Standardizing Care of the Late Preterm Infant.

BACKGROUND: Late preterm infants are infants born between 34 and 36 6/7 weeks gestation. Compared to term infants, late preterm infants are at increased risk for breastfeeding difficulties, hypoglycemia, hyperbilirubinemia, and hypothermia due to their relative physiologic and metabolic immaturity. PROBLEM: Medical record reviews performed at a level III maternal and newborn hospital in central Illinois revealed only 64% of late preterm infants admitted to the newborn nursery received care per the unit late preterm infant policy. The aim of this quality improvement project was to increase nurse adherence to the policy to 80%. METHODS: Between May 2022 and September 2022, several interventions were implemented for maternal-child nurses and support clinicians: an education offering, creation of a late preterm infant-specific breastfeeding log, and electronic medical record updates. Post-intervention medical record reviews measured policy adherence through documentation of feeding sessions, hypoglycemia, hypothermia, and hyperbilirubinemia. Descriptive statistics were performed to determine improvement. RESULTS: Nurse adherence to the late preterm infant policy increased to 90% over the period of the project. CLINICAL IMPLICATIONS: Late preterm infant care protocols should be in place in all newborn nurseries. Late preterm infant policy adherence can be supported through electronic medical record prompts, use of a late preterm infant-specific breastfeeding log, and continuing education.

Establishing a Nurse Champion Education Program for Perinatal Home Health Nurses.

Professional development is essential for the ongoing professional growth of nurses and ensures employers and patients that staff have current knowledge in the field. But what happens when there's no budget for professional development? This quality improvement project describes the use of a nurse champion intervention for a professional development program for perinatal home health nurses at a nonprofit health organization. A nurse champion mentors and advocates for nurse colleagues during a change project. In this case, the nurse champion partnered with nurse educators from the supporting hospital and instituted a program to provide regular professional development content to perinatal home health nurses. Results showed their level of confidence in providing prenatal, labor and delivery, and early pediatric education improved. Level of confidence in providing postpartum education stayed the same, and level of confidence in providing neonatal intensive care unit education decreased. The Nurse Champion Education Program was a budget-friendly solution that fostered professional nursing development. Although this intervention was applied to a specific population, all home health nurses could benefit from a nurse champion education model in their professional setting.

New requirements for hospitals to maintain tax-exempt status.

Tax-exempt hospitals are now facing more legislative requirements to maintain tax-exempt status. This article outlines each of these requirements imposed by the Patient Protection Act of 2010. Health care administrators, executives, and consultants must be aware of these new laws to ensure each facility is capable of maintaining tax-exempt status. Despite the issuance of new requirements, a conclusive definition of charity does not exist. Therefore, the debate surrounding charity care and the justification for tax-exempt status will continue.

An examination of contemporary financing practices and the global financial crisis on nonprofit multi-hospital health systems.

This study examines the impact of the 2008 global financial crisis on large US nonprofit health systems. We proceed from an analysis of the contemporary capital financing practices of 25 of the nation's largest nonprofit hospitals and health systems. We find that these institutions relied on operating cash flows, public issues of insured variable rate debt, and accumulated investment to meet their capital financing needs. The combined use of these three financial instruments provided these organizations with $22.4 billion of long-term capital at favorable terms and the lowest interest rates. Our analysis further indicates that the extensive utilization of bond insurance, auction rate debt, and interest rate derivatives created significant risk exposures for these health systems. These risks were realized by the broader global financial crisis of 2008. Findings indicate these health systems incurred large losses from the early retirement of their variable rate debt. In addition, many organizations were forced to post nearly $1 billion of liquid collateral due to the falling values of their interest rate derivatives. Finally, the investment portfolios of these large nonprofit health systems suffered millions of dollars of unrealized capital losses, which may minimize their ability to finance future capital investment requirements.

Cost-volume-profit analysis and expected benefit of health services: a study of cardiac catheterization services.

