Service Line Research Articles

Failure analysis and structural optimization of abnormal cracking of through-channel support seats of digital rail vehicles

In this paper, the failure analysis and structural optimization of a new type of digital rail vehicle throughway support bracket with abnormal cracking are investigated. This paper addresses the failure case of a new digital rail vehicle throughway bracket. From the simulation point of view and the vibration test point of view of the service line, it verifies and reproduces the reasons for the fatigue fracture failure of the original through-channel bracket structure. The fatigue fracture failure of the throughway bracket is caused by external excitation. The shortcomings of the optimized structure of the through-channel support filled with steel plates are explained from the simulation point of view and the fracture mechanics damage tolerance theory. The feasibility of the vibration decoupling optimized structure is completely evaluated from the service line perspective and simulation perspective, and the results show that the service environment load of the vehicle meets the life requirements, and the research method can provide guidance for the service safety and fatigue life assessment of other components of the new type of digital rail vehicles.

Antimicrobial bathing of the critically ill for the prevention of healthcare-associated infection at a hospital in California

Background: Patients in the intensive care unit (ICU) have invasive lines increasing their risk for healthcare-associated infections (HAIs). Our objective was to determine if antimicrobial bathing with 2% chlorhexidine gluconate (CHG) compared to the colloidal silver-based antimicrobial product would reduce the incidents of central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: We performed a before-and-after study in four adult ICUs at a two-hospital facility in California. Prospective surveillance of CLABSI and CAUTI prevention bundles monitoring was established. The intervention consisted of daily bathing with CHG for all patients in the ICUs. A baseline period of one year was followed by an intervention period of one year. The incidence rates of CLABSIs and CAUTIs were compared between the baseline and intervention periods utilizing a t-test analysis. Results: A total of 10103 patients were included. At Facility A, a mean CLABSI rate of 2.43/1000 central line catheter days (CL) with 2149 patients days (Mean differences 95% CI -0.5–3.1; P>0.0975), during the baseline period followed by 1.11/1000 CL days with 2193 patient days in the intervention period. At Facility B, the mean CLABSI rate of 1.82/1000 CL days with 2976 patient days (Mean differences 95% CI -0.6–2.31; P>0.161) during the baseline period was followed by 1.01/1000 CL days with 2785 patient days in the intervention period. At Facility A, the mean CAUTI rate of 1.37/1000 indwelling catheter days (IUC) with 2149 ICU patient days (Mean difference 95% CI is 0.28–1.97; P 0.2160) was noted in the baseline period, followed by 0.45/1000 IUC days with 2785 in the intervention period. Conclusion: Daily bathing with CHG significantly reduced the incidence of CAUTI at Facility A. It is unclear why Facility A saw a statistically significant reduction in CAUTI, but Facility B did not. The difference in outcomes may be related to hospital size, service lines, supply constraints, and discrepancies in staffing. CHG bathing was not directly associated with a reduced risk of CLABSI at Facility A and B during our limited study, but it was encouraging enough that our organization will continue this intervention to obtain additional data to determine if bathing with CHG will reduce CLABSI and CAUTI.

Immediate Use Steam Sterilization and the Effect on Surgical Site Infections in an Acute Care Facility

Background: Immediate use steam sterilization (IUSS) shortens the time from sterilization to the aseptic transfer onto the surgical sterile field. Published data incompletely defines the extent to which IUSS increases risk of surgical site infection (SSI), compared to standard sterile reprocessing methods. We aimed to measure the association between IUSS use for surgical instrument reprocessing and SSI risk in a facility where IUSS use increased due to staffing constraints and case volumes. Methods: In this retrospective observational study at a tertiary care hospital with a diverse mix of surgery types, we used sterile reprocessing logs and SSI outcomes defined using National Health and Safety Network definitions to compare SSI rates among surgeries using surgical devices sterilized using IUSS compared to standard terminal sterilization methods. We calculated a risk ratio (RR) and 95% confidence interval (95%CI), including stratification by eleven high-volume service lines. Results: Among 23,919 surgical procedures, 416 (1.74%) developed SSIs. IUSS was used to sterilize instruments prior to 1,524 (6.37%) surgical procedures, and of these procedures 39 (2.56%) developed an SSI, compared to 1.68% of non-IUSS procedures (377 SSI in 22,395 procedures; risk ratio [RR] 1.52, 95% confidence interval [95%CI] 1.10-2.11). Two surgical services had statistically significant RRs for SSI development after IUSS: transplant surgery (RR 2.47, 95%CI 1.32-4.60] and plastic surgery (RR 3.64, 95%CI 1.13-11.74; Figure). Conclusion: IUSS is associated with a significant increase in SSIs, including among varied surgery types. IUSS utilization should be minimized.

