Financial and temporal costs of patient isolation in Norwegian hospitals.

BACKGROUND: Isolation of patients colonized or infected by antibiotic-resistant bacteria is an established infection-control measure taken in Norway. Local reliable data on the costs of this isolation are needed. METHODS: A micro-costing study from a healthcare perspective was conducted on infectious disease wards in three general acute hospitals, utilising direct observation, staff registration, interviews and survey data. FINDINGS: The daily additional cost of isolation was €56.8 (95% confidence interval (CI) 42.4-72.7) for non-bedridden patients and €87.5 (95% CI 48.3-129.6) for bedridden patients. Of these sums, labour costs accounted for the largest share (71-72%), followed by the costs of personal protective equipment (21-23%) and waste management (6-8%). Overall, isolation-specific workload amounted to 65 min/day for non-bedridden patients and 95 min/day for bedridden patients, predominantly in the form of extra time used by nurses. Higher isolation costs for bedridden patients were largely attributable to resources used for personal hygiene practices. One-time isolation costs incurred for room cleaning after patient discharge averaged at €14.0 (95% CI 10.7-17.6). CONCLUSIONS: Our study provides novel, detailed evidence on resource use attributable to patient isolation in hospitals that can be used to inform future assessments directed toward precautionary hygienic measures. Our results suggest that allocating additional nurse staffing to wards with large numbers of isolated patients should be considered.

Case-control study of end-of-life treatment preferences and costs following advance care planning for adults with end-stage kidney disease.

AIM: The aim of the present study was to examine the efficacy of advance care planning (ACP) to improve the likelihood that end-stage kidney disease (ESKD) patient's preferences will be known and adhered to at end-of-life. METHODS: A case-control study of a nurse-led ACP programme in adults with ESKD from a major tertiary hospital. The primary outcome was the proportion of patients whose preferences were known (by substitute decision maker and/or clinicians) and adhered to by their treating doctors. Secondary measures were health system resource use and costs ($AUD) for a nurse-led ACP intervention in the last 12-months of life. RESULTS: In total, 57 cases (38 men, mean age 73.8 years) and 57 historical controls (38 men, mean age 74.0 years) were included. Cases (38/57, 67%) were significantly more likely than controls (15/57, 26%) to have their preferences known and adhered to by their treating doctor at end-of-life (P < 0.001). Cases (33/40, 83%) were also significantly more likely to withdraw from dialysis in accordance with their preferences than controls (11/33, 33%) (P < 0.001). For cases, the average hospital costs in the last 12 months of life was AUD $99 077 (SD = $71 002) per patient. The total cost of the ACP programme in 2010/2011 was AUD $26 821. CONCLUSION: Advance care planning was associated with improvements in end-of-life care preferences being known and adhered to for people with ESKD.

Quantification of nursing care and creation of economic indicators: an observational study protocol.

BACKGROUND: The literature on hospital admissions costs shows that classification of hospitalization systems such as the DRG system used in Italy, do not reflect the real cost of the production factors used, including those of nursing care in relation to the complexity of the hospital effort. OBJECTIVE: This concept paper outlines the study protocol and the methodology used to measure nursing care in economic terms. The objective of the study is developed on the assumption of creating economic indicators from a quantitative analysis of nursing activities provided to specific patients, in order to determine not only who costs but also the reasons for the cost, and demonstrate the variability of nursing not only for DRG, but also each individual patient. METHODS: A retrospective study and a longitudinal prospective study will be performed. In the first phase of the study, using a bottom-up Microcosting methodology the type, volume, time and costs of nursing activities for DRG will be determined and the incidence of nursing costs on reimbursement will be highlighted.In the second phase, the above analysis will be supplemented by the recognition of the complexity of individual cases measured through the Corridor Triage(Tri-CO), in order to figure out the incidence of costs of nursing activities on the reimbursement in relation to the level of care complexity. Main sources of data: hospital discharge card (SDO); Professional Assessment Instrument (PAI); datasets for collecting the time of delivery of nursing activities on PAI. Power calculation: For retrospective study, the survey will be conducted on a sample of 150 patients hospitalized in the first quarter of 2016. For the longitudinal prospective study, 150 patients will be included in the first quarter of 2017 after the structured introduction of Tri-CO as a valuation tool of care complexity. The sample examined is approximately 30% of the total number of admissions per year. RESULTS: The study started in February 2016 and the results are expected for May 2017. Through this study it is expected to verify whether by implementing a unbundling approach, ie the "unpacking" of the production factors (nursing activity costs) used for the explication of hospitalization, and by adopting a methodology based on standard analytical costs, a more detailed knowledge of the overall DRG rate data available today will be obtained, which is currently lacking of explicit notation of all the amounts that make up it.

