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1.
J Stroke Cerebrovasc Dis ; 29(1): 104464, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31699576

RESUMEN

INTRODUCTION: Emergency departments play a key role in the diagnosis and treatment of transient ischemic attacks, but limited data are available about the early management of such patients in emergency wards. Therefore, we aimed to evaluate emergency physicians' management of transient ischemic attack and analyze variations factors. METHODS: A multicenter survey among emergency physicians of the Grand Est region network (Est-RESCUE) was conducted from January 28th to March 28th, 2019. Medical and administrative data were collected by the same network and the national directory of medical resources. RESULTS: Among 542 emergency physicians recipients, 78 answered (14%) and 71 were finally included, practicing in 25 public hospitals homogeneously distributed across the territory, including 3 university hospitals. A cerebral magnetic resonance imaging was obtained for 75%-100% of patients by 4.3% of responders, 36.4% of which were performed within more than 24 hours. A cardiac monitoring was prescribed in 75%-100% of cases by 32.4% of responders. A neurologic consultation was routinely requested by 84.6% of responders practicing in a university hospital and 36.8% of responders practicing in a community hospital (P = .02). Patients were hospitalized in a neurovascular unit in 75%-100% of cases by 17.4% of responders, which happened more likely in university hospitals (P < .001). CONCLUSIONS: Transient ischemic attack suffers from management disparities across territories, due to limited access to technical facilities and neurologic consultations. Therefore, international recommendations are too often not followed. Implementation of territorial neurovascular tracks may help to standardize the management of these patients.


Asunto(s)
Servicio de Urgencia en Hospital/tendencias , Disparidades en Atención de Salud/tendencias , Hospitales/tendencias , Ataque Isquémico Transitorio/terapia , Pautas de la Práctica en Medicina/tendencias , Tiempo de Tratamiento/tendencias , Adulto , Femenino , Francia , Encuestas de Atención de la Salud , Hospitalización/tendencias , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Masculino , Persona de Mediana Edad , Derivación y Consulta/tendencias , Factores de Tiempo , Resultado del Tratamiento
2.
BMC Health Serv Res ; 19(1): 611, 2019 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-31470854

RESUMEN

BACKGROUND: This paper examines perinatal death reporting and reviews in Bungoma county, Kenya, where substantial progress has been made, providing important insights for wider scale up to other contexts. METHODS: Quantitative methods were used to analyse trends in perinatal death reporting and reviews between 2014 and 2017 throughout Kenya based on data from the District Health Information System. Qualitative methods helped further understand the success of perinatal death reporting and review in Bungoma county through focus group discussions and individual interviews at 5 hospitals and 1 health centre. Thematic analysis was used to draw out codes for the analysis. RESULTS: Only 13 of the 47 counties in Kenya conduct perinatal death reviews. In 2017, the year after the perinatal death review system was introduced, only 3.6% of perinatal deaths were reviewed in Kenya. Bungoma county has made the greatest strides in Kenya, reviewing 59% of the perinatal deaths that occurred within the county in 2017. Bungoma accounted for 51% of all the perinatal deaths reviewed in Kenya. Factors contributing to the success in Bungoma include harmonisation of facility based perinatal reporting tools with the national level; prioritising the need to document and report mortalities; tailoring continual medical education and supportive supervision visits to needs identified from the review; and better documentation and referral processes. Supportive management and administrative staff have also helped drive forward implementation of actions and increased health staff motivation to reduce perinatal deaths and improve quality of care. CONCLUSIONS: Successful implementation of perinatal death reviews requires clear delineation of roles and responsibilities for action, which are routinely monitored to track implementation progress. As in other low-income settings, Bungoma county has demonstrated that in Kenya, perinatal death reviews can be effectively implemented and sustained, through a focus on learning, solution-oriented responses, influencing those in a power to act, accountability for results, and observable quality of care improvements.


