Development of service standards and manpower calculation criteria for hospital clinical pharmacies in South Korea: a survey-based study.

BACKGROUND: After the revision of the Korean Pharmaceutical Affairs Act, the certification of specialized pharmacists is scheduled to be legally recognized in 2023. Considering that the specialized pharmacist certification was developed based on the working model of hospital clinical pharmacists, it is necessary to establish standards for clinical pharmacists in hospitals and to calculate appropriate manpower. Through this study, we aim to establish practical standards for clinical pharmacists and propose a method for calculating staffing levels based on an investigation of actual workloads. METHODS: This survey-based study consisted of two phases. In the first phase, a literature review was conducted to establish standards for clinical pharmacy services, and tasks in relevant literature were classified to identify clinical pharmacy service tasks that are applicable to the practice of Korean hospitals. Additionally, a preliminary survey was conducted to investigate the essential tasks. In the second phase of the investigation, a multicenter survey was conducted targeting pharmacists in facilities with more than 1,000 beds to explore their perceptions and actual workloads related to tasks. RESULTS: According to the standards for clinical pharmacists in Korea, clinical pharmacy services consist of a total of 23 tasks, of which 16 have been identified as essential tasks. Essential tasks accounted for 93% of the total tasks in clinical pharmacy services. The average full-time equivalent (FTE) through workload calculation was 2.5 ± 1.9 for each field, while the FTE allocated to actual practice was 2.1 ± 1.6. The distribution of each type of clinical pharmacy service was as follows: 77% for medication therapy management, 13% for medication education, 8% for multidisciplinary team activities, and 3% for medication use evaluation. CONCLUSION: This study identified essential tasks common to clinical pharmacy services across different healthcare institutions. However, the FTE of clinical pharmacists in actual practice was insufficient compared to the required amount. In order to establish and expand clinical pharmacy services in a hospital, it is necessary to ensure an adequate workforce for essential tasks.

Improvement in nurse staffing ratios according to policy changes: a prospective cohort study.

BACKGROUND: Since 1999, reimbursements for nursing services for inpatients have been paid differentially according to the nurse staffing ratios in Korea. However, differentiated nursing fees are insufficient for nurse staffing; thus, steps have been taken to improve the policy. This study aimed to identify the impact of a policy that changed the method of calculating nurse staffing ratios from the nurse-to-bed ratio to the nurse-to-patient ratio on improving the nurse staffing ratio in medical institutions. METHODS: Data were collected from 1,339 medical institutions that continuously provided medical services from 2017 to of 2021, and a prospective cohort was used for analysis. A generalized estimating equation for longitudinal ordered logistic regression was used to identify the impact of this policy change on the nurse staffing ratios in medical institutions. RESULTS: During the cohort study, 59.8% of the first-applied group of medical institutions and 65.6% of the second-applied group of medical institutions improved their nurse staffing ratios. However, only 22.6% of the medical institutions to which the revised calculation method was not applied improved their nurse staffing ratios. A statistically significant difference was found in the improved nurse staffing ratio depending on whether and when the revised calculation method was applied (χ2 = 89.830, p < .001). The analysis of nurse staffing ratios of medical institutions from 2017 to 2021 showed that the likelihood of improving the nurse staffing ratio increased gradually after the revised calculation method was adopted. Also,the likelihood of the nurse staffing ratio improving in the first-applied group was 1.41 times higher (odds ratio = 1.41, 95% confidence interval = 1.04-1.92) than in the non-applied group. The odds ratio for the improvement of nurse staffing ratio in the second-applied group was 2.35 (95% confidence interval = 1.76-3.14). CONCLUSIONS: Financial incentives inherent in the new policy can be regarded as the driving force behind improvements in nurse staffing ratios. The revised calculation method should be extended to all medical institutions nationwide, and the law should be revised to secure the minimum number of nurses.

Effects of a disincentive policy on behavioral changes by South Korean medical institutions that do not submit official nursing grade data.