Mitigating the Impact of Nurse Manager Large Spans of Control.

Nurse managers are instrumental in achievement of organizational and unit performance goals. Greater spans of control for managers are associated with decreased satisfaction and performance. An interprofessional team measured one organization's nurse manager span of control, providing administrative assistant support and transformational leadership development to nurse managers with the largest spans of control. Nurse manager satisfaction and transformational leadership competency significantly improved following the implementation of large span of control mitigation strategies.

Philanthropic Donor Perspectives on Supporting Nursing Excellence in a Community Hospital.

OBJECTIVE: The purpose of this research is to explore donors' perspectives on support of nursing excellence in a community hospital. BACKGROUND: Philanthropic support is rapidly becoming critical to support nursing excellence in hospitals, including continuing education, nursing research, and professional development. However, no research has examined the experience of private donors who support nursing programs in community hospitals. METHODS: Structured interviews were conducted with individuals with a history of providing significant financial support (gifts >$50 000) targeted specifically for nursing in a 176- bed community hospital in the southeastern United States. Analysis was performed using descriptive content analysis. RESULTS: Four themes emerged that centered around making a difference, helping nurses meet new challenges, an existing foundation of service, and valuing excellent nursing care received. CONCLUSIONS: This research provides specific information that nursing administrators can use when seeking philanthropic gifts to support nursing excellence programs in US community hospitals.

Unsocial hours pay is a question of fairness.

Should you be paid extra for working weekends? What about nights, or public holidays? Unsocial hours go with the job for most nurses, but the issue of whether and how staff should be rewarded is currently being scrutinised by the NHS Pay Review Body. In the past week there has also been a heated political discussion, as the parties vie for nurses' votes.

Certificación de los servicios enfermeros. Norma UNE-EN-ISO 9001-2008 / Nursing service certification. Norm UNE-EN-ISO 9001-2008

Objetivo: Certificar los servicios enfermeros mediante un sistema de gestión de calidad, tomando como referencia una norma internacional basada en un enfoque por procesos y en la mejora continua. Material y método: La norma fue revisada, actualizando la documentación del control del sistema de gestión, formado por el Manual de calidad y 7 procedimientos de control. Se codificaron todos los procedimientos existentes de acuerdo al proceso de control de la documentación. Cada proceso operativo tuvo asociado un conjunto de indicadores que permitieron conocer los resultados obtenidos, analizar las desviaciones e implantar mejoras. Resultados: El sistema se implantó satisfactoriamente. Se incorporaron al sistema de gestión 28 procedimientos de cuidados y 11 relativos a técnicas. Se establecieron 30 indicadores que permitieron monitorizar el proceso. El 100% de los pacientes tuvo asignada una enfermera en la historia clínica y todos contaron con un plan de cuidados personalizado acorde con la metodología de planificación y utilizando clasificaciones internacionales de la North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) y Nursing Outcomes Classification (NOC). La incidencia de caídas y de heridas cutáneas crónicas (HCC) fue baja, atendiendo a las características de los pacientes y a la duración de la estancia (X = 35,8 días). Los indicadores de seguridad tuvieron un alto grado de cumplimiento (90% el de identificación inequívoca del paciente y 100% el protocolo de higiene). La valoración sobre la confianza que proporcionaban las enfermeras fue del 91%. Conclusión: La certificación permitió mejorar la calidad del servicio de manera estructurada, analizando resultados, tratando las no conformidades e introduciendo mejoras (AU)

Objective: To certify the nursing services using a quality management system, taking an international standard as a reference, and based on a continuous improvement process. Material and method: The standard was revised, and the Quality Management System documentation was updated, consisting of a Quality Manual and 7 control procedures. All the existing procedures were coded in accordance with the documentation control process. Each operational procedure was associated with a set of indicators which permitted to know the results obtained, analyze the deviations and to implement further improvements. Results: The system was implemented successfully. Twenty-eight care procedures and eleven procedures concerning techniques were incorporated into the management system. Thirty indicators were established that allowed the whole process to be monitored. All patients were assigned to a nurse in their clinical notes and all of them had a personalized Care Plan according to planning methodology using North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) international rankings. The incidence of falls, as well as the incidence of chronic skin wounds, was low, taking into account the characteristics of the patient and the duration of the stay (mean = 35.87 days). The safety indicators had a high level of compliance, with 90% of patients clearly identified and 100% with hygiene protocol. The confidence rating given to the nurses was 91%. Conclusion: The certification enabled the quality of the service to be improved using a structured process, analyzing the results, dealing with non-conformities and introducing improvements (AU)

Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol.