Asunto(s)
Mortalidad Materna/tendencias , Mortalidad Perinatal/tendencias , Prestación de Atención de Salud/tendencias , Salud de la Familia , Femenino , Grupos Focales , Hospitales/estadística & datos numéricos , Hospitales/tendencias , Humanos , Kenia/epidemiología , Muerte Perinatal , Embarazo
3.
J Orthop Surg Res ; 14(1): 213, 2019 Jul 12.
Artículo en Inglés | MEDLINE | ID: mdl-31299998

RESUMEN

BACKGROUND: The aim of this study was to describe hand fracture epidemiology/etiology in city children and describe time trend during six decades. PATIENTS AND METHODS: A single hospital serves the entire city population of 271,271 (year 2005). Through the hospital medical and radiological archives, we collected epidemiology and etiology data concerning pediatric (age < 16 years) hand fractures in city residents, treated during 2005-2006. We compared these data to previously collected data in in the same city during 12 evaluated periods from 1950/1955 to 1993-1994. We present period-specific crude and age- and gender-adjusted fracture incidence rates and group differences as incidence rate ratios (RR) with 95% confidence intervals (95% CI). RESULTS: In 2005-2006, we identified 414 hand fractures (303 in boys and 111 in girls), 247 phalangeal fractures (60% of all hand fractures), 140 metacarpal/carpal fractures (except the scaphoid bone) (34%), and 27 scaphoid fractures (6%). The crude hand fracture rate in children was 448/100,000 person years (639/100,000 in boys and 247/100,000 in girls), with a 2.5 times higher age-adjusted incidence in boys than in girls. Compared to 1950/1955, the age and gender-adjusted hand fracture incidence was twice as high in 2005-2006 and more than twice as high in 1976-1979. Compared to 1976-1979, we found no significant difference in the age and gender-adjusted hand fracture incidence in 2005-2006. In 2005-2006, sports injuries explained 42%, fights 20%, and traffic accidents 13% of the hand fractures. In 1950/1955, sports injuries explained 27% of fractures, fights 10%, and traffic accidents 21%. CONCLUSIONS: The incidence of hand fractures in children was more than twice as high in the end of the 1970s compared to the 1950s, where after no significant change could be found. Also, fracture etiology has changed. New studies are needed, to adequately allocate health care resources and identify new fracture prone activities suitable for preventive measures. LEVEL OF EVIDENCE: III.


Asunto(s)
Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/epidemiología , Traumatismos de la Mano/diagnóstico por imagen , Traumatismos de la Mano/epidemiología , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Fracturas Óseas/etiología , Traumatismos de la Mano/etiología , Hospitales/tendencias , Humanos , Incidencia , Masculino , Factores Sexuales , Suecia/epidemiología , Factores de Tiempo
4.
PLoS One ; 14(6): e0218244, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31216307

RESUMEN

INTRODUCTION: Safety climates are perceptions of safety culture shared by staff in organizational units. Measuring staff perceptions of patient safety culture by using safety climate surveys is a possible way of addressing patient safety. Studies have documented that patient safety climates vary significantly between work sites in hospitals. Across-ward variations in the measurements of safety climate factor scores may indicate ward-specific risk of adverse events related to patient care routines, work environment, staff behaviour, and patient results. Variation in patient safety climates has not yet been explored in nursing homes. OBJECTIVES: To investigate whether the Norwegian translation of the Safety Attitudes Questionnaire-Ambulatory Version is useful to identify significant variation in the patient safety climate factor scores: Teamwork climate, Safety climate, Job satisfaction, Working conditions, Stress recognition, and Perceptions of management, across wards in nursing homes. METHODS: Four hundred and sixty three employees from 34 wards in five nursing homes were invited to participate. Cronbach alphas were computed based on individual respondents' scores on the six patient safety climate factor scores. Intraclass correlation coefficients were calculated by multilevel analysis to measure patient safety climate variance at ward level. RESULTS: Two hundred and eighty eight (62.2%) returned the questionnaire. At ward level Intraclass correlation coefficients (ICCs) for the factors were 10.2% or higher for the factors Safety climate, Working conditions and Perceptions of management, 2.4% or lower for Teamwork climate, Job satisfaction, and zero for Stress recognition. ICC for variance at nursing home level was zero or less than one per cent for all factor scores. CONCLUSIONS: Staff perceptions of Safety climate, Working conditions and Perceptions of management varied significantly across wards. These factor scores may, therefore, be used to identify wards in nursing homes with high and low risk of adverse events, and guide improvement resources to where they are most needed.


