Regionalization of Critical Care in the United States: Current State and Proposed Framework From the Academic Leaders in Critical Care Medicine Task Force of the Society of Critical Care Medicine.

OBJECTIVES: The Society of Critical Care Medicine convened its Academic Leaders in Critical Care Medicine taskforce on February 22, 2016, during the 45th Critical Care Congress to develop a series of consensus papers with toolkits for advancing critical care organizations in North America. The goal of this article is to propose a framework based on the expert opinions of critical care organization leaders and their responses to a survey, for current and future critical care organizations, and their leadership in the health system to design and implement successful regionalization for critical care in their regions. DATA SOURCES AND STUDY SELECTION: Members of the workgroup convened monthly via teleconference with the following objectives: to 1) develop and analyze a regionalization survey tool for 23 identified critical care organizations in the United States, 2) assemble relevant medical literature accessed using Medline search, 3) use a consensus of expert opinions to propose the framework, and 4) create groups to write the subsections and assemble the final product. DATA EXTRACTION AND SYNTHESIS: The most prevalent challenges for regionalization in critical care organizations remain a lack of a strong central authority to regulate and manage the system as well as a lack of necessary infrastructure, as described more than a decade ago. We provide a framework and outline a nontechnical approach that the health system and their critical care medicine leadership can adopt after considering their own structure, complexity, business operations, culture, and the relationships among their individual hospitals. Transforming the current state of regionalization into a coordinated, accountable system requires a critical assessment of administrative and clinical challenges and barriers. Systems thinking, business planning and control, and essential infrastructure development are critical for assisting critical care organizations. CONCLUSIONS: Under the value-based paradigm, the goals are operational efficiency and patient outcomes. Health systems that can align strategy and operations to assist the referral hospitals with implementing regionalization will be better positioned to regionalize critical care effectively.

Considerations for development of pharmacy support models for COVID-19 alternate care sites.

PURPOSE: Guidance on alternate care site planning based on the experience of a health-system pharmacy department in preparing for an expected surge in coronavirus disease 2019 (COVID-19) cases is provided. SUMMARY: In disaster response situations such as the COVID-19 pandemic, healthcare institutions may be compelled to transition to a contingency care model in which staffing and supply levels are no longer consistent with daily practice norms and, while usual patient care practices are maintained, establishment of alternate care sites (eg, a convention center) may be necessitated by high patient volumes. Available resources to assist hospitals and health systems in alternate care site planning include online guidance posted within the COVID-19 resources section of the US Army Corps of Engineers website, which provides recommended medication and supply lists; and the Federal Healthcare Resilience Task Force's alternate care site toolkit, a comprehensive resource for all aspects of alternate care site planning, including pharmacy services. Important pharmacy planning issues include security and storage of drugs, state board of pharmacy and Drug Enforcement Administration licensing considerations, and staff credentialing, education, and training. Key medication management issues to be addressed in alternate site care planning include logistical challenges of supply chain maintenance, optimal workflow for compounded sterile preparations (eg, on-site preparation vs off-site preparation and delivery from a nearby hospital), and infusion pump availability and suitability to patient acuity levels. CONCLUSION: Planning for and operation of alternate care sites in disaster response situations should include involvement of pharmacists in key decision-making processes at the earliest planning stages.

Reduction of Neonatal Mortality Requires Strengthening of the Health System: A Situational Analysis of Neonatal Care Services in Ballabgarh.

Background: Planning a comprehensive program addressing neonatal mortality will require a detailed situational analysis of available neonatal-specific health infrastructure. Methods: We identified facilities providing essential and sick neonatal care (ENC, SNC) by a snowballing technique in Ballabgarh Block. These were assessed for infrastructure, human resource and equipment along with self-rated competency of the staff and compared with facility-based or population-based norms. Results: A total of 35 facilities providing ENC and 10 facilities for SNC were identified. ENC services were largely in the public-sector domain (68.5% of births) and were well distributed in the block. SNC burden was largely being borne by the private sector (66% of admissions), which was urban-based. The private sector and nurses reported lower competency especially for SNC. Only 53.9% of government facilities and 17.5% of private facilities had a fully equipped newborn care corner. Conclusions: Serious efforts to reduce neonatal mortality would require major capacity strengthening of the health system, including that of the private sector.

