Statewide and national impact of California's Staffing Law on pediatric cardiac surgery outcomes.

OBJECTIVE: The objective of the study was to examine the impact of staffing ratios on risk-adjusted outcomes for pediatric cardiac surgery programs in California and relative to other states combined. BACKGROUND: California performs 20% of the nation's pediatric cardiac surgery and is the only state with a nurse ratio law. Understanding the imposition of mandated ratios on pediatric outcomes is necessary to inform the debate about nurse staffing. DATA SOURCES: Patient variables were extracted from the Healthcare Cost and Utilization Project Kids' Inpatient Database. The American Hospital Association database was used for institutional variables. METHODS: Descriptive analyses were used to identify and describe patient, nursing, and hospital characteristics. Changes in nursing ratios and full-time equivalents (FTEs) between 2003 and 2006 were examined. Associations between nursing characteristics and each outcome variable were examined using general estimating equation models. The RACHS-1 (Risk Adjustment for Congenital Heart Surgery) risk adjustment method was used for mortality. RESULTS: Hospitals in California significantly increased RN FTEs (P = .025) and RN ratios (P = .036) after enactment of AB 394 in 2006. Neither RN FTEs nor RN ratios were associated with mortality, complications, or resource utilization after risk adjustment. After the law, California's standardized mortality ratio (SMR) decreased more (33%) than in all other states combined (29%). Standardized complication ratio (SCR) increased by 5% but decreased by 5% for all other states combined, and the increase in charge differential ($53,443) was more than twice the increase ($23,119) for other states combined. CONCLUSION: Hospitals in California made upward adjustments in nursing FTEs and ratios after enactment of AB 394. There was a substantial increase in California's charge differential, a decrease in SMR, and an increase in SCR after enactment of the legislation.

Operating room scheduling. Choosing the best system.

The multiple criteria involved in the hospital OR scheduling problem cannot be ignored. Our goal is to identify the important criteria regarding this problem and determine the degree to which the scheduling approaches in use do or do not support these criteria. This contingency approach to selecting an OR scheduling system should enable hospital administrators to make policy decisions that will most effectively support stated and unstated organizational objectives.

Absentee patterns among OR staff. Identifying aspects of the problem.

Absenteeism continues to be a great concern to hospital administrators. Nursing personnel should have a clear idea of acceptable attendance parameters based on written policies that are routinely administered. Efforts are now directed toward exploring strategies that reward personnel for good attendance records. Early development of professional attitudes related to absenteeism should continue to be supported and fostered. Implications from this preliminary study indicate that it may be more cost-effective to hire RNs than STs to work in ORs.

Implications of Working Time Regulations for theatre nurses working in the NHS.

The European Working Times Regulations have implications for staff throughout the NHS. In particular, theatre staff and others working on call and shifts need to be aware of the implications of these regulations. In this article, Jon Richards, National Officer for Unison, explains the background to and implications of these regulations for theatre staff.

Durable improvements in efficiency, safety, and satisfaction in the operating room.

BACKGROUND: Enhanced productivity and efficiency in the operating room must be balanced with patient safety and staff satisfaction. In December 2004, transition to an expanded replacement hospital resulted in mandatory overtime, unpredictable work hours, and poor morale among operating room (OR) staff. A staff-retention crisis resulted, which threatened the viability of the OR and the institution. We report the changes implemented to efficiently deliver safe patient care in a supportive environment for surgeons and OR staff. STUDY DESIGN: University of Alabama at Birmingham University Hospital OR data were evaluated for fiscal year 2004 and compared with fiscal years 2005 and 2006. Case volumes, number of operational ORs, and on-time case starts were evaluated. OR adverse events were tabulated. Percentage of registered nurse hires and staff departures served as a proxy for staff satisfaction. RESULTS: Short, intermediate, and longterm strategies were implemented by an engaged OR management committee with the guidance of surgical, anesthesia, and hospital leadership. These included new block time release policies; use of traveling nurses until new staff could be hired and trained; and incentive-based, voluntary, employee-scheduled overtime. Mandatory nursing education time was blocked weekly. Enforcement of the National Patient Safety Goals were implemented and adjudicated with a "surgeon-of-the-day" system providing backup for nurse management. We demonstrated an increase in operations per year, on-time starts, and registered nurse hires in fiscal years 2005 and 2006. During this same time, we were able to markedly decrease the number of adverse events, admitting delays, and staff departures. CONCLUSIONS: Change is difficult to accept but essential when vital clinical activities are impaired and at risk. To maintain important clinical environments like the OR in an academic center, we developed and implemented effective, data-driven changes. This allowed us to retain critical human resources and restore a supportive environment for the patients, the doctors, and the staff.