Asunto(s)
Actitud del Personal de Salud , Hospitales/normas , Casas de Salud/normas , Seguridad del Paciente/normas , Empleo/normas , Femenino , Hospitales/tendencias , Humanos , Masculino , Noruega/epidemiología , Enfermeras y Enfermeros/psicología , Casas de Salud/tendencias , Factores de Riesgo , Encuestas y Cuestionarios
5.
Surgery ; 166(5): 867-872, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31208862

RESUMEN

BACKGROUND: We hypothesized that general surgeons are more likely to use a robotic surgical platform at hospitals where more urologic and gynecologic robotic operations are performed, suggesting that hospital-related factors are important for choice of usage of minimally invasive platforms. METHODS: We queried the National Inpatient Sample from 2010 to 2014 for patients who underwent stomach, gallbladder, pancreas, spleen, colon and rectum, or hernia (general surgery), prostate or kidney (urologic surgery), and ovarian or uterine surgery (gynecologic surgery). Hospitals were grouped into quartiles according to percent volume of robotic urologic or gynecologic operations. Multivariable logistic regression modeling determined independent variables associated with robotics. RESULTS: Survey-weighted results represented 482,227 open, 240,360 laparoscopic, and 42,177 robotic general surgical operations at 3,933 hospitals. Robotics use increased with each year studied and was more likely to be performed on younger men with private insurance. The odds of a general surgery patient receiving a robotic operation increased with urologic and gynecologic use at the hospital. Patients at top quartile hospitals for robotic urologic surgery had 1.34 times greater odds of receiving robotic general surgery operations (confidence interval 1.15-1.57, P < .001) and 1.53 times greater odds (confidence interval 1.32-1.79, P < .001) at top quartile robotic gynecologic hospitals. These findings were independent of study year, surgical site, insurance type, and hospital type and persisted when only comparing laparoscopic to robotic procedures. CONCLUSION: Use of robotics in general surgery is independently associated with use in urologic and gynecologic surgery at a hospital, suggesting that institutional factors are important drivers of use when considering laparoscopy versus robotics in general surgery.


Asunto(s)
Cirugía General/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Laparoscopía/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Cirugía General/métodos , Cirugía General/tendencias , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Procedimientos Quirúrgicos Ginecológicos/tendencias , Hospitales/tendencias , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Robotizados/tendencias , Procedimientos Quirúrgicos Urológicos/métodos , Procedimientos Quirúrgicos Urológicos/estadística & datos numéricos , Procedimientos Quirúrgicos Urológicos/tendencias
6.
Anesth Analg ; 129(2): 493-499, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31166229

RESUMEN

BACKGROUND: Current guidelines for the administration of therapeutic epidural injections suggest that these be limited to a maximum of 4 per year. We sought to gain an understanding of the proportion of lumbosacral epidural injections administered to patients who had received ≥4 such injections during the preceding 364 days, and whether these proportions varied among hospitals. METHODS: This observational cohort study included data from all facilities owned by the 121 nonfederal hospitals in the State of Iowa, July 2012 through September 2017. One end point was the percentage of all lumbar or sacral transforaminal or interlaminar epidural injections where the patient had received ≥4 such injections during the preceding 364 days. Comparisons also were made among hospitals' percentages of injections that were the fifth or greater (ie, patient had already received ≥4 during preceding 364 days) using Bonferroni-adjusted conservative 95% confidence intervals. RESULTS: There were 48,270 unique patients who underwent at least 1 lumbosacral epidural steroid injection. The patients received care at 112 hospitals' facilities. Most patients received no additional steroid injections within 364 subsequent calendar days after the first steroid injection (54.1%). There were ≥5 steroid injections for 1.27% of patients (ie, the injection was the fifth or greater). Among the 39 hospitals in Iowa that performed overall at least 1 steroid injection every 4 days, there were 6 hospitals at which the percentages of injections that were the fifth or greater significantly exceeded the overall prevalence of 1.91% (range: 3.0%-6.4%). There were 14 of the 39 hospitals with prevalences significantly less. CONCLUSIONS: Although most patients received only 1 lumbosacral steroid injection within 1 year, 1.27% of patients received 5 or more, and 1.91% of injections were the fifth or greater. Several hospitals had significantly greater than the overall average percent of steroid injections which were fifth or more. This heterogeneity warrants study of whether annual steroid injections per patient should be a clinical quality measure for the care received by patients with lower back pain or whether payment should be greater when injections are in accordance with guidelines.


