Hospital Providers Research Articles

Abstract 14287: Development of an Innovated Heart Failure Hospitalist Program Drives Best Practice and Exceptional Outcomes From 2018-2021

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Hypothesis: The UPMC Hospitalist and Cardiology leadership recognized the need to foster consistent inpatient hospitalist providers, which was lacking in the current model. The concept of a dedicated Heart Failure Hospitalist service line emerged. Methods: Patients with both primary HF: UPMC Hospitalist, Cardiologist, teaching service N= 4192 (70%); CHF hospitalist Team N=1785 (30%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups from 2018-2021. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all providers is 21% from 2018-2021, matching the national average. HF Hospitalist team (only at Harrisburg Hospital) has consistently lower readmission rates: 9% (2018), 8.34% (2019), 8.6% (2020), 6.95% (2021). HF hospitalist length of stay was also consistently lower, by 0.5 to 0.9 days. Potential cost savings to UPMC hospitals is $1.5 million dollars since start of HF Hospitalist service line. Conclusions: Heart failure is a major health care issue. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. The HF Hospitalists provide quality care with frequent daily rounding, optimization of HF medications, providing education to the patient and family to improve treatment plan adherence, as well as engaging in early discussion of palliative and hospice transition. At this community-based healthcare system, HF Hospitalist outcomes include decreasing length of stay; decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 4yrs of the HF Hospitalist service line at UPMC.

The Effects of the Medicaid Expansion on Hospital Utilization, Employment, and Capital.

In recent years, hospitals reacted to changes in demand caused by the Affordable Care Act Medicaid expansions. We conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. We used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. During the period studied, the Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. We find strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. We found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.

Analysis of Corporate Governance, Organisational Resilience and Sustainable Practices Developed by Brazilian Companies during the COVID-19 Pandemic: An Exploratory Study

This paper aims to present aspects related to corporate governance, organisational resilience and sustainable practices developed by Brazilian companies during the COVID-19 pandemic. The methodological strategy included documentary research to identify sustainability reports published by companies listed on the Ibovespa index, which were examined through the content analysis technique. The results allowed light to be shed on opportunities for improvement concerning sustainability and corporate governance. Regarding organisational resilience, risk management is central for the development of sustainability practices by organisations. The support to society related to the COVID-19 pandemic was evidenced mainly through the donation of financial resources, equipment and hospital supplies. Practices related to reducing energy consumption and minimising waste generation were those most associated with environmental aspects. The actions identified were mapped according to their relations with the SDGs. Managers can benefit from the information presented in this study to enhance organisational sustainability and resilience, while researchers can use it as a starting point for future studies.

Characteristics and levers in the business model of hospital pharmacies in German-speaking countries

ABSTRACT Background The pharmaceutical supply in hospitals in German-speaking countries shows inadequate structural and procedural characteristics with regard to the quality of supply and security of supply. The question arises: How should a business model be designed to control and optimize the internal pharmaceutical supply in hospitals in German-speaking countries? Method With an adapted Analytic Hierarchy Process (AHP), pharmaceutical supply in hospitals in German-speaking countries is examined by means of two online surveys (2017, 2021) among managers of hospital pharmacies in Austria, Germany and Switzerland (2017: N = 412; n = 61, rr = 14.8%; 2021: N = 332, n = 44, rr = 13.3%). Results In addition to cross-sector trends in procurement and logistics, the communication and interaction among members of the health professions and the pharmacy and the associated relationship of trust are decisive for the security of supply and the quality of patient care. Targeted communication, digitization and performance measurement are relevant levers for a targeted development and optimization of pharmaceutical supply in hospitals. Conclusions The business model of the hospital pharmacy must be designed and applied conceptually and strategically. In addition to innovative logistics tools, also includes special communication approaches and interprofessional knowledge management.