Determinantes para suspensões cirúrgicas em um hospital universitário / Reasons for cancelling surgery at a university hospital / Factores determinantes para la suspensión de cirugías en un hospital universitario

Este é um estudo documental, retrospectivo e de natureza quantitativa, que trata dos determinantes para as suspensões cirúrgicas eletivas em um centro cirúrgico de um hospital universitário do município do Rio de Janeiro. O objetivo foi identificar o quantitativo de cirurgias eletivas suspensas em um recorte temporal de nove meses, considerando e analisando determinantes sobre as implicações emocionais, físicas e sociais para clientes, familiares e instituição. O resultado da investigação apontou que 27,4% das cirurgias suspensas tiveram como fator determinante as relações entre os clientes e a instituição. Além disso, a falta de condições clínicas (24,5%), o não comparecimento para internação (8,3%), a falta de material (10,3%) e o adiantado da hora (12%) foram citados como fatores que interferem no processo que culmina numa cirurgia. Parece evidente que alguns determinantes para os cancelamentos cirúrgicos podem e devem ser controlados e restringidos, o que leva à recomendação de um sistemático procedimento de conscientização de todos os envolvidos no processo, a fim de que se alcance a diminuição dos índices de suspensão cirúrgica na instituição em questão.

This is a documentary, retrospective and quantitative study that aims to determine the reasons for cancelling elective surgery at a University Hospital of Rio de Janeiro. It aims to identify the number of elective surgeries cancelled in a periodof nine months, considering emotional, physical and social implications for the clients, family and institution. The most frequent reason for cancelling a surgery was the relationship between customer and institution (27.4%). Lack of clinical conditions (24.5%), no show at the hospital (8.3%), lack of material (10.3%) and late hours (12%) were also mentioned as factors that interfere with the surgery. Apparently, some reasons could and should be controlled and restricted, leading to the recommendation of a systematic process of awareness in order to diminish surgical cancellation rates in this hospital.

El presente estudio es documental, retrospectivo y cuantitativo y enfoca los factores determinantes para la suspensión de cirugías electivas en el quirófano de un hospital universitario de Río de Janeiro. Su objetivo era determinar el número de cirugías electivas suspendidas durante un recorte de tiempo de nueve meses, teniendo en cuenta y analizando determinantes de las repercusiones emocionales, físicas y sociales en los clientes, la familia y la institución. El resultadode la investigación mostró que en 27,4% de las cirugías el factor determinante para su suspensión fue la relación entre el cliente y la institución. Además, la falta de condiciones clínicas (24,5%), el no presentarse para la internación (8,3%), la falta de material (10,3%) y la hora avanzada (12%) fueron citados como factores que interfieren en el proceso que culmina con la cirugía. Es evidente que algunos de los factores determinantes de la cancelación de cirugías pueden y deben ser...

Non-nursing duties in theatre. Part 2.

In part 1 the author described the methodology for identifying theatre nurse perceptions of the theatre nursing role and of non-nursing duties. This article moves on to describe stage 2, a non-participant observational study of what the nurses were actually doing.

Staffing a laser program.

The setting of laser use influences the identification of laser safety officer selection, education, and responsibilities. These are influenced by American National Standards Institute criteria and the quality management plan.

P*R*A*I*S*E: professional recognition for achievement in surgical excellence.

1. Professional medical organizations must have a well-defined and properly planned system for rewarding nurses. It must be fair to everyone and reward specific accomplishments. 2. Rewarding OR nurses for working in a highly specialized area and giving them recognition for their contributions and professionalism is important to nurses, patients, and the organization. Such positive reinforcement results in a heightened sense of satisfaction among nurses and loyalty to their organizations. 3. In an era of cost cutting and increased competition among hospitals in employing quality nurses, P*R*A*I*S*E can be an effective method of recruiting and retaining nurses.

Staff selection for an ambulatory surgery unit.

Major changes in the care delivery system affect the selection of the professional nursing staff for an ambulatory surgery unit. The skills required are diverse and dynamic. Selecting the right applicant requires not only knowledge of the interview process, but also acute observation and communication skills. The use of a matrix system helps to organize the process as well as to quantify and qualify the information gained.

Aprendizagem teórica da instrumentação cirúrgica por alunos de graduação em enfermagem / Theorical learning of surgical instrumentation by nursing graduate students

Ministrada como conteúdo da disciplina de Enfermagem em Centro Cirúrgico na maior parte dos cursos de graduação em enfermagem, a instrumentação cirúrgica é uma técnica na qual os alunos frequentemente encontram dificuldades. O presente objeto de estudo foi realizado com o objetivo de avaliar o conhecimento teórico adquirido pelos estudantes do curso superior de Enfermagem nessa atividade, comparando a aprendizagem antes e depois do treinamento no laboratório. A amostra compreendeu 33 alunos do sexto semestre de graduação, que realizam duas avaliações teóricas, uma que antecedeu a experiência prática e outra posterior a ela, nas quais descreveram cada um dos passos da instrumentação cirúrgica...