AIM: Academic research investigating health care costs in the Palestinian region is limited. Therefore, this study examines the costs of the cardiac catheterization unit of one of the largest hospitals in Palestine. We focus on costs of a cardiac catheterization unit and the increasing number of deaths over the past decade in the region due to cardiovascular diseases (CVDs). METHODS: We employ cost-volume-profit (CVP) analysis to determine the unit's break-even point (BEP), and investigate expected benefits (EBs) of Palestinian government subsidies to the unit. RESULTS: Findings indicate variable costs represent 56 percent of the hospital's total costs. Based on the three functions of the cardiac catheterization unit, results also indicate that the number of patients receiving services exceed the break-even point in each function, despite the unit receiving a government subsidy. CONCLUSIONS: Our findings, although based on one hospital, will permit hospital management to realize the importance of unit costs in order to make informed financial decisions. The use of break-even analysis will allow area managers to plan minimum production capacity for the organization. The economic benefits for patients and the government from the unit may encourage government officials to focus efforts on increasing future subsidies to the hospital.

Perceptions of continuing medical education, professional development, and organizational support in the United Arab Emirates.

INTRODUCTION: This paper investigates the views of health care providers on continuous medical education (CME). To our knowledge, this is one of the first surveys to examine perspectives of CME in the United Arab Emirates (UAE). METHODS: A 6-part questionnaire focused on the following areas of CME: the workshop leaders/trainers, the training experience, the relevance of CME information provided in the training session, the training approach, the convenience of CME sessions, and organizational support. RESULTS: Results from 147 respondents indicated moderate satisfaction with these 6 CME areas. Respondents did not indicate satisfaction with organizational support received. Furthermore, participants agreed with the importance of CME to professional development. DISCUSSION: In our sample of UAE health care workers, they agree on the importance and relevance of CME to the development of their profession, even though the majority of health care workers are expatriates. However, several issues must be addressed, such as organizational, logistical, and financial support to attend CME programs. These issues must be addressed in order to sustain the viability of healthcare workers attending CME.

The determinants of hospital cost: a cost-volume-profit analysis of health services in the occupied territories: Palestine.

OBJECTIVE: The purpose of this study is to examine the unit costs of a multi-service hospital in Palestine for the period 2005-2007. We investigate the cost structure of the Rafidya Hospital located in Nablus city, for both inpatient and outpatient departments. METHODS: This study uses cost-volume-profit (CVP) analysis, also known as breakeven analysis. CVP analysis requires examining total costs, along with fixed and variable costs. CVP analysis illuminates how changes in assumptions about cost behaviour and the relevant range in which those assumptions are valid affect the relationships among revenues, variable costs and fixed costs at various production levels. KEY FINDINGS: For the hospital of interest, we find that fixed costs account for 70% of total costs, and variable costs were 30% of total costs. Inpatient departments accounted for 86% of total costs, and outpatient departments were 14% of total costs. Results of the breakeven analysis illustrate that several departments charge sufficient fees to cover all unit costs. CONCLUSIONS: Results provide useful information about unit cost based on four categories: (1) unit cost per admission of each department, (2) unit cost per patient day of each department, (3) unit cost per admission with annual capital cost of each department and (4) unit cost per patient day with annual capital cost. Our results provide hospital cost information that can be used by decision-makers to provide and expand healthcare services, in an effort to increase sustainability and profitability. The use of cost analysis by administrators and regulators will improve the quality of financial information, as well as enhance the efficient use of scarce resources.

The development of certificate of need legislation.

This article examines the development of Certificate of Need (CON) legislation in the United States. Over time, CON legislation developed into efforts to contain rising health care costs, while maintaining quality of care. In recent years, numerous states have begun to reevaluate the current impact of CON regulations, and ask whether the programs should be discontinued. State regulators as well as academic researchers must address the costs vs. benefits of such legislation. Specific measures within such regulations must be addressed in order for health policy makers, administrators, and researchers to help meet the escalating demand for health services.

Unraveling the new Form 990: implications for hospitals.

This article examines the recent significant changes to the Form 990 information return for tax-exempt organizations. Specifically, we address those changes to the return that may impact the health care industry. The Internal Revenue Service (IRS) argues the redesign of the Form 990 is based on the following three principles: enhancing transparency, promoting tax compliance, and minimizing the burden on the filing organization. It has yet to be determined whether the significant reorganization of the informational return will benefit the stakeholders of the health care industry. We argue that these changes are a step in the right direction in providing necessary disclosure for policymakers and federal regulators.

