A perceção de líderes formais de enfermagem sobre a prática baseada na evidência / Formal nurse leaders' perception of evidence-based practice / La percepción de los líderes formales de enfermería sobre la práctica basada en la evidencia

Resumo Enquadramento: A implementação da Prática Baseada na Evidência (PBE) é crucial para a qualidade dos cuidados de enfermagem. As ações desenvolvidas pelos líderes formais são essenciais para implementar a PBE, tornando-se determinante conhecer as suas perceções. Objetivo: Conhecer as perceções de líderes formais de enfermagem sobre a PBE. Metodologia: Estudo descritivo exploratório com abordagem qualitativa. Foram realizadas entrevistas semiestruturadas a 17 líderes de três hospitais portugueses. Os dados foram analisados através de análise de conteúdo e do software MAXQDA Analytics Pro 2022. Salvaguardados os pressupostos éticos. Resultados: Emergiram dois temas com respetivas categorias − Conhecimento sobre PBE (Conceito de PBE, Impacto da PBE nos resultados em saúde e Autoperceção do conhecimento sobre PBE); Papel na implementação da PBE (comportamentos e caraterísticas). Conclusão: Os líderes descreveram a sua perceção sobre o Conceito de PBE e a relação do Impacto da PBE com resultados em saúde, a necessidade de conhecimento e o seu investimento formativo, bem como o seu papel neste processo. Futuros programas formativos deverão ser implementados nesta área.

Abstract Background: The implementation of Evidence-Based Practice (EBP) is critical to the quality of nursing care. Formal leaders play a crucial role in developing interventions to implement EBP, so it is important to understand their perceptions. Objective: To examine formal nurse leaders' perceptions of EBP. Methodology: Descriptive exploratory study with a qualitative approach. Semi-structured interviews were conducted with 17 leaders from three Portuguese hospitals. Data were analyzed using content analysis and MAXQDA Analytics Pro 2022 software. All ethical principles were observed. Results: Two themes and their categories emerged − Knowledge of EBP (Concept of EBP, Impact of EBP on health outcomes, and Self-perception of the knowledge about EBP) and Role in EBP implementation (behaviors and characteristics). Conclusion: The leaders described their perception of the concept of EBP and the association between the impact of EBP and health outcomes, the need for knowledge, and the investment in training, as well as their role in this process. Future training programs should be implemented in this area.

Resumen Marco contextual: La implantación de la Práctica Basada en la Evidencia (PBE) es esencial para la calidad de los cuidados de enfermería. Las acciones emprendidas por los líderes formales son esenciales para implantar la PBE, y es fundamental conocer sus percepciones. Objetivo: Conocer las percepciones de los líderes formales de enfermería sobre la PBE. Metodología: Estudio exploratorio descriptivo con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a 17 líderes de tres hospitales portugueses. Los datos se analizaron mediante análisis de contenido y el programa MAXQDA Analytic Pro 2022. Se garantizaron los presupuestos éticos. Resultados: Surgieron dos temas con sus respectivas categorías − Conocimiento sobre la PBE (Concepto de la PBE, Impacto de la PBE en los resultados sanitarios y Autopercepción del conocimiento sobre la PBE); Papel en la aplicación de la PBE (comportamientos y características). Conclusión: Los líderes describieron su percepción del concepto de PBE y la relación del Impacto de la PBE con los resultados sanitarios, la necesidad de conocimientos y su inversión formativa, así como su papel en este proceso. Los futuros programas de formación deberían aplicarse en este ámbito.

Revisiting the effects of state anesthesia policy interventions: A comprehensive look at certified registered nurse anesthetist service provision in U.S. hospitals from 2010 to 2021.

