Children's Hospital Ambulatory Response to the 2019 Novel Coronavirus Disease (COVID-19) Pandemic.

The 2019 novel coronavirus disease (COVID-19) pandemic produced an abrupt and near shutdown of nonemergent patient care. Children's National Hospital (CNH) mounted a multidisciplinary, coordinated ambulatory response that included supply chain management, human resources, risk management, infection control, and information technology. To ensure patient access, CNH expanded telemedicine and instituted operational innovations for outpatient procedures. While monthly in-person ambulatory subspecialty visits decreased from 25 889 pre-COVID-19 to 4484 at nadir of the COVID-19 pandemic, telemedicine visits increased from 70 to 13 539. Further studies are needed to assess the impact of innovations in health care delivery and operations that the crisis prompted.

Is the "July Effect" Real? Pediatric Trainee Reported Medical Errors and Adverse Events.

INTRODUCTION: The "July Effect" suggests an increase in patient adverse events in July compared with other months due to the introduction of new providers throughout the training continuum. The aim of this initiative was to analyze reported pediatric trainee medical errors from May through September 2015 at a tertiary care free-standing academic children's hospital to determine if there were more reported medical errors and more adverse events from those errors in July. METHODS: An error surveillance system is used to report and track near misses, adverse events, and medical errors. Three of the authors reviewed each report, which was electronically collected in the institution during the time period of interest. The reported medical error incidence per 1,000 trainee-days was compared against those in July for a significant difference. RESULTS: There are a total of 282 trainees (86 pediatric residents, 81 nonpediatric residents, and 115 fellows) who are clinically active in the hospital at any given month. Pediatric residents had more reported medical errors in July (31) compared with May (16; P = 0.015), June (16; P = 0.019), and August (19; P = 0.046). There was no significant difference in the number of adverse events from reported medical errors by trainees in July (7) compared with May (5), June (8), August (4), or September (8; P > 0.2). CONCLUSION: In this single-center evaluation, there is an increase in reported medical errors involving pediatric residents in July compared with the months surrounding July. However, there is no difference in numbers of adverse events from those errors between these months.

Legal briefs.

This column provides executive summaries of developments in legal and regulatory issues related to healthcare, lists a bibliography of pertinent healthcare law-related articles, and discusses interesting health law court decisions.

Healthcare reform after the Supreme Court ruling: implications for nurse executives.

On June 28, 2012, the US Supreme Court upheld the provisions of the Patient Protection and Affordable Care Act of 2010, as amended by the Healthcare and Education Reconciliation Act of 2010, with the exception that the Department of Health and Human Services may not withhold existing Medicaid funding from states that refuse to adopt the Medicaid expansion, but rather only new Medicaid funding associated with the expansion. This article will review the impact of this ruling on healthcare providers with a focus on the practice of the nurse executive.

A review of basic patient rights in psychiatric care.

Although patient rights is a concept that all nurse managers need to be aware of, this concept often becomes confusing when applied to patients undergoing psychiatric treatment. It is important for the nurse manager to understand the basic rights that psychiatric patients are entitled to, to best be able to help staff nurses under his/her supervision to protect these rights. The nurse manager on a psychiatric unit often serves as a reference for staff nurses, and even for physicians, when questions regarding patient rights present themselves. The nurse manager should be certain to discuss these issues with the facility's legal and risk management team to be aware of particulars of the law of the state in which the facility is located, as state laws may differ somewhat in their treatment of psychiatric patients.

Criminal prosecution for nursing errors.

Headlines describing nurses being prosecuted for crimes related to nursing errors raise numerous questions for nurses and their managers. Nurse managers need to be aware of situations in which nurses may be subject to criminal prosecution to assist staff in educating themselves and acting to minimize risk. After reading this article, the reader should be able to (a) identify the legal basis for criminal charges for nursing errors, (b) list 3 errors likely to result in criminal prosecution, and (c) discuss licensure implications of criminal charges for nursing errors.

Refusal to care.

There are many reasons why a nurse might refuse to care for a patient. The nurse manager needs to be aware of the nexus between moral dilemmas in healthcare and the right of providers to refuse to participate in certain controversial procedures, as well as other professional and ethical reasons such as lack of training or fatigue that may lead a staff nurse to refuse a patient care assignment. This article explores each of these situations and outlines federal and state laws that impact this situation. Suggestions are given for the nurse manager to help himself/herself and his/her staff avoid the potential negative consequences of refusals to care.

Do psychiatric advance directives protect autonomy?

A psychiatric advance directive (PAD) is a legal resource that allows a person to document his or her wishes about receiving mental health services in the event that he or she is unable to provide consent at a future time. Advantages for completing a PAD include promoting the person's autonomy and authentic self, minimizing harms, and promoting beneficence. However, more research is needed to describe the positive and negative consequences associated with completing and implementing a PAD in the clinical setting.

Healthcare fraud: a primer for the nurse executive.

Healthcare fraud has become an issue about which all healthcare providers must be aware. Unfortunately, for most of us, the laws and the regulations developed to enforce the laws regarding fraud in healthcare are among the most confusing ever written. Healthcare fraud is an important area of risk for the nurse executive and an area about which all nurse executives need to be aware. Healthcare fraud primarily relates to improper billing of governmental healthcare programs. A basic understanding of these programs is therefore fundamental to understanding the problem of healthcare fraud and how to prevent it. This article will provide a basic overview of this subject for the nurse executive.