[Potential of cooperative learning in project development : Relevance of cooperative participation procedure for the further development of generation-appropriate accomodation in structurally weak rural areas]. / Potenziale kooperativen Lernens in der Projektentwicklung : Relevanz kooperativer Beteiligungsverfahren für die Weiterentwicklung generationengerechter Wohnformen in strukturschwachen ländlichen Räumen.

BACKGROUND: A joint initiative of existing senior care organizations, the municipality of Meyenburg and the state of Brandenburg was further developed by affiliation of an institute of the Brandenburg University of Technology Cottbus-Senftenberg (ABV) in cooperation with members of the architecture and social work departments in 2014. MATERIAL AND METHODS: A cooperative process between different players was central to create an appropriate structure of services for this region. RESULTS: Cooperative projects are necessary to establish new forms of generation-appropriate living and care concepts in rural areas. CONCLUSION: Cooperative learning methods are needed to develop new forms of generation-appropriate living and care concepts in rural areas, which take the diversity of elderly people, the rural context, intergenerational residential arrangements and affordable accommodation that meets the requirements of the social security system into account. Furthermore, the project had to reflect the recent developments of the German care insurance. The article describes the participatory methods, the coordination process and the resulting concept.

Succession Planning and Management: The Backbone of the Radiology Group's Future.

The transition of leadership within radiology practices is often not a planned replacement process with formal development of potential future leaders. To ensure their ongoing success, however, practices need to develop comprehensive succession plans that include a robust developmental program for potential leaders consisting of mentoring, coaching, structured socialization, 360-degree feedback, developmental stretch assignments, job rotation, and formal education. Succession planning and leadership development will be necessary in the future for a practice to be successful in its business relationships and to be financially viable.

Planning Staff and Space Capacity Requirements during Wartime.

Determining staff and space requirements for military medical centers can be challenging. Changing patient populations change the caseload requirements. Deployment and assignment rotations change the experience and education of clinicians and support staff, thereby changing the caseload capacity of a facility. During wartime, planning becomes increasingly more complex. What will the patient mix and caseload volume be by location? What type of clinicians will be available and when? How many beds are needed at each facility to meet caseload demand and match clinician supply? As soon as these factors are known, operations are likely to change and planning factors quickly become inaccurate. Soon, more beds or staff are needed in certain locations to meet caseload demand while other locations retain underutilized staff, waiting for additional caseload fluctuations. This type of complexity challenges the best commanders. As in so many other industries, supply and demand principles apply to military health, but very little is stable about military health capacity planning. Planning analysts build complex statistical forecasting models to predict caseload based on historical patterns. These capacity planning techniques work best in stable repeatable processes where caseload and staffing resources remain constant over a long period of time. Variability must be simplified to predict complex operations. This is counterintuitive to the majority of capacity planners who believe more data drives better answers. When the best predictor of future needs is not historical patterns, traditional capacity planning does not work. Rather, simplified estimation techniques coupled with frequent calibration adjustments to account for environmental changes will create the most accurate and most useful capacity planning and management system. The method presented in this article outlines the capacity planning approach used to actively manage hospital staff and space during Operations Iraqi Freedom and Enduring Freedom.

Setting up a Nuchal Translucency Clinic: What Radiologists Need to Know.

The purpose of this article was to discuss the process of setting up a nuchal translucency (NT) screening clinic in clinical practice, how to interpret the information in combination with other clinical tests, what to do if abnormal results are obtained, and to illustrate some of the fetal anomalies that are associated with an increased NT. The NT was initially implemented to predict the likelihood of a fetus with Down syndrome. Maternal age can be combined with fetal NT and maternal serum biochemistry (free ß-hCG and PAPP-A) at 11 to 14 weeks to identify about 90% of affected fetuses. Setting up a clinic to perform the NT screening requires certified physicians and certified sonographers. Certification can be obtained for both physicians and sonographers through Nuchal Translucency Quality Review and Fetal Medicine Foundation. Cell-free DNA testing is now altering what our patients are choosing to evaluate fetuses at risk for chromosomal anomalies and congenital anomalies. Common pitfalls to performing, interpreting, and conveying results of the NT are illustrated in this article. Nasal bone measurement, fetal anatomy examination and fetal echocardiography are tools that add sensitivity to the detection of chromosomal abnormalities. Examples of fetal anomalies discovered during the NT screening are also illustrated. Screening for obstetric complications is an additional benefit to the NT clinic.

