Lessons From the Northeast COVID-19 Surge: Well-Being of the Health Care Workforce.

The COVID-19 pandemic has had an unprecedented impact on the US health care system which was already experiencing higher levels of personal burnout among health care workers than the average US worker. Well-being efforts to support the workforce have become a critical countermeasure during the pandemic. This work was presented at the Thomas Jefferson University, College of Population Health Seminar Series: Clinical Lessons from the Northeast Surge, COVID-19: Spread the Science, not the Virus, held August 18, 2020. The entire series was held virtually from July 21 to September 29, 2020. The authors describe issues impacting health care workers during this early period of the pandemic with two examples of concrete strategies to approach well-being at the organizational level and lessons learned.

Postoccupancy Evaluation of a Neighborhood Concept Redesign of an Acute Care Nursing Unit in a Planetree Hospital.

OBJECTIVE: A comparative study was undertaken to survey nurses working in an acute care nursing unit before and after moving to a new hospital to investigate the impact of a nursing unit designed utilizing Planetree build criteria. BACKGROUND: The physical and emotional demands of frontline practitioners is a serious concern for patient safety and staff retention as the environmental design of nursing units can influence human errors from fatigue and interruption. METHOD: A pre-move survey was conducted with acute care nurses in a conventional design nursing unit who were moving to a new facility. After the move to the new hospital design, the same survey was readministered to obtain comparative performance information. Qualitative responses were analyzed for triangulation with survey responses. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey scores were collected over a 5-year period. RESULTS: There were statistically significant improvements for most of the survey questions, especially for work efficiency and productivity, the design of the patient room and of support spaces, the information systems, and the environmental conditions. There were statistically significant improvements in the HCHAPS and Press Ganey survey questions. CONCLUSIONS: The postoccupancy survey showed statistically significant improvements in most of the concerns highlighted in the pre-move survey and significant improvements in the workflow and overall satisfaction of nurses. Press Ganey results revealed all but five domains fell in the significantly improved category.

Implementing safety hotlines: Stamford Health's experience and future opportunities.

Improving safety event reporting has been a focus of increased study. Improved opportunities for patient and family safety event reporting have been described in the literature. Consistent with the organization's patient-centered care philosophy, we launched a safety hotline at Stamford Health. This article describes the process of implementation, vendor selection, understanding initial results, and areas for further study.

The role of the non-ICU staff nurse on a medical emergency team: perceptions and understanding.

OBJECTIVE: Medical emergency teams (METs) have been shown to contribute to a decrease in in-hospital cardiac arrests, unplanned ICU admissions, and overall hospital mortality rates. But their use is relatively new and our understanding of them is incomplete; in particular, the role of the non-ICU staff nurse during a MET call has received scant attention. To better understand the role of such nurses, and possibly to increase the effectiveness of these teams, we sought to determine the nursing staff's familiarity with and perceptions of the MET at one hospital. METHODS: After examining survey formats used in previous studies of nurses' perceptions of and attitudes toward METs, a 30-item survey was developed, consisting of 13 demographic and background items and 17 items based on a 5-point Likert agreement scale. In August 2008, the survey was distributed to the 388 nurses at Allegheny General Hospital in Pittsburgh, Pennsylvania, for whom the MET is a possible resource-that is, non-ICU staff nurses working outside critical care units or the ED. Responses were anonymous and voluntary. Data were entered and analyzed using Microsoft Excel software. RESULTS: One hundred and thirty-one surveys (34%) were returned. Nearly all of the respondents (97%) were familiar with the MET, and a majority (72%) had participated in a MET call. Initiating the call (77%) and relaying the patient's history (84%) were the most common actions. A majority of respondents agreed or strongly agreed that use of the MET improved patient care (92%) and nurses' working conditions (83%). But only 41% agreed or strongly agreed that they were comfortable with their role as a member of the MET, and 39% reported neutral feelings about this. Just 41% agreed or strongly agreed that they felt prepared to administer nursing care during a MET call. A majority (52%) agreed or strongly agreed that an increase in experience corresponded to an increase in preparedness, but only 28% agreed or strongly agreed that their MET education had prepared them for their role. Nearly a third (31%) reported that they'd been hesitant to call a MET, citing physician discouragement as the most common reason. CONCLUSIONS: Nurses felt that the MET improved both patient care and their working conditions, something that other studies have found may contribute to nurse retention and recruitment. But the role of the non-ICU staff nurse during a MET call remains unclear; nurses were neutral about their level of understanding of and comfort with their roles as members of the MET. More specific guidelines and further education may help the non-ICU staff nurse feel more valued as a team member and better prepared to administer nursing care during a MET call. Intimidation by other team members proved not to be a significant factor in nurse participation on the team, but the data may not have accurately described the unique relationship between the non-ICU staff nurse and the responding ICU nurses. Some non-ICU staff nurses were hesitant to call the team, for reasons that included physician discouragement; this could seriously undermine the effectiveness of the MET and indicates that better interprofessional education is needed. KEYWORDS: bedside nurse, medical emergency team, non-ICU staff nurse, nurse attitudes, patient crisis, patient safety, rapid response system, survey.