"Covering provider": an effort to streamline clinical communication chaos.

This report describes a root cause analysis of incorrect provider assignments and a standardized workflow developed to improve the clarity and accuracy of provider assignments. A multidisciplinary working group involving housestaff was assembled. Key drivers were identified using value stream mapping and fishbone analysis. A report was developed to allow for the analysis of correct provider assignments. A standardized workflow was created and piloted with a single service line. Pre- and post-pilot surveys were administered to nursing staff and participating housestaff on the unit. Four key drivers were identified. A standardized workflow was created with an exclusive treatment team role in Epic held by a single provider at any given time, with a corresponding patient list column displaying provider information for each patient. Pre- and post-survey responses report decreased confusion, decreased provider identification errors, and increased user satisfaction among RNs and residents with sustained uptake over time. This work demonstrates structured root cause analysis, notably engaging housestaff, to develop a standardized workflow for an understudied and growing problem. The development of tools and strategies to address the widespread burdens resulting from clinical communication failures is needed.

Information system of support of economic decisions on the development of the Internet provider network

The paper suggests and confirms the hypothesis about the dependence of the price of internet service provider tariffs on the main economic and demographic determinants, and also defines the list of these determinants. An economic-mathematical model for optimizing the distribution of the budget for the expansion of the Internet provider's network between the execution of connection requests for separate service lines and tariffs has been developed. One of the key elements of the activity of Internet providers is the solution of the "last mile" problem, which consists in providing a communication service between the end user and the provider's Internet access node. Taking into account the orientation of such enterprises to the maximization of their own profit, this problem should be considered in the technical and economic dimension. Solving this problem requires a multidimensional approach that takes into account technology, economics and geography, as well as the significant investment required to expand network coverage and meet the demands of a distributed customer base. Internet providers should take into account the negative impact of possible network congestion, non-linear pricing, as well as consumer demand when optimizing pricing strategies and network development strategies. The developed model was applied to historical data on the activity of the Internet provider. The proposed approaches are combined into a single information system to support economic decision-making for the development of network of Internet providers, which contributes to the implementation of the developed model in practice and allows to increase the efficiency of the production activities of such enterprises. The paper put forward and confirmed the hypothesis about the dependence of prices for fixed Internet connection services on the dollar exchange rate, the cost of connecting to the trunk node, and the population. Approaches to economic decision-making in the management of the Internet provider's activities were further developed, namely, an economic-mathematical model was developed and tested to optimize the allocation of the budget for the expansion of the Internet provider's network between the satisfaction of applications of potential subscribers for connection in the section of individual tariffs of the provider's current tariff grid. As a result of the test of the developed economic-mathematical optimization model on the historical data of the enterprise, the possibility of improving the expected profit relative to the basic plan by 18% was established.

Surgical Intraoperative Handoff Initiative: Standardizing Operating Room Communication Using SHRIMPS.

