Staffing Models Research Articles

Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system

BackgroundIn response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in intensive care units (ICUs) across Pakistan. An initial step in creating a plan toward strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities.MethodsTo assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was created from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles.ResultsA total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%). We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model, while 37.7% of hospitals did not have surge policies. On Chi-square analysis, statistically significant differences (p < 0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public–private and metropolitan–rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks.ConclusionPakistan has an underdeveloped critical care network with significant inequity between public–private and metropolitan–rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.

A Value Co-Creation Perspective on Faculty Staffing

Colleges and universities increasingly employ temporary instructors. Researchers in higher education have voiced strong concerns about this trend because of its impact on educational outcomes, operations of academic institutions, and the composition of academic workforce. To enhance our understanding of this employment practice, this article makes three contributions to the research on the growing non-tenured employment in academia. First, we advance the theory by arguing that the value co-creation framework, also referred to as service science, is an appropriate theoretical lens for studying higher education, including faculty employment. Second, we use this framework to analyze operations of a selective undergraduate program in Finland that has been functioning for over 30 years without permanent teaching faculty. Housed at a premier business school, the program relies on an expansive international network of instructors who travel to teach on short-term contracts. Third, we demonstrate that the staffing model used by this Finnish program is distinct from other forms of temporary academic employment, and therefore we label it a networked faculty staffing model. To the best of our knowledge, this is the first time the value co-creation framework is used as a theoretical lens to study employment in higher education. Moreover, this is the first time a networked faculty staffing model is explicitly identified and described. Besides researchers, this article might be of interest to the diverse international audience who are involved in management and policy setting in higher education.

Strategy for the development of the public health system of Ukraine in line with modern changes in society

The purpose of this study: scientific substantiation of the strategy for the development of the public health system of Ukraine in modern conditions of its functioning. The work used analytical, epidemiological, sociological, expert, statistical research methods, which are aimed at determining methodological approaches to the development of the competencies of public health specialists in Ukraine in the preventive block of the system, a model for staffing and industry management. According to a specially developed author's program, 120 experts - specialists of the Center for Disease Control and Prevention of the Ministry of Health of Ukraine, gave their conclusions on the need to: consolidate at the legislative level the network of institutions and staffing of the industry; employment of public health specialists who have received specialized higher medical education in the relevant positions; use adequate mechanisms for the functioning of the public health system on the basis of contractual relations with the National Health Service of Ukraine in the preventive block; creation of a unified information fund on the state of health of the population and the environment, real working conditions in different sectors of the country's economy; development of an effective and efficient program of recreational activities available at all levels of administration in Ukraine; the formation of the economic interest of the whole society in the preservation and strengthening of the country's health; to strengthen the preventive activities of the public health system of Ukraine. The environmental situation in the country requires prompt resolution of issues of risk management for public health.

Focusing on fundamentals of care in an ICU setting during a pandemic.

This manuscript aims to describe one acute care hospital's ICU journey during the COVID-19 pandemic and how fundamental care was central to the implementation of team-based models of care. Over the course of the COVID-19 pandemic, team-based and alternative models of care are being employed to manage and address global shortages and surge capacity. Employing these alternate models of care required attention to ensure fundamental care needs of patients were being met. The following paper describes an ICU's journey of focusing on the delivery of the fundamentals of care through the implementation of team-based models of care to address the surge in patient care demands experienced in response to our global pandemic. The implementation of an evidence-informed approach to optimizing models of care and staffing in the ICU amid the evolving COVID-19 waves in one acute-care hospital is provided. This local approach focused on meeting patients' fundamental care needs throughout the necessary introduction of team-based care models and staffing changes and drew from evolving evidence, the ILC Fundamentals of Care Framework, and regulatory guidance.

Staffing models in the cardiac intensive care unit.