Asunto(s)
Disparidades en Atención de Salud/tendencias , Hospitales/tendencias , Dolor de la Región Lumbar/tratamiento farmacológico , Esteroides/administración & dosificación , Adulto , Anciano , Esquema de Medicación , Femenino , Adhesión a Directriz/tendencias , Humanos , Inyecciones Epidurales/tendencias , Iowa , Dolor de la Región Lumbar/diagnóstico , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Indicadores de Calidad de la Atención de Salud/tendencias , Estudios Retrospectivos , Sacro , Factores de Tiempo , Adulto Joven
8.
J Vasc Access ; 20(6): 697-700, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31057048

RESUMEN

INTRODUCTION: The objective of our study was to document the level of preparedness for renal replacement therapy assessed by incident hemodialysis vascular access and the access at least 3 months after initiation of hemodialysis at Kenyatta National Hospital, Nairobi. METHODS: Between June and July 2018, we carried out a cross-sectional descriptive study on the preparedness for hemodialysis by patients who were on chronic hemodialysis in the Kenyatta National Hospital Renal Department. Sociodemographic, medical history, duration of follow-up, and state of preparedness parameters were obtained through interview and entered into the questionnaire. The data were entered in preprogrammed format in the Statistical Package for the Social Sciences (SPSS) version 20.0 for analyses. RESULTS: Eighty-two patients were enrolled. Males were 50% (41). The mean age was 45.39 ± 15.96 years but females were 5 years younger than their male counterparts. About 85.4% of the patients were drawn from the hypertension and diabetes clinics, and the mean, mode, and median of the duration of follow-up were 41, 0, and 0 months, respectively, in these clinics. Almost three in every four patients (74.4%) were initiated on hemodialysis as emergency (p value < 0.001). About 80% were initiated hemodialysis via acute catheters placed in the jugular and subclavian veins (p value < 0.001). At least 3 months later, 40% still had acute catheters on the same veins (p value < 0.001). Acute venous catheters in the femoral veins were in 9.2% at initiation and 6.6% of the patients at least 3 months later. Less than 2% of the patients had arteriovenous fistulae at initiation, which rose to 14.5% in 3 months. Tunneled catheters were placed in 11.8% initially and at least 3 months, were almost in 40% of the patients. CONCLUSION: In conclusion, our young hemodialysis population mainly drawn from hypertension and diabetes clinic requires more input in hemodialysis vascular access planning. Focused individualized follow-up and early referrals to nephrologists are required. Uptake of arteriovenous grafts for hemodialysis might reduce the prevalence of hemodialysis catheters. As it is, this population is threatened with iterative vascular accesses complications as well as real danger of exhaustion of their vascular capital. There is real danger of increase in mortality from access complications.


Asunto(s)
Derivación Arteriovenosa Quirúrgica/tendencias , Cateterismo Venoso Central/tendencias , Hospitales/tendencias , Pautas de la Práctica en Medicina/tendencias , Diálisis Renal/tendencias , Insuficiencia Renal Crónica/terapia , Adulto , Estudios Transversales , Femenino , Humanos , Kenia , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/diagnóstico , Factores de Tiempo
9.
Emerg Med J ; 36(6): 326-332, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30944115

RESUMEN

INTRODUCTION: Hospital inspection and the publication of inspection ratings are widely used regulatory interventions that may improve hospital performance by providing feedback, creating incentives to change and promoting choice. However, evidence that these interventions assess performance accurately and lead to improved performance is scarce. METHODS: We calculated six standard indicators of emergency department (ED) performance for 118 hospitals in England whose EDs were inspected by the Care Quality Commission, the national regulator in England, between 2013 and 2016. We linked these to inspection dates and subsequent rating scores. We used multilevel linear regression models to estimate the relationship between prior performance and subsequent rating score and the relationship between rating score and post-inspection performance. RESULTS: We found no relationship between performance on any of the six indicators prior to inspection and the subsequent rating score. There was no change in performance on any of the six indicators following inspection for any rating score. In each model, CIs were wide indicating no statistically significant relationships. DISCUSSION: We found no association between established performance indicators and rating scores. This might be because the inspection and rating process adds little to the external performance management that EDs receive. It could also indicate the limited ability of hospitals to improve ED performance because of extrinsic factors that are beyond their control.