Operating room (OR) handoffs are not universally standardized, although standardized sign outs have been proven to provide effective communication in other aspects of healthcare. We hypothesize that creating a standardized handoff will improve communication between OR staff. A frontline stakeholder approached our quality improvement team with concern regarding inadequate quality surgical technician handoffs during staff changes. An audit tool was created for a pilot cohort of 23 cases to evaluate surgical technician handoffs from May 2022 to November 2022. Handoffs occurred in 82.6% of cases. Elements of handoff varied significantly, with an average of 34.4% completion of critical handoff elements. Audits were reviewed with stakeholders to develop a standardized communication checklist, including domains regarding sponges, sharps, hidden items, replaced items, instruments, implants, medications, procedure overview, and specimens. An acronym of these domains, SHRIMPS, was affixed to each OR wall. In the initial Plan-Do-Study-Act cycle, piloted in urology, general surgery, and neurosurgery, 100% of the 15 observed cases included handoff, averaging 76 seconds per handoff. Additionally, 100% of cases announced a handoff to the surgeon, and all elements were addressed 99.6% of the time. Plan-Do-Study-Act cycle 2 involved implementation to all service lines. Of the 68 cases observed, 100% included handoff, averaging 69.4 seconds per handoff, with 98.2% of elements addressed, though only 97.1% of handoffs were announced. Little communication standardization exists within the OR, especially regarding intraoperative staff changes. Implementation of a standardized handoff between surgical technicians resulted in substantial improvement in critical communication during staff changes.

A Critical Assessment of Inpatient Dermatology Service Line in the Rural United States

Objective: We sought to classify dermatologic conditions presenting in rural inpatient hospitalization. Methods: Retrospective chart review. Conclusion: Limited rural dermatology care in the United States prompted the establishment of an inpatient dermatology consult line in rural Upstate New York. Over 3 years, 27.7% of consults were admitted for dermatologic concerns, 21.5% for both dermatologic and medical issues and, 50% for non-dermatologic reasons but later seen by dermatologists. Common conditions included eczematous rashes, infections, drug reactions, edematous skin conditions, and autoimmune diseases. Among patients admitted for dermatologic concerns, cellulitis (3) and rashes (3) were the most common. Interestingly, 74% of provisional dermatologic diagnoses matched final diagnoses before further workups. Approximately 58.5% of consults were deemed highly valuable. Followup showed 73.8% improvement, 23.1% deceased from different pathologies, and 3.1% stable. Understanding the rural dermatology landscape could enhance access, diagnostic accuracy, and the feasibility of inpatient consult services. Understanding the rural dermatology landscape may improve access to specialist care, increase diagnostic accuracy, reduce disease burden and associated costs, and communicate the feasibility of inpatient consult services either in-house or via teledermatology to rural hospital systems.

Current and anticipated future state of cachexia care in patients with cancer.

Aims: We assessed care in cancer patients with cachexia across leading health systems (LHSs).Patients & methods: Qualitative interviews and quantitative surveys were conducted with LHSs executives and frontline health care personnel, representing 46 total respondents and 42 unique LHSs and including oncology service line leaders, supportive care services, dietitians and surgical oncologists.Results: Cachexia was not considered a top priority, and formal diagnoses were rare. Participants highlighted the importance of addressing barriers to increase clinical trial enrollment and support frontline health care personnel and patients in early detection of cachexia.Conclusion: Cachexia prioritization needs to be elevated across LHSs executives to obtain capital and strategic imperatives to advance related care.

Is it time for the death knell of single-unit plasma?

A plasma transfusion dose should be weight-based (10-20 mL/kg), which equates to three to four units in an average-sized adult; therefore, the transfusion of single units under most circumstances is sub-therapeutic. This retrospective observational study examined the prevalence of single-unit plasma transfusion in adults within a 12-hospital system from 1 January 2018, to 31 December 2019. During the study period, 5791 patients received plasma transfusions. The overall prevalence of single-unit plasma was 17.1% for 988 patients. The majority, 3047 (52.6%), occurred at one hospital, 2132 (36.9%) among five hospitals and 612 (10.7%) at the remaining six hospitals. Cardiac and gastrointestinal (GI)/transplant transfused 2707 (46.8%), combined respiratory, neurological, orthopaedic and congenital/dermatology/other comprised 2133 (36.9%) of the six hospitals that transfused less than 200 patients, four (66.7%) transfused single units above the overall prevalence. In this hospital system, more than one in six patients received a transfusion of a single plasma unit. Six of the 12 hospitals had 89.5% of the patients who were transfused plasma. Six service lines transfused 83.7% of all patients receiving plasma. Hospitals that infrequently transfused plasma were more likely to under-dose.