AIM: This study aimed to determine whether the policy of imposing deductions on medical institutions in South Korea led to increased submission of nursing grade data. BACKGROUND: In Korea, medical institutions are required to report data on their nursing workforce; however, many institutions did not comply with this regulation, making it difficult to gauge their level of nurse staffing. Therefore, in 2020, a nursing fee deduction policy was introduced that penalizes medical institutions financially for failing to submit nursing workforce data. METHODS: We prospectively collected data on the characteristics, nursing grade, and data submission status of 1,200 hospitals in South Korea from 2015 to 2021. We analyzed the submission rate of data related to nursing grades according to the characteristics of the medical institutions and evaluated the effect of policy change on data submission status using multiple logistic regression. FINDINGS: The submission rate of data increased from 50.2% in 2015 to 93.3% in 2021, and 39.3% of medical institutions that had not previously submitted data did so after the policy was introduced. The submission rate of medical institutions unaffected by the policy also increased after its introduction. Compared with 2015, the likelihood of medical institutions submitting data increased by 23.69 times in 2020 and 20.47 times in 2021. CONCLUSION: The appropriate use of disincentive policies, such as financial deductions for medical institutions showing inappropriate behavior, was found to be effective in inducing desirable changes in the behavior of medical institutions. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Properly planned and implemented policies can contribute to improved quality of medical services and patient safety through effective administrative control.

Is nurse staffing associated with critical deterioration events on acute and critical care pediatric wards? A literature review.

Pediatric and neonatal patients admitted to acute and critical care wards may experience critical deterioration events that may lead to unexpected deaths if unrecognized and untreated promptly. Adequate levels and skill-mix of nurse staffing are essential for the quality of patient monitoring and response to deteriorating patients. Insufficient staffing may have an impact on the occurrence of missed care and consequently on critical deterioration events, increasing the risk of mortality and failure-to-rescue. To review the literature to explore the association between nurse staffing levels or skill-mix and pediatric and neonatal critical deterioration events, such as mortality, pediatric intensive care unit (PICU)/neonatal intensive care unit (NICU) unplanned admissions, cardiac arrests, and failure-to-rescue. A structured narrative literature review was performed. Pubmed, Cinhal, and Web of Science were searched from January 2010 to September 2022. Four independent reviewers conducted the study screening and data extraction. The quality of the studies included was evaluated using the Joanna Briggs Institute critical appraisal tools. Out of a total of 2319 studies, 15 met the inclusion criteria. A total of seven studies were performed in PICU, six in NICU, and two in general pediatric wards. Nurse staffing measures and outcomes definitions used were heterogeneous. Most studies suggested nursing skill-mix, increased working experience, or higher nursing degrees were associated with increased survival in PICU. Decreased nursing staffing levels were associated with increased mortality in NICU and mechanically ventilated patients in PICU. CONCLUSION: Evidence on the association of nurse staffing and critical deterioration events in PICU and NICU is limited, while there is no evidence reported for pediatric wards. Future research is needed to determine adequate levels of nurse/patient ratios and proportion of registered nurses in the skill-mix for pediatric acute and critical care nursing to improve outcomes on in-patient wards. WHAT IS KNOWN: • Adult nursing skill-mix, staffing ratios, and level of education are associated with patient mortality and failure to rescue. • In children, nurse staffing levels are associated with clinical outcomes. WHAT IS NEW: • Evidence on the association of nurse staffing levels or skill-mix with pediatric or neonatal mortality is limited. • There is some evidence regarding the association of nursing work experience, certification, higher level degree with in-hospital survival in PICU.

Timing of submissions to The Journal of Paediatrics and Child Health: Associations with the COVID-19 pandemic and editorial decisions.

AIM: To determine if the timing of manuscript submissions to The Journal of Paediatrics and Child Health (JPCH) changed following the onset of the COVID-19 pandemic and to determine if the timing of manuscript submissions influenced editorial decisions. METHODS: A retrospective observational study of submissions to JPCH from 1 January 2015 to 1 August 2022 was performed. Regression models were used to explore the change over time. Editorial decisions were examined using a multinomial regression model with the three-category ordinal outcome of reject, revise and accept. All statistical models were fitted using a Bayesian approach and show 95% credible intervals (CI). RESULTS: The analyses included 11 499 manuscript submissions between 2015 and 2022. The mean number of manuscript submissions increased by 17 papers per month (CI 15-19), with a larger 4-month long increase after the COVID-19 pandemic was declared of 86 submissions per month (CI 67-103). There was no clear effect of the pandemic on weekend submissions, mean difference in probability 0.003 (CI -0.021 to 0.026). Throughout the study period, the peak submission time was later in the day and was shifted +37 min later post-March 2020 (CI +22 to +52 min). Throughout the study period, submissions out-of-hours and on weekends were less likely to get an editorial decision of 'accept' or 'revise': odds ratio weekend versus weekday 0.87 (CI 0.78-0.97). CONCLUSION: The COVID-19 pandemic had a limited effect on the timing of manuscript submissions to JPCH. However, the timing of manuscript submission impacted the likelihood of a more positive editorial decision. While the time of manuscript submission is only one part of the research process, it is postulated that it may be associated with research quality.