Asunto(s)
Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/organización & administración , Inglaterra , Hospitales/normas , Hospitales/tendencias , Humanos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Medicina Estatal/organización & administración , Medicina Estatal/normas , Encuestas y Cuestionarios , Factores de Tiempo
10.
BMC Geriatr ; 19(1): 108, 2019 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-30991950

RESUMEN

BACKGROUND: Deprescribing is a partnership between practitioners, patients and caregivers. External characteristics including age, comorbidities and polypharmacy are poor predictors of attitude towards deprescribing. This hospital-based study aimed to describe the desire of patients and caregivers to be involved in medicine decision-making, and identify attitudinal predictors of desire to try stopping a medicine. METHODS: Patients and caregivers recruited from seven Older People's Medicine wards across two UK hospitals completed the revised Patients'Attitudes Towards Deprescribing (rPATD) questionnaire. Patients prescribed polypharmacy and caregivers involved in medication decision-making of such patients were eligible. A target of 150 patients and caregivers provided a 95% confidence interval of ±11.0% or smaller around rPATD item agreement. Descriptive statistics characterised participants and rPATD responses. Responses to items regarding desire to be involved in medication decision-making and desire to try stopping a medicine were used to address the aims. Binary logistic regression provided the adjusted odds ratios (OR) for predictors of desire to try stopping a medicine. RESULTS: Patient participants (N = 75) were a median (IQ) 87.0 (83.0, 90.0) years old and the median (IQ) number of pre-admission medication was 8.0 (6.0, 10.0). Caregiver participants (N = 76) were a median (IQ) 70.0 (57.0, 83.0) years old and the majority were a spouse (63.2%). For patients and caregivers respectively, the following were reported: 58.7 and 65.8% wanted to be involved in medication decision-making; 29.3 and 43.5% reported a desire to try stopping a medicine. Attitudinal predictors of low desire to try stopping a medicine for patients and caregivers are a perception that there are no unnecessary prescribed medicines [OR = 0.179 (patients) and 0.044 (caregivers)] and no desire for dose reduction [OR = 0.199 (patients) and 0.024 (caregivers)]. A perception of not being prescribed too many medicines also predicted low patient desire to try stopping a medicine [OR = 0.195]. CONCLUSION: A substantial proportion of patients and caregivers did not want to be involved medication decision-making, however this should not result in practitioners dismissing deprescribing opportunities. The three diagnostic indicators for establishing desire to try stopping a medicine are perceived necessity of the medicine, appropriateness of the number prescribed medications and a desire for dose reduction.


Asunto(s)
Cuidadores/psicología , Toma de Decisiones , Deprescripciones , Servicios de Salud para Ancianos/tendencias , Relaciones Médico-Paciente , Encuestas y Cuestionarios , Anciano , Anciano de 80 o más Años , Toma de Decisiones/fisiología , Femenino , Predicción , Conocimientos, Actitudes y Práctica en Salud , Servicios de Salud para Ancianos/normas , Hospitales/normas , Hospitales/tendencias , Humanos , Masculino , Persona de Mediana Edad , Polifarmacia
11.
Am J Med ; 132(8): 907-911, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30928345

RESUMEN

Thirty-two percent of US health care spending goes to hospital care, and 20% goes to physicians' charges. The cost of hospital care in the United States is 2-3 times greater than in most similar countries. A large part of the high cost is due to a very large administrative overhead. Both higher quality and lower cost would be achieved if complex procedures were done in fewer centers. Hospitals with a geographic or prestige monopoly receive higher payments than warranted. As physicians are increasingly employed by hospitals rather than independent, costs go up with no added benefit to patients. The United States has too many specialists and too few primary care physicians. Practice guidelines are slanted to favor expensive treatments, often with little solid evidence behind the recommendations.