Decision-Making Model in Information Technology Management of Logistics Companies

The research is devoted to developing an innovative decision-making model for automating the sorting processes of postal item sorting. In today’s environment of rapid development of logistics services and growing volumes of mail, there is a need to improve existing technologies and methods of managing sorting lines. The main goal of this study is to create an effective model that will ensure the optimisation of sorting terminals with loading points. The purpose of the research is to develop decision-making models for managing postal service lines that implement sorting logic for terminals with loading points. The research methodology is based on a systematic approach that allows us to take into account all aspects of sorting lines. The theories of finite predicate algebra and set algebra were used to create mathematical sorting models. Methods of building decision support systems and modern information technologies ensure the integration of the developed algorithms into real postal systems. The scientific novelty lies in defining and implementing a variant of the decision-making model for an automated sorting line for mail. The model implements the specified sorting logic, which makes it possible to significantly improve the efficiency and accuracy of the processes of loading and sorting mail. Conclusions. A variant of implementing the model of the decision support system for an automated sorting line of mail is proposed. The developed model makes it possible to implement the logic of sorting mail for terminals with defined loading points. This helps to increase the efficiency and reliability of postal services, reducing the likelihood of errors and ensuring timely delivery.

Enabling Islamic internet-only banks acceptance: an empirical analysis of the UTAUT framework and Islamic compliance

PurposeThe purpose of this study is to explore a theoretical model using the unified theory of acceptance and use of technology framework by adding Islamic compliance (IC) and security assurance to build antecedents of intention to use Islamic internet-only banks (IIOBs) in Muslim youth.Design/methodology/approachThis study involved 262 Muslim youths from several Islamic communities in Indonesia. The analysis was conducted using partial least squares structural equation modelling (PLS-SEM). Moreover, PLS techniques such as the variance accounted for (VAF) were used to verify the statistical analysis of findings.FindingsThe findings show that effort expectancy (EE) and online social influences (OSI) strongly correlate with the intention to use IIOBs. In addition, user reviews (online reviews) are proven to form a solid social influence and impact consumer decision-making. Finally, IC and security assurance are still critical factors in the IIOBs acceptance.Practical implicationsPractically, IIOB providers need to strengthen information about performance, accessibility, security and benefits when running service applications. Providers must show their strengths and advantages compared to the traditional banks in various service lines. Besides, providers are expected to be more careful regarding IC applications in their products and services.Originality/valueThis study considers the effects of OSI, EE, security and IC as the unique characteristics of Muslim youth in using the IIOBs. In particular, the significance of IC and OSIs provides a valid picture of the pathways of acceptance creation towards IIOBs.

A cancer center department of supportive oncology: Patient demographic characteristics.

e13518 Background: Supportive Oncology is critical to whole-person, modern cancer care. Our Department of Supportive Oncology (DSO) provides the following services: palliative medicine, senior oncology, integrative oncology, cancer survivorship, genetics, cancer rehabilitation, oncology nutrition, patient navigation, and psycho-oncology. Little is known on the patient population who access these services which makes program development difficult. We describe the key demographic variables in a Supportive Oncology Department (DSO) for age, payor, gender, language preference, and race across our health system, geographical locations, and DSO services. Methods: Patient encounters, as noted in the EMR, were analyzed in a Microsoft PowerBI (www.microsoft.com) database using visits from July 1, 2022 through December 31, 2023. Variables were pre-defined by the healthcare system. Descriptive statistics in grouped frequency distribution tables were used. Results: Female, White, English-speakers (respectively) were the top utilizers across our healthcare system (57%,62%,94%), the oncology service line (64%,69%,97%), and DSO (68%,68%,96%). By gender, females were predominant users (84%) of Integrative Oncology & Survivorship services. Males used Senior Oncology & Palliative Medicine most often of all DSO services (45%). Differences in race were noted in geography (Black urban 26% vs rural 18%). In DSO services, Black patients access for senior oncology/palliative medicine (combined) was highest at 26%. Lowest utilization for Blacks was psycho-oncology & genetics at 18 and 13% respectively. While the overall system had more managed care (55%), both the oncology service line and DSO had more Medicare and less Medicaid. DSO had more managed care (46%) than the service line (42%). In rural settings, DSO patients (39%) were more likely to be in managed care than those in the service line (34%). DSO had more patients in younger age groups (ages 45-64, 42%) than both the oncology service line (35%) and the health system (24%), regardless of urban/rural location. In both the health system and the oncology service line, younger patients were more likely to be in urban locations and older were more likely rural. For DSO services, younger patients (ages 18-44) were more involved in psychology (27%), genetics (26%), and integrative & survivorship care (19%). Older patients were more likely to utilize palliative medicine and senior oncology (ages > 65, 47%). Conclusions: This Supportive Oncology population reveals variation in service access related to demographic characteristics that can inform future program development. Important similarities and differences were noted compared to the wider oncology service line and health system. Age, gender, geographic, payor, and racial disparities may influence service utilization in Supportive Oncology.