The effect of the capitation policy withdrawal on maternal health service provision in Ashanti Region, Ghana: an interrupted time series analysis

BackgroundPayment methods are known to influence maternal care delivery in health systems. Ghana suspended a piloted capitation provider payment system after nearly five years of implementation. This study aimed to examine the effects of Ghana’s capitation policy on maternal health care provision as part of lesson learning and bridging this critical literature gap.MethodsWe used secondary data in the District Health Information Management System-2 and an interrupted time series design to assess changes in level and trend in the provision of ANC4+ (visits of pregnant women making at least the fourth antenatal care attendance per month), HB36 (number of hemoglobin tests conducted for pregnant women who are at the 36th week of gestation) and vaginal delivery in capitated facilities-CHPS (Community-based Health Planning and Services) facilities and hospitals.ResultsThe results show that the capitation policy withdrawal was associated with a statistically significant trend increase in the provision of ANC4+ in hospitals (coefficient 70.99 p < 0. 001) but no effect in CHPS facilities. Also, the policy withdrawal resulted in contrasting effects in hospitals and CHPS in the trend of provision of Hb36; a statistically significant decline was observed in CHPS (coefficient − 7.01, p < 0.05) while that of hospitals showed a statistically significant trend increase (coefficient 32.87, p < 0.001). Finally, the policy withdrawal did not affect trends of vaginal delivery rates in both CHPS and hospitals.ConclusionsThe capitation policy in Ghana appeared to have had a differential effect on the provision of maternal services in both CHPS and hospitals; repressing maternal care provision in hospitals and promoting adherence to anemia testing at term for pregnant women in CHPS facilities. Policy makers and stakeholders should consider the possible detrimental effects on maternal care provision and quality in the design and implementation of per capita primary care systems as they can potentially impact the achievement of SDG 3.

Reducing Unnecessary 'Admission' Chest X-rays: An Initiative to Minimize Low-Value Care.

Introduction Internal medicine admission services often request a baseline admission chest X-ray (CXR) for patients already admitted to the emergency department (ED) and who are waiting for inpatient beds, despiterarely providing clinical value. Adverse consequences of such CXRs include unnecessary radiation exposure, cost, time, and false positives, which can trigger a diagnostic cascade. Extraneous CXRs performed on already-admitted ED patients can delay inpatient transfer, thereby increasing boarding and crowding, whichin turnmay affect mortality and satisfaction. In 2016, our ED and internal medicine hospitalist services implemented guidelines (reflecting those of the American College of Radiology) to reduce unnecessary admission CXRs. All relevant providers were educated on the guideline. The primary aim of this study was to determine if there were changes in the percentage of patients with pre-admission and admission CXRs following guideline implementation. Our secondary aim was to determine which patient characteristics predict getting a CXR. Methods All ED and internal medicine hospitalist providers were educated once about the guideline. We performed a retrospective analysis of pre- vs. post-guideline data. Patients were included if admitted to the internal medicine service during those timeframes with an admission diagnosis unrelated to the cardiac or pulmonary systems. A CXR performed during ED evaluation prior to the admission disposition time was recorded as "pre-admission," andif performed after disposition time it was recorded as "admission." A CXR was "unwarranted" if the admission diagnosis did not suggest a CXR was necessary. The numerator was the number of unnecessary admissionCXRs ordered on patients with diagnoses unrelated to the cardiac or pulmonary systems (minus those with a pre-admission CXR); the denominator was the number of such admissions (minus those with a pre-admission CXR). Variables of interest that might influence whether a CXR was ordered were age, gender, respiratory rate ≥20,cardiac- or pulmonary-related chief complaint, ED diagnosis category, or past medical history. Results Among admitted patients with diagnoses that did not suggest a CXR was warranted, there was no change in the percentage of admission CXRs (21.7% to 25.6%, p = 0.2678), whereas the percentage with pre-admission CXRs decreased (66.6% to 60.7%, p = 0.0152). This decrease was driven by fewer CXRs being performed on patients whose chief complaint did not suggest one was indicated (p = .0121). In multivariate analysis, risk factors for an unwarranted CXR were age >40 (risk ratio (RR) = 2.9) and past medical history of cardiovascular disease (e.g., myocardial infarction, atrial fibrillation), renal disease, or hyperkalemia. Conclusion This educational initiative was not associated with the intended decrease in ordering unwarranted admission CXRs among ED boarding patients, though there was an unanticipated decrease in pre-admission CXRs. This decrease was driven by fewer CXRs being performed on patients whose chief complaint did not suggest one was indicated. Organizations interested in reducing processes with little clinical value might adopt a similar program while emphasizing the lack of benefit to admitted patients through iterative educational programs on hospital admitting services.