AIMS: Rural hospitals in the United States often rely on nonphysician providers such as advanced practice nurses to care for their patients. One important role that is served by advanced practice nurses is that of anesthesia provider (certified registered nurse anesthetist or CRNA). In 2001, Centers for Medicare & Medicaid Services (CMS) passed an opt-out law affording state governors the right to loosen physician supervision requirements on CRNAs in their respective states, thus potentially improving access in targeted areas. Since then, 24 states have adopted these opt-out provisions. We aim to understand the extent to which the CMS opt-out law has resulted in increased CRNA service provision in hospitals, especially in rural areas. DESIGN: The study used a longitudinal design. We compiled 2010-2021 American Hospital Association data, which includes 4,464 unique U.S. hospitals observed an average of 8 times annually (35,863 total hospital-year observations). METHODS: We model CRNA services provision at the hospital level using longitudinal mixed effects generalized linear models that incorporate state, county, and hospital control variables. RESULTS: Using descriptive statistics and mixed effects generalized linear models, we discovered that adopting opt-out provisions does not universally result in increased CRNA service provision in U.S. hospitals. Notably, opt-out provisions do not improve access in rural counties. However, in supplemental analysis, we discover some of the conditions under which the likelihood of CRNA service provision is influenced. CONCLUSIONS: Hospitals often utilize CRNAs to staff their hospitals. However, many hospitals use both CRNAs and physician anesthesiologists; this can be a potential source of contention and confusion, given the lack of uniformity in the scope of practice policies. We offer some suggestions with regard to the effects of state interventions into the field, and how they might impact this dispute. Lastly, policymakers should consider additional measures to address rural access limitations, as the opt-out policy does not seem to be working as intended.

The Rhetoric of Healthcare and the Moral Debate About Theatre-Funded Hospitals in Early Modern Spain.

While early modern Spain may seem a world away, it is an extremely rich and relevant context for gaining a better understanding of the Rhetoric of Health, specifically the power of metaphor, in the related spheres of policy-making and public debate. It was a time and place in which the urban populace's physical well-being depended upon the fortunes of theatrical performances due to a system of alms for hospitals driven by ticket receipts. Anti-theatricalists argued that the immoral nature of theatrical performances made them spiritually and medically detrimental to society. Pro-theatricalists argued that plays were always a public good on balance because they raised much-needed funds for hospitals. Instead of producing a conflict between morality and public health, each side reinforced their connection until the two topics became nearly inseparable in the sphere of public debate. While pro-theatricalists mainly stayed with their arguments about funding hospitals, anti-theatricalists developed a new strategy of literalising the metaphor of theatre as a "plague of the republic" and arguing that immoral entertainment brought literal disease to the populace as a punishment from God. This exemplifies Stephen Pender's observation of how, in an early modern medical context, "Rhetoric as a way of perceiving probabilities and adjusting one's argument to the audience and circumstance offers a model of ethical action and interaction". This article is organised chronologically to track specific adjustments to a specific public-health debate that rely upon moral metaphors of medicine. Each side wrangled over these metaphors in an effort to break a deadlock in a public-health policy debate with entertainment, finance, and morality at its centre. By the end of the seventeenth century, anti-theatricalists finally found their best rhetorical weapon in the literalisation of the "plague of the republic" metaphor, but it only offered a short-term solution to banning theatre contingent upon the ebb and flow of epidemics. Simultaneously, the finance structure of funding hospitals began to erase the role of hospitals from the longstanding debate about the morality of public theatre. The case of early modern Spain provides valuable lessons about the power of metaphor in the Rhetoric of Healthcare that are still applicable today.

Addressing Registered Nurse Retention and Attrition in Thailand Hospitals: An Integrative Review.