Heterogeneous impacts of the built environment on survival of customized bus services across the downtown and suburbs

Customized bus services (CBS) lines have been increasingly added in cities to better serve diversified travel needs. The notable variations in the built environment across the downtown and suburbs could result in wide differences in local customers' behaviors and preferences. The allocation of CBS stops thus needs to be considered separately in urban centers and peripheries to ensure the best performance, but such spatial heterogeneity is not specifically studied and justified in the literature. This study takes empirical data containing continuous CBS stops in Shanghai, China, as an example. Using a latent class binomial logit model, it investigates the effects of bus characteristics, geographic, and built environment elements on the survival of CBS stops in downtown and suburbs. The findings demonstrate that the performance of CBS systems is significantly influenced by factors including road density, population density, POI, sidewalk width, greenery area, ticket fare, and the type of CBS line (commute or general) across urban centers and peripheries. Specifically, two latent classes of CBS stops are found to have different effects depending on the stop's location or type of the linked areas, i.e. downtown or suburbs, on a CBS line.

A descriptive and prescriptive analysis of rail service subsidies in the China–Europe freight transportation market

This study delivers a descriptive and prescriptive analysis of rail service subsidies for China Railway Express (CRE) in the China-Europe freight transportation market. The analysis is conducted by advanced mathematical modeling and programming methods. Specifically, we implemented a multicommodity multimodal freight transportation network equilibrium model that can be used for predicting the commodity-specific mode-route cargo flow pattern and hence for assessing the effectiveness and limitations of the current CRE subsidy scheme. To properly quantify the impact of subsidies on individual shippers’ decision making, the model explicitly characterizes individual shippers’ mode-route choice behavior and takes into account shipping cost, transit time, capacity-induced congestion surcharge, and unobserved transportation impedances as shippers’ disutility. The solution of the network equilibrium model resorts to a disaggregate simplicial decomposition algorithm within the well-known Lagrangian relaxation framework. A bi-level network-based subsidy optimization model is constructed, in which the upper level aims at minimizing the sum of revenue loss and congestion charge, and the lower level is the aforementioned freight transportation network equilibrium model. A tabu search procedure is proposed and implemented to derive the solution of the bi-level model. The above models and algorithms are then applied to the China-Europe containerized freight transportation network, which comprises all China-Europe liner shipping lines, all CRE service lines, and the highway networks in China and Europe. The evaluation and optimization results show that the current subsidy scheme creates an imbalanced capacity utilization pattern across CRE service lines while an optimized line-specific subsidy solution can yield noteworthy improvements in the service utilization and economic efficiency of CRE.

Finding the Right Setting for the Right Treatment During the Acute Treatment of Individuals with Schizophrenia: A Narrative Review and Clinical Practice Guideline.