The association between nurse continuity and hypospadias repair patient outcomes: A retrospective study.

BACKGROUND: Recently, nurse continuity, the intensity and consistency of a patient's exposure to nurses during hospitalization, has been shown to be associated with patient outcomes. However, little is known about how nurse continuity is related to patients' surgical outcomes. AIMS: To examine the association between nurse continuity and outcomes of hypospadias repair to clarify the importance of nurse continuity as a nursing practice. DESIGN: This is a retrospective study. METHODS: We analysed the data from electronic health records of patients under 1 year who had undergone proximal hypospadias repair between January 2014 and December 2016. Nurse continuity was measured using the Continuity of Care Index. Since approximately half of the patients reportedly needed further operations in the long term, the primary outcome was whether patients with proximal hypospadias repair had two or more additional operations within 3 years of discharge. RESULTS: The rate of undergoing two or more follow-up operations in 3 years was significantly higher in patients with low nurse continuity-38.6% versus 12.8% for high continuity. CONCLUSION: This study identified nurse continuity as an important factor related to patients' surgical outcomes. These findings suggest that nurse continuity be considered an important nursing strategy for patient outcomes and further research is needed on this topic. IMPACT STATEMENT: As empirical evidence regarding the association between nurse continuity and patient outcomes grows, nurse managers and policymakers should view nurse continuity as a critical factor for positive patient outcomes when considering nursing workforce regulations. NO PATIENT OR PUBLIC CONTRIBUTION: The data for this study were obtained from electronic health records, and the entire process of this study did not involve patient or public participation.

Standards of practice for hospital libraries and librarians, 2022: Medical Library Association Hospital Libraries Caucus Standards Task Force.

The Hospital Library Caucus of the Medical Library Association (MLA) follows the practice established in 1953 of developing quality indicators and best practices in the newly developing and fast-changing world of hospital libraries. As these libraries increased in number and prominence, the Joint Commission on the Accreditation of Hospitals (JCAHO) included in 1978 a hospital library standard developed in collaboration with MLA. Subsequent changes in JCAHO, then The Joint Commission (TJC) knowledge management criteria as well as technological changes in the curation and delivery of evidence-based resources influenced standards changes over the years. The 2022 standards mark the most recent edition, replacing the 2007 standards.

Evaluation of a proactive hiring model to achieve workforce stability in the intensive care unit.

AIM: The purpose was to evaluate an innovative Prospective Hiring Equation to determine registered nurse hiring needs. BACKGROUND: The American Organization for Nursing Leadership identifies human resource management as a competency for nurse managers, yet calculations to determine when and how many registered nurses to hire are not readily available. METHODS: We implemented an educational intervention to teach nurse mangers the Prospective Hiring Equation. We evaluated the processes (adoption and confidence) and outcomes (vacancy rates) using a pre-evaluation/postevaluation design in a single cohort of nurse managers (n = 9). We used a statistical process control chart to depict mean differences in vacancy rate at baseline and 6-month postimplementation. RESULTS: Participants (n = 9) were on average 43 years' old, female, and had 2.94 (SD = 2.66) years' of nurse manager experience. Following implementation of the intervention, the combined vacancy rates of the intensive care units improved by 11.8% (SD = 7), and use of agency nurses decreased by 42.5% (premedian = 7.2, interquartile ratio = 3.6, 10.8; postmedian = 1.8, interquartile ratio 0.9, 8.55). CONCLUSIONS: The Prospective Hiring Equation may be a useful tool to improve nurse managers human resource management competencies. IMPLICATIONS FOR NURSING MANAGEMENT: The Prospective Hiring Equation may help nurse managers improve accuracy when evaluating hiring needs.

Putting People First: The Importance of Recommending Minimum Staffing Levels and Skills Mix.