Medical tourism and its impact on the US health care system.

The health care industry within the United States continues to face unprecedented increases in costs, along with the task of providing care to an estimated 46 million uninsured or underinsured patients. These patients, along with both insurers and employers, are seeking to reduce the costs of treatment through international outsourcing of medical and surgical care. Knows as medical tourism, this trend is on the rise, and the US health care system has not fully internalized the effects this will have on its economic structure and policies. The demand for low-cost health care services is driving patients to seek treatment on a globally competitive basis, while balancing important quality of care issues. In this article, we outline some of the issues facing legislators, health care policy makers, providers, and health service researchers regarding the impact of medical tourism on the US health care system.

An evaluation of charity care for tax-exempt hospitals engaging in joint ventures.

The study examines whether the level of charity care and financial stability contribute to a nonprofit hospital's motivation for partnering with a for-profit hospital through a joint venture. The Internal Revenue Service (IRS) has heightened its scrutiny of joint ventures within the health care sector. Considering recent calls to investigate the merit of the tax-exempt status of hospitals engaged in joint ventures, this research will assist policy makers in the evaluation of nonprofit hospitals. Constituents will continue to question whether joint ventures contribute to a reduced focus on charitable activities. Results indicate that the propensity to engage in a joint venture significantly increases with increased levels of charity care. Furthermore, nonprofit hospitals with lower profitability are more likely to engage in joint ventures. These results are useful to policy makers when evaluating the level of charity care provided by hospitals seeking alternative strategic alliances. Considering many critics allege hospitals are reducing the provision of charity care to the community, it is imperative for management to be conscious of the impact of joint ventures on the provision of charity care.

The need for strategic tax planning among nonprofit hospitals.

Strategic tax planning issues are important to the nonprofit health care sector, despite its philanthropic mission. The consolidation of the industry has led management to fight for resources and develop alternative strategies for raising money. When management evaluates alternative collaborative structures to increase efficiency, the impact on governance structures must also be considered. The increased governmental scrutiny of joint ventures within the health care sector warrants management's attention as well. The financial incentives must be considered, along with the various tax policy implications of cross-sector collaborations.

Machiavellian tendencies of nonprofit health care employees.

Federal and state regulators have heightened scrutiny of nonprofit hospital operations, particularly in billing collections. The move for hospitals to adopt more compassionate methods within their business functions drives the need to examine the ethical reasoning of their employees. The purpose of this study is to assess the existence of Machiavellian propensities among health care employees. People defined as Machiavellian are impersonal, rational, and strategy-oriented rather than person-oriented. Results indicate employee participants exhibit these propensities, and tend to agree with questionable scenarios. Knowledge of the ethical propensities of employees may serve as a crucial factor to the success of any plan in establishing an ethical work environment.

An empirical investigation of for-profit and tax-exempt nonprofit hospitals engaged in joint ventures.

Joint ventures between nonprofit and for-profit hospitals offer opportunities for collaboration to increase efficiency. These transactions have attracted the attention of the Internal Revenue Service, which may threaten tax-exempt status. This article analyzes inherent financial characteristics of nonprofit hospitals that joint venture with for-profit hospitals and those that choose not to joint venture.

The role of the primary care advanced practice nurse in evaluating and monitoring childhood cancer survivors for a second malignant neoplasm.

The purpose of this literature synthesis was to (a) identify second malignant neoplasms found in childhood cancer survivors and (b) make recommendations for the advanced practice nurse's role in the primary care setting regarding health promotion activities and surveillance strategies for survivors across the life span. The database search produced 73 research articles published in English between 1990 and 2000 that were significant to the purpose of the study. The results identified genetic or familial factors, radiation therapy, and chemotherapy as risk factors for later developing a second malignant neoplasm. Each theme was analyzed, and guidelines were developed for primary care advanced practice nurses which integrated health promotion and surveillance activities for this patient population.