Determining the Need for Thrombectomy-Capable Stroke Centers Based on Travel Time to the Nearest Comprehensive Stroke Center.

BACKGROUND: In January 2018 The Joint Commission introduced its Thrombectomy-Capable Stroke Center (TSC) certification program to recognize hospitals capable of performing endovascular thrombectomy for patients with ischemic strokes due to large vessel occlusions, intended for hospitals not in close geographic proximity to Comprehensive Stroke Centers (CSCs). This study was conducted to determine (1) the travel times between current and potential TSCs and the nearest CSC and (2) the proportion of TSCs that were in areas of high need. METHODS: The locations of current and applicant TSCs (N = 44) were mapped and paired with the closest CSCs. Google Maps estimated travel times for each pair at 8:00 a.m., 12:00 a.m., and 5:00 p.m. on Wednesdays, providing the minimum, maximum, and midpoint for each period. The area served by each TSC was classified based on the number of time periods with drive times > 30 or > 60 minutes to the closest CSC ("very low need" [0 of 3], "low need" [1 of 3], "high need" [2 of 3], or "very high need" [3 of 3]). RESULTS: Using minimum drive times and the > 30 minute to the nearest CSC threshold, 68.2% of the 44 TSCs were in very low need areas, and 29.5% were in very high need areas. Using maximum drive times, 31.8% were in high need areas, and 31.8% were in very high need areas. With a 60-minute threshold, 25.0% were still in very high need areas. CONCLUSION: Many TSCs were in very low need areas using a 30-minute threshold. This methodology may help regional authorities determine how a TSC should be included in stroke systems of care prehospital destination protocols.

Opportunities to bridge gaps between respiratory protection guidance and practice in US health care.

Healthcare organizations are required to provide workers with respiratory protection (RP) to mitigate hazardous airborne inhalation exposures. This study sought to better identify gaps that exist between RP guidance and clinical practice to understand issues that would benefit from additional research or clarification.

Language services in hospitals: discordance in availability and staff use.

Despite efforts to advance effective patient-provider communication, many patients' language needs continue to be unmet or inappropriately addressed by healthcare providers (Wielawski 2010; Patek et al. 2009; Wilson-Stronks and Galvez 2007). This study presents a picture of the language resources currently provided by hospitals and those resources practitioners actually use. Questionnaire data were collected from 14 hospitals in Florida's Palm Beach, St. Lucie, and Martin counties on availability, staff awareness, and staff use of linguistic resources and services. Inconsistencies were identified between the language tools, services, and resources hospitals provide and those staff use. In addition, a large majority of staff respondents still rely upon someone accompanying the patient for communication with patients who have limited English proficiency, despite evidence that this practice contributes to miscommunication and serious medical errors (Flores et al. 2003; Flores 2005; HHS OMH 2001; Patek et al. 2009). Hospitals that use bilingual staff as interpreters often do not test the competency of these staff, nor do they assess the utilization or effectiveness of the tools and resources they provide. Hospitals can improve the cultural and linguistic care they provide if they (1) address the practice of using ad hoc interpreters, (2) effectively disseminate information to hospital staff regarding how and when to access available resources, and (3) collect patient population data and use it to plan for and evaluate the language services they provide to their patients.

The perceived impact of public reporting hospital performance data: interviews with hospital staff.

OBJECTIVE: To assess perceptions about the value and impact of publicly reporting hospital performance measure data. DESIGN: Qualitative research. SETTING AND PARTICIPANTS: Administrators, physicians, nurses and other front-line staff from 29 randomly selected Joint Commission-accredited hospitals reporting core performance measure data. METHODS: Structured focus-group interviews were conducted to gather hospital staff perceptions of the perceived impact of publicly reporting performance measure data. RESULTS: Interviews revealed six common themes. Publicly reporting data: (i) led to increased involvement of leadership in performance improvement; (ii) created a sense of accountability to both internal and external customers; (iii) contributed to a heightened awareness of performance measure data throughout the hospital; (iv) influenced or re-focused organizational priorities; (v) raised concerns about data quality and (vi) led to questions about consumer understanding of performance reports. Few differences were noted in responses based on hospitals' performance on the measures. CONCLUSIONS: Public reporting of performance measure data appears to motivate and energize organizations to improve or maintain high levels of performance. Despite commonly cited concerns over the limitations, validity and interpretability of publicly reported data, the heightened awareness of the data intensified the focus on performance improvement activities. As the healthcare industry has moved toward greater transparency and accountability, healthcare professionals have responded by re-prioritizing hospital quality improvement efforts to address newly exposed gaps in care.