Australia's Royal Commission into Aged Care Quality and Safety has concluded. The Commission's final report described a sector failing to deliver care that older Australians deserve despite the best efforts of many staff. Throughout the Commission, staffing was a frequent concern, with the size and composition of the direct care workforce a prominent focus. Throughout the Commission, many stakeholders campaigned for mandated staffing levels in skills mix in nursing homes and the Commission's report and Commonwealth Government response included recommendations for these. While this is a necessary step toward wider reform, the Royal Commission's recommendation and the Australian Government's response must support the delivery of best practice care more strongly. This column argues that the minimum standard for nursing home staff care time must be higher, and that higher minimum staffing levels and more clearly defined skills mix are critical to the delivery of safe, respectful, dignified person-centred care.

[Staffing situation in home-care services: A qualitative study on current and future challenges]. / Die Personalsituation in der ambulanten Pflege.

Staffing situation in home-care services: A qualitative study on current and future challenges Abstract. Background: There are increasing signs of staff shortages in home-care nursing in Germany. Home care providers have an increasing number of vacancies and the provision of care for people in need of care is a challenge. There are only a few approaches to planning personnel requirements in home care and the existing ones are rather complex. Aim and research question: The objective of this study was to gain insights into how staff deployment and staff planning currently take place in German home care services and to evaluate options for the development of staffing measures in home care. Methods: Qualitative, guideline-based expert interviews (N = 33) were conducted and analyzed. Experts were representatives of home care service providers, advisors of home care service providers and experts in the field of human resources management. Data analysis was performed by using content analysis. Results: From the experts' point of view home care services cannot ensure sufficient provision of home care services as needed by care-recipients due to staff shortages. Staff planning as well as recruitment and retention of staff pose an increasing challenge. Staff planning is mainly determined by contractual requirements and the reimbursement system. It is less determined by individual care-recipients' needs. The company size of home care providers depends on staff recruitment and turnover. Conclusions: The staffing situation will be a remaining challenge in the foreseeable future. It will go along with the task to ensure an adequate home care supply. Approaches that go beyond reimbursement driven personnel planning can contribute valuable hints for the future.

Development and evaluation of a prospective staffing model to improve retention.

AIMS: To improve predictability and accuracy of hiring using historical staffing data, quality improvement and workforce engagement. BACKGROUND: Twenty-three per cent of newly licensed nurses leave their first job within one year, costing employers $52,100 per nurse replacement. Tools for anticipatory hiring strategies are not available in the literature. METHODS: We used retrospective, secondary data analysis to develop a Prospective Staffing Model and conduct a five-year longitudinal evaluation of the implementation of the model in a convenience sample at a quaternary academic Cardiothoracic Intensive Care Unit. We used a team-based, quality improvement approach to restructure recruitment and hiring strategies, standardize new graduate nurse orientation and implement AACN Healthy Work Environment standards. RESULTS: Over the five-year prospective evaluation period (2014-2018), 388 nurses were hired and included in the evaluation cohort. Retention increased (n = 286 days) and turnover decreased (17.6%) between 2014 and 2018. Improvements in workforce stability were sustained at five years. CONCLUSIONS: Use of a Prospective Staffing Model is associated with improved nurse retention and decreased turnover, and may improve workforce stability. IMPLICATIONS FOR NURSING MANAGEMENT: Results suggest that an innovative tool can mitigate the deleterious effects of turnover, adding to current knowledge and providing a method for anticipatory assessment of local turnover.

Association of Neonatologist Continuity of Care and Short-Term Patient Outcomes.

OBJECTIVES: To describe neonatologist continuity of care and estimate the association between these transitions and selected patient outcomes. STUDY DESIGN: We linked Children's Hospitals Neonatal Database records with masked neonatologist daily schedules at 4 centers, which use 2- and 3-week and 1-month "on service" blocks to provide care. After describing the neonatologist transitions, we estimated associations between these transitions and selected short-term patient outcomes using multivariable Poisson, logistic, and linear regression analyses, independent of length of stay (LOS) and case-mix. We also completed analyses after stratifying the cohort by LOS, birthweight, age at admission categories, and selected diagnoses. RESULTS: Stratified by LOS, patient transitions varied between centers in both unadjusted (P < .001) and multivariable analyses (adjusted incidence rate ratio; 95% CI for center B = 3.98 (3.81-4.15), center C = 4.92 (4.71-5.13), center D = 4.2 (4.0-4.4), P < .001), independent of LOS, gestational age, birthweight, surgical intervention, ventilator duration, and mortality. Only central venous line duration (adjusted incidence rate ratio 1.015, 95% CI 1.01-1.02) was minimally and independently associated with the number of transitions. No differences were observed in ventilator duration, oxygen use at neonatal intensive care unit discharge, bloodstream infections, or urinary tract infections. Surviving infants with meconium aspiration, hypoxic ischemic encephalopathy, cerebral infarction, bronchopulmonary dysplasia, and diaphragmatic hernia demonstrated similar findings. CONCLUSIONS: Transitions in neonatologists are frequent in regional neonatal intensive care units but appear unrelated to short-term patient outcomes. Future work to define continuity of care and develop effective strategies that promote longitudinal inpatient management is needed.