Asunto(s)
Prestación de Atención de Salud/normas , Hospitales/tendencias , Médicos/economía , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/tendencias , Eficiencia Organizacional/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Gastos en Salud/tendencias , Hospitales/estadística & datos numéricos , Humanos , Práctica Asociada/economía , Práctica Asociada/estadística & datos numéricos , Médicos/estadística & datos numéricos , Estados Unidos
12.
Work ; 62(2): 353-359, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30829645

RESUMEN

BACKGROUND: Management by Objectives (MbO) has been shown to establish efficient team work in both industry and medicine. Its most important prerequisite for success is target agreements between managers and medical professionals on equal footing. In medicine, lump-sum financing urges the delivery of a health care service with minimal effort. Consequently, daily clinical life changed, with economic goals seeming to become priority over medical principles. OBJECTIVE: To determine how well MbO can still be practiced in hospitals with lumped treatment prices. METHODS: We used an anonymized questionnaire for already retired physician executives who completed their active leadership positions between 2010 and 2015 in Saxony (Germany). We asked various type of target agreements that had been used in order to achieve medical or economic targets. RESULTS AND CONCLUSIONS: Out of 111 former executives, the questionnaires of 25 respondents could be analysed. Eight respondents confirmed target agreements that were mostly set by managing directors. If used, most targets had not been adapted to the infrastructure and personnel strength, nor were they coordinated with neighbouring departments. Four respondents received financial incentives. Most medical executives were unsatisfied and preferred to abandon further goal setting. Due to the low number of cases, the representativeness of the study is limited. Nevertheless, it might be questioned if a flat-rate remuneration system facilitates the change into an authoritarian leadership concept.


Asunto(s)
Administración Hospitalaria/normas , Liderazgo , Ejecutivos Médicos/psicología , Alemania , Administración Hospitalaria/métodos , Administración Hospitalaria/tendencias , Hospitales/normas , Hospitales/tendencias , Humanos , Ejecutivos Médicos/normas , Encuestas y Cuestionarios
13.
15.
Nurs Forum ; 54(3): 376-385, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30847940

RESUMEN

AIM: This study examined the extent, range, and nature of registered nurse (RN) and practical nurse (PN) collaboration in acute care hospitals and identified research gaps in the existing literature. BACKGROUND: Optimal patient care requires collaboration between RNs and PNs. A lack of unity and unresolved tension among different types of nurses influences collaboration and has significant implications on practice and the organizations where nurses work. METHODS: Using Arksey and O'Malley's (2005) framework, a scoping review was undertaken to answer the research question: what is known from the existing literature about the structures, processes, and outcomes of RN-PN collaboration in hospitals? RESULTS: Twenty-nine studies were included with the majority coming from North America. Donabedian's model assisted with the identification of three themes: scope of practice, interpersonal skills, and nurse and patient-related outcomes. CONCLUSION: The findings demonstrate there is a paucity of research specific to RN-PN collaboration. Nurse administrators/managers play an important role in addressing the interpersonal skills of nurses and providing an ongoing education on collaboration in the practice setting. Additional studies should focus on the development of nursing collaborative practice models of patient care, the examination of interventions to improve RN-PN collaborative practice, and the assessment of outcomes relating to collaboration among nurses.


Asunto(s)
Conducta Cooperativa , Hospitales/normas , Enfermeros no Diplomados/psicología , Enfermeras y Enfermeros/psicología , Hospitales/tendencias , Humanos , Rol de la Enfermera/psicología
16.
Worldviews Evid Based Nurs ; 16(1): 4-11, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30714308

RESUMEN

BACKGROUND: In 2006, our healthcare system created a hospital Evidence-based Practice Center (EPC) to support the local delivery of high-quality, safe and high value patient care. Since then, the importance of healthcare staff work life has also been highlighted, and together these four elements form the Quadruple Aim framework. Synergistic to this Aim, the Magnet® program promotes and recognizes organizational nursing excellence. OBJECTIVE: To examine the EPC's work to inform nursing policy and practice in support of the goals of the Quadruple Aim framework and Magnet® designation. METHODS: Methods used included the following: (1) descriptive analysis of the hospital EPC's database of rapid reviews; and (2) administration of a 40-item electronic questionnaire to nurses who requested an EPC review during fiscal years (FY) 2015 and 2016. RESULTS: Of 308 rapid reviews completed in the EPC's first 10 years, 59 (19%) addressed nursing topics. The proportion of reviews relevant to nursing increased from 5% (2/39) in the center's first 2 years to 44% (25/60) in FY 2015-2016. The majority of nursing reviews (39/59) examined processes of care. Of 23 nurses eligible to participate in the survey, 21 responded (91%). Nurses with administrative or managerial responsibilities requested 70% of reviews; clinical nurse specialists and bedside nurses requested 17% and 9%, respectively. Reviews were used to support clinical program development (48%), provide clinical guidance (33%), update nursing policies or procedures (24%) and develop training and curricula (24%). Nurses were satisfied with the hospital EPC reviews (mean; 4.7/5), and 95% indicated they were likely to request a future review. LINKING EVIDENCE TO ACTION: A dedicated hospital EPC in partnership with nursing offers a unique mechanism for promoting a culture of evidence-based practice. Nurses at all organizational levels use the services of a hospital EPC to inform nursing policy and practice and are highly satisfied with the process, supporting the Quadruple Aim and Magnet® designation.