Thailand is one of the Southeast Asia countries that has been significantly impacted by Registered Nurse (RN) workforce shortages. This integrative review aims to critically analyze factors influencing the attrition and retention of RNs practicing in Thailand's hospital sector. The databases searched included CINAHL (via EBSCOhost), EMBASE, Nursing Allied (via ProQuest), Ovid, Scopus, Web of Science, and Medline. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were utilized to record the search strategy findings in compliance with the review standards, while the Mixed-Methods Appraisal Tool (MMAT) was used to appraise quality. Sources for review totaled 35, using quantitative methods (n = 30), qualitative methods (n = 3), and mixed methods (n = 2). Thematic analysis revealed factors that challenge RNs' job motivation fueled by a lack of autonomy, a loss of confidence and sense of competence, and negative workplace relations with co-workers, resulting in poor job satisfaction. Future research is needed to elicit an understanding of "how" Thai RNs sense of autonomy, competence, and relatedness in their workplace practice provides insight into "why" they choose to remain employed or leave the nursing workforce.

Home-Time, Mortality, and Readmissions Among Patients Hospitalized With Heart Failure: A Baseline Prior to IMPLEMENT-HF.

BACKGROUND: Home-time is an emerging, patient-centered outcome that represents the amount of time a patient spends alive and outside of health care facility settings, comprising of hospitals, skilled nursing facilities, and acute rehabilitation centers. Studies evaluating home-time in the context of heart failure are limited, and the impact of quality improvement interventions on home-time has not been studied. METHODS: Medicare beneficiaries aged 65 years or older who were hospitalized for heart failure in the Get With the Guidelines-Heart Failure registry between 2019 and 2021 were included. Postdischarge home-time, mortality, and readmission rates at 30 days and 1 year were calculated with the goal of establishing baseline metrics before the initiation of IMPLEMENT-HF, a multicenter quality improvement program aimed at improving heart failure management. RESULTS: Overall, 66 019 patients were included across 437 sites. Median 30-day and 1-year home-time were 30 (18-30) and 333 (139-362) days, respectively. Only 22.1% of patients experienced 100% home-time in the year after discharge. Older patients spent significantly less time at home, with a median 1-year home-time of 302 (86-359) compared with 345 (211-365) days in patients over 85 and those between 65 and 74 years old, respectively (P<0.001). Black patients also experienced the least amount of home-time with only 328 (151-360) days at 1-year follow-up. Rates of heart failure readmission and all-cause mortality 1-year post-discharge were high at 29.8% and 37.0%, respectively. CONCLUSIONS: In this contemporary multicenter cohort, patients hospitalized with heart failure spent a median of 91.2% of their time in the year after discharge alive and at home, largely driven by high mortality rates. These findings serve as a preimplementation baseline for IMPLEMENT-HF, which will evaluate the impact of targeted heart failure initiatives on home-time and other clinical outcomes.

Health Care Worker Usage of Large-Scale Health Information Exchanges in Japan: User-Level Audit Log Analysis Study.

Background: Over 200 health information exchanges (HIEs) are currently operational in Japan. The most common feature of HIEs is remote on-demand viewing or searching of aggregated patient health data from multiple institutions. However, the usage of this feature by individual users and institutions remains unknown. Objective: This study aims to understand usage of the on-demand patient data viewing feature of large-scale HIEs by individual health care workers and institutions in Japan. Methods: We conducted audit log analyses of large-scale HIEs. The research subjects were HIEs connected to over 100 institutions and with over 10,000 patients. Each health care worker's profile and audit log data for HIEs were collected. We conducted four types of analyses on the extracted audit log. First, we calculated the ratio of the number of days of active HIE use for each hospital-affiliated doctor account. Second, we calculated cumulative monthly usage days of HIEs by each institution in financial year (FY) 2021/22. Third, we calculated each facility type's monthly active institution ratio in FY2021/22. Fourth, we compared the monthly active institution ratio by medical institution for each HIE and the proportion of cumulative usage days by user type for each HIE. Results: We identified 24 HIEs as candidates for data collection and we analyzed data from 7 HIEs. Among hospital doctors, 93.5% (7326/7833) had never used HIEs during the available period in FY2021/22, while 19 doctors used them at least 30% of days. The median (IQR) monthly active institution ratios were 0.482 (0.470-0.487) for hospitals, 0.243 (0.230-0.247) for medical clinics, and 0.030 (0.024-0.048) for dental clinics. In 51.9% (1781/3434) of hospitals, the cumulative monthly usage days of HIEs was 0, while in 26.8% (921/3434) of hospitals, it was between 1 and 10, and in 3% (103/3434) of hospitals, it was 100 or more. The median (IQR) monthly active institution ratio in medical institutions was 0.511 (0.487-0.529) for the most used HIE and 0.109 (0.0927-0.117) for the least used. The proportion of cumulative usage days of HIE by user type was complex for each HIE, and no consistent trends could be discerned. Conclusions: In the large-scale HIEs surveyed in this study, the overall usage of the on-demand patient data viewing feature was low, consistent with past official reports. User-level analyses of audit logs revealed large disparities in the number of days of HIE use among health care workers and institutions. There were also large disparities in HIE use by facility type or HIE; the percentage of cumulative HIE usage days by user type also differed by HIE. This study indicates the need for further research into why there are large disparities in demand for HIEs in Japan as well as the need to design comprehensive audit logs that can be matched with other official datasets.