AIMS: With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs. BACKGROUND: DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively. METHODS/DESIGN: A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting quantitative and qualitative findings. CONCLUSION: The research program will produce baseline data on nursing service context factors in Swiss acute care hospitals prior to DRG introduction as well as a theoretical model and a methodology to support nursing managers and hospital executive boards in distributing resources effectively. The study was approved by the ethics committees of Basel, Bern, Solothurn and Zürich.

Value-based resource management: a model for best value nursing care.

With the health care environment shifting to a value-based payment system, Catholic Health Initiatives nursing leadership spearheaded an initiative with 14 hospitals to establish best nursing care at a lower cost. The implementation of technology-enabled business processes at point of care led to a new model for best value nursing care: Value-Based Resource Management. The new model integrates clinical patient data from the electronic medical record and embeds the new information in care team workflows for actionable real-time decision support and predictive forecasting. The participating hospitals reported increased patient satisfaction and cost savings in the reduction of overtime and improvement in length of stay management. New data generated by the initiative on nursing hours and cost by patient and by population (Medicare severity diagnosis-related groups), and patient health status outcomes across the acute care continuum expanded business intelligence for a value-based population health system.

Business case for Magnet® in a small hospital.

There is minimal evidence related to Magnet® designation and the benefits in small hospitals. A business strategy for small hospitals (<100 beds) to achieve Magnet designation is presented, including a cost-benefit analysis, outcome measures, and financial impact data.

Specialized vascular floors after open aortic surgery: cost containment while preserving quality outcomes.

BACKGROUND: Postoperative care of open abdominal aortic surgery (OAAS) traditionally involves the intensive care unit (ICU). We hypothesized that in patients without an indication for postoperative ICU admission, admission to a specialized vascular floor unit (hemodynamic monitoring, 2:1 nursing) offers cost savings to both payer and institution without compromising care. METHODS: The electronic medical record was used to collect perioperative data for patients who underwent OAAS between July 2007 and July 2011. The university's cost accounting system provided information on revenue, total margin, and professional billing. Patients with ICU indications (spinal drain, Swan-Ganz monitoring, vasopressors, intubation, or blood product resuscitation) were excluded. Comparative cost and outcome analysis was performed on vascular ward and ICU admissions using the Fisher's exact test for dichotomous categorical variables and the Student's t-test for continuous variables. Long-term survival comparison was calculated using Kaplan-Meier survival estimates. RESULTS: One hundred thirty of 215 patients were included for analysis (85 excluded, 51 floor, 79 ICU). Perioperative data amongst the floor and ICU cohorts were similar. Day of operation professional billing fees were comparable (ICU $13,365 vs. floor $12,626; P = 0.18); however, postoperative professional fees were significantly higher in the ICU cohort (ICU $3,258 vs. floor $2,101; P = 0.001) primarily because of intensivist billing. The hospital generated an average of 8.7% more revenue from the ICU cohort (ICU $37,770 vs. floor $34,756; P = 0.023). This was offset by greater expenses in the ICU cohort (ICU $30,756 vs. floor $25,144; P = 0.02), yielding a hospital profit margin of 107.5% favoring floor admission (ICU $2,858 vs. floor $5,931; P = 0.19). Duration of stay was similar (ICU 8.0 days vs. floor 7.8 days; P = 0.86). Kaplan-Meier survival analysis was not significantly different between cohorts (ICU 10.1%, median follow-up, 1,070 days vs. floor 0%, median follow-up, 405 days; P = 0.13). CONCLUSIONS: Postoperative admission to the ICU is not always necessary after OAAS. Specialized vascular floors offer a financial savings to both payer and institution, which allows for simultaneous cost containment while preserving quality outcomes.

Costs of most frequent nursing activities in highly dependent hospitalized patients.