Asunto(s)
Práctica Clínica Basada en la Evidencia/organización & administración , Práctica Clínica Basada en la Evidencia/normas , Política de Salud/tendencias , Hospitales/tendencias , Humanos , Pennsylvania , Desarrollo de Programa/métodos , Desarrollo de Programa/normas , Encuestas y Cuestionarios
17.
J Nurs Manag ; 27(5): 896-917, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30801808

RESUMEN

AIMS: To evaluate and summarize current evidence on the relationship between the patient-nurse ratio staffing method and nurse employee outcomes. BACKGROUND: Evidence-based decision-making linking nurse staffing with staff-related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented. EVALUATION: A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes. KEY ISSUE(S): Future research should focus on unit-level data, incorporate other methodologies and aim for comparability between different types of clinical settings as well as different health care systems. CONCLUSION: A relationship between the patient-nurse ratio and specific staff-related outcomes is confirmed by various studies. However, apart from the patient-nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity). IMPLICATIONS FOR NURSING MANAGEMENT: Hospital management should pursue the access and use of reliable data so that the validity and generalizability of evidence-based research can be assessed, which in turn can be converted into policy guidelines.


Asunto(s)
Personal de Enfermería en Hospital/provisión & distribución , Admisión y Programación de Personal/normas , Hospitales/normas , Hospitales/tendencias , Humanos , Relaciones Enfermero-Paciente , Personal de Enfermería en Hospital/psicología , Personal de Enfermería en Hospital/tendencias , Admisión y Programación de Personal/tendencias , Indicadores de Calidad de la Atención de Salud , Carga de Trabajo/psicología , Carga de Trabajo/normas , Lugar de Trabajo/psicología , Lugar de Trabajo/normas
18.
J Nurs Manag ; 27(5): 963-970, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30707783

RESUMEN

OBJECTIVES: There is an international policy trend for building government hospitals with greater proportions of single-occupancy rooms. The study aim was to identify advantages and disadvantages for patients and nursing staff of a pending move to 100% single-room hospital, in anticipation of the challenges for nurse managers of a different ward environment. This paper presents these findings, summarizing potential advantages and disadvantages as well as comparison with findings from similar studies in England. METHODS: Mixed method case study design was undertaken in four wards of a large hospital with multi-bed rooms. Three components of a larger study are reported here: nurse surveys and interviews, patient interviews of their experiences of the current multi-bedroom environment and expectations of new single-room environment. Integration was achieved via data transformation where results of the nursing staff survey and interviews and patient interviews were coded as narrative allowing for quantitative and qualitative data to be merged. RESULTS: Four constructs were derived: physical environment; patient safety and comfort; staff safety; and importance of interaction. CONCLUSION: There are important factors that inform nurse managers when considering a move to an all single-room design. These factors are important for nurses' and patients' well-being. IMPLICATIONS FOR NURSING MANAGEMENT: This study identified for nurse managers key factors that should be considerd when contributing to the design of a 100% single-room hospital. Nurses' voices are critically important to inform the design for a safe and efficient ward environment.