Addressing Shortcomings in Contingency Standards of Care

Addressing Shortcomings in Contingency Standards of Care

The Friend at Midnight: A ‘realistic’ reading as a feminist tool

The voices of women have historically been muted in biblical texts from their ancient to more modern interpretations. This article will attempt to ‘unhide’ the voices of women in the Parable of the Friend at Midnight by using a combination of social-scientific criticism and a ‘realistic’ reading as a methodology to inform an understanding of how 1st-century Mediterranean audiences would have understood women to be present in the parable where modern audiences might not. In the 1st-century Mediterranean world, women were key figures in facilitating group hospitality values, the baking and supply of bread, and caring for children. These women, however, are not directly mentioned in the parable and often excluded in modern commentaries. This contribution aims to pave a way forward for modern New Testament commentaries to not only include but also focus on the roles and importance of women in the parable of the Friend at Midnight.Intradisciplinary and/or interdisciplinary implications: The interdisciplinary nature of this article contributes to the debate on the roles and importance of women in the church by investigating the value that women had in the parables of Jesus. By reading women as present in the text, emphasis is given to the voices of women in the Bible and the importance of their representation today.

Not Clearing the Air: Hospital Price Transparency for a Laparoscopic Cholecystectomy

IntroductionIn 2019, Centers for Medicare and Medicaid Services (CMS) established a new requirement that all hospitals publish information on the standard costs of services provided. Increased price transparency allows patients to compare healthcare costs and make informed decisions about their care. We investigated compliance with this rule with regards to laparoscopic cholecystectomy, a commonly performed operation and one of the 70 shoppable services (SSs) included in the CMS requirement, among prominent hospitals in the United States. MethodsThe 2021-2022 US News “Best Hospitals for Gastroenterology and GI Surgery” was used to identify the top 50 hospitals for gastrointestinal surgery. Each hospital's website was assessed for the presence of a machine-readable file (MRF) as required by CMS. Each MRF was then evaluated for inclusion of all seven required elements: description of item/service, gross charge, payer-specific negotiated charge, deidentified minimum and maximum negotiated charges, discounted cash price, and billing code. The presence of a consumer-friendly display of SSs was also evaluated. The Current Procedural Terminology code 47562 (removal of gallbladder with an endoscope) was used to search for all six required elements: payer-specific negotiated charge, discounted cash price, de-identified minimum and maximum negotiated charges, campus location of the SS, and billing code. The SS display was further evaluated for provision of additional information on ancillary charges, which are recommended but not required. The MRF and SS were also evaluated for accessibility and date of last update. Hospitals were analyzed according to rank. Compliance with CMS requirements was compared between hospitals. ResultsFifty one hospitals were included. Of these 51 hospitals, one (2%) provided all the required information for both MRF and SS, 44 (86%) did not provide all necessary components of both the MRF and SS, six (12%) had all necessary elements of an MRF only, and two (4%) had all necessary elements of the SS only. The MRF was accessible in 80% (41) of studied hospitals and 76% (39) provided a gross charge but just 35% (18) of hospitals included the discounted cash price. The SS specified location for all hospitals, indicated a billing code in 96% (49), and provided a payer-specific charge in 96% (48), but less often provided de-identified minimum (30; 59%) and maximum (30; 59%) charges. Thirty nine (76%) hospitals reported that the listed price included an ancillary charge. There was no significant difference between hospitals in having all required elements of both the MRF and SS or the MRF only or SS only. ConclusionsHospitals are providing healthcare consumers with standard charge information, although with significant variation in what is disclosed. There is no association between hospital reputation and provision of standard charge information.