Trauma VAP SWAT team: a rapid response to infection prevention.

The prevention of ventilator-associated pneumonia (VAP) has been a challenge within many healthcare organizations. The initial efforts for VAP prevention focused on compliance with "ventilator bundles." VAP rates initially improved with implementation of the bundles but then reached a plateau. The trauma surgical intensive care unit (ICU) was interested in investigating measures to further improve the prevention of VAP after bundle implementation. A multidisciplinary team was formed to investigate innovative strategies to prevent VAP. The group identified their initial focus as head of bed (HOB) elevation intervention within and outside of the ICU through HOB audits and a transport checklist. Through these efforts, the VAP rate within the trauma surgical ICU dropped to the lowest level in 4 years.

Chronic abdominal complaints and Helicobacter pylori in a Haitian population.

The objective of this study was to examine demographic, clinical, and pathologic variables, including Helicobacter pylori infection and malignancy, associated with chronic abdominal pain in a rural Haitian population. One hundred four patients underwent esophagogastroduodenoscopy, with biopsy only in those with gross findings. Associations between demographic, clinical, and pathologic variables were examined using the chi-square test. P values less than or equal to 0.05 were considered statistically significant. The majority (n = 66; 63%) required biopsy. Of these, 62% were positive for H. pylori. The associations between (1) chest complaints and esophageal disease, (2) female gender and benign esophageal disease, and (3) chronic active gastritis and presence of H. pylori were significant. There was one malignancy. H. pylori gastritis was common; malignancy was rare. Demographic and clinical variables poorly predicted pathologic diagnosis, which is consistent with previous studies. Further study is needed to assess the influence of other variables, including the African enigma, on disease progression in this population.

The effect of a teaching hospital's financial crisis and reorganization on a group of residents.

PURPOSE: Allegheny General Hospital (AGH) in Pittsburgh, Pennsylvania, was part of a statewide health care system that underwent a financial crisis and operational reorganization between 1998 and 2000. This study assessed internal medicine (IM) residents' perceptions of the effects of AGH's financial crisis on their residencies METHOD: A confidential, program-based questionnaire was distributed to 75 IM residents at AGH in spring 2000 and included questions on demographic information, inpatient and outpatient medical education, and the hospital's financial crisis. Residents were asked to assess the effects of the financial crisis on their residencies, personal experiences, and attitudes toward health care systems. Outcomes included consideration of transfer, recommendation of the program to a medical student, concerns about fellowship opportunities, opinions about large health care systems, and medicine as a career recommendation. RESULTS: A total of 71 residents (95%) responded to the questionnaire. Fifty-five (79%) had experienced effects on their residencies due to the financial crisis, but perceptions differed widely. Eighteen (25%) considered transferring from the program, but 44 of 59 (75%) would have recommended the program to a medical student. Because of the financial crisis, respondents reported significant changes in concerns about fellowship opportunities (p <.001), opinions about large health care systems (p <.001), and opinions about recommending medicine as a career (p <.001). CONCLUSION: This study highlights the fact that residents serve as program ambassadors and their experiences may influence recruitment and retention. Thus, programs should consider ways to assess and address residents' concerns during any system crisis or reorganization.

Willingness to pay for new Papanicolaou test technologies.

The amount of money a woman is willing to pay for liquid-based cytology technology has not been measured. In the present study, 175 women answered a questionnaire asking how much they would pay to decrease their risk of dying of cervical cancer if a new (liquid-based) Papanicolaou (Pap) test was used in place of the conventional smear. When women assumed that the new Pap test reduced the risk of dying of cervical cancer from 1 in 37,000 to 1 in 50,000, the mean amount they were willing to pay was $237. If women had more than 2 children, they were willing to pay more for the new Pap test than women with 2 or fewer children. These data indicate that liquid-based and conventional Pap tests are undervalued and that cost-effectiveness studies generally have not taken into account the preference of women for new Pap test technologies.