How geographical information systems analysis influences the continuum of patient care.

As the vast repository of data about millions of patients grows, the analysis of this information is changing the provider-patient relationship and influencing the continuum of care for broad swaths of the population. At the same time, while population health management moves from a volume-based model to a value-based one and additional patients seek care due to healthcare reform, hospitals and healthcare networks are evaluating their business models and searching for new revenue streams. Utilizing geographical information systems to model and analyze large amounts of data is helping organizations better understand the characteristics of their patient population, demographic and socioeconomic trends, and shifts in the utilization of healthcare. In turn, organizations can more effectively conduct service line planning, strategic business plans, market growth strategies, and human resource planning. Healthcare organizations that use GIS modeling can set themselves apart by making more informed and objective business strategy decisions.

[Nurse's effective participation in planning: focus on costs]. / Participação efetiva do enfermeiro no planejamento: foco nos custos.

This research searched to verify if the nurses of a private hospital in São Paulo-SP, Brazil, have costs management view and to observe how occur their participation in the planning levels, specifically in relation to the costs. Forty nurses were interviewed during their journey through a questionnaire about caring costs management and the levels of organizational planning. It was observed that 85% of the nurses interviewed affirmed that they don't participate on the caring costs management, and that 45% of the participants didn't know to explain the importance of this knowledge. The majority of the nurses interviewed (62.5%) affirmed that they don't participate of the strategic institutional planning and, among those that participated; the majority didn't know to explain about their participation.

Participação efetiva do enfermeiro no planejamento: foco nos custos / Nurse's effective participation in planning: focus on costs / Participación efectiva del enfermero en la planificación: enfoque en los costos

Trata-se de uma pesquisa que buscou verificar se os enfermeiros de uma instituição hospitalar privada da cidade de São Paulo-SP possuem visão de gerenciamento de custos e observar como ocorre a participação destes profissionais nos níveis de planejamento, com ênfase nos custos. Foram entrevistados 40 enfermeiros, durante seu turno de trabalho, através da aplicação de um questionário a respeito de gerenciamento de custos assistenciais e dos níveis de planejamento organizacional. Observou-se que 85% dos entrevistados afirmaram não participar do gerenciamento de custos assistenciais, sendo que 45% dos participantes não soube explicar a importância desse conhecimento. A maioria dos entrevistados (62,5%) afirmou não participar do planejamento estratégico institucional e dentre os que participaram a maior parte não soube explicar sua participação.

This research searched to verify if the nurses of a private hospital in São Paulo-SP, Brazil, have costs management view and to observe how occur their participation in the planning levels, specifically in relation to the costs. Forty nurses were interviewed during their journey through a questionnaire about caring costs management and the levels of organizational planning. It was observed that 85% of the nurses interviewed affirmed that they don't participate on the caring costs management, and that 45% of the participants didn't know to explain the importance of this knowledge. The majority of the nurses interviewed (62.5%) affirmed that they don't participate of the strategic institutional planning and, among those that participated; the majority didn't know to explain about their participation.

Se trata de una investigación que buscó verificar si los enfermeros de una institución hospitalaria privada de la ciudad de São Paulo-SP, Brasil, poseen visión sobre gestión de costos y observar como ocurre la participación de estos profesionales en los niveles de planeamiento, con énfasis en los costos. Fueron entrevistados 40 enfermeros, durante su trabajo, empleando un cuestionario sobre la gestión de costos y planeamiento. Se pudo observar que 85% de los entrevistados afirmaron que no participan de la gestión de costos, siendo que 45% de ellos no supieron explicar la importancia de este conocimiento. La mayoría de los entrevistados (62,5%) afirmó que no participa del planeamiento estratégico institucional y entre los que participaron la mayor parte no supo explicar su participación.

Health systems engineering as an improvement strategy: a case example using location-allocation modeling.

Finding the optimal geographic location for a medical service is a common challenge for healthcare organizations. However, there is limited use or description of methods to determine the optimal location of a medical service. We describe a case study of how location-allocation techniques used by industrial engineers assisted a regional healthcare network develop a plan for optimal location of sleep medicine services within its network.