Association between 12-hr shifts and nursing resource use in an acute hospital: Longitudinal study.

AIM: To evaluate whether ≥12-hr shifts are associated with a decrease in resource use, in terms of care hours per patient day and staffing costs per patient day. BACKGROUND: Nurses working long shifts may become less productive and no research has investigated whether potential cost savings are realized. METHOD: A retrospective longitudinal study using routinely collected data from 32 wards within an English hospital across 3 years (1 April 2012-31 March 2015). There were 24,005 ward-days. Hierarchical linear mixed models measured the association between the proportion of ≥12-hr shifts worked on a ward-day, care hours per patient day and staffing costs per patient day. RESULTS: Compared with days with no ≥12-hr shifts, days with between 50% and 75% ≥12-hr shifts had more care hours per patient day and higher costs (estimate for care hours per patient day: 0.32; 95% CI: 0.28-0.36; estimate for staffing costs per patient day: £8.86; 95% CI: 7.59-10.12). CONCLUSIONS: We did not find reductions in total care hours and costs associated with the use of ≥12-hr shifts. The reason why mixed shift patterns are associated with increased cost needs further exploration. IMPLICATIONS FOR NURSING MANAGEMENT: Increases in resource use could result in additional costs or loss of productivity for hospitals. Implementation of long shifts should be questioned.

[Activities without patient contact : Estimate of time costs based on telephone interviews in eight psychiatric hospitals]. / Tätigkeiten ohne Patientenkontakt : Zeitaufwandsschätzungen aus Telefoninterviews in acht psychiatrischen Kliniken.

The aim of this pilot study was to estimate the share of working time that staff in psychiatric hospitals theoretically spend on obligatory activities, such as training and further education, organizational and documentation tasks as well as statutory lecturing duties without patient contact. A total of 47 physicians, 39 nurses, 34 psychologists and 35 social workers from eight psychiatric hospitals were interviewed. The results reveal that the theoretically remaining time for direct patient contact is low. The ratio of time spent with versus time spent without patient contact was even worse for senior physicians and leading nurses as well as part-time employees; however, all activities without direct contact to patients seemed to be indispensable in terms of quality of treatment and care. Hence, employees in German psychiatric hospitals regularly have to make decisions on which of their duties they prefer to neglect, to which they are actually obligated.

A model for internal medicine physicians in a small rural hospital.

CONTEXT: Finding providers to work in the hospitals and clinics in the small towns of the USA is a significant struggle. In the traditional model, the primary care doctor sees patients in the inpatient setting in addition to a clinic practice. In the usual hospitalist model, providers specialize to work only in the inpatient setting. ISSUES: Rural communities often lack the resources, facilities, and volume to safely adopt the usual hospitalist model, which has its own disadvantages. Small town hospitals have found several ways to find a middle ground between the two models. A provider staffing model is described that utilizes internal medicine physicians to provide inpatient and consultative outpatient care in a rural 10-bed hospital in Washington State. The hospital is located in a town with a population of about 3100, in a county with an approximate population of 70 000 people. It has a 24-hour emergency room, three primary care clinics, urgent care, X-ray, pharmacy, and laboratory capabilities. In this model, the internist on duty provides care in the inpatient unit and in the afternoon sees patients consulted from primary care providers, as well as follow-up patients from the emergency room and the inpatient setting. LESSONS LEARNED: The model potentially increases access to a higher level of care in the rural setting. It potentially provides work that for the provider is interesting, satisfying, balanced, purposeful, and appropriate to their training level. Specific norms, standards, and leadership are key to functionality, including some continued experience in a larger hospital. The model has been functioning successfully for more than 3 years. The potential cost savings over the usual hospitalist model are substantial. The model could be used in other locations and in training internal medicine physicians in the rural setting. Research in this area could include randomizing communities to this and other staffing models and following the care given and the health of the community members over time.

Pre-implementation studies of a workforce planning tool for nurse staffing and human resource management in university hospitals.