Can we take the heat?

The month of July 2022 saw the UK reach a historic 40°C, leading to major disruptions in the provision of public services, as trains, hospitals and schools struggled to combat the high temperatures. With the possibility of this heat becoming a &apos;new normal&apos; for large parts of the country, climate change advisers have highlighted the need to address the problem of overheating in UK homes - or face deadly consequences. The country has little regulation to prevent overheating in new buildings, even though as many as 4.6 million homes overheat every year in England alone, according to a recent survey by Loughborough University. If no action is taken to keep homes insulated from the heat, scientists fear that heat-related deaths could triple over the next 10 years. "By 2050, we will regularly have temperatures above 35°C in the south of the UK," says Chloe Brimicombe, a heat stress researcher at the University of Reading. "By the 2050s, between 5,000 and 7,000 people will die annually from extreme heat every year.".

Perception of neonatology staff regarding the availability of equipment and supplies for the care of patients in need of nCPAP.

Respiratory distress syndrome (RDS) is Mexico's second leading cause of neonatal mortality. The 75% reduction in mortality due to RDS has been attributed to the use of nasal continuous positive airway pressure (nCPAP). A survey was conducted to determine the perception of the medical staff regarding the availability of nCPAP equipment and supplies in Mexican hospitals with neonatal intensive care units (NICUs). We sent a survey via e-mail to several neonatologists in each state of the country, requesting only one response per hospital. We performed statistical analysis with SPSS software. We received 195 surveys from private (HPri) and public (HPub) hospitals with NICUs nationwide: 100% of HPri and 39% of HPub. More than 75% of the nursing and medical staff had received formal training in nCPAP in 11% of HPri and 5% of HPub. The perceived availability of CPAP equipment was 83.7% vs. 52.1%; nasal cannula supply, 75.5% vs. 36.3%; air/oxygen blender availability, 51.0% vs. 32.9%, in HPri and HPub, respectively. The observed differences were statistically significant. Significant differences were also found among healthcare institutions. The availability of CPAP equipment and consumables between HPub and HPri is unbalanced and is lower in public institutions. Bubble CPAP is not included essential equipment in the national catalog of instruments and equipment for public hospitals, and its request is complicated. The training of CPAP staff and the availability of bubble CPAP and supplies in public hospitals should be improved.

The Building of Dr Steevens’ Hospital, Dublin, 1710–33

This paper investigates the factors affecting hospital provision in early eighteenth-century Dublin by examining the early history of Dr Steevens’ Hospital. It explores Richard Steevens’s motivations for endowing a hospital and the friendship networks reflected in his will and that of the hospital trust, the latter initially set up in 1717 and expanded over the decades. In particular it focuses on the role of his sister Grizel Steevens in bringing the hospital into being. By using subscription and benefaction lists it plots the growth in support for the hospital until its eventual opening in July 1733. At the same time, it goes beyond a focus on the wealthy patrons of the hospital to investigate the people who actually worked on the building site in the fateful year 1720 - the year of the laying of the foundation stone and the year of the stock market crash which hampered fundraising efforts.

EBUS-TBNA versus mediastinoscopy for mediastinal staging of lung cancer: a cost-minimization analysis