The modern cardiac intensive care unit (CICU) has evolved into a high-intensity unit that cares for critically ill patients. Despite this transformation, changes to the staffing model and organizational structure in these specialized units have only recently begun to meet these challenges. We describe the most recent evidence which will inform future CICU staffing models. In the United States, the majority of CICUs are open as opposed to closed units, yet recent data suggests that transition to a closed staffing model is associated with a decrease in mortality. These reductions in mortality in closed CICUs are most pronounced in the most critically ill populations, such as patients with mechanical circulatory support, cardiac arrest, and respiratory failure. In addition, one study has shown that transition to a cardiac intensivist staffed CICU was associated with a reduction in mortality. Finally, multidisciplinary and protocolized teams imbedded within the CICU, specifically 'shock teams,' have recently been developed and may reduce mortality in this particularly sick patient population. Although the preponderance of data suggests improved outcomes with a closed, intensivist staffed CICU model, future multicenter studies are needed to better define the ideal staffing models for the contemporary CICU.

HSD51 Increasing Dialysis Program Sustainability through a Technology Enabled, High-Efficiency Staffing Model

In-center HD (ICHD) registered nurse (RN) staff to patient (RN:Pt) ratios are commonly as high as 1:9 and home dialysis (PD or HHD) ratios 1:15. Newer dialysis technologies, like the Tablo® Hemodialysis System (Tablo), have sensor-based automation and remote monitoring which may facilitate safer care and improve staff efficiency by reducing technology associated burden, allowing licensed professionals to manage patients more efficiently. We modeled potential increases in patient census and reimbursement by implementing new dialysis technology with existing staff.

Emergency clinician output in a district hospital emergency centre: a cross-sectional analysis.

Appropriate and efficient staffing is a cornerstone of emergency centre performance. There is however a paucity of literature describing clinician output in low- and middle-income countries with current staffing models based on anecdotal evidence. This study aimed to assess clinician output at a district level emergency centre, and how it varied depending on shift, clinician, and workload factors. We conducted a retrospective cross-sectional study using an existing electronic patient registry, to determine the patients consulted per hour (PPH) during each clinician shift and how this is affected by various clinician, shift, and workload factors. Data was collected over three non-contiguous randomly selected four-week cycles from Mitchells Plain Hospital's electronic patient registry. Associations between PPH and various factors were assessed using ANOVA with post-hoc adjustments where appropriate. The correlation between PPH and workload metrics was calculated with the Pearson's Rank correlation test. Statistical significance was defined as p<0.05. A total of 1 289 clinician shifts were analysed with an overall PPH of 0.7. A significant association between PPH and shift type (p=0.021), clinician category (p<0.001) and cumulative shifts (p<0.001) were shown. There was a decline in clinician output during a shift and output was significantly decreased by the number of boarders in the emergency centre but increased with higher numbers of patients waiting at the start of the shift. This study describes a relatively low clinician output as compared to evidence from high-income countries and has highlighted several associations with various shift, clinician, and workload factors. The results from this study will form the basis of quality improvement interventions to improve patient throughput and will inform staff scheduling and surge planning strategies.

Impacts of COVID-19 on primary, secondary and tertiary education: a comprehensive review and recommendations for educational practices.

COVID-19 lockdown has caused disruption to education of all levels with far-reaching implications and unveiled the shortfalls of the current education model. Cycles of tightening and relaxation of COVID-19 lockdown confer uncertainty to the continuity of education. This article aims to comprehensively present the impacts of COVID-19 on primary, secondary and tertiary education and propose sound educational practices in the COVID-19 era. Papers related to educational impacts and implications of COVID-19 were selected for this review through a PRISMA model. The review shows that a shift of learning remotely or online has affected educators and learners, especially in relation to learning loss among learners, limitations in instructions, assessment and experiential learning in virtual environment, technology-related constraints, connectivity, learning resources and materials, besides psychosocial well-being. These impacts are exacerbated by inequalities in the distribution of resources as well as inequities attributed to socioeconomic status, gender, ethnicity, learning ability and physical conditions. The recommendations for future educational practices comprise adaptability of curricula to embed independent and online learning options, concurrence of diverse learning modalities for seamless learning transitions and flexibility, flexible staffing and learning model, enhanced support, technological and curricular innovation with simplification and standardization, as well as interactive, responsive and authentic virtual environment. This review contributes significantly to enhance preparedness of education to crisis while ensuring continuity and quality of education in the era of COVID-19 uncertainty.