Schizophrenia is most times a chronic and often debilitating illness associated with poor mental health outcomes. Early and effective treatment of schizophrenia in the most appropriate setting can make a significant difference in the long-term recovery. The aim of this narrative review was to provide suggestions and recommendations for effectively managing patients with schizophrenia during acute exacerbations and to enhance awareness and skills related to personalized medicine. A panel of academics and clinicians with experience in the field of psychosis met virtually on July 13th 2023 to narratively review and discuss the research evidence and their clinical experience about the most appropriate acute treatments for patients with schizophrenia. This manuscript represents a synthesis of the panel analysis and discussion. First contact is very important for service users, as is finding the most adequate treatment setting. If patients present to the emergency department, which may be a traumatic setting for service users, a dedicated environment with adequate space and specialized mental health support, including personnel trained in de-escalation techniques, is recommended. A well-connected continuum of care is strongly recommended, possibly with seamless links between inpatient units, day hospital services, outpatient facilities and rehabilitation services. Ideally, this should be structured as part of a coordinated step-down service line. Treatment challenges include suboptimal response, side effects, and nonadherence, which is reduced by the use of long-acting injectable antipsychotics. Individual circumstances, including age, gender, and presence of hostility/aggression or self-harm, cognitive impairment and negative symptoms, comorbidities (depression, substance use disorders) or associated symptoms (anxiety, insomnia), should be considered when selecting the most appropriate treatment for the acute phase of schizophrenia. Efficacy and feasibility, as well as acceptability and tolerability of treatments, require joint consideration from the early stages of schizophrenia, thereby enhancing the possibility of improved short- and long-term outcomes.

The structure of academic cancer service lines: Results of an Association of American Cancer Institutes survey.

e13566 Background: An integrated cancer service line (CSL) in academic medical centers provides a patient-centered approach with the goals of improving the patient experience and clinical outcomes; managing financial operations; increasing access to clinical research; and decreasing health disparities. The Association of American Cancer Institutes (AACI) Physician Clinical Leadership Initiative Steering Committee sought to evaluate the current state of cancer services lines among the membership of AACI to identify common areas of organizational structure and function and potential areas for enhancing integration. Methods: A 29-question, mixed-methods, descriptive survey with multiple choice and short answer questions addressing the characteristics of the center’s CSL, was sent electronically to the cancer center directors and administrators at 107 academic centers on July 31, 2023, and again on August 24, 2023. Descriptive statistics were used to summarize the survey data. Results: Of 107 centers, 75 (70%) responded to the survey. Of the 68 respondents with clinical services, 58 centers (85%) had a defined CSL. Twenty-three centers (40%) noted that they did not have a formal charter defining governance and structure; 11 (48%) of the 23 are National Cancer Institute (NCI)-Designated Cancer Centers. Twenty-six (45%) reported a defined funds flow. Fifty (86%) cancer centers have a physician as a primary leader and the majority have a leadership team of two or more individuals (55, 95%). While hematology and medical oncology, radiation oncology, and surgical specialties were part of every CSL, pathology (31, 53%) and radiology (28, 48%) were included in only half of the centers. Center respondents noted that quality and safety were a primary focus (48, 83%), with regional growth (45, 78%), ambulatory operations (44, 76%), and budgeting and margin management (43, 74%) as additional responsibilities. Key performance metrics tracked by the CSL included the number of new patients (57, 98%), time to first appointment (55, 95%), and accrual to clinical trials (47, 81%), while 48% (28) tracked palliative care referrals within 90 days of death. Most CSL services, inclusive of records collection (86%), billing (86%), and coding (81%) are centralized within the center’s health system. Conclusions: There is widespread variability in the structure of academic CSLs with 40% and 55% of respondents not having a formal charter or funds flow, respectively. Leadership, key responsibilities, and metrics differed across centers. These results can serve as a tool for centers to refine their existing CSL or as a guide for CSL development. Our survey highlights a potential to evaluate CSL structures, which are inclusive of a broader series of departments and services, to determine the optimal approach for a multidisciplinary patient-centered care model. Efforts to obtain outcome data on CSL structures are warranted.

Emergency Medicine Physician Residents' Perceptions of Emergency Medicine Clinical Pharmacists' Involvement in Their Training.