This quantitative study aimed to identify the costs of the most frequent nursing activities in highly dependent hospitalized patients at a medical clinic. The non-probabilistic convenience sample corresponded to 607 observations regarding oral feeding activities (OF), blood pressure verification (BP) / heart rate (HR), body temperature checking (BTC), performance of intimate hygiene and management of feeding probe. The costs identified corresponded to R$2.40 (SD±2.64) for OF feeding; R$1.26 (SD±0.48) to verify the BP/HR; R$1.17 (SD±0.46) for BTC; R$15.59 (SD±8.62) to perform intimate hygiene and R$5.95 (SD±2.13) for management of feeding probe. This study will facilitate cost management, with a view to avoiding waste related to unnecessary resource consumption and establish a correlation between costs and care delivery results.

Costs of most frequent nursing activities in highly dependent hospitalized patients / Custos das atividades de enfermagem realizadas com maior frequência em pacientes de alta dependência / Costos de las actividades de enfermería realizadas con mayor frecuencia a los pacientes de alta dependencia hospitalizados

This quantitative study aimed to identify the costs of the most frequent nursing activities in highly dependent hospitalized patients at a medical clinic. The non-probabilistic convenience sample corresponded to 607 observations regarding oral feeding activities (OF), blood pressure verification (BP) / heart rate (HR), body temperature checking (BTC), performance of intimate hygiene and management of feeding probe. The costs identified corresponded to R$2.40 (SD±2.64) for OF feeding; R$1.26 (SD±0.48) to verify the BP/HR; R$1.17 (SD±0.46) for BTC; R$15.59 (SD±8.62) to perform intimate hygiene and R$5.95 (SD±2.13) for management of feeding probe. This study will facilitate cost management, with a view to avoiding waste related to unnecessary resource consumption and establish a correlation between costs and care delivery results.

Este estudo quantitativo objetivou identificar os custos das atividades de enfermagem realizadas com maior frequência em pacientes de alta dependência, hospitalizados em uma unidade de clínica médica. A amostra de conveniência, não probabilística, correspondeu a 607 observações referentes às atividades alimentação via oral (VO), verificação da pressão arterial (PA) / frequência cardíaca (FC), verificação da temperatura corporal (TC), realização de higiene íntima e administração de dieta via sonda. Os custos identificados corresponderam a R$2,40 (dp±2,64) para alimentação VO; R$1,26 (dp±0,48) para verificação da PA/FC; R$1,17 (dp±0,46) para verificação da TC; R$15,59 (dp±8,62) para realização da higiene íntima e R$5,95 (dp±2,13) para administração de dieta via sonda. Este estudo auxiliará o gerenciamento de custos, visando evitar desperdícios relativos ao consumo desnecessário de recursos, bem como o estabelecimento de correlação entre os custos e os resultados da assistência prestada.

El propósito de este estudio cuantitativo fue identificar los costos de las actividades de enfermería realizadas con mayor frecuencia en pacientes hospitalizados con una unidad de alta dependencia en una clínica médica. La muestra de conveniencia, no probabilística, correspondió a 607 observaciones en relación a las actividades de alimentación por vía oral (VO); verificación de la presión arterial (PA) / frecuencia cardiaca (FC), verificación de la temperatura corporal (TC); realización de la higiene íntima y la administración de alimentación a través de la sonda. Los costos identificados correspondía a R$2,40 (DP±2,64) para la alimentación de VO; R$1,26 (DP±0,48) para verificar la PA/FC; R$1,17 (DP±0,46) para la verificación de la TC; R$15,59 (DP±8,62) para la realización de la higiene íntima y R$5.95 (DP±2,13) para la administración a través de la sonda de alimentación. Este estudio ayudará a administrar los costos con el fin de evitar que los desechos relacionados con el consumo innecesario de recursos, así como el establecimiento de una correlación entre los costos y resultados de la atención.

