Maintaining Safety Standards While Building an Urban Alternate Care Facility in a Global Pandemic.

The Philadelphia region responded to the shortage of health care resources imposed by the 2020 COVID-19 pandemic through the creation of the COVID-19 Surge Facility at Temple University's basketball arena. The facility was designed as an acute care medical unit capable of supporting COVID-19 patients who were stable enough to be released from the intensive care unit but not ready for discharge home. Safety was optimized through the application of recommendations from the Joint Commission and Centers for Disease Control and Prevention (CDC). The safety goals include those established by the Joint Commission with regard to patient identification, security, identification of patient safety threats, communication, fire safety, laboratory services, and pharmacologic services. COVID-19-specific goals outlined by the CDC also are addressed and include recommendations for facility layout, managing staff respite and personal protective equipment, patient care areas, supply storage, airflow, and patient hygiene. Although the goal was to meet all of these recommendations, some were not possible due to the austere environment of the arena. However, these shortcomings were met with innovative solutions that provided the next best options. By sharing these experiences, the authors hope to guide future alternate care facilities in their efforts to optimize safety.

The effect of traffic calming on pedestrian injuries and motor vehicle collisions in two areas of the eThekwini Municipality: a before-and-after study.

BACKGROUND: Motor vehicle collisions and pedestrian injuries in areas where schools are located are public health problems in Durban. OBJECTIVE: To evaluate the effect of traffic calming humps on the number and severity of incidences of collisions and injuries in the Chatsworth and KwaMashu residential areas of the eThekwini Municipality. METHODS: The evaluation used an observational interrupted time-series study design, with data obtained from the eThekwini Traffic Authority for roads constituting the routes to 34 schools for 2 years prior to and following the implementation of road humps (excluding the intervening year of implementation). A non-probability convenience sample of 19 schools with 39 roads in Chatsworth and 15 schools with 24 roads in KwaMashu was selected. RESULTS: The traffic calming humps improved safety in both areas with respect to the severity of collisions. Serious pedestrian-vehicle collisions (PVCs) dropped by 23% and 22%, while fatal collisions decreased by 68% and 50% in Chatsworth and KwaMashu, respectively. The median annual PVC rate/km of road/year decreased from 1.41 to 0.96 (p=0.007) and from 2.35 to 1.40 (p<0.001) in Chatsworth and KwaMashu, respectively. There was a 1.6% reduction in the median number of fatal or serious PVCs after implementation in Chatsworth (p=0.03) while in KwaMashu, although the number of collisions decreased, the median number increased by 9% (p=0.07). CONCLUSIONS: Traffic calming has been shown to be effective in reducing the number of PVCs but needs to be supported by additional measures to further improve the safety of pedestrians.

Unannounced, compared with announced inspections: a systematic review and exploratory study in nursing homes.

Politicians and regulators have high expectations of unannounced inspections. Unannounced inspections, unlike announced ones, would, they believe, lead to a clearer insight into the risks and a reduction of the regulatory burden. In order to verify these assumptions, a systematic review of the scientific literature and an exploratory study were conducted. In the systematic review only three relevant articles were found concerned with research into the difference between unannounced and announced inspections. In the exploratory study, Dutch nursing homes were inspected, unannounced, and later announced, in order to compare the risks detected during the inspections. It is concluded that unannounced inspections did not reveal more or different risks, but provided a better insight into the quality of care delivered. Announced inspections are the best option for the assessment both of the organization and of its preconditions for good care. Evidence was found that an unannounced inspection leads to a reduction of the regulatory burden.

Who governs federally qualified health centers?

To make them more responsive to their community's needs, federally qualified health centers (FQHCs) are required to have a governing board comprising at least 51 percent consumers. However, the extent to which consumer board members actually resemble the typical FQHC patient has not been assessed, which according to the political science literature on representation may influence the board's ability to represent the community. This mixed-methods study uses four years of data from the Health Resources and Services Administration, combined with Uniform Data System, Bureau of Labor Statistics, and Area Resource File data, to describe and identify factors associated with the composition of FQHC governing boards. Board members are classified into one of three groups: nonconsumers, nonrepresentative consumers (who do not resemble the typical FQHC patient), and representative consumers (who resemble the typical FQHC patient). The analysis finds that a minority of board members are representative consumers, and telephone interviews with a stratified random sample of thirty FQHC board members confirmed the existence of significant socioeconomic gaps between consumer board members and FQHC patients. This may make FQHCs less responsive to the needs of the predominantly low-income communities they serve.