Comparison of Diagnosis-Related Group Rehabilitation Reimbursement Payments With Those of a Novel Patient Classification-Based Payment System.

Objective: To compare the difference of reimbursement payments between diagnosis-related group (DRG) and a novel patient classification-based payment system, diagnosis-intervention packet (DIP), among rehabilitation inpatients in tertiary hospitals. Design: Retrospective cohort study. Setting: TTertiary hospitals in Shenzhen, China. Participants: We assessed the records of 268,362 individuals who visited tertiary hospitals providing rehabilitation services. Interventions: Not applicable. Main Outcome Measures: The outcome variable was the patients' rehabilitation hospitalization cost of in our study. A quantile regression analysis was conducted to estimate the effects of DIP payment on the rehabilitation hospitalization cost. Results: The results showed that the predicted marginal hospitalization cost with DRG payment were 9%, 7%, 14%, and 10% higher than that with DIP payments in 2019, 2020, 2021, and 2022. The total difference in predicted marginal hospitalization cost between DRG and DIP was -1269 RMB (-193 USD). This difference in 2019, 2020, 2021, and 2022 was -1419 RMB (-228 USD), -1088 RMB (-158 USD), -1585 RMB (-246 USD), and -1034 RMB (-154 USD), respectively. All differences in predicted marginal hospitalization cost between DRG and DIP was significant (P<.001), after controlling for patients' age, sex, public or private hospital, the type of disease, and the length of stay of hospitalization. Conclusions: The findings of DIP payment reduced the rehabilitation hospitalization cost would be helpful in developing more effectively and efficiently tailored interventions for rehabilitation health care in China. Furthermore, the results of this study could provide advice on building more effective strategies and intervention options for other countries that struggle with controlling rehabilitation hospitalization costs.

Hospital crisis management in the epidemic: A qualitative study.

Background: Despite the advances in medical science, the epidemic of infectious diseases has faced serious challenges to the health system of countries, so the purpose of this study was to identify obstacles and management strategies to prepare for planning preventive measures and better care in dealing with infectious diseases in hospitals. Method: The current qualitative research was of the grounded theory type, which was conducted in 2023. The semistructured interview questions were obtained from experts. The initial selection of the sample was made from experts in the field of health and treatment from all over the country. The snowball method was used to increase the sample volume until it reached sufficient Value. After analyzing the data through MAXQDA2020 software, this research reached saturation by interviewing 20 experts. Results: Four main areas, 15 subthemes, and 93 codes were identified in the management of epidemics, which included leadership and management (planning, physical structure, information management, financial resources, manpower, medicine and equipment, and internal and external coordination), Stewardship (macro policy and syndromic care system), safety and resilience (crisis management and emergency and disaster risk management), management of infectious diseases (instructions, education, infection prevention and control, treatment management). Conclusion: This study presents the strategies of the health system in dealing with the epidemic of infectious diseases to overcome the obstacles and challenges of preparation and response, which can help health managers in designing future programs, and finally, it shows that hospitals should have a plan for resilience in crises.