Determining Infection Prevention Staffing for Pediatric Ambulatory and Procedural Setting

Background Since 2002, the recommended staffing levels for infection prevention and control (IPC) departments has been one full-time equivalent (FTE) per 100 occupied inpatient beds (O'Boyle et al., 2002). However, analyses by Bartles et al. (2018) suggest that this ratio should be one FTE per 69 beds, after accounting for facility/system complexity. With ambulatory utilization rising across the healthcare sector, accounting for these locations in infection preventionist (IP) staffing models is becoming increasingly important. With our pediatric enterprise's expanding ambulatory footprint, we sought to understand the complexity of our outpatient operations and assess the IPC staffing needed to support these locations/services. Methods This needs assessment applied the tool developed by Bartles et al. for their 2018 staffing analysis. Ambulatory and procedural areas on the main campus and 11 satellite/affiliated locations were surveyed for clinic complexity indicators. We obtained total IP hours/week dedicated to ambulatory/procedural locations by summing the estimated number of hours/week IPs spent engaged in rounding, offsite tasks, and education. IP hours spent on education were estimated as 30% of the total IP hours/week dedicated to rounding and offsite tasks. Results From our review, the institution's ambulatory and procedural locations represent 238 unique locations/services. The most common indicators of clinic complexity included performing surgical procedures (20.6%) and aerosol-generating procedures (31.9%). Moreover, an estimated 178 IP hours/week were dedicated to these locations, of which 43.8% consisted of providing consultative services. These hours equate to 4.4 FTEs required for our ambulatory and procedural areas. Conclusions Without accounting for future state operations, this analysis showed that our department would benefit from 2.4 additional FTEs to support our ambulatory/procedural operations. Assessing the complexity and scope of pediatric ambulatory/procedural locations is a valuable tool for (1) assessing IP staffing needs and (2) for determining whether there is an appropriate distribution of IP time and resources in such locations. Since 2002, the recommended staffing levels for infection prevention and control (IPC) departments has been one full-time equivalent (FTE) per 100 occupied inpatient beds (O'Boyle et al., 2002). However, analyses by Bartles et al. (2018) suggest that this ratio should be one FTE per 69 beds, after accounting for facility/system complexity. With ambulatory utilization rising across the healthcare sector, accounting for these locations in infection preventionist (IP) staffing models is becoming increasingly important. With our pediatric enterprise's expanding ambulatory footprint, we sought to understand the complexity of our outpatient operations and assess the IPC staffing needed to support these locations/services. This needs assessment applied the tool developed by Bartles et al. for their 2018 staffing analysis. Ambulatory and procedural areas on the main campus and 11 satellite/affiliated locations were surveyed for clinic complexity indicators. We obtained total IP hours/week dedicated to ambulatory/procedural locations by summing the estimated number of hours/week IPs spent engaged in rounding, offsite tasks, and education. IP hours spent on education were estimated as 30% of the total IP hours/week dedicated to rounding and offsite tasks. From our review, the institution's ambulatory and procedural locations represent 238 unique locations/services. The most common indicators of clinic complexity included performing surgical procedures (20.6%) and aerosol-generating procedures (31.9%). Moreover, an estimated 178 IP hours/week were dedicated to these locations, of which 43.8% consisted of providing consultative services. These hours equate to 4.4 FTEs required for our ambulatory and procedural areas. Without accounting for future state operations, this analysis showed that our department would benefit from 2.4 additional FTEs to support our ambulatory/procedural operations. Assessing the complexity and scope of pediatric ambulatory/procedural locations is a valuable tool for (1) assessing IP staffing needs and (2) for determining whether there is an appropriate distribution of IP time and resources in such locations.

A Survey of Implementation of ABCDE Protocols.