Improving patient safety and physician accountability using the hospital credentialing process.

The lack of systematic oversight of physician performance has led to some serious cases related to physician competence and behaviour. We are currently implementing a hospital-wide approach to improve physician oversight by incorporating it into the hospital credentialing process. Our proposed credentialing method involves four systems: (1) a system for monitoring and reporting clinical performance; (2) a system for evaluating physician behaviour; (3) a complaints management system; and (4) an administrative system for maintaining documentation. In our method, physicians are responsible for implementing an annual performance assessment program. The hospital will be responsible for the complaints management system and the system for collecting and reporting relevant health outcomes. Physicians and the hospital will share responsibility for monitoring professional behaviour. Medical leadership, effective governance, appropriate supporting information systems and adequate human resources are required for the program to be successful. Our program is proactive and will allow our hospital to enhance safety through a quality assurance framework and by complementing existing safety activities. Our program could be extended to non-hospital physicians through regional health or provider networks. Central licensing authorities could help to coordinate these programs on a province- or state-wide basis to ensure uniformity of standards and to avoid duplication of efforts.

Does state regulation of quality impose costs on nursing homes?

BACKGROUND: Government regulation is intended to enhance quality, safety, fairness, or competition in the regulated industry. Such regulation entails both direct and indirect costs. OBJECTIVES: To estimate the costs associated with the regulation of quality of the nursing home industry. SAMPLE: This study includes 11,168 free-standing nursing homes nationally, between 2004 and 2006. RESEARCH DESIGN: Data included information from the Medicare cost reports, Minimum Data Set, Medicare Denominator file, OSCAR, and a survey of States' Certification and Licensing Offices conducted by the authors. These data were used to create variables measuring nursing homes costs, outputs, wages, competition, adjusted deficiency citations, ownership, state-fixed effects, and an index of each state's regulatory stringency. We estimated hybrid cost functions which included the regulatory stringency index. RESULTS: The estimated cost functions demonstrated the typical behavior expected of nursing home cost functions. The stringency index was positively and significantly associated with costs, indicating that nursing homes located in states with more stringent regulatory requirements face higher costs, ceteris paribus. The average incremental costs of a 1 standard deviation increase in the stringency index resulted in a 1.1% increase in costs. CONCLUSIONS: This study for the first time places a price tag on the regulation of quality in nursing homes. It offers an order of magnitude on the costs to the industry of complying with the current set of standards and given the current level of enforcement. Complementary studies of the benefits that these regulations entail are needed to gain a comprehensive assessment of the effect of the regulation.

[Healthcare regulation and healthcare management as tools to assure comprehensiveness and equity in health]. / A regulação assistencial e a produção do cuidado: um arranjo potente para qualificar a atenção.

Healthcare production that assures comprehensiveness and equity has posed a challenge for Brazil's Unified National Health System. The aim of this study was to contribute to the debate on the issue, analyzing an experience with municipal healthcare management using regulation to improve quality of care. We conducted a case study in which data were obtained through direct observation, interviews, written narratives, and document analysis. The research subjects were health services managers and health workers. The results feature the concept of a living network, produced actively by building relations between the health workers in the different services. The study highlights the measures to support the care produced by the teams, based on healthcare regulation and work processes management. The results were expressive in upgrading the care, reducing the waiting lines for the specialties, and increasing the health workers' satisfaction. The key feature in the process was the evident need to enrich (through acts) the technical knowledge with light technologies and active movements by management in the production of care.

Nursing home deficiency citations for safety.

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.

The Bonfire of the Regulators: the HFEA an unjustified death?

The Government has confirmed that the Human Fertilisation and Embryology Authority is to be abolished with a number of its functions transferred to other bodies as part of the 'bonfire of the quangos'. This article explores these proposals and questions whether such wide-scale reform is an appropriate approach to the regulating of what remains such an ethically controversial area.