Toward hospital resilience: a qualitative study on the identification of hospital shocks during disruption era in Indonesia.

BACKGROUND: Hospital resilience has been well recognized among healthcare managers and providers as disruption of hospital services that threatens their business environment. However, the shocks identified in the recent hospital resilience concept are mainly related to disaster situations. This study aims to identify potential shocks that hospitals face during disruptions in Indonesia. METHOD: This qualitative study was conducted in Makassar, Indonesia in August-November 2022. Data was collected through semi-structured interviews with hospital managers and resilience experts using a semi-structured interview guide. 20 key informants were interviewed and data were analyzed by thematic analysis. RESULTS: The study identified seven shocks to hospitals during the disruption era: policy, politics, economics, hospital management shifting paradigms, market and consumer behavior changes, disasters, and conflicts. It also identified barriers to making hospitals resilient, such as inappropriate organizational culture, weak cooperation across sectors, the traditional approach of hospital management, inadequate managerial and leadership skills, human resources inadequacies, a lack of business mindset and resistance to change. CONCLUSION: This study provides a comprehensive understanding of hospital shocks during disruptions. This may serve as a guide to redesigning the instruments and capabilities needed for a resilient hospital.

Salivary Antimicrobial Peptide in Patients With Dementia Before and After Clinical Oral Rehabilitation Programme: A Randomised Controlled Trial.

BACKGROUND: Emerging evidence suggests a link between salivary metabolite changes and neurodegenerative dementia, with antimicrobial peptides (AMPs) implicated in its pathogenesis. OBJECTIVE: We investigated the effects of a clinical oral rehabilitation programme tailored for dementia patients on salivary flow rate, AMP levels and oral health-related quality of life (OHRQoL). METHODS: Eligible patients were randomly assigned to either the experimental group (EG; n = 28) or the control group (CG; n = 27). Both groups received a leaflet on oral health. In addition, the EG received an oral care intervention that included individual lessons on oral muscle exercises and oral self-care practices. Saliva samples and OHRQoL data were collected at baseline and follow-up visits. Generalised estimating equation models were used to analyse the changes over time. RESULTS: At the 3-month follow-up, EG showed significantly lower histatin 5 (HTN-5) levels (ß = -0.08; effect size [ES] = 0.72) than CG. At 6 months, EG exhibited improved salivary flow rate (ß = 0.89; ES = 0.89) and OHRQoL (ß = 6.99; ES = 1.31) compared to CG. Changes in salivary flow rate (ß = 4.03), HTN-5 level (ß = -0.78) and beta-defensin 2 level (BD-2) (ß = -0.91) at 3 months predicted improved OHRQoL at 6 months (all p < 0.05). CONCLUSIONS: Our clinical oral rehabilitation programme reduced the level of salivary HTN-5, increased salivary flow rate and enhanced OHRQoL in dementia patients. Furthermore, changes in salivary flow rate, HTN-5 level and BD-2 level were associated with improvements in patients' OHRQoL.

Health & Productivity Management Associated With Improved Efficiency of Inpatient Health Care: Cross-sectional Study Using FY2021 Bed Function Report.