ABSTRACTObjective:To assess cost differences between EBUS-TBNA and mediastinoscopy for mediastinal staging of non-small cell lung cancer (NSCLC). Methods:This was an economic evaluation study with a cost-minimization analysis. We used a decision analysis software program to construct a decision tree model to compare the downstream costs of mediastinoscopy, EBUS-TBNA without surgical confirmation of negative results, and EBUS-TBNA with surgical confirmation of negative results for the mediastinal staging of NSCLC. The study was conducted from the perspective of the Brazilian public health care system. Only direct medical costs were considered. Results are shown in Brazilian currency (Real; R$) and in International Dollars (I$). Results:For the base-case analysis, initial evaluation with EBUS-TBNA without surgical confirmation of negative results was found to be the least costly strategy (R$1,254/I$2,961) in comparison with mediastinoscopy (R$3,255/I$7,688) and EBUS-TBNA with surgical confirmation of negative results (R$3,688/I$8,711). The sensitivity analyses also showed that EBUS-TBNA without surgical confirmation of negative results was the least costly strategy. Mediastinoscopy would become the least costly strategy if the costs for hospital supplies for EBUS-TBNA increased by more than 300%. EBUS-TBNA with surgical confirmation of negative results, in comparison with mediastinoscopy, will be less costly if the prevalence of mediastinal lymph node metastasis is ≥ 38%. Conclusions:This study has demonstrated that EBUS-TBNA is the least costly strategy for invasive mediastinal staging of NSCLC in the Brazilian public health care system.

Adaptive Organizational Technology Approaches to Public Health and Hospital Supply Chains

COVID-19 has made supply chain and logistics risk management a significant aspect of healthcare organizations strategic focus area in 2022 and beyond in the United States. It is essential to consider how medical equipment, medicines, and supplies can save lives but only if they can reach those in need quickly and when most needed. Pandemic-induced disruptions in public health and hospital supply chains have created a need for more responsive and adaptive leadership and organizational practices. This study uses a qualitative research approach to explore the healthcare supply chain and logistics management best practices and innovations in the post-COVID-19 onset world.

Exploring Organizational Behavior and Workplace Diversity in Healthcare

Overlook hospital is facing major impacts that include (1) the minority nursing workforce is 4 percent, while the minority patient representation is 39%, (2) the hospital supply chain does not have one minority vendor, (3) 85 percent of minority nurses are dissatisfied with the work culture and job advancement opportunities, and (4) the hospital does not have a diversity and inclusion strategy. The hospital has experienced a series of community protests against the lack of diversity and discrimination at the hospital. The focus of is study is an exploration of diversity and inclusion in a hospital setting. An action research approach used included fact-finding interviews, barrier analysis, company policy assessments, content analysis of the problem in the literature, and recommendations based on the amalgamation of the triangulated data.

Post Anesthesia Response Unit: Development of an Intensive Care Unit within a Post Anesthesia Care Unit

Background InformationDuring the COVID-19 pandemic, the bed availability in Intensive Care Unit's (ICU) at Strong Memorial Hospital was limited. The Post Anesthesia Care Unit (PACU) was able to help load balance the intensive care units (ICU's) by caring for 6 ICU patients utilizing a team nursing model.Objectives of ProjectThe goal of the Post Anesthesia Response Unit (PARU) development was to utilize a team nursing model successfully caring for ICU patients. Because not all of the nurses who work within the PACU are traditionally trained to care for ICU patients, perioperative services leadership wanted to provide comprehensive ICU care by pairing the few ICU trained nurses with added support staff for safe patient care.Process of ImplementationThe PACU converted the extended recovery area into separate areas to care for ICU patients indefinitely. Leadership identified items that were critical in caring for ICU patients, worked alongside the hospital supply chain on creating a supply room, and built a code cart specifically for the PARU. The PARU scheduler paired an in-patient PACU RN who had prior knowledge working in an ICU with an assistive RN creating a buddy pairing. This paring was maintained throughout the entirety of the PARU and had a patient ratio of two patients to one pairing. Focusing on the PACU RN's skillset and knowledge base, leadership was able to identify staff member to care for individuals either receiving surgery or the chronic ICU population.Statement of Successful PracticePARU leadership found by having an ambulatory nurse or nurse anesthetists paired with a PACU nurse, a team nursing model approach was successful. The PACU nurses delegated tasks appropriately to their supportive staff member for safe patient care. PARU was open for total of 46 days caring for chronic surgical ICU patients. There was a total of 26 patients: 11 patients transitioned to floor level of care. 2 patients transitioned to comfort measures only. 2 patients were discharged to long term ventilator care units. 6 patients returned to the ICU's. Through collaborative efforts, ICU patients were able to be cared for by a nurse pairing in a safe comprehensive manner.Implications for Advancing the Practice of Perianesthesia NursingThe second surge of the COVID-19 pandemic caused an influx of critically ill patients. Perioperative leadership recognized the opportunity to help load balance the patient population by having 6 patients be cared for within the PACU setting. We learned that PACU nurses can successfully and confidently care for a two patient ICU assignment by utilizing a team nursing model.