Although the clinical impact of emergency medicine clinical pharmacists (EMCPs) on patient care outcomes is well documented, their educational impact on resident physicians' training is not. To further highlight the utility of EMCPs, this study evaluated emergency medicine (EM) resident physicians' perceptions of EMCPs' involvement in their training. A voluntary, anonymous web-based survey was sent by email to all 44 EM resident physicians in July 2022. The survey included multiple choice, 5-point Likert scale, and free response questions derived from Accreditation Council for Graduate Medical Education pharmacotherapy competency-based milestones. Thirty-six of the 44 (82%) residents completed the survey and all 10 PGY-4 class residents completed the survey. Nearly half of the respondents (44.4%) reported they consulted/interacted with the EMCPs 3 to 5 times per week and this number increased with the level of training. Respondents most often consulted the EMCPs to obtain medication indications, antibiotic dosing, pediatric dosing, and contraindications. Overall, respondents primarily reported strongly agree to all survey questions. Nearly all respondents strongly agreed the EMCPs are an important part of the patient care team and provide education that is different from what a supervising physician provides. All respondents who completed the pharmacy elective strongly agreed the elective was valuable and strongly recommended other residents to complete it. Respondents reported EMCPs are an important part of the patient care team, play a significant role in their training, and provide education that is different from what a supervising physician provides. Our findings encourage other institutions to leverage physicians' views of EMCPs to expand their service line.

Service mix and financial performance in rural hospitals: A contingency theory perspective.

Rural hospitals are increasingly at risk of closure. Closure reduces the availability of hospital care in rural areas, resulting in a disparity in health between rural and urban citizens, and it has broader economic impacts on rural communities as rural hospitals are often large employers and are vital to recruiting new businesses to a community. To combat the risk of closure, rural hospitals have sought partnerships to bolster financial performance, which often results in a closure of services valuable to the community, such as obstetrics and certain diagnostic services, which are viewed as unprofitable. This can lead to poor health outcomes as community members are unable to access care in these areas. In this article, we explore rural hospital service offerings and financial performance, with an aim to illuminate if specific service offerings are associated with positive financial performance in a rural setting. Our study used hospital organization data, as well as county-level demographics with periods of analysis from 2015 and 2019. We employed a pooled cross-sectional regression analysis with robust standard errors examining the association between total margin and service lines among rural hospitals in the United States. The findings suggest that some services deemed unprofitable in urban and suburban hospital settings-such as obstetrics and drug/alcohol rehabilitation-are associated with higher margins in rural hospitals. Other unprofitable service lines-such as psychiatry and long-term care-are associated with lower margins in rural hospitals. Our results suggest the need of rural hospitals to choose services that align with environmental circumstances to maximize financial performance. Hospital administrators in rural settings need to take a nuanced look at their environmental and organizational specifics when deciding upon the service mix. Generalizations regarding profitability should be avoided to maximize financial performance.

Institution of a Vascular Surgery Acute Care Service Line Improves Resident and Faculty Wellness

Institution of a Vascular Surgery Acute Care Service Line Improves Resident and Faculty Wellness

Lessons Learned-A Case for Required Student Services 1:1 Orientation.

Both faculty and student learners associated with physician assistant/associate (PA) programs continue to suffer from the effects of the ongoing mental health crisis. Furthermore, student learners may have other personal needs impacting their potential success in PA school (ie, financial, academic, or other). A proactive approach to supporting student learners early in their PA educational journey is warranted. Required 1:1 face-to-face orientations between incoming PA students and a representative from the Office of Wellness and Academic Support (OWAS) were implemented during the first week of PA program orientation. Students were allowed time and space to privately share their individual experiences and concerns as they entered PA school. In addition, the student services representative from OWAS was able to provide customized education on the variety of resources available for students. The student services representative from OWAS established personal relationships with each of the incoming PA students. Multiple follow-up appointments and referrals were made to various service lines including tutoring, learner accommodations, and mental health counseling. The implementation of required 1:1 face-to-face orientations between incoming PA students and student services during the first week of PA program orientation was highly effective. The primary lesson learned is that a simple, preventative, proactive approach can be extremely impactful if we are willing to view the challenges of student learners in PA education through a different lens.