This study examined the relationship between health and productivity management (H&PM) and inpatient health care efficiency in hospitals. This cross-sectional study is based on 1108 hospitals using data from the FY2021 Bed Function Report. The presence of Certified H&PM Organization was the proxy variable for H&PM implementation. The efficiency value obtained using the input-oriented Banker-Charners-Cooper model of data envelopment analysis was a proxy variable for inpatient health care efficiency. The input variables were the number of hospital beds, registered physicians, ward nurses, and other staff members in the ward. The output variable was the total number of patients in the ward per year. We conducted a Wilcoxon rank-sum test and compared certified and non-certified hospitals. The efficiency value was the objective variable, and certification presence was the explanatory variable. We used a stepwise method, including adjustment variables, to confirm whether the certification presence remained in the final multiple regression model. Efficiency was significantly higher in certified hospitals than non-certified hospitals. Certification presence remained in the final multiple regression model (ß = .027, CI = -0.004 to 0.057, P = .085). Although not statistically significant, certified hospitals tended to have higher efficiency compared to non-certified hospitals. These findings suggested that hospitals that actively engage in H&PM may have higher efficiency in inpatient health care. However, further research is needed to establish the causal relationship.

Determinants of citizens' choice between public and private hospitals.

OBJECTIVE: This study assesses what factors determine citizens' preferences for a public or private hospital (assuming the choice is free of charge) according to the severity of the disease. MATERIAL AND METHOD: A web-based discrete choice experiment was carried out with 1777 individuals distinguishing between a control group (posed with a simple choice for each health condition) and added information for respondents of the treatment groups (distance, waiting time, advice from the family doctor, and recommendations from the social context). The relevance of these factors in relation to the severity of one's illness is investigated. The outcome variable is the choice of a public versus a private hospital for the treatment of a health issue of a different severity. RESULTS: The severity of the health issue has a moderator effect on the additional information for the treatment groups. Waiting time has a direct positive impact on the patient's preferred choice for a private hospital both for severe and non-severe health issues. Distance to the hospital and the family doctor's recommendation positively impact the preferred choice for a private hospital for non-severe health issues but not for severe health issues. Covariates like gender and age are not relevant in explaining the effects of the treatments, and educational level has a positive impact on one of the treatments: advice from the patient's environment. Satisfaction with public hospitals has a positive impact on all treatments. CONCLUSIONS: Results indicate that waiting time is a key factor in choosing a private hospital against the majority-stated preference for a public hospital.

Pre-disaster family visits and post-evacuation return to Fukushima among psychiatric inpatients evacuated to out-of-area hospitals after the nuclear accident.

OBJECTIVE: This study aimed to elucidate the effects of pre-evacuation family hospital visits on post-evacuation returns to Fukushima Prefecture (hometown) among psychiatric inpatients who mandatorily evacuated to hospitals outside the prefecture because of the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. METHOD: Of the inpatients in Fukushima, 44 were admitted to a hospital in the nearby Soso district on March 11, 2011, and were therefore included in the current analysis. We collected information on their discharge after the evacuation and family visits before the evacuation by reviewing the medical records of both the evacuation destination and former hospitals. RESULTS: The average durations from the accident to post-evacuation return among patients with and those without former family visits were 681.8 days (standard error [SE] = 163.3) and 1,027.8 days (SE = 152.0), respectively. The log-rank test showed a tendency of earlier return to Fukushima among inpatients who had received family visits to the hospital before evacuation (p = .073). CONCLUSIONS: The results highlight the critical need for close collaboration between psychiatric medical practitioners and families, to not only support patients' community reintegration into daily life but also facilitate a timely return to their hometowns following long-distance evacuation caused by an unforeseen large-scale disaster.

Electronic health records model to improve the quality of patients' healthcare.

Background: Electronic health records (EHR) has been acknowledged for bringing down healthcare costs and enhancing hospital service standards. Aim: The aim of this study was to develop an EHR model to lower patient treatment costs and enhance healthcare quality in South African public healthcare. Methods: In this study, a cross-sectional quantitative methodology was used. The research data for this study were provided by medical healthcare professionals, at Dr. George Mukhari Academic Hospital (DGMAH). This included doctors, nurses, pharmacists, radiologists, and radiographers who completed a semi-structured questionnaire. Results: The final model's findings show that the use of EHR significantly improves information quality (IQ) and positively influences medical errors reduction (MER). Knowledge quality (KQ) has a positive significant impact on MER, whereas IQ has a considerable negative impact on MER. Furthermore, cost reduction in patient treatment (CRPT) has a positive significant influence on MER. Conclusion: Patients obtain better medical care when medical professionals have access to complete and accurate information. Medical errors can be reduced or even prevented with the use of EHRs, which can lead to better patient outcomes. Contribution: The quality of patient care at South African public hospitals and in other developing countries can be enhanced by using this framework as a guide to reduce treatment costs.