Spontaneous awakening trials (SATs), spontaneous breathing trials (SBTs), delirium assessment/management, early mobility have been termed the ABCDE bundle. The ABCDE bundle has been proven to improve patient outcomes. However, there is often a long gap in dissemination and implementation of evidence-based medicine. To determine the prevalent implementation of and determinants for ABCDE protocol adoption in Pennsylvania. We developed a survey of ABCDE bundle protocols. We surveyed factors around implementation including written protocol presence, standardized assessments to guide protocols, timing of creation of protocols, and estimated adherence to protocols. We also collected data on factors that might be determinants for protocol adoption including ICU staffing models, hospital and ICU level factors. We validated the survey tool using the Michigan Health and Hospital Association Keystone ICU collaborative. We then administered the validated survey to a leader of the medical ICU or mixed medical-surgical ICU of all Pennsylvania Hospitals. Multivariable logistic and ordinal regression were used to determine associations between ICU staffing models and hospital and ICU level factors with the presence of ABCDE bundle protocols. In the study cohort of Pennsylvania ICUs (n = 144), we had 100 respondents (69% response). The median number of hospital beds among the respondents was 185 (IQR 111-355) with a median of 14 ICU beds (IQR 10-20). 86% reported spontaneous awakening trial protocols, 60% reported spontaneous breathing trial protocols, 43% reported delirium assessment/management protocols, and 27% reported early mobility protocols. Being a medical ICU compared to a mixed medical-surgical ICU (OR 3.48, 95% CI 1.19-10.21, P = .02) and presence of multidisciplinary rounds (OR 4.97, 95% CI 2.07-11.94, P < .001) were associated with increasing number of ABCDE bundle protocol components. Variable implementation of ABCDE bundle protocols was present across Pennsylvania. Team communication is important to implementation of these protocols.

Obstetric Anesthesia Procedure-Based Workload and Facility Utilization of Society of Obstetric Anesthesia and Perinatology Centers of Excellence Designated Institutions.

Optimal workload and staffing for obstetric anesthesia services have yet to be determined. We surveyed Society of Obstetric Anesthesia and Perinatology (SOAP) Centers of Excellence (COE) for Obstetric Anesthesia Care institutions to evaluate procedure-based obstetric anesthesia workload and facility use. After institutional review board (IRB) exemption, an online survey instrument (REDCap) was sent by email (1 initial and 2 reminders) to all SOAP COEs. Survey data included the number of deliveries, cesarean delivery rate, neuraxial labor analgesia rate, the number of labor and operating rooms, and the number of in-house and backup obstetric anesthesia providers. Obstetric anesthesia activity was estimated using a time-based workload ratio per provider (Stanford Work Index, 1.0 = clinically working every minute of every hour on duty) during weekday, weeknight, and weekend shifts. We compared workload between academic and nonacademic centers and correlated operating and labor rooms with cesarean and vaginal delivery volume. Fifty-one of 53 surveys were returned (96% response rate). Data from 33 academic and 14 nonacademic US institutions were analyzed. For academic centers, median Stanford Work Index for all staff (included trainees and Certified Registered Nurse Anesthetists) was 0.20 (weekday) and 0.19 (weeknight and weekends); nonacademic centers were 0.33 (weekday, P < .001 versus academic), 0.23 (weeknight, P = .009 versus academic), and 0.23 (weekends, P = .03 versus academic practices). Attending-only Stanford Work Indices were similar between academic and nonacademic centers. Total number of rooms on the obstetric suite (operating, labor, or triage room) was strongly correlated with delivery volume ( R2 = 0.55). The results outline staffing procedure-based workload ratios and facility utilization at SOAP COEs in the United States. These data can be used by other institutions that provide obstetric anesthesia services to guide their obstetric anesthesia staffing. The importance of considering the workload associated with different shifts and between academic and nonacademic centers is also highlighted. The results show that approximately one-third of an obstetric anesthesiologist's workload is spent on performing procedures. We did not, however, measure the other tasks anesthesiologists practice as peripartum physicians (eg, managing critically ill parturients, doing pre- and postprocedural evaluations, or performing emergent and unexpected procedures), and future studies are required to determine the time required to perform these tasks. Studies to determine the optimal staffing models to handle workload fluctuations and improve outcomes are also required.