AIM: To investigate the reliability, validity and feasibility of the RAFAELA workforce planning system (including the Oulu patient classification system - OPCq), before deciding on implementation in Dutch hospitals. BACKGROUND: The complexity of care, budgetary restraints and demand for high-quality patient care have ignited the need for transparent hospital workforce planning. METHODS: Nurses from 12 wards of two university hospitals were trained to test the reliability of the OPCq by investigating the absolute agreement of nursing care intensity (NCI) measurements among nurses. Validity was tested by assessing whether optimal NCI/nurse ratio, as calculated by a regression analysis in RAFAELA, was realistic. System feasibility was investigated through a questionnaire among all nurses involved. RESULTS: Almost 67 000 NCI measurements were performed between December 2013 and June 2014. Agreement using the OPCq varied between 38% and 91%. For only 1 in 12 wards was the optimal NCI area calculated judged as valid. Although the majority of respondents was positive about the applicability and user-friendliness, RAFAELA was not accepted as useful workforce planning system. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Nurses' performance using the RAFAELA system did not warrant its implementation. Hospital managers should first focus on enlarging the readiness of nurses regarding the implementation of a workforce planning system.

Impact of a financial incentive policy on Korean nurse staffing.

AIM: This study was designed to determine (1) the impact of policy on longitudinal changes in nurse staffing levels and (2) the characteristics of policy-responsive Korean hospitals. BACKGROUND: A policy of varying nursing fees according to staffing grade by measuring the nurse-to-bed ratio has been implemented in Korean hospitals since 1999 with the aim of satisfying patient care needs and providing safe and high-quality nursing care. METHODS: Nurse staffing hospital characteristics data were collected from Korean Hospital Nurses Association yearbooks for the period 1996-2011. The obtained time series nurse staffing data were analysed by assessing the nurse-to-bed ratio. Graphs were used to view nurse staffing trends in various nursing units by hospital type during the study period. Mixed repeated-measures modelling was used to analyse nurse staffing and hospital characteristics, with year categorized as a dummy variable. There were 585 and 1239 observations related to measurements of nurse staffing grade in 44 tertiary and 193 general hospitals, respectively. For measuring the nurse staffing grade in intensive care units, the number of observations for general hospitals was decreased to 1170. RESULTS: Long-term nurse staffing in general and intensive care units was improved post-policy compared with pre-policy in both tertiary and general hospitals. Nurse staffing was improved more in Seoul than in other areas and was significantly better for hospitals with more beds for both hospital types. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: Although the financial incentive policy implemented in Korea has had an overall positive result on nurse staffing, the effect was not assure in small-sized hospitals in rural area. A more refined method for calculating nurse staffing and increasing financial incentives relative to staffing grade is needed to improve hospital nurse staffing.

An innovative on-call system for paediatric residency programs: The alternate night float.

BACKGROUND: Night-float systems, in which residents work consecutive nights, have been increasingly adopted in paediatric programs, but may be detrimental to residents' sleep and mood. OBJECTIVE: To describe the self-reported impact of a novel system consisting of two consecutive weeks of 16 h overnight shifts every second day that was piloted at the Children's Hospital of Eastern Ontario (Ottawa, Ontario). METHODS: A survey of 28 senior paediatric residents examined their experience with the alternate night-float system in three domains (patient care, resident professional development and well-being) and their comparison of the system with the traditional overnight on-call system. RESULTS: Twenty-six of 28 residents responded. Nearly all (96%) felt familiar with important details of inpatients and that handover was effective (92%). Results were mixed for professional development, with concerns about the quality of supervisors' feedback and perceived difficulty in attending daytime teaching. All residents believed that the night-float system provided a better learning experience compared with the traditional system. Less than 35% considered fatigue to be a notable problem, although 20% increased use of sleep aids or stimulants beyond their typical use. Ninety-six percent believed their workload was appropriate. All residents felt equally or less fatigued under the night-float system compared with the traditional system. Ninety-six percent recommended that the night-float model continue as the on-call system. CONCLUSIONS: This novel night-float system is an alternative method of providing paediatric inpatient night coverage because it meets duty hour regulations and has strong resident approval. Studies to examine its impact on residents and patient care in comparison with other systems are warranted.