Responsive patient care in Israel: A qualitative study of hospital rules and regulations.

Hospital rules and regulations can contribute to standardizing care, streamlining processes, and improving the quality of care. Over the past decade, hospitals in Israel have introduced written rules and regulations for staff that provide guidance on quality control, patient safety, and the patient-provider relationship. This study aimed to explore how these written guidelines, when implemented, can promote responsive care for inpatients. Using a thematic analysis, the study analyzed the content of staff guidelines from six Israeli hospitals. The analysis found that hospital rules and regulations provide similar, relatively precise instructions with regard to improving the responsiveness to and dignity of care of patients. The guidelines address three essential aspects of responsiveness - disclosing medical information and respecting the patients' autonomy and physical space. The guidelines highlight that healthcare providers should implement security measures to safeguard medical information, respect patients' autonomy, involve patients in decision-making, and provide adequate physical space to maintain their privacy and modesty. The guidelines contribute to ensuring patients' legal and ethical rights. Policymakers should consider introducing and implementing the dimensions of responsiveness that were stressed by Israeli hospitals' rules and regulations. Further research is needed to confirm the relevance of the various rules and regulations for improving the quality of care provided to patients.

Implementation and outcomes of a dementia-friendly training program in five hospitals.

BACKGROUND: Hospitalized patients living with dementia (PLWD) age 65+ generally experience poor outcomes. This study's purpose was to implement dementia-friendly training with staff, track patient outcomes, and implement sustainable system changes. METHODS: We conducted a prospective study in five hospitals. The hospitals adopted HealthCare Interactive's CARES® Dementia 5-Step Method for Hospitals Online Training and Certification Program . After on-line modules completion, a didactic session was offered, and a retrospective pre/post survey was completed. Patient falls, length of stay, and readmission rates were collected. RESULTS: 1,836 (41 %) staff completed the training. Positive changes in staff ratings from pre- to post- intervention were observed. Number of falls and readmissions did not change. The average number of stays per patient decreased by .24 (p=0.01). Hospitals made system changes including innovative identification for PLWD. CONCLUSIONS: Dementia-friendly hospital training is effective in improving staff recognition of the symptoms and needs of PLWD, and responding appropriately.

Long-term probabilistic forecasts of activity mitigation in English hospitals: a national elicitation exercise providing an outside view based on judgements of experts in support of the New Hospital Programme.

OBJECTIVES: The planning process for a new hospital relies on assumptions about future levels of demand. Typically, such assumptions are characterised by point estimates, the flaw-of-averages, base-rate neglect and overoptimism from an inside view. To counteract these limitations, we elicited an outside view of probabilistic forecasts based on judgements of experts about the extent to which various types of hospital activity might be mitigated over 20 years, in support of the New Hospital Programme (NHP) in the English National Health Service. DESIGN: A prospective online elicitation exercise, over two rounds, to forecast the reduction (0% no reduction to 100% total reduction) in 77 types of hospital activity across England via five types of activity mitigation: outpatient attendance avoidance (n=8); inpatient admission avoidance (n=31); A&E attendance avoidance (n=12); outpatient delivery mode (n=4); inpatient length of stay reduction (n=22) and eight types of activity groups.Primary outcomes are the aggregated forecasts representing the percentage reduction (0%-100%) in hospital activity across England based on 'surprisingly low' (10th percentile-P10) to 'surprisingly high' (90th percentile-P90) forecasts from 17 experts. RESULTS: We had 657 forecasts from 17 experts. The most pessimistic forecast was for inpatient avoidance of frail elderly admissions (mean 5.71%, P10=0.43%, P90=16.40%). The most optimistic forecast was for inpatient admission avoidance for vascular surgery (mean 48.27%, P10=19.82%, P90=78.57%). The overall (n=77) aggregate means ranged from a low of 5.71% to a high of 48.27% with an average width of 50.08%. Experts highlighted mainly four types of mitigation mechanisms-prevention, displacement, quality improvement and de-adoption. CONCLUSION: A national elicitation exercise has provided long-term aggregate forecasts across England that make explicit the wide variation and uncertainty associated with future mitigation activities from an outside perspective. These aggregate forecasts may now be incorporated into the NHP, providing a more robust foundation for planning.