Can a new ward environment and intensive allied health staffing model enhance therapeutic opportunities in trauma care? A behavioural mapping study of patients’ activities and interactions

Objective The aim of this study was to assess changes in patient activities and interactions observed in response to a new trauma ward at a level 1 trauma centre, and subsequently, a new allied health staffing model. Design Explorative case study using behavioural mapping. Setting Level 1 trauma centre in Melbourne, Australia. Participants Hospitalised trauma patients. Main measures Behavioural mapping of patients’ activities and interactions was conducted by two observers over three 4-day observation phases: (i) at baseline, (ii) on the new ward and (iii) with the new staffing model. Changes in activities and interactions were assessed via negative binomial regression models and reported as incident rate ratios. Results In total, 1264 patient observations were recorded over an 18-month period. After moving to the new ward, patients were observed performing activities of daily living at a 2.1-fold higher rate than at baseline (95% confidence interval: 1.18, 3.81) but walking/standing/climbing stairs 54% less (95% confidence interval: 0.22, 0.94). Subsequent to the new staffing model, patients were observed in the gym at a 4.1-fold higher rate (95% confidence interval: 1.60, 10.32) and interacting with allied health professionals at a 9.1-fold higher rate (95% confidence interval: 4.88, 16.98), than at baseline. After COVID-19 restrictions were introduced, patients were observed lying down 22% more (95% confidence interval: 1.04, 1.43), with 73% fewer visitor interactions (95% confidence interval: 0.17, 0.43). Conclusions Greater engagement in physical and social activities was observed following the implementation of the new allied health staffing model at a level 1 trauma centre. Whether these changes translate to improved trauma outcomes is important to investigate.

Measuring and driving hospitalist value: Expanding beyond wRVUs.

Measuring and driving hospitalist value: Expanding beyond wRVUs.

Open Mental Health: A Mental Health Eco System Developed in Collaboration With Communities

AimsSomerset drew upon the Community Mental Health (MH) Service Framework, and local experience and recognised that too often service user experience of mental health was beset with artificial barriers, gateways and eligibility with people sometimes needing to deteriorate before they got the vital support they needed. In addition, we recognised that the gap between secondary care and primary care was experienced by service users as a “cliff edge”. The radical redesign of mental offers in Somerset aimed to deliver an experience of “no wrong door” and where, via a partnership between health, social care and Voluntary, Community and Social Enterprise (VCSE), people's needs could be met; both in terms of specific mental health offers as well as tackling the wider determinants of mental ill health.MethodsOMH was launched early 2019, just before the pandemic, and so traditional project methodology did not always apply. Instead all partners focused on standing up the offer at pace in order to support the population within Somerset with the emotional and psychological consequences of the pandemic, and any pre existing challenges. The model was co-produced with Experts by Experience significantly contributing to the shape of the offers.The model developed comprised of two key facets: •A mental health offer, where the needs of individuals, families and carers are met by a range of health, social care and VCSE partners (including the wider determinants of mental well being such as finance / housing)•A mental health eco system developed in collaboration with communities (including underserved communities), where support is available throughout geographical communities and communities of identity.ResultsThe project has delivered both quantitively and qualitatively. Over 4100 additional appointments are offered to people in Somerset per month and reported outcomes and evaluation has been very positive. Work is underway to collate further Patient Related Outcome Measures. Following a Realist Evaluation methodology, the researcher in residence has highlighted the culture changes that are key to delivering the aspirations of the Community MH Service framework. These include; the narrative of “no wrong door”, an increased and open range of offers and interventions, blended staffing models across traditional organisational boundaries, partnership working, the role of lived experience and the ambition of addressing inequalities.ConclusionOMH, the product of Community MH Transformation in Somerset, is a radical and co produced redesign of MH services in partnership with the VCSE and Local Authority that has improved access and support to all people in Somerset.

It's Not Just the Prices: Time-Driven Activity-Based Costing for Initiation of Veno-Venous Extracorporeal Membrane Oxygenation at Three International Sites-A Case Review.

