interaction increased as the staff-patient ratio increased.

1. Rainford Ward, Rainhill Hospital, Merseyside

Following discussions with representatives of medical and nursing staff in September 1974, it was decided that each of the four mental hospitals of the Merseyside Region should make interim arrangements pending the construction of a purpose-built Regional Secure Unit. Three hospitals decided to open an Interim Secure Unit, the other to accept the monies offered to increase staffing levels on admission wards.