An updated model of rural hospital financial distress.

PURPOSE: To create a model that predicts future financial distress among rural hospitals. METHODS: The sample included 14,116 yearly observations of 2311 rural hospitals recorded between 2013 and 2019. We randomly separated all sampled hospitals into a training set and test set at the start of our analysis. We used hospital financial performance, government reimbursement, organizational traits, and market characteristics to predict a given hospital's risk of experiencing one of three financial distress outcomes-negative cash flow margin, negative equity, or closure. FINDINGS: The model's area under the receiver operating characteristic curve (AUC) equaled 0.87 within the test set, indicating good predictive ability. We classified 30.55% of the observations in our sample as lowest risk of experiencing financial distress over the next 2 years. In comparison, we classified 32.52% of observations as mid-lowest risk of distress, 26.40% of observations as mid-highest risk, and 10.52% of observations as highest risk. Among test set observations classified as lowest-risk, 5.78% experienced negative cash flow margin within 2 years, 1.50% experienced negative equity within 2 years, and zero observations experienced closure within 2 years. Within the highest-risk group, 61.57% of observations experienced negative cash flow margin, 43.02% experienced negative equity, and 3.33% experienced closure. CONCLUSIONS: Given the ongoing challenges and consequences of rural hospital unprofitability, there is a clear need for accurate assessments of financial distress risk. The financial distress model can be used by researchers, policymakers, and rural health advocates as a screening tool to identify at-risk rural hospitals for closer monitoring.

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study.

BACKGROUND: Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies. METHODS: Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach. RESULTS: Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies. CONCLUSION: Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

Workplace Violence against Nurses Working at Private Teaching Hospitals of Kathmandu: A Descriptive Cross-sectional Study.

INTRODUCTION: Workplace violence in hospitals is a global concern and is considered as a major occupational hazard for all health care providers including the nurses. The aim of this study was to assess the status of workplace violence against nurses at hospitals in Kathmandu and determine the actions taken to investigate its cause. METHODS: A descriptive cross-sectional study was conducted among a convenient sample of 100 registered nurses employed in Nepal Medical College and Teaching Hospital, and Kathmandu Medical College and Teaching Hospital. All eligible nurses who were willing to participate irrespective of their academic fulfilment, from all different shifts and of age below 45 years were included. Data were collected using a structured questionnaire and analysed using SPSS software. Ethical approval was taken from the Institutional Review Committee (IRC) of Nepal Medical College and Kathmandu Medical College. RESULTS: Among 100 participants, the prevalence of workplace violence was 72 (72%) (62.13-80.52, 95% Confidence Interval). Verbal abuse accounted to 50 (69.44%), followed by physical violence accounting 17 (23.61%). Action was taken to investigate the causes of both physical violence 5 (29.41%) and verbal abuse 2 (4%) by the hospital administration 3 (60%) in physical violence and 2 (100%) in verbal abuse and police 2 (40%) in physical violence. CONCLUSIONS: The study reveals a troubling reality, as the vast majority of nurses reported experiencing various forms of violence in their workplace. So, addressing this issue immediately could protect nurses' well-being and ensure quality care which benefits both healthcare professionals and patients.