Procurement Systems of Health and Pharmaceuticals in Hospitals during COVID-19 Pandemic: A Systematic Literature Review

Background: Due to the rise of the COVID-19 pandemic, medical health care plays a more crucial role in handling the increase. Countries worldwide accidentally collapsed because of unpreparedness in facing COVID-19, which caused a hospital panic phenomenon to stock medical equipment. Objective: To describe the procurement system for health and pharmaceutical supplies in hospitals during pandemic COVID 19. Method: A Systematic literature review. In a literature search from 2019 to 2022, the investigation found as many as 92 papers extracted using PRISMA guidelines, and a total of fourteen articles were selected for review. Results: in this review, we found that the government in every country has different procurement systems, revealing that each has its strengths and weaknesses. However, centralized procurement systems have a distinct advantage.

The Role of Forecasting and Planning Management in Sustainable Hospital Supply Chain

In the continually evolving landscape of healthcare services, sustainable hospital supply chain management (SCM) has become a focal point in driving efficiency and improving patient care. This paper builds upon previous discussions about the critical roles of Hospital Infrastructure Development (HID) and Collaboration &amp; Information Flow (CIF) in enhancing sustainable SCM. Herein, the significance of Forecasting and Planning Management (FPM) is examined as an essential component for sustainable SCM in the healthcare setting.

Identifying Hospital Deserts in Texas Before and During the COVID-19 Outbreak.

In this study, we proposed a GIS-based approach to analyzing hospital visitors from January to June 2019 and January to June 2020 with the goal of revealing significant changes in the visitor demographics. The target dates were chosen to observe the effect of the first wave of COVID-19 on the visitor count in hospitals. The results indicated that American Indian and Pacific Islander groups were the only ones that sometimes showed no shift in visitor levels between the studied years. For 19 of the 28 hospitals in Austin, TX, the average distance traveled to those hospitals from home increased in 2020 compared with 2019. A hospital desert index was devised to identify the areas in which the demand for hospitals is greater than the current hospital supply. The hospital desert index considers the travel time, location, bed supply, and population. The cities located along the outskirts of metropolitan regions and rural towns showed more hospital deserts than dense city centers.

Collaborative hospital supply chain network design problem under uncertainty

Since 2016, hospitals in France have met to form Territorial Hospital Groups (THGs) in order to modernize their health care system. The main challenge is to allow an efficient logistics organization to adopt the new collaborative structure of the supply chain. In our work, we approach the concept of logistics pooling as a form of collaboration between hospitals in THGs. The aim is to pool and rationalize the storage of products in warehouses and optimize their distribution to care units while reducing logistics costs (transportation, storage, workforce, etc.). Besides, due to the unavailability and the incompleteness of data in real-world situations, several parameters embedded in supply chains could be imprecise or even uncertain. In this paper, a Fuzzy chance-constrained programming approach is developed based on possibility theory to solve a network design problem in a multi-supplier, multi-warehouse, and multi-commodity supply chain. The problem is designed as a minimum-cost flow graph and a linear programming optimization model is developed considering fuzzy demand. The objective is to meet the customers’ demand and nd the best allocation of products to warehouses. Different instances were generated based on realistic data from an existing territorial hospital group, and several tests were developed to reveal the benefits of collaboration and uncertainty handling.