The United States spends more for intensive care units (ICUs) than do other high-income countries. We used time-driven activity-based costing (TDABC) to analyze ICU costs for initiation of veno-venous extracorporeal membrane oxygenation (VV ECMO) for respiratory failure to estimate how much of the higher ICU costs at 1 US site can be attributed to the higher prices paid to ICU personnel, and how much is caused by the US site's use of a higher cost staffing model. We accompanied our TDABC approach with narrative review of the ECMO programs, at Cedars-Sinai (Los Angeles), Hôpital Pitié-Salpêtrière (Paris), and The Alfred Hospital (Melbourne) from 2017 to 2019. Our primary outcome was daily ECMO cost, and we hypothesized that cost differences among the hospitals could be explained by the efficiencies and skill mix of involved clinicians and prices paid for personnel, equipment, and consumables. Our results are presented relative to Los Angeles' total personnel cost per VV ECMO patient day, indexed at 100. Los Angeles' total indexed daily cost of care was 147 (personnel: 100, durables: 5, and disposables: 42). Paris' total cost was 39 (26% of Los Angeles) (personnel: 12, durables: 1, and disposables: 26). Melbourne's total cost was 53 (36% of Los Angeles) (personnel: 32, durables: 2, and disposables: 19) (rounded). The higher personnel prices at Los Angeles explained only 26% of its much higher personnel costs than Paris, and 21% relative to Melbourne. Los Angeles' higher staffing levels accounted for 49% (36%), and its costlier mix of personnel accounted for 12% (10%) of its higher personnel costs relative to Paris (Melbourne). Unadjusted discharge rates for ECMO patients were 46% in Los Angeles (46%), 56% in Paris, and 52% in Melbourne. We found that personnel salaries explained only 30% of the higher personnel costs at 1 Los Angeles hospital. Most of the cost differential was caused by personnel staffing intensity and mix. This study demonstrates how TDABC may be used in ICU administration to quantify the savings that 1 US hospital could achieve by delivering the same quality of care with fewer and less-costly mix of clinicians compared to a French and Australian site. Narrative reviews contextualized how the care models evolved at each site and helped identify potential barriers to change.

Preliminary Planning for Mars Sample Return (MSR) Curation Activities in a Sample Receiving Facility (SRF).

Preliminary Planning for Mars Sample Return (MSR) Curation Activities in a Sample Receiving Facility (SRF).

Hospice Glassdoor and CAHPS® Scores-Glassdoor Scores and Hospice Financial Characteristics Predict Hospice Consumer Assessment of Healthcare Providers and Systems Scores.

Recent public data transparency on both decedent caregiver satisfaction and employee satisfaction is impacting the three most essential needs of any hospice, admitting hospice enrollees, attracting hospice professionals and delivering on quality. Explore the relationship between Glassdoor hospice employee recommendation data, hospice financial characteristics, and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores among the 50 largest US hospices. Retrospective data with multivariate regression analysis. Provider CAHPS hospice survey data from 2019-2020 and Glassdoor employee recommendation data. Glassdoor Composite and CAHPS Composite were positively correlated (r = .469, p < .01). Glassdoor scores, profit status, and acquisition status predicted Hospice CAHPS scores and explained 44% of the variation in CAHPS Composite. Being a large, for-profit hospice in acquisition status each predicted lower CAHPS scores. Non-profit hospices had significantly higher Glassdoor and CAHPS scores than for-profit hospices. CAHPS Composite and CAHPS Star Rating have potential as global indicators to inform customers of a given hospice's overall quality on the Hospice Compare website of CMS. Hospice leaders seeking improvements in CAHPS scores are encouraged to seek feedback on whether their own employees would recommend their hospice to a friend. Communication and responsiveness were the strongest indicators of overall hospice quality. Skelton hospice staffing models must give way to realistic models that value company culture and employee satisfaction. Hospice quality and hospice profits are not necessarily mutually exclusive. Future research should explore the difference in themes emerging from positive and negative online caregiver reviews.

Jail Health Care in the Southeastern United States From Entry to Release.