HISTORIQUE: Les systèmes de garde de nuit, dans le cadre desquels les résidents travaillent plusieurs nuits consécutives, sont de plus en plus fréquents dans les programmes de pédiatrie, mais ils peuvent nuire au sommeil et à l'humeur des résidents. OBJECTIF: Décrire les répercussions autodéclarées d'un nouveau système constitué de deux semaines consécutives de quarts de nuit de 16 heures tous les deux jours, piloté à Ottawa, au Centre hospitalier pour enfants de l'est de l'Ontario. MÉTHODOLOGIE: Dans un sondage auprès de 28 résidents seniors en pédiatrie, les chercheurs ont examiné l'expérience de ces résidents au sein du système de garde de nuit tous les deux jours (soins aux patients, bien-être des résidents et perfectionnement professionnel) et les comparaisons que ces résidents ont faites avec le système de garde de nuit habituel. RÉSULTATS: Vingt-six des 28 résidents ont répondu. Presque la totalité (96 %) connaissait l'information importante sur les patients hospitalisés et trouvait le transfert des soins efficace (92 %). Les résultats étaient mitigés à l'égard du perfectionnement professionnel, car les résidents se préoccupaient de la qualité de la rétroaction des superviseurs et trouvaient difficile d'assister à l'enseignement pendant la journée. Tous les résidents trouvaient que le système de garde de nuit assurait une meilleure expérience d'apprentissage que le système habituel. Moins de 35 % considéraient la fatigue comme un problème notable, même si 20 % utilisaient plus d'aides au sommeil ou de stimulants qu'à l'habitude. De plus, 96 % trouvaient leur charge de travail adéquate. Tous les résidents se sentaient aussi fatigués ou moins fatigués dans le système de garde de nuit que dans le système habituel. Enfin, 96 % recommandaient d'adopter le modèle de garde de nuit comme système de garde. CONCLUSIONS: Ce nouveau système de garde de nuit est une autre méthode pour assurer les services nocturnes auprès des enfants hospitalisés. Il respecte la réglementation sur les heures de garde et est fortement approuvé par les résidents. Des études s'imposent pour en examiner les effets sur les résidents et les soins aux patients par rapport aux autres systèmes.

An optimization based on simulation approach to the patient admission scheduling problem using a linear programing algorithm.

BACKGROUND: As patient's length of stay in waiting lists increases, governments are looking for strategies to control the problem. Agreements were created with private providers to diminish the workload in the public sector. However, the growth of the private sector is not following the demand for care. Given this context, new management strategies have to be considered in order to minimize patient length of stay in waiting lists while reducing the costs and increasing (or at least maintaining) the quality of care. METHOD: Appointment scheduling systems are today known to be proficient in the optimization of health care services. Their utilization is focused on increasing the usage of human resources, medical equipment and reducing the patient waiting times. In this paper, a simulation-based optimization approach to the Patient Admission Scheduling Problem is presented. Modeling tools and simulation techniques are used in the optimization of a diagnostic imaging department. RESULTS: The proposed techniques have demonstrated to be effective in the evaluation of diagnostic imaging workflows. A simulated annealing algorithm was used to optimize the patient admission sequence towards minimizing the total completion and total waiting of patients. The obtained results showed average reductions of 5% on the total completion and 38% on the patients' total waiting time.

Associations between rates of unassisted inpatient falls and levels of registered and non-registered nurse staffing.

OBJECTIVE: To enhance understanding of how nurse staffing relates to unassisted falls by exploring non-linear associations between unassisted fall rates and levels of registered nurse (RN) and non-RN staffing on 5 nursing unit types, thereby enabling managers to improve patient safety by making better-informed decisions about staffing. DESIGN: Cross-sectional analysis of routinely collected data using hierarchical negative binomial regression. SETTING: 8069 nursing units in 1361 U.S. hospitals participating in the National Database of Nursing Quality Indicators(®). Main outcome measure Rate of unassisted falls per inpatient day. RESULTS: Associations between unassisted fall rates and nurse staffing varied by unit type. For medical-surgical units, higher RN staffing was weakly associated with lower fall rates. On step-down and medical units, the association between RN staffing and fall rates depended on the level of staffing: At lower staffing levels, the fall rate increased as staffing increased, but at moderate and high staffing levels, the fall rate decreased as staffing increased. Higher levels of non-RN staffing were generally associated with higher fall rates.. CONCLUSIONS: Increasing non-RN staffing seems ineffective at preventing unassisted falls. Increasing RN staffing may be effective, depending on the unit type and the current level of staffing.