Coste enfermero asociado a los procedimientos realizados en un hospital de día médico / No disponible

Objetivo: identificar indicadores con los que poder evaluar anualmente los recursos consumidos en la realización de cada procedimiento realizado en el Hospital de Día Médico (HDM), así como el coste de los mismos. Metodología: estudio descriptivo retrospectivo de costes asociados a la ejecución de cada prestación realizada en el HDM del Hospital Universitario Infanta Cristina durante el año 2010. Para asignar un valor a cada prestación realizada en el HDM, se asignó un peso relativo a cada procedimiento realizado en la unidad, sobre la suma del coste del tiempo de Enfermería empleado en cada procedimiento, el coste del material fungible de cada procedimiento y los gastos indirectos que se pueden imputar al HDM. El tiempo de Enfermería es ponderado por medio de Unidades de Producción Enfermera (UPE). La asignación de UPEs a cada prestación se realiza por medio un de grupo nominal de expertos. Se realizó un análisis de idoneidad de las prestaciones en función del número de procedimientos asociados. Resultados: se ha cuantificado el coste de las prestaciones realizadas en la unidad y el coste asociado a cada procedimiento incluido. El HDM contaba con una cartera de servicios de 64 procedimientos gestionados por 39 prestaciones distintas. El número de visitas en este período fue de 11.395 sesiones. Un total de 10 prestaciones fueron catalogadas de no idóneas, bajo las cuales se gestionaron 211 sesiones. Se introdujeron tres nuevas prestaciones en las agendas de la unidad, cada una destinada a un procedimiento y se cambió la prestación asignada a dos procedimientos. Conclusiones: se considera factible la monitorización anual del coste del producto enfermero del HDM a partir de los indicadores propuestos, así como estudiar su evolución y realizar posteriores estudios de eficacia y eficiencia para optimizar los recursos de la unidad (AU)

Objective: to identify indicators with which to be able to evaluate on a yearly basis the resources consumed in each procedure at the Medical Day-Hospital (MDH) as well as the cost thereof. Methodology: descriptive retrospective study of costs associated with the performance of each procedure carried out at the MDH at the Hospital Universitario Infanta Cristina during the year 2010. In order to assign a value to each procedure carried out at the MDH, a relative weight was assigned to each procedure carried out at the unit, over the sum of the cost of nursing time employed in each procedure, the cost of fungible material of each procedure and the indirect expenses that might be charged to the MDH. The nursing time was weighted by means of the Nursing Production Units (NPU).The allocation of NPUs to each service was carried out by means of a nominal group of experts. An adequacy analysis of the services performed was carried out based on the number of associated procedures. Results: the cost of services provided in the unit and the cost associated with each procedure included were quantified. The MDH had a portfolio of services that includes 64 procedures managed by 39 different services. The number of visits in this period was 11,395 sessions. A total of 10 services were classified as unsuitable, under which 211 sessions were managed. Three new features were introduced to the agendas of the unit, each intended for a procedure, and the assigned service was changed to 2 procedures. Conclusions: the annual monitoring of the nursing product cost of the MDH is feasible based on the proposed indicators. It is also feasible to study its evolution and to perform subsequent efficacy and efficiency studies in order to optimize the unit's resources (AU)

[Analysis of cost and efficiency of a medical nursing unit using time-driven activity-based costing].

PURPOSE: Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. METHODS: Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. RESULTS: The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. CONCLUSION: These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

Nurse staffing and patient care costs in acute inpatient nursing units.

OBJECTIVE: Studies suggest that a business case for improving nurse staffing can be made to increase registered nurse (RN) skill mix without changing total licensed nursing hours. It is unclear whether a business case for increasing RN skill mix can be justified equally among patients of varying health needs. This study evaluated whether nursing hours per patient day (HPPD) and skill mix are associated with higher inpatient care costs within acute medical/surgical inpatient units using data from the Veterans Health Administration. METHODS: Retrospective cross-sectional study, including 139,360 inpatient admissions to 292 acute medical/surgical units at 125 Veterans Health Administration medical centers between February and June 2003, was conducted. Dependent variables were inpatient costs per admission and costs per patient day. RESULTS: The average costs per surgical and medical admission were $18,624 and $6,636, respectively. Costs per admission were positively associated with total nursing HPPD among medical admissions ($164.49 per additional HPPD, P<0.001), but not among surgical admissions. Total nursing HPPD and RN skill mix were associated with higher costs per hospital day for both medical admissions ($79.02 per additional HPPD and $5.64 per 1% point increase in nursing skill mix, both P<0.001) and surgical admissions ($112.47 per additional HPPD and $13.31 per 1% point increase in nursing skill mix, both P<0.001). Patients experiencing complications or transferring to an intensive care unit had higher inpatient costs than other patients. CONCLUSIONS: The association of nurse staffing level with costs per admission differed for medical versus surgical admissions.