Millions of people are incarcerated in US jails annually. These individuals commonly have ongoing medical needs, and most are released back to their communities within days or weeks. Jails are required to provide health care but have substantial discretion in how they provide care, and a thorough overview of jail health care is lacking. In response, we sought to generate a comprehensive description of jails' health care structures, resources, and delivery across the entire incarceration experience from jail entry to release. We conducted in-depth interviews with jail personnel in five southeastern states from August 2018 to February 2019. We purposefully targeted recruitment from 34 jails reflecting a diversity of sizes, rurality, and locations, and we interviewed personnel most knowledgeable about health care delivery within each facility. We coded transcripts for salient themes and summarized content by and across participants. Domains included staffing, prebooking clearance, intake screening and care initiation, withdrawal management, history and physicals, sick calls, urgent care, external health care resources, and transitional care at release. Ninety percent of jails contracted with private companies to provide health care. We identified two broad staffing models and four variations of the medical intake process. Detention officers often had medical duties, and jails routinely used community resources (e.g., emergency departments) to fill gaps in on-site care. Reentry transitional services were uncommon. Jails' strategies for delivering health care were often influenced by a scarcity of on-site resources, particularly in the smaller facilities. Some strategies (e.g., officers performing medical duties) have not been well documented previously and raise immediate questions about safety and effectiveness, and broader questions about the adequacy of jail funding and impact of contracting with private health care companies. Beyond these findings, our description of jail health care newly provides researchers and policymakers a common foundation from which to understand and study the delivery of jail health care.

Organisational models at the emergency department to reduce hospital admissions among paediatric patients: a systematic literature review.

Paediatric attendances at the emergency department (ED) are often admitted to the hospital less than 24 h to allow time for more extended evaluation. Innovative organisational models could prevent these hospital admissions without compromising safety or quality of delivered care. Therefore, this systematic review identifies evidence on organisational models at the ED with the primary aim to reduce hospital admissions among paediatric patients. Following the PRISMA guidelines, three bibliographic databases (Ovid Medline, Embase, and Cochrane Library) were searched. Studies on organisational models in Western countries, published between January 2009 and January 2021, which applied a comparative design or review and studied at least hospital admission rates, were included. Analyses were mainly descriptive because of the high heterogeneity among included publications. The primary outcome is hospital admission rates. Secondary outcomes are ED length of stay (LOS), waiting time, and patient satisfaction. Sixteen publications described several innovative organisational models ranging from the creation of dedicated units for paediatric patients, innovative staffing models to bringing paediatric critical care physicians to patients at rural EDs. However, the effect on hospital admission rates and other outcomes are inconclusive, and some organisational models may improve certain outcomes in certain settings or vice versa. It appears that a paediatric consultation liaison team has the most consistent effect on hospital admission rates and LOS of paediatric patients presenting with mental problems at the ED. Implementing new innovative organisational models at the ED for paediatric patients could be worthwhile to decrease hospital admissions. However, the existing evidence is of rather weak quality. Future service developments should, therefore, be conducted in a way that allows objective evaluation.

Not So Easy: Cost Analysis of Staffing Models of Anesthesia Care

Features| May 2022 Not So Easy: Cost Analysis of Staffing Models of Anesthesia Care Amr E. Abouleish, MD, MBA, FASA Amr E. Abouleish, MD, MBA, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor May 2022, Vol. 86, 27–29. https://doi.org/10.1097/01.ASM.0000830836.76055.38 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Amr E. Abouleish; Not So Easy: Cost Analysis of Staffing Models of Anesthesia Care. ASA Monitor 2022; 86:27–29 doi: https://doi.org/10.1097/01.ASM.0000830836.76055.38 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: anesthesia care, personnel staffing and scheduling In our previous ASA Monitor article, we showed that moving from anesthesiologist-only care to the anesthesia care team may not result in a significant reduction in staffing costs and actually increase the cost (ASA Newsletter 2010;74:30-51). In the intervening decade, the cost analysis of one's staffing model and hypothetical changes in the model continue to be a challenge for anesthesiologists and anesthesiology leaders. Unfortunately, basic errors or omissions in the analysis can lead to erroneous conclusions that can ruin a well-functioning facility for many years. Therefore, in this article, we discuss the issues that need to be considered when doing a cost analysis as well as updating our previous evaluation of moving from anesthesiologist-only to anesthesia care team staffing. A discussion of how to determine the best staffing model is beyond this article (ASA Monitor 2022;86:14-5; ASA Newsletter 2013;77:10-3). The World Health Organization and World... You do not currently have access to this content.