Asunto(s)
Arquitectura y Construcción de Hospitales/métodos , Hospitales/tendencias , Habitaciones de Pacientes/normas , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Australia , Ocupación de Camas/tendencias , Femenino , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Arquitectura y Construcción de Hospitales/normas , Arquitectura y Construcción de Hospitales/tendencias , Hospitales/normas , Humanos , Masculino , Persona de Mediana Edad , Pacientes/psicología , Pacientes/estadística & datos numéricos , Habitaciones de Pacientes/tendencias , Encuestas y Cuestionarios
19.
Ann R Coll Surg Engl ; 101(3): 208-214, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30698459

RESUMEN

INTRODUCTION: Fractures are a common reason for admission to hospital around the world. Varying incidences have been reported but these are mainly based on small studies from individual centres. The aim of our study was to analyse fracture admissions in England over a ten-year period. METHODS: Data were collated from the Hospital Episodes Statistics database. Since 2004, data have been collected for all admitted patients in England using the International Classification of Diseases codes for the primary diagnosis. Data were analysed for the ten-year period between 2004-2005 and 2013-2014. RESULTS: There were 2,489,052 fracture admissions in England over the 10-year study period. The risk of admission for fracture was 47.84 per 10,000 population. The rate of fracture admission has remained stable. Hip fractures were the most common fracture requiring hospitalisation (n=641,263), followed by distal radius fractures (n=406,313), ankle fractures (n=332,617) and hand fractures (n=244,013). Hip fractures accounted for 58% of hospital bed days, ankle fractures for 10%, and femoral shaft fractures and subtrochanteric femoral fractures for 5% each. The number of bed days per year for hip fractures has reduced from 1,549,939 bed days in 2004-2005 to 1,319,642 in 2013-2014. CONCLUSIONS: This study provides an updated picture of the incidence of fractures that required hospital admission over a ten-year period in England. It may be used as a platform from which the effect of modern patient treatment pathways can be monitored.


Asunto(s)
Bases de Datos Factuales/estadística & datos numéricos , Fracturas Óseas/cirugía , Hospitalización/tendencias , Hospitales/tendencias , Adolescente , Adulto , Anciano , Inglaterra/epidemiología , Femenino , Fracturas Óseas/epidemiología , Hospitalización/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Distribución por Sexo , Adulto Joven
20.
Circ Cardiovasc Interv ; 12(1): e007097, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-30616362

RESUMEN

BACKGROUND: Many studies have revealed no outcome differences among patients undergoing percutaneous coronary intervention (PCI) in hospitals with and without surgery on-site (SOS), but one earlier study found differences in target vessel PCI rates and in mortality for patients with acute myocardial infarction who did not undergo PCI. It is important to examine outcome differences between SOS and non-SOS hospitals with more contemporary data. METHODS AND RESULTS: A total of 21 924 propensity-matched patients who were discharged between January 1, 2013, and November 30, 2015, who were in the New York PCI registry and other hospital databases were used to compare outcomes in hospitals with and without SOS for all patients and for patients with and without ST-segment-elevation myocardial infarction (STEMI) undergoing PCI. Also, 30-day mortality was compared for patients with STEMI regardless of whether they underwent PCI. For all patients with PCI and patients without STEMI, there were no significant differences in in-hospital/30-day mortality, 2-year mortality, or 2-year repeat target lesion PCI. For patients with STEMI, there were no significant mortality differences between patients in SOS and non-SOS hospitals. Patients with STEMI in SOS hospitals had significantly lower 2-year repeat target lesion PCI rates (adjusted hazard ratio, 0.68 [0.49-0.94]). There was no difference in the percentage of patients undergoing PCI in the 2 types of hospitals (75.7% versus 74.6%; P=0.21) or in 30-day mortality of all patients with STEMI (patients who did and did not undergo PCI, 10.86% versus 11.32%; adjusted odds ratio, 1.06 [0.88-1.29]). CONCLUSIONS: Short-term and long-term outcomes were not different in SOS and non-SOS hospitals except that 2-year repeat target lesion PCI rates were lower in SOS hospitals for patients with STEMI.


Asunto(s)
Puente de Arteria Coronaria/tendencias , Enfermedad de la Arteria Coronaria/terapia , Accesibilidad a los Servicios de Salud/tendencias , Hospitales/tendencias , Infarto del Miocardio/terapia , Intervención Coronaria Percutánea/tendencias , Anciano , Anciano de 80 o más Años , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/mortalidad , New York , